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April-June 2022
Volume 66 | Issue 2
Page Nos. 89-236

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EDITORIAL  

The role of traditional medicine in public health Highly accessed article p. 89
Ritu Priya
DOI:10.4103/ijph.ijph_753_22  
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ORIGINAL ARTICLES Top

Assessment of health status and impact of pollution from thermal power plant on health of population and environment around the plant in Udupi District, Karnataka Highly accessed article p. 91
Ramachandra Kamath, Sharvanan Eshwar Udayar, G Jagadish, Poornima Prabhakaran, Kishore Kumar Madhipatla, Research Team
DOI:10.4103/ijph.IJPH_1422_20  
Background: Coal-fired thermal power plants (TPPs) have a serious impact on soil, air, and water quality resulting in deterioration of health and environment around the plant. Objective: The present study was undertaken with the objectives of assessing the respiratory health status of the population around the plant and to measure selected heavy metals in fly ash, air, water, and soil samples. Materials and Methods: The current cross-sectional study was conducted among 3533 adult residents living in two strata within 10 km radius around the TPP in Udupi district of Karnataka state. Data were collected by using semi-structured questionnaire and spirometry and environmental air monitoring by DustTrak aerosol monitor, water, and soil samples were collected for analysis. Results: Majority of the study participants were in the age group of >45 years (41.4%). 70.6% were females and 0.39% were trans-genders. 4.3% were suffering from various respiratory problems. Bivariable logistic regression showed subjects aged 46–65 years and >65 years have 2.91 times and 4.42 times higher odds of respiratory disease as compared to those with age ≤45 years. Multivariable logistic regression showed significant association between higher age group (P < 0.0001) and in subjects who had closed window during cooking (P < 0.006). Levels of heavy metals in soil samples and particulate matter 2.5 were well within permissible limits whereas the ground water samples had excess levels of iron, manganese, and copper. Conclusion: The present study has implications for policymaking to protect the environment and health of vulnerable populations in industrial clusters and the vicinity of power plants.
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COVID-19 Vaccine hesitancy among pregnant women: A facility-based cross-sectional study in Imphal, Manipur Highly accessed article p. 98
Avantika Gupta, Soubam Christina, A Yanal Umar, Jalina Laishram, Brogen Singh Akoijam
DOI:10.4103/ijph.ijph_1826_21  
Background: Vaccine hesitancy has been recognized as a public health issue which needs to be addressed urgently. Pregnant women with COVID-19 are at increased risk of adverse pregnancy outcomes. An assessment of the determinants of vaccine hesitancy will aid in the acceleration of vaccine administration among pregnant women. Objectives: The present study aimed to determine COVID-19 vaccine hesitancy among pregnant women in Imphal, Manipur and assess associated factors. Methods: A cross-sectional study was conducted among pregnant women attending Obstetrics and Gynecology Department of a Tertiary Care Institute in Imphal, Manipur during August 2021. One hundred and sixty-three pregnant women were interviewed using a structured questionnaire over phone calls. Univariate analysis was carried out using the Chi-square test and multivariable logistic regression was performed to determine the factors significantly associated with vaccine acceptance. Results: The mean age of the participants was 28.3 ± 5.5 years and majority, 102 (62.6%) were multigravida and 27 (16.6%) had comorbidities. Vaccine hesitancy was found in 127 (77.9%) participants. Logistic regression analysis indicated that awareness on COVID-19 vaccine eligibility (P = 0.002), disagreement of vaccine being unsafe during pregnancy (P = 0.005), and agreement on vaccine benefiting the baby (P = 0.003) were the significant predictors of vaccine acceptance. Conclusion: Nearly four out of every five pregnant women had COVID-19 vaccine hesitancy. Pregnant women should be informed about the benefits and encouraged to take COVID-19 vaccine.
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Online educational program for parents of adolescents on human papillomavirus vaccination during COVID pandemic: A feasibility check p. 104
CT Abra Pearl, M Navaneetha, S Malarvilizhi, K Mony
DOI:10.4103/ijph.ijph_1791_21  
Background: Human papillomavirus (HPV) vaccination for adolescents helps in the prevention of preventable cancers caused due to HPV infection. However, many adolescents are not vaccinated due to lack of knowledge among parents. Objective: This study aimed to compare the level of knowledge and attitude of parents on HPV vaccination before and after the online educational intervention. Methods: A cross-sectional pilot study was conducted among a sample of 45 parents of adolescents studying in class 7th–9th. The parents were selected two-stage simple random sampling and assigned randomly to three groups with three different methods of education – online lecture with PowerPoint presentation, online short film with discussion, and self-learning online booklet. Pre- and postintervention knowledge was assessed with a structured questionnaire and attitude with modified Likert scale administered online. Wilcoxon and Kruskal–Wallis tests were used to find the statistical significance in the study. Results: Only 36% of samples stated that they have not heard about HPV vaccination, while others had heard from health-care workers, family members, friends, or television, but their knowledge was inadequate. In all the three groups, there was significant improvement in level of knowledge, but there was no significant difference in attitude. The posttest knowledge scores of parents educated with short film were significantly more than the other two interventions. Conclusion: Online educational programs were found to be effective in improving the knowledge of parents on HPV vaccination and of the three methods; short film was more effective than the other two methods.
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Pain management policy formulation at a tertiary care teaching institute in India: A prospective observational study p. 109
Raghav Gupta, Ram Singh, Brajesh Kumar Ratre, Priodarshi Roychoudhury, Himanshu Prince Yadav, Sushma Bhatnagar
DOI:10.4103/ijph.ijph_1769_21  
Background: Access to pain management has been recognized as a fundamental human right. Inadequate pain relief hampers the quality of life and has a physiological and psychosocial impact on the patient and caregivers. Inadequate pain relief remains the leading cause of suffering in hospitalized patients worldwide. Objective: The objective of this article is to provide adequate pain relief to hospitalized patients through proper assessment, treatment, and monitoring of pain by the trained health-care workers through a sustainable and effective institutional pain management policy. Methods: The formulation of pain management policy at a tertiary care teaching institute was conducted in three phases – Phase 1: need assessment by an open-label, uncontrolled, prospective observational study over 1 month period, Phase 2: teaching, training, and awareness of health-care workers, and Phase 3: constitution of the committee at the institute level with the formation of pain resource teams. Results: An open-label, prospective observational study conducted over 1 month revealed that among 814 hospitalized patients, 108 out of 235 (46%) patients in medical and 385 out of 579 (66.5%) patients in the surgical cohort had NRS score of ≥3, implying an inadequate pain relief even at 24 h following medical or surgical intervention, respectively. Conclusion: The provision of effective and adequate pain relief to hospitalized patients requires trained health-care workers and a uniform and structured pain management policy at the institutional level. Recognition and addressal of the barriers and challenges while framing an institutional pain policy is of utmost importance.
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Appropriateness of hospital admissions in a university hospital in Egypt: Analyzing a preintervention phase p. 113
Aya Mostafa Abdellatif, Mahi Mahmoud A L Tehewey, Mervat Hassan Rady, Amany Mokhtar Abdelhafez, Mai Ahmed Eldeeb, Hebat Allah Mohammed Salah Gabal
DOI:10.4103/ijph.ijph_1726_21  
Background: Identifying the magnitude of this improper use and applying interventions to eliminate unnecessary hospitalization will reduce health-care expenditure, improve the quality of care for patients, and increase the accessibility to care for actual patients in need on waiting lists. Aim of Work: To measures the rate of inappropriate admissions at the Ain Shams University Hospital. Methods: This research is the preintervention phase of a study conducted to improve the appropriateness of patient admission at this hospital. The appropriateness evaluation protocol (AEP) was used to review the appropriateness of 576 hospital admissions over 100 days. The patients' medical records were stratified according to the admission route into two groups, namely emergency and outpatient admission. Next, the systematic random samples were taken from each stratum based on the admission list of the previous day. Results: The results showed that 20.5% of the sampled cases were inappropriately admitted. Furthermore, a statistically significant difference was observed between appropriately and inappropriately admitted cases regarding gender and shifts during which admission occurred in addition to body systems affected; inappropriate admissions were more among females, and admissions occurred most frequently during the morning shifts (8:00 am–2:00 pm). The remaining other factors that were studied also proved insignificant. Conclusion: It can be concluded that a considerable proportion of hospital admissions is inappropriate, especially in the elective surgery department, and these admissions vary according to patient's gender, shifts during which admission occurred, and the affected body systems. Recommendations: Adopting hospital admission policies based on the AEP criteria in addition to training of physicians on these criteria would help prevent inappropriate admission and ensure optimization during use of hospital facilities.
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Parenting a child with autism spectrum disorder: A qualitative study p. 121
Prahbhjot Malhi, Abhishek R Shetty, Bhavneet Bharti, Lokesh Saini
DOI:10.4103/ijph.ijph_1779_21  
Background: Research in India has seldom studied caregivers' perceptions, experiences, and needs for information and personal support after an autism spectrum disorder (ASD) diagnosis. Objectives: The objectives of the study were to understand the perceived barriers for obtaining a diagnosis and the perspectives and experiences of parents of children with autism. Materials and Methods: Parents with a diagnosed ASD child (within a year of diagnosis) in the 3–8 years range were recruited from the Pediatric Psychology and Neurodevelopmental Clinic from a tertiary care teaching hospital in North India. An interview guide elicited information about experiences regarding obtaining an ASD diagnosis, perceived barriers and facilitators, reactions to diagnosis, postdiagnostic family and community experiences, and stress experienced by parents. Qualitative responses were analyzed using thematic analysis. Participants were recruited till there was a saturation of themes. The ethics clearance was provided by the institutional review board. Results: Twenty-eight caregivers of children with ASD were recruited for the study. Overall, nine themes were identified from the qualitative analysis of the interviews: two before diagnosis (delayed help-seeking and experiences with healthcare), one at the time of diagnosis disclosure (heightened emotional response to diagnosis), and six themes after the diagnosis (increased stress, behavioral challenges, deterioration in family relationships, negative attitudes of the family, seeking support, and moving forward with hope for the future). Conclusions: There are several barriers and gaps in the autism-related available services in the country, and there is a need to provide inclusive, supportive, culturally sensitive, and family-centered model of care for parents raising children with ASD.
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Prevalence and Associated Factors of Stroke among Older Adults in India: Analysis of the Longitudinal Aging Study in India-Wave 1, 2017–2018 p. 128
Naveen Kumar Kodali, Lekha D Bhat
DOI:10.4103/ijph.ijph_1659_21  
Introduction: Stroke is one of the leading causes of death and disability in India. Stroke survivors may suffer from lifelong physical and cognitive frailty. There is a need for more studies on the prevalence and determinants of this debilitating disease at the national level. Thus, assessing the factors associated with stroke is vital to developing appropriate preventive strategies in India. Methods: Data from the Longitudinal Aging Study in India wave 1 (2017–2018) are utilized for this analysis. The survey collected demographics, social, economic, and health data, including lifestyle factors and stroke, from 65,900 older adults ≥45 years representing all states and union territories. Stroke prevalence was calculated for each independent variable, and the differences were compared using the χ2 test. An unconditional multivariable logistic regression model was used to obtain the adjusted odds ratios (AOR) and 95% confidence intervals (CIs) of each lifestyle and socioeconomic variable for stroke prevalence. Results: The prevalence of self-reported stroke was 1.71% (95% CI: 1.61–1.80). Older adults with hypertension (AOR=3.69, 95% CI: 2.95–4.62), family history of stroke (AOR=3.09; 95% CI: 2.33–4.12), arrhythmias (AOR=2.27; 95% CI: 1.20–4.29), physical inactivity (AOR=1.91; 95% CI: 1.55–2.34) were strong contributors of stroke. Diabetes and high cholesterol individuals have 1.5 times more odds for stroke than those without those conditions. Increasing age (AOR=1.57 for 55–69 older adults, and AOR 2.05 for ≥70 years), male sex (AOR=1.75; 95% CI 1.36–2.26), and rich (AOR=1.58; 95% CI: 1.21–2.06) were also associated with increased odds for stroke. Conclusion: The prevalence of stroke was high among adults aged ≥45 years in India. Hypertension, family history of stroke, arrhythmias, and low physical activity were significant contributors to stroke. The findings suggest that preventing and controlling these lifestyle conditions and behaviors may help prevent stroke.
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Outcome of surgical condition of neonates who underwent surgery: A prospective study from a tertiary care center p. 136
Ghanshyam Das, Vijay Gupta, Neetu Sharma
DOI:10.4103/ijph.ijph_1564_21  
Background: The neonatal period is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra- uterine survival. If the neonate has a coexisting pathology which needs surgery, this challenge is magnified. Neonatal surgical conditions are unique in their type because some require early diagnosis, prompt surgery and postoperative care to improve the survival and outcome. Objective: The aim of this study was to know the clinical profile of congenital surgical conditions and to estimate the burden and outcome in special new born care unit. Method: The study population include 138 surgical neonate admitted in special new born care unit, department of paediatrics, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior (M.P.) from April 2017 to April 2018 including six month follow up period. Results: Total admission in special new born care unit were 5378 out of which 138 (2.5%) neonates of surgical condition were admitted in the study period. Incidence of neonatal surgical condition was found to be 8.48%. Surgery was performed in 57 (41.30%) neonates. The Commonest neonatal surgical condition was constituted by gastrointestinal system (39.13%). Among gastrointestinal system anomalies, tracheoesophageal fistula were 28.6% of total gastrointestinal system cases. The most common surgical condition encountered was meningomyelocele, 23.36% of total cases. The survival of neonatal surgical condition in hospital was 52.89% and after six month follow up was 26.08%. The overall mortality with neonatal surgical condition in this study was 73.91%. Maternal age, antenatal care, history of congenital malformation, socioeconomic status, mode of delivery, prematurity, type of admission, single or multiple surgical condition, inotropic and ventilation support, post operative complication were significantly associated with final outcome of neonatal surgical condition. Conclusion: High mortality was found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of gastrointestinal tract. Maternal age more than 35 year, poor antenatal care, prematurity, vaginal delivery, extra mural neonate, multiple surgical condition, inotropic and ventilation support and post operative complications were associated with increased mortality.
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Process Evaluation of the Universal Immunization Program in Imphal-East District of Manipur: A Cross-Sectional Study p. 141
Dayananda Ingudam, Heisnam Kulabidhu Singh, Longjam Usharani Devi
DOI:10.4103/ijph.ijph_1583_21  
Background: Various strategies have been made to make vaccines universally available including to most hard-to-reach and vulnerable population. However, change in coverage level never reached upto expected level in spite of giving so much effort by the Govt. of India and World bodies. Therefore, there is the need to look beyond. Hence, the process evaluation of Universal Immunization Program (UIP) was conducted to evaluate the process of UIP using selected variables. Methods: A cross-sectional observation was done during the period from May 2017 to April 2020 among the 14 health-care facilities and 36 selected session sites, and interview was done to 48 health-care providers working at different levels, located in Imphal East district of Manipur. Both checklist and pretested semi-structured questioners were used for collection of data. Descriptive statistics such as frequency, proportion, and percentage were used. Results: Ice-lined refrigerator and Deep-freezer were found to be present in working condition in 11 (100%) centers. The use of vaccine carrier was found in all 36 (100%) centers. Way of vaccine administration was found to be correct in 26 (72.2%) centers. Availability of up-to-date microplan was found in 18 (78.3%) centers. Conclusions: Barriers in the UIP were not uniform throughout the villages and districts. Hence, area-specific measures need to be taken up for overcoming the barriers and challenges.
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Perceptions on COVID-19 Vaccination among People Aged more than 50 years in Urban Field Practice Area of Department of Community Medicine in a Tertiary Care Teaching Hospital, Hyderabad: A Reflection from Focus Group Discussions p. 147
Swetha Rajeshwari, S Suthanthira Kannan, Husna Shahnoor, Sushma Katkuri
DOI:10.4103/ijph.ijph_1737_21  
Background: Despite several efforts to limit the viral transmission, the COVID-19 vaccine has been the only “the ray of hope” to end the pandemic. However, vaccine hesitancy could reduce coverage and hinder herd immunity. People's intention to get vaccinated can be shaped by several factors, including risk perception which, in turn, is influenced by effect. The need to acquaint oneself to the beliefs, concerns, and circumstances of one's own population in the community becomes important for successful implementation of the program. Therefore, the present study was conducted to gain insights into perceptions of vaccination. Objectives: The objective is to understand the felicitating factors and hindering factors for acceptance of vaccines by the population among people aged 50 years in urban field practice area of the Department of Community Medicine in a Tertiary care teaching hospital, Hyderabad. Subjects and Methods: Data were extracted from audio recording of five focus group discussions that were conducted in the urban field practice care of a tertiary care teaching hospital in Hyderabad through open-ended questions. Categories, subcategories, and themes were created by deductive approach. Results: The motivating factors for vaccine acceptance were found to be fear of getting disease, wanting to return normalcy, and trust in treating doctors, whereas, barriers were fear of death due to vaccine, opacity in vaccine details, anxiety, and misinterpretation of adverse events. Conclusion: Having a clear understanding about the belief system of the target population could help in designing the guidelines for vaccination program to escalate the immunization and increase the acceptance.
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Analysing the burden of morbidity, associated expenditure, and coping strategies among india's elderly population: Evidence from national sample survey 75th round p. 152
Sujata Sujata, Bhed Ram, Ramna Thakur
DOI:10.4103/ijph.ijph_1705_21  
Background: An increase in average life expectancy has raised a concern about whether these extra added years are characterized by good health and independence or health problems and dependency on others for care. The current study aimed to analyze the morbidity burden, associated expenditure, and coping strategies among India's elderly population. Data and Methods: The study uses cross-sectional data of the National Sample Survey 75th round. Multivariable logistic regression has been used to examine morbidity and associated expenditure differentials among the elderly population in different socioeconomic variables in India. Results: Findings show that cardiovascular diseases (CVDs) are the leading cause of morbidity and economic burden among the elderly population in India in the case of inpatient care. However, in outpatient care, CVDs are the leading cause of morbidity, while cancer is the main cause of economic burden (measured only through OOPE). Although CVDs are the leading cause of morbidity and economic burden, psychological and neurological, injuries, cancer, and gastrointestinal ailments force the elderly population to borrow for inpatient care. Further, it is the oldest, minority (Muslims) and richest section of the elderly population who are most likely to report health issues. Gender differential is also clear from the results as females are more likely to report for ailments in outpatient care, whereas the reverse is the incident in inpatients. Conclusion: The study concluded that there is a need to increase government spending on social security such as old age pensions like Indira Gandhi National Old Age Pension Scheme, keeping in view the changing needs of the elderly population.
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Impact of intervention on nutritional status of under-fives in tribal blocks of Palghar District in Maharashtra, India p. 159
Suchitra Surve, Ragini Kulkarni, Sagar Patil, Lalit Sankhe, ICMR Co-ordinating group
DOI:10.4103/ijph.ijph_1770_21  
Background: There is a need to improve their nutritional status of under-five children through specific targeted interventions. The present study discusses the impact of intervention on nutritional status among under-five children in Palghar district from Maharashtra. Objective: The objective is to improve the nutritional status of under-five children by implementing multi-component health and nutrition education intervention, focusing on dietary counseling and modification keeping in view the cultural and socio-economic status of population. Methods: A prospective pre- and post-intervention study was conducted in two tribal blocks. Total 480 under-five children were included in pre- and post-intervention survey each. Results: Exclusive breastfeeding rates improved from 48.9% to 50.5% and initiation of complementary feeding at 6 months improved from 48.3% to 72.5% in post intervention survey as compared to preintervention survey. Among other Infant and Young Child Feeding indicators, Minimum Meal Frequency increased significantly to 67.03% from 5.91% and minimum acceptable diet improved from 5.37% to 47.2% in post intervention survey. The prevalence of Severe Acute Malnutrition (SAM) reduced from 5.4% to nil whereas severe stunting and underweight significantly decreased by 17% and 8% respectively in post intervention survey. Severe anemia decreased from 16.24% to nil post intervention. Conclusion: The study reveals a substantial improvement in timely initiation of complementary feeds, nil cases of SAM, stunting, and underweight along with severe anemia in postintervention phase. This highlights the impact of multicomponent health and nutrition education interventions which may be adapted at a programmatic level to reduce child mortality and morbidity in India.
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Age at diagnosis for autism spectrum disorders: Does it differ by place of residence? p. 166
Malhi Prahbhjot, Pratibha Singhi
DOI:10.4103/ijph.ijph_1801_21  
Background: Despite steady decline in the age of diagnosis (AOD) at the global level, it has not declined uniformly, and marked disparities are documented by income, education, race, and access to health care. Objectives: The objectives of the study are to examine the urban/rural disparities in the initial age of autism diagnosis and to understand the interplay of the underlying demographic and social factors. Methods: A retrospective case record review of all children who received their initial diagnosis of autism at the Pediatric Psychology Clinic (1997–2018) of a tertiary advanced pediatric center at Chandigarh was conducted. A structured abstraction data form was used to extract demographic, socioeconomic, and clinical information from the files maintained at the clinic. Results: A total of 1321 case records were examined. The mean AOD was 4.62 years (standard deviation = 2.38) and children from rural communities were diagnosed at 4.87 years, nearly 0.35 years later than urban children (t = 2.47, P = 0.013). Results indicated that 31.1% of the variance in the AOD for children from rural areas was predicted by two variables, namely the number of children in the family and total Childhood Autism Rating Scale (CARS) score (F = 13.62, P = 0.001). For the urban sample, three variables emerged as significant predictors including the number of children in the family, total CARS score, and maternal education and these together explained 20.2% of the variance in the AOD (F = 19.60, P = 0.001). Conclusion: The public health system must be sensitized to the unmet needs of the marginalized socioeconomic groups to access diagnostic and management services in a timely manner.
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Cost-Effectiveness of photoscreeners in screening at-risk amblyopia in Indian children p. 171
Kaushik Murali, C Vidhya, Sowmya Raveendra Murthy, Sowmya Mallapa
DOI:10.4103/ijph.ijph_1848_21  
Objectives: Amblyopia is the most common cause of preventable vision impairment in children. This study tried to evaluate the cost-effectiveness of photoscreeners in identifying refractive errors making children at risk of amblyopia. Materials and Methods: This was designed as a prospective, open-label, randomized controlled study to compare the cost-effectiveness of photoscreeners (2WIN Adaptica and Plusoptix) versus autorefractor and Mohindra retinoscopy to identify the at-risk amblyopia. This study was conducted from October 2018 to December 2018 in coordination with Nanna Kannu school screening project and children in the age group of 5–11 years were included in the study. The photoscreening was done by lay screeners. A supervising ophthalmologist collated all data. Cost-effectiveness was calculated for the individual instruments and compared. The average time is taken for each instrument to record the refractive error was calculated and compared with the Mohindra retinoscopy. Results: Number of children included in this study was 2910. The mean age of the children was 7.82 + 0.65 years. The mean time taken for 2WIN Adaptica was 6 sec, Topcon –10 s, and Plusoptix –4 s. Plusoptix showed the minimal time for screening a child when compared to all other methods. The Plusoptix and 2WIN Adaptica were shown to be cost-effective when compared to Mohindra retinoscopy (P < 0.05). Conclusion: Photoscreening using Plusoptix and 2WIN Adaptica with lay screeners was < seven times the cost incurred and five times faster than the trained optometrists using either autorefractor or Mohindra retinoscopy and thus more cost-effective in screening a large number of young children with at-risk amblyopia at the community level.
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Effect of a quality improvement package on reducing newborn mortality from 26 to 14 in a Himalayan North Indian State p. 176
Seema Sharma, Mangla Sood, Kavya Sharma, Ishaan Sood
DOI:10.4103/ijph.ijph_1647_21  
Background: In India, newborn mortality remains high due to a number of factors, including poor quality of care at health facilities. The experience of executing complete neonatal care quality improvement (QI) package at selected hospitals in Himachal Pradesh and reduction in newborn mortality rate (NMR) is described in this study. Objective: The short-term objective was the participants' retention of knowledge and skills, and the achievement of uniform QI objectives following training and after a minimum of 6 months. Overall reduction in NMR was long-term objective. Methods: Newborn care QI package was implemented according to India Newborn Action Plan over a period of 48 months from 2013 to 2016, through infrastructure, trainings, and supportive supervision. Results: Total 13 health facilities were upgraded; 350 staff nurses and medical officers were trained. The mean posttraining knowledge score was 75% compared to 29% in the pretraining test, and 63% 1 year later. The competencies of health workers in the care of high-risk babies and 12 QI targets had improved, resulting in a 46% reduction in neonatal mortality in the state across all gestations and weights based on sample registration survey. Conclusion: Implementation of a bundle of evidence-based practices in low-resource setting for health system strengthening for intrapartum and neonatal care was linked to changed care behaviors among health-care providers, and reduction in NMR.
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Prevalence of anemia and associated risk factors among the lactating and nonpregnant-nonlactating Tangkhul women p. 182
Chingmila Shimrah, H Sorojini Devi
DOI:10.4103/ijph.ijph_1633_21  
Background: Anemia is a major public health issue throughout the world. Nutritional deficiencies in terms of iron, B12 (cobalamin) and B9 (folate) are the main causes of anemia in the absence of genetic abnormalities and chronic diseases in many countries. Lactating mothers are susceptible to anemia because of maternal iron depletion during lactation as well as blood loss during childbirth. Objective: The present study examines the prevalence of anemia among the lactating (cases) and nonpregnant-nonlactating (control) married Tangkhul women of Ukhrul district. Materials and Methods: A community-based cross-sectional study was conducted among 400 individuals (lactating: 150; nonpregnant-nonlactating women: 250) from 11 villages of the Ukhrul district in Manipur. A pretested schedule, which included height, weight, and socio-demographic parameters were used. Body mass index = weight (in kg)/height (in metre2) was computed of each subject and categorized. Hemoglobin concentration was measured using Sahli's method. Statistical methods namely Chi-square (χ2) test and binary logistic regression were applied. Results: The prevalence of anemia was higher in the lactating women (62.0%) than nonpregnant-nonlactating women (56.8%). Odds ratio (OR) of multivariate logistic regression analysis indicated that anemia was significantly associated in both cases and control with low literacy level (OR = 5.03 and 3.71), low income (OR = 2.51 and 3.56), cultivator (OR = 6.20 and 3.86), and multigravida >4 (OR = 5.25 and 2.67), respectively. Conclusion: Dietary practices play an important role in causing anemia. Low literacy level, low income, cultivator, and high gravidity were identified as the associated risk factors of anemia.
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BRIEF RESEARCH ARTICLES Top

“Oxygen Pheriwala:” An innovative model for SARS-CoV-2 screening in resource-limited settings p. 187
Vijaya Nath Mishra, Varun Kumar Singh, Abhishek Pathak, Nidhi Kumari, Anand Kumar, Rameshwar Nath Chaurasia
DOI:10.4103/ijph.ijph_1553_21  
The second wave of SARS-CoV-2 infection came as a hypoxic emergency and situation became worse in rural India, where undiagnosed COVID-19 patients died without any diagnosis or intervention. The primary aim of this innovative model was the early diagnosis of suspected SARS-CoV-2 cases, providing empirical treatment and timely referral to appropriate COVID care facilities. Fever was measured with infrared thermometer and oxygen saturation level with pulse oximeter. A total of 8203 people were screened, of which 274 persons were febrile and 69 (25%) were hypoxic too. Sixty-four out of 69 (93%) patients turned COVID-19 positive on reverse transcription-polymerase chain reaction. At the end of 3 weeks, 48/64 (75%) patients were successfully discharged. This model can be easily implemented in resource-limited regions to identify and prioritize the patients not only in this pandemic but also in outbreak of other communicable diseases.
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Envisioning the financial and psychological hardships of cancer p. 190
Rupak Kumar Borah, Bhavana Barman, Hari Kanta Choudhury
DOI:10.4103/ijph.ijph_1844_21  
Cancer is one of the leading causes of premature death and disability worldwide. With the progress of the health-care system, the cost of cancer treatment is also rising. Poor households suffer disproportionately from the financial burden of cancer treatment, which has pushed many households into poverty. Thus, cancer poses an economic burden for individuals, families, societies, and governments because of the prolonged medical costs, out-of-pocket expenditures, loss of productivity, and premature deaths. Moreover, the psychological breakdown phenomenon and social implications of cancer play a vital role in dealing with cancer patients. The psychological effect of battling with cancer falls not only on the patient but also on the caregivers and family members. With these backgrounds, an attempt is made in this review paper to highlight the implications of cancer on financial and psychological aspects.
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Influence of socioeconomic factors on the nutritional status of pupils of 5 to 11 in rural areas in cameroon: Case of the Nyambaka municipality in the Adamawa region p. 193
Mbarawa Marat Kofia Ibrahim, Mohamadou Lawan Loubou, Kagoue Simeni Luc-Aime, Mohamadou Aminou, Ndoe Guiaro Marcellin
DOI:10.4103/ijph.ijph_1516_21  
Malnutrition greatly increases the risk of infant mortality and vulnerability to various diseases later in the long run. It has been shown that children's malnutrition is the result of low household income. Rural areas in Cameroon are mainly made up of poor families. This guided the present research to analyze some socioeconomic factors and their impact on the nutritional status of pupils. Using a simple random sampling technique, 300 pupils were recruited. About 66.33% of pupils were from poor families. Obesity was more prevalent in the category of rich pupils (09.52%) compared to poor (06.53%). The height and weight of pupils studied were lower than the reference (P < 0.001). This study carried out in a single council is proven to be limited for a better understanding of the epidemiology of malnutrition among students, and large-scale studies would be adequate to better prevent and control malnutrition in rural areas.
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Kasurdi health and demographic surveillance system: A profile and way forward p. 196
Arun Kumar Yadav, T Prabhakar Teli, Sanjay K Juverkar, Rahul Kumar, Renuka Kunte, Dharamjeet Singh Faujdar
DOI:10.4103/ijph.ijph_1329_21  
Kasurdi Health and Demographic Surveillance System (Kasurdi HDSS) was established at Rural Health Training Center Kasurdi on February 16, 2018. Kasurdi HDSS has been established to increase the research potential of medical colleges and develop real-time data for research purposes to study the changes in population demography, health, and health-care utilization. Kasurdi HDSS currently follows 2755 individuals living in 549 households. The system collects the data from the population through annual rounds conducted by postgraduate residents of the department of community medicine. The data are collected in the digital format with the help of android-based tablets. HDSS has collected demographic data, reproductive data, data on diseases such as tuberculosis and noncommunicable diseases, and socioeconomic data. The HDSS is in the process to upgrade its data management system to a more integrated platform, coordinated and guided by national/international standards, and data sharing policy.
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Usage of aluminum vessels in various types of cooking procedures by subjects aged 60 years and above residing in Urban Vadodara and its correlation with Alzheimer's disease p. 200
Mini Sheth, Arpi Shah
DOI:10.4103/ijph.ijph_1833_21  
Aluminum vessels are being used from a long time for various cooking purpose. Using cross-sectional study design, 90 participants, 30 in each category of normal, mild – moderate and severe Alzheimer's disease (AD), aged of 60 years and above were enrolled using SAGE scale. Data on the frequency of usage of aluminum vessel for various types of cooking such as frying, baking, boiling, roasting/sautéing, and packing of food using aluminum foil were collected using the pretested semistructured questionnaire. Results showed that severity of AD was significantly associated (P < 0.05) with usage of aluminum utensils for various cooking purpose in all the three groups, with least total score for usage of aluminum vessels in normal category (3.2) and highest in severe category (18.67). Frying (P < 0.001), boiling (P < 0.05), and roasting/sautéing (P < 0.01) of foods in aluminum vessels was be significantly associated with the AD score. Degree of AD positively correlated with usage of aluminum vessels.
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Profile of health care workers infected with SARS-CoV-2 infection in a central district in Kerala with focus on infection control practices p. 203
Aarati Krishnan, Serin Kuriakose, C Rohini, Resmi S Kaimal, S Sreedevi
DOI:10.4103/ijph.ijph_1542_21  
There were reports of severe acute respiratory syndrome coronavirus 2 infection cases among health-care workers from all around the world. We did a cross sectional study among 533 COVID19 affected health-care workers. About 87.43% of participants were involved in duties not directly related to COVID-19 management. About 19.6% contracted the disease from their colleagues. About 15% of the affected health-care workers had at least one comorbidity and diabetes mellitus was the most common (5%). 57% of participants presented with fever followed by body ache in 40%. Only 0.4% of the participants needed ventilator support during treatment. 36% of the participants reported household transmission from them. Adequate personal protective equipment (PPE) usage and functioning infection control committee in their hospital were reported by most of the participants. The study points towards the need of adequate PPE use in the nonCOVID settings and the need for periodical assessment of infection control practices.
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Dental caries and their relation to hba1c in adults with type 2 diabetes mellitus p. 206
Deepasri Mohan, Yogesh Bhuvaneshwar, Ramakrishnan Manjankarni Jeyaram, Sukanya Saravanan, Anandakumar Amutha, Research Team
DOI:10.4103/ijph.ijph_1935_21  
Diabetes mellitus with poor glycemic control is often associated with dental caries. We aim to assess the relationship between dental caries and HbA1c levels among adults with type 2 diabetes (T2D) in Chennai. A cutoff of HbA1c ≥7.0 to 7.9% (53–63 mmol/mol) was used to define Group 1 (n = 113) as moderately controlled and HbA1c ≥8.0% (64 mmol/mol) to define Group 2 (n = 228) as poorly controlled T2D. The absolute numbers of decayed, missing, and filled teeth were examined to calculate the decayed, missing and filled teeth index. Group 2 had a significantly higher percentage (48.2%) of decayed teeth when compared to Group 1 (28.3%). Group 2 had a 2.65 times higher risk of decayed teeth when adjusted for mean carbohydrate consumption, sweets consumption, oral hygiene, and brushing habit. T2D with higher HbA1c levels is associated with an increased number of decayed teeth. Hence, there is a need for monitoring dental status in T2D as earlier treatment may prevent or delay decay teeth.
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Outcomes of teleconsultation services and patient satisfaction among pregnant women delivering at a tertiary care center in South India during coronavirus disease 2019 pandemic p. 210
R Sujithra Devi, T Naik Parvathi, R Rupesh Bala Murugan, Haritha Sagili, Subitha Lakshminarayanan, T Priyadarshini
DOI:10.4103/ijph.ijph_1942_21  
Coronavirus disease 2019 pandemic has disrupted the antenatal care in low- and middle-income countries such as India. Telemedicine was introduced for the first time in India for continuing antenatal care. Hence, a questionnaire-based descriptive cross-sectional study is done to assess the outcomes of teleconsultation services, factors influencing it, and patient's perceived satisfaction. Three hundred and fifty-five women who delivered the following teleconsultation from July 2020 to October 2020 were included in the study. Thirty-two percent were high-risk pregnancies and 15% of the babies required neonatal intensive care unit admission. Ninety-eight percent could convey their health concerns, 18% had a referral to other departments, and 25% had visited casualty. Sixty-three percent procured medicine through e-prescription. Seventy-six percent were happy with teleconsultation overcrowded clinic, 82% were happy about saving travel expenditure, whereas overall satisfaction was 50%. Fourteen percent did not have access to smartphone and 9% did not receive the call at scheduled time. Telemedicine has a vital role in managing pregnancy concerns during this pandemic.
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REVIEW ARTICLE Top

Factors influencing the emergence of self-reliance in primary health care using traditional medicine: A scoping review p. 214
Shivanand Basappa Savatagi, Prashanth Nuggehalli Srinivas, Unnikrishnan Payyappallimana
DOI:10.4103/ijph.ijph_1863_21  
Self-reliance is the responsible behavior and the ability of an individual to take care of one's own health using local resources. A substantial proportion of the population use traditional medicine (TM) for primary health care (PHC) in low- and middle-income countries (LMIC). The underlying philosophy of the TM approach is self-reliance due to its emphasis on culture, traditions, customs, and local resources. Given the complexity and ambiguity of how self-reliance emerges, there is a need to have clarity in its understanding and the practice in relation to TM. Hence, we conducted this review to synthesize the factors determining the emergence of self-reliance in PHC using TM in resource-poor settings with a specific focus on LMICs. We searched PubMed, Google scholar, and the Social Science Research Network databases, and conducted reference tracking of selected articles. We included articles published between 2000 and 2020 May. Thematic analysis was done using QDA-miner Lite software version 2.1. We retained 29 papers for review and analysis. A conceptual framework was developed that located factors influencing the emergence of self-reliance. Self-reliance manifests through a socially constructed interaction between factors from the macro (policy and environment) to the micro context (community and household). Due to the lack of explanatory models, there is a substantial gap between understanding self-reliance and its application in health policy and practice. Achieving comprehensive PHC and universal health coverage requires policy provisions to create an enabling environment in health-care facilities, communities, and households that allows the emergence of self-reliance.
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COMMENTARIES Top

Smartphone: A smart assistive device for people visual disabilities among COVID-19 pandemic p. 223
Suraj Singh Senjam
DOI:10.4103/ijph.ijph_1492_21  
Smartphones are becoming one of the most indispensable gadgets for everyone in today's digital world, with the continued incorporation of computer technology. For the past few years, the interaction between human and smartphone content has been improved significantly with innovative technologies using gestures, haptic, and sound instead of visual-based interaction. Such technologies are in the form of built-in features and accessible apps. Such an advanced way of interface design helps to access not only the content in phones but also assist to perform daily living activities. Evidence shows that such smartphones technology help in executing a wide range of functioning among people with visual impairment. Today, the COVID-19 pandemic causes a challenge to everyone, including one living with a vision loss, in maintaining the daily supplies and civic life. Unfortunately, the majority of such people cannot access smartphones, so they depend on a simple basic phone. It is the time to promote the benefits of such evolving smartphones technology in all the corners of the health-care sectors, practitioners, special educators, and even family members. Meanwhile, the relevant ministerial divisions of the Government of India need to develop a clear policy to augment access to smartphones, particularly among people with visual disabilities.
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The Honorable “Honorary system” in teaching/university public hospitals - An ideal blend of academics and prosperity for the medical professional p. 226
Mohinish G Bhatjiwale, Mrudul Mohinish Bhatjiwale
DOI:10.4103/ijph.ijph_1817_21  
The options available for a specialist in India today can be broadly divided into joining a public teaching institution in the capacity of lecturer or higher, freelancing, and taking up a full-time corporate position. Whereas public teaching institutions have an abundance of academics, skill and mastery development potential, corporate positions and freelancing offer better monetary stability. From an ideal blend of both systems, stems the honorary system. This article elaborates on and exemplifies the same with several doyens who have been involved, and have been a product of the honorable “honorary system.”
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Challenges in setting up a diagnostic microbiology laboratory during coronavirus disease 2019 crisis and impact on the diagnosis of communicable diseases p. 230
Ashima Jain Vidyarthi, Arghya Das, Rama Chaudhry
DOI:10.4103/ijph.ijph_1774_21  
The coronavirus disease 2019 (COVID-19) pandemic has left the health-care workers exhausted and the system dwindling. The challenges have been immense everywhere and even worse in developing countries. Despite the Indian Government's forethought and active investment in various national programs, the pandemic has brought unconceivable repercussions on the management and notification of several other lethal infectious diseases including human immunodeficiency virus (HIV) and tuberculosis. Although the phenomenal capacity building for COVID-19 testing and diagnosis over a short time is admirable, the journey has been arduous. From convincing the hospital managements to create the recommended infrastructure, to the procurement of necessary equipment and consumables on an urgent basis, and providing services round the clock with limited workforce, the laboratory personnel throughout the country have done a remarkable job in their quest to combat the pandemic. However, the work needs to be pursued further in apprehension and preparedness for any emerging agents.
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LETTER TO EDITOR Top

How uniform is the utilization pattern of Janani suraksha yojana in sikkimese population: A community-based study p. 234
Eden Jamyang Bhutia, Dechenla Tshering Bhutia, Jayden Lhamu Bhutia
DOI:10.4103/ijph.ijph_2153_21  
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BOOK REVIEW Top

Epidemiology and management for health care p. 235
Kapil Goel
DOI:10.4103/ijph.ijph_749_22  
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