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   Table of Contents - Current issue
October-December 2022
Volume 66 | Issue 4
Page Nos. 399-536

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Digital technology for improving health Highly accessed article p. 399
Jayashree Sachin Gothankar, Prakash Prabhakarrao Doke, Sujata Kapil Murarkar
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Post-COVID-19 pandemic public health: Issues and challenges in India Highly accessed article p. 401
Harshad Thakur
COVID-19 was an unexpected public health emergency. The key positive features of the Indian health system were demonstrated during the pandemic. Postpandemic is the time to introspect. Various issues and challenges facing the Indian Public Health System require due attention.
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Looking back to move forward: A travel rule underlined by the current pandemic p. 403
Samiran Panda
Learning from the past – is easier said than done. In this narrative, “travel” refers to the forward movement of the society at large on the path of health and development. It is suggested that looking back and learning from the lived experiences of the past outbreaks could help generating public health insights and incorporating them in planning for a better future. In the process, a country may choose to revisit what took place in the recent past during the COVID-19 pandemic within its boundary and beyond. However, unfolding of events in the past, which is not as immediate as COVID neither too far as the flu pandemic of 1918, also has lessons to offer. Recognizably, a few alarms, that rang in the recent past and cried for mass attention towards beefed up public health preparedness, were missed. It is therefore necessary now to critically examine the past-efforts to eradicate, eliminate or control diseases such as small pox, polio, HIV, tuberculosis, leprosy, measles or malaria. Results of such evaluation could inform the future courses of actions around disease elimination science and health (DESH) and help develop better nations.
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Maternal Mortality Perspective: A Success Story of Maharashtra p. 407
Archana Vasant Patil
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Study on intimate partner violence against rural tribal women of reproductive age group in siliguri subdivision of Darjeeling District, West Bengal p. 410
Ananya Ramanandi Jyotirmay, Sharmistha Bhattacherjee, Louis Tirkey, Anirban Dalui
Background: Since the early 1990s, several milestone international declarations have recognized violence against women as a violation of human rights. Intimate partner violence (IPV), often used synonymously with domestic abuse or domestic violence against women, is a big burden to our society which manifests itself in many forms and it has its existence in every corner of the world irrespective of all the boundaries. Objectives: The objective of this study was to find out the prevalence of IPV against reproductive age group tribal women in Siliguri subdivision of Darjeeling district. Methodology: A cross-sectional study was carried out among 360 tribal women aged between 15 and 49 years residing at selected villages across Siliguri subdivision. Data regarding IPV were collected using the Indian Family Violence and Control Scale questionnaire. The data were analyzed using SPSS version 20 and multi-variable logistic regression was done to find out factors associated with domestic violence. Results: The study revealed that 70.3% of women had experienced domestic violence in any form in their lifetime. Logistic regression revealed that IPV was significantly associated with: age between 30 and 49 years, education above primary school, unskilled occupation, ₹ 2500 and above per-capita monthly income, and participants who are separated/broken up. Among the factors related to the male partner, literacy above primary school level was associated with experience to domestic violence. Conclusion: Domestic violence in all its manifestations was found to be present in the study population. The report may offer policymakers fresh perspectives on how to allocate funds for the complete elimination of domestic violence against women.
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Realistic personal exposure assessment of air pollutants and health outcomes – A cross-sectional study among Kolkata slum dwellers p. 415
Arup Chakraborty, Arista Lahiri, Shibaji Gupta, Nibedita Banerjee, Asim Saha, Urmila Dasgupta
Background: Rapid, unplanned, and unsustainable patterns of urban development can result in many emerging environmental and health hazards. One of the important public health problems of urban environment is regular exposure to dust and pollutants and consequence of such exposure in the form of changes in the pulmonary function. Being the immediate environment, indoor pollution poses a higher risk to human health than the ambient environment. Realistic personal exposure assessment gives the actual idea about the exposure status. Objectives: This study determined the household principal environmental exposures (Dust, SO2, NO2, and total volatile organic compound) among urban slum dwellers and assessment of the respiratory function to determine any possible relationship between those exposures and outcomes. The study also described the knowledge, attitude, and practice of these urban slum people regarding air pollution and its effect. Methods: A cross-sectional study was carried out among 442 urban slum people residing in the slums of the Kolkata Municipal area. Household environmental exposures were collected by standardized methods and outcome was observed by conducting a pulmonary function test. Finally, knowledge, attitude, and practice regarding air pollution were carried out with the help of a questionnaire-based survey. Results and Discussion: Almost all the pollutants exposure was associated with impairment of lung function. Younger age and female gender were statistically associated protective factors for the development of any lung disease. Those who had an overall good awareness regarding the means and effects of air pollution were found to be protected from developing lung disease. Using exhaust ventilation, relocation to inner side of slums, using personal protective measures, and adequate pollution awareness can help the slum citizens to overcome the problem.
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Conformance of the food vendor carts design to the prescribed standards as per food safety and standards regulations: Assessment from an urban area of North India p. 421
Kumar Pushkar, Garima Bhatt, Madhur Verma, Sonu Goel, Amarjeet Singh
Background: Food Safety and Standards Authority of India, established under the Food Safety and Standards Act, 2006, is mandated with disseminating evidence-based standards, regulating the manufacture, storage, distribution, sale, and import of street food, for ensuring the availability of safe and wholesome food for human consumption and matters connected in addition to that or incidental to that. Hence, this study was conducted to ascertain the conformance of the design of street food vendor's carts to the prescribed standards. Methods: We conducted a cross-sectional study in Chandigarh between July 2017 and March 2018 among 400 street food vendors. The primary dependent variable of the study was conformance. The carts were evaluated for their conformance to the standard recommended design based upon a checklist designed using the guidelines of Food Safety and Standards Regulations, 2011. Results: Almost half of the respondents had an experience of 6–15 years (48.5%) and were earning between Rs. 500 and 1000/day (56.3%). The majority of them (95%) were migrants from other states. Only 26.3% were using mobile vending sites. On regression analysis, better cart score was predicted by age, education, increasing experience, higher income, when food was prepared at home only, and with assistance in the form of helpers. Conclusions: This study indicates that although the policy was formulated 8 years back, the standards of street food carts were still below par in Chandigarh. The government should give technical specifications and ensure uniformity at the national level.
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Promotion of toilet construction and usage in rural Tamil Nadu: A mixed-methods evaluation study p. 427
S Nancy, Suguna Elayaperumal, Amol R Dongre
Background: Open defecation is the leading cause for malnutrition and diarrhoeal deaths in low- and middle-income countries. The negative public health impacts of open defecation could be neutralized by toilet usage. However, the usage of improved sanitation facilities is unsatisfactory in rural India. Objectives: The study was carried out to find the psycho-social barriers among households for not having toilets and for not using the owned toilets and to develop and find out the effect of Behaviour Change Communication (BCC) strategy on toilet construction and usage. Methods: A community-based Embedded Experimental Mixed Methods study was undertaken in the four field practice villages of Urban Health Training Centre, Villupuram. For baseline and end-line surveys, 422 independent sample households who were not having or not using the toilets were selected by Simple Random Sampling. After IEC clearance, interviews and direct observation of the toilets were undertaken. Context-specific multi-faceted BCC strategy was employed through community participation. The data were analyzed in SPSS software. Chi-square test was used to determine the significance of difference and effect size was calculated to estimate the size of the difference between the baseline and end-line data. Results: Toilet ownership and utilization improved by 21.3% and 23.3% points, respectively. There was a significant reduction in households' perceived psychosocial barriers in toilet adoption. Conclusion: Our intervention demonstrated considerable improvements in both toilet construction and usage surpassing the psycho-social barriers. Future sanitation promotion interventions should focus more on community participation and the key messages should be reinforced multiple times using different channels.
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Analysis of cesarean section rates and its indications using robson's classification at a tertiary care hospital, Manipur p. 434
L Janani, Soubam Christina, Brogen Singh Akoijam, Dipabali Nameirakpam, Ranjit Singh Laiphrakpam
Context: The World Health Organization proposed the Robson's classification system as a global standard for assessing and comparing cesarean section (CS) rates within health-care facilities over time and between facilities. Aims: This study aims to assess the frequency and indications of CS and to identify the groups within the obstetric population contributing to CS using Robson's classification. Settings and Design: A retrospective chart review was conducted in a Tertiary Care Teaching Hospital in Imphal, Manipur. Methods: All women who delivered between January and December 2019 were classified using the Robson's Ten Group Classification System. The overall CS rate and the CS rate in each Robson's group were calculated. The indications for CS were also recorded. Statistical Analysis Used: Descriptive statistics, such as frequency, percentage, mean, and standard deviation, was used. Results: A total of 10,282 births were reported. The overall CS rate was 35.2%. Group 3 (multiparous women without previous CS in spontaneous labor) (27.6%) and Group 1 (nulliparous women in spontaneous labor) (23.7%) contributed to most of the obstetric populations. The majority of CS belonged to the women in Group 5 (multiparous women with previous lower segment CS) (11%), followed by Group 2 (nulliparous women with labor induced or prelabor CS) (8.6%) and Group 4 (multiparous women without previous CS were induced or taken for prelabor CS) (5.5%). Conclusions: The study revealed that Groups 5, 2, and 4 contributed to the high CS rate. Efforts to reduce the overall CS rate should be directed at increasing vaginal births after CS, performing effective pelvic examinations, and encouraging obstetricians to perform versions when indicated.
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Effectiveness of psychoeducative intervention on quality of life among caregivers of patients with schizophrenia: A randomized control trial p. 439
GJ Sara Sapharina, Ganapathy Neelakshi
Background: The caregiver, who is taking care of a patient with schizophrenia, needs to spend an extensive amount of time, energy, and money during the process of caregiving, which is the major root cause for the psychological strain and physical exhaustion. Objectives: The objectives were to evaluate the effectiveness of psychoeducative intervention on quality of life (QOL) and associate QOL with selected background variables among caregivers of patients with schizophrenia. Methods: A quantitative research with evaluative approach was used. The research design adopted was randomized controlled trial. The study had two groups, a study group and a control group. A sample size of 150 (75 in each group) caregivers of patients with schizophrenia equally distributed to study and control groups were included. The World Health Organization QOL – BREF scale is used to assess the QOL among caregivers, in this study. Data were analyzed using descriptive and inferential statistics. Results: The repeated measures of analysis of variance computed for QOL scores for within the study group (F = 15.82, P = 0.001), control group (F = 5.06, P = 0.004), and between the study and control groups (F = 1.42, P = 0.02) were significant. The changes observed from pretest to posttest 1 were statistically significant. There was a significant association between QOL scores and selected background variables such as social support and medical expenses among caregivers in the control group. Conclusion: The present study concludes that psychoeducative intervention was found to be very effective in improving QOL among caregivers of patients with schizophrenia.
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Electronic versus paper-based data collection for conducting health-care research: A cost-comparison analysis p. 443
Sirshendu Chaudhuri, Bhavani Shankara Bagepally, Ditipriya Bhar, Uday Kumar Reddy Singam
Background: Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC). Objectives: As economic evidence in this area is scanty, especially in low- and middle-income countries, the objectives of the study are to perform an economic evaluation and compare the cost between EDC and PDC. Methods: A cost-comparison study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community-based survey. Step-down cost accounting was adopted with a bottom-up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e-SPSS and p-SPSS, respectively). We conducted scenario analyses based on the usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA, and p-STATA, respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results. Results: In the base-case analysis, total costs of EDC and PDC were ₹72,617 ($1060.9) and 87,717 ($1281.5), respectively, with estimated cost reduction of ₹15,100 ($220.6). In other scenarios, the estimated cost reduction for e-R, e-STATA, p-R, p-STATA was ₹−274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2), respectively, when compared to EDC-SPSS. On one-way and PSA, the results of the cost-comparison analysis were robust. Conclusion: EDC minimizes institutional cost for conducting health research. This finding will help researchers in efficiently planning for the budget for their research.
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Study of maternal and fetal outcomes in obese women p. 448
Mansi Kumar, Kimaya A Mali
Background: Obesity in Indian women had increased from 10.6% to 14.8% in India. Mothers who are overweight or obese during pregnancy and childbirth cause significant antenatal, intrapartum, postpartum and also neonatal complications. Aim and Objective: The present study aimed to explore various maternal and fetal outcomes influenced by maternal obesity. The objective was to find the effect of obesity on maternal and perinatal outcome among obese pregnant women compared to those of normal weight. Methods: The study was conducted in antenatal women attending antenatal outpatient department of of Obstetrics and Gynecology in a teriary care referral hospital in Mumbai. Results recorded in simple percentages. Results: Eighteen percent cases developed gestational diabetes mellitus during their antenatal period and 15% developed gestational hypertension. 44% patients underwent lower segment caesarean section. The need for induction of labour and caesarean section was found to be 37% which is significantly higher. Increased NICU admissions due to hypoglycemia or congenital malformations,prematurity was found to be on a higher side. Conclusions: It was clearly evident from the present study that maternal obesity had adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, gestational hypertension, preeclampsia and increase in need for induction of labour and operative interference.
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Social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic: A cross-sectional study from central India p. 451
Akkilagunta Sujiv, S Kalaiselvi, Mithilesh Kumar Tiwari, Pradeep Deshmukh
Background: In the present COVID-19 pandemic, social distancing measures have been advised to protect elderly from infection which might have led to poor mental health state. Objective: A cross-sectional study was carried out to assess the magnitude of social isolation, social support, and psychological distress among the elderly during the COVID-19 pandemic in Central India. Methods: The estimated sample size was 1535. The sample was equally distributed among rural, semiurban, and urban strata of districts. Social isolation was measured using Lubben's Social Network Scale-Revised, and psychological distress was assessed using Kessler K10 Psychological Distress Scale. Other parameters such as a history of COVID-19 illness and COVID-19 vaccination were assessed. Results: The prevalence of social isolation was higher at 23.6% during the COVID-19 pandemic compared to before the pandemic period (15.0%). The majority perceived a high level of social support during the pandemic (55.3%) and 39.9% received moderate support. Overall, 18.4% of the respondents had psychological distress. Out of them, 56.2% had mild distress, 20.1% had moderate distress, and 23.7% had severe distress. Significant predictors of psychological distress were female gender, lower socioeconomic status, history of COVID-19 disease among the participants, social isolation, and lack of social support. Conclusion: Social isolation and lack of social support were significant predictors of psychological distress among the elderly during the pandemic.
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The impact of COVID-19 pandemic on influenza surveillance: A systematic review and meta-analysis p. 458
Sasidharanpillai Sabeena, Nagaraja Ravishankar, Sudandiradas Robin
Background: Influenza activity was reported to be below the seasonal levels during the Coronavirus disease-2019 (COVID-19) pandemic globally. However, during the severe acute respiratory syndrome corona virus-2 outbreak, the routine real-time surveillance of influenza-like illness and acute respiratory infection was adversely affected due to the changes in priorities, economic constraints, repurposing of hospitals for COVID care, and closure of outpatient services. Methods: A systematic review and meta-analysis were carried out to assess the pooled proportion of symptomatic cases tested for influenza virus before the current pandemic in 2019 and during the pandemic in 2020/21. An electronic search of PubMed/MEDLINE, Scopus, and Google Scholar was carried out for the articles reporting the impact of the COVID-19 pandemic on influenza surveillance among humans using search terms. The study was designed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the meta-analysis was performed to synthesize the pooled proportion of patients sampled for influenza with 95% confidence interval (CI). Results: The nine qualified studies from the WHO European region, Canada, Japan, Germany, Italy, Spain, South Africa, and the United States were pooled by random-effects meta-analysis. The overall pooled proportion of symptomatic cases sampled for influenza surveillance before and during the pandemic was 2.38% (95% CI 2.08%–2.67%) and 4.18% (95% CI 3.8%–4.52%), respectively. However, the pooled proportion of samples tested for influenza before the pandemic was 0.69% (95% CI 0.45%–0.92%) and during the pandemic was 0.48% (95% CI 0.28%–0.68%) when studies from Canada were excluded. Conclusion: The meta-analysis concludes that globally there was a decline in influenza surveillance during the COVID-19 pandemic except in Canada.
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Effect of COVID-19 lockdown on lifestyle habits and self-care practices of diabetic and hypertensive patients in rural Shimla and Udaipur – Findings from the HealthRise India program p. 466
Santhosh Kumar Kaza, Pallavi Gupta, Ruchi Vaidya, Shalini Chandrashekar Nooyi, Nayanjeet Chaudhury
Background: COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self-care practices are not only associated with less severe COVID-19 infections but also with a high recovery rate. Objectives: This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur. Methods: A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year. Results: Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID-19 pandemic. During COVID-19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001). Conclusion: Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.
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Postpartum depression and its clinico-social correlates – A community-based study in aligarh p. 473
Mehnaz Aslam, Tabassum Nawab, Anees Ahmad, Ali Jafar Abedi, Suhail Ahmed Azmi
Context: Postpartum depression (PPD) is onset of depressive symptoms in postpartum period from 2 weeks to 1 year. It causes maternal morbidity and long-term negative effects on growth and development of infant and child. It is often unreported and underdiagnosed. Aims: (1) To estimate the prevalence of PPD, (2) To determine socio-demographic, clinical, and obstetric correlates of the same. Settings and Design: A cross-sectional study was done in urban and rural areas of District Aligarh. Methods: A total of 304 females between 6 weeks and 6 months' postpartum period giving consent were included in this study. Sociodemographic, obstetric, and clinico-social factors were recorded using predesigned, pretested questionnaire. Edinburgh Postnatal Depression Scale (EPDS) score ≥10 was used to screen for PPD and International Classification of Disease (ICD-10) criteria for confirmation. Statistical Analysis Used: Correlates of PPD were determined using logistic regression analysis. Results: The prevalence of PPD was 9.5% using EPDS and was confirmed by ICD-10 criteria. History of abortion (adjusted odds ratio [AOR]: 6.0, 95% Confidence Interval [CI] 2.2–16.5), poor relationship with in-laws (AOR: 5.1; 95% CI 1.3–20.5), marital conflict (AOR: 13.3; 95% CI 2.2–77.6), and substance abuse in husband (AOR: 3.1; 95% CI 1.1–9.0) were found to be significant correlates for PPD. Conclusions: About one in every 10 postpartum females suffered from depression but did not seek health care for the same. Women facing social pathologies such as substance abuse in husband, marital conflict, and poor relationship with in-laws are more at risk of PPD. Screening for PPD should be included in the maternal and child health care programs to ensure early diagnosis and treatment.
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A survey of the training and working arrangements of general practitioners providing asthma and chronic obstructive pulmonary disease care in a rural area of Maharashtra State p. 480
Dhiraj Agarwal, Makrand Ghorpade, Pam Smith, Sanjay Juvekar, Hilary Pinnock
Background: Chronic respiratory diseases (CRD), especially asthma and chronic obstructive pulmonary disease (COPD), are common public health problems resulting in a substantial burden of disease for individuals. There is a need to understand the perceptions and practices of primary care physicians (“general practitioners [GPs]”) who provide most of the health care in rural India. We surveyed all private and public practitioners listed as practising in a rural area of Western India with the aim of identifying GPs (GPs: graduates, registered and allowed to practice in India) to understand their training, working arrangements, and asthma/COPD workload. Methodology: We administered a short questionnaire at educational meetings or via e-mail to all private and public practitioners listed as providing community-based services in the Junnar block, Pune district, Maharashtra. The survey asked about qualifications, experience, and working arrangements, and about current asthma and COPD workload. A descriptive analysis was performed. Results: We approached 474 practitioners (434 from private sector and 40 from public sector). Eighty-eight were no longer practising in the study area. The response rate was 330/354 (93.2%) of private and 28/32 (87.5%) of public sector practitioners. We excluded 135 nonrespiratory hospital specialists and 23 private practitioners whose highest qualification was a diploma. Our final sample of 200 GPs (70% males) was 177 from private sector and 23 from public sector. The private GPs had more experience in clinical practice in comparison to public GPs (18.6 vs. 12.8 years). Eighty-four percent of GPs from the private sector only had Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) qualifications, though >90% provided “modern medicine” services. In the public sector, 43.5% GPs only had AYUSH qualifications, though all provided “modern medicine” services. A minority (9% of private GPs and 16% of public GPs) provided both services. Nearly two-thirds (62%) of private GPs had inpatient facilities compared to only 9% of public sector GPs. In both sectors, more GPs stated that they managed people with asthma than treated COPD (Private: 97% vs. 75%; Public 87% vs. 57%). Conclusion: Many GPs practising “modern medicine” only had qualifications in Ayurveda/Homeopathy and fewer GPs are involved in the management of COPD as compared to asthma. These are important factors that form the context for initiatives seeking to improve the quality of community-based care for people with CRD in Maharashtra state in India.
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Spectrofluorimetric-based approach to screen urine contamination in drinking water: A step toward the development of screening method for leptospirosis p. 487
Deepak Kumar, Deepak Yadav, Sumanpreet Kaur, Sheemona Chowdhary, Rajasri Bhattacharyya, Dibyajyoti Banerjee
Hygiene hypothesis and sanitization are two important pivots of modern civilization. The drinking water should be free from urine and stool contamination. Coliform test is popular for understanding feces contamination. However, understanding urine contamination in drinking water is a difficult task. On the other hand, urine contamination can cause disease like leptospirosis. It occurs mainly in animals and infects humans through contaminated water, food, and soil and causes serious consequences. Rat urine is the most common source of such disease outbreaks. Further, sophisticated laboratories with high-end technologies may not be present at the site of disease outbreaks. In this context, we have proposed a spectrofluorimetric approach to screen urine contamination in water. The screening method can sense up to 156 nl/ml of rat urine.
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Trends in selected birth defects among parents from below poverty line population in Karnataka during 2010–2020 p. 490
DC Nanjunda, S Jyothi Lakshmi, H Rajesh Acharya, Amit Kumar Mishra
The aim of the study is to reveal the common birth defects among parents of newborns belonging to the below poverty line (BPL) category in Karnataka state (South India) by analyzing Suvarna Arogya Suraksha Trust data. In the last 10 years, 3672 kids in BPL families have been born with various birth abnormalities. It is found that 50.3% of newborns have anorectal malformations, 33.1% have hypospadias, 6.0% have diaphragmatic hernia, 5.1% have esophageal atresia, and 2.8% have intestinal atresia and obstruct. As a parent's age rises, the likelihood of having a child with birth abnormalities raise as well, particularly anorectal malformations than diaphragmatic hernia. Male newborns have a higher risk of birth defects. We hypothesized that poverty, material deprivation, and low socioeconomic profile throughout the life course among the BPL community could be some of the key reasons for poor maternal health care and related neonatal outcomes.
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Risk factors for severe rhino-orbital mucormycosis during its epidemic post-COVID-19 pandemic p. 494
Gopal Krushna Das, Ankur Singh, Nitika Beri, Pramod Kumar Sahu, Tanya Bisht, Isha Sharma
Postsecond wave of COVID-19 pandemic in the year 2021, rhino-orbital mucormycosis (ROM) was seen as an epidemic in the Indian community. Severe ROM disease has poor prognosis and requires a multidisciplinary approach for treatment. Hence, its prevention is better than cure. Studies done during the epidemic assessed predisposing factors, but this was a novel study which focused on assessing risk factors for severe disease of ROM. Ninety-four consecutive patients of ROM admitted at our designated nodal tertiary hospital of North India were enrolled, and data were collected and analyzed. Facial edema was the most common presenting complaint. Subclinical and mild COVID-19 infection was associated with severe ROM. Uncontrolled diabetes mellitus and prophylactic zinc supplementation were other significant risk factors for severe ROM. Public awareness among the general population for the above risk factors can prevent a debilitating disease like severe ROM.
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Technology-based tobacco cessation training in Indian context p. 498
Venkata Lakshmi Narasimha, Abhinav Prakash Arya, Gaurav Jain, Anandakumar Pandi, Saurabh Varshney
In tobacco use disorders (TUDs), technology-based training of health-care professionals can reduce the treatment gap and bring attitudinal change. The study aimed to assess the practices and determine the change in knowledge and attitude among health-care professionals following an online training program (OTP). Half-day OTP on tobacco cessation using prepost quasi-experimental study design with a structured questionnaire-based assessment was conducted. Among 293 completed surveys, knowledge post-OTP was higher but insignificant (P = 1.2). Post-OTP, participants felt less angry and disappointed toward tobacco users (mean of difference (MOD) =0.21, P = 0.0007); more sympathetic and concerned (MOD = −0.22, P = 0.0005); and acknowledged tobacco users deserve the same medical care as nonusers (MOD = −0.177, P = 0.001). Post-OTP scores in attitudes did not change significantly for the responsibility domain (P < 0.05). In practice, relatively greater number of health-care professionals asked about tobacco use and advised cessation, however lesser assessed, assisted, and referred. To conclude, technology-based training program can result in attitudinal changes toward tobacco users.
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Spatial Modeling of leprosy disease in east java province with spatially varying regression coefficients models p. 501
Husnul Chotimah, IG N. Mindra Jaya
Indonesia ranks third with the most leprosy cases globally. East Java is the province that has the highest leprosy cases. The Provincial Government socialized the East Java Leprosy Eradication Program, which targets a maximum of one leprosy case per 10,000 residents. We propose spatially varying regression coefficients models to evaluate the effects of risk factors on of leprosy cases in East Java, use Geographically Weighted Generalized Poisson Regression and Geographically Weighted Negative Binomial Regression (GWNBR) models. The best models GWNBR categorize municipalities into six groups based on variables that have a significant impact on leprosy cases. The percentage of households with access to adequate sanitation is a significant factor in determining leprosy cases in all municipalities in East Java. We can conclude that clean and healthy living behavior, health facilities, and health workers significantly affect the number of leprosy cases in East Java.
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Extent, spectrum, and predictors of cognitive impairment in urban geriatric population in a district of North India p. 504
Priya Keshari, Hari Shankar
Cognitive impairment (CI) is no longer considered a normal and inevitable change of aging. This study was carried out to assess extent, spectrum, and predictors of cognitive impairment in the participants. A community-based cross-sectional study was done on 616 urban geriatric participants of Varanasi city selected by multistage sampling procedure. The participants were interviewed about their sociodemographic profile using a predesigned and pretested pro forma, and their cognition was assessed through Mini-Mental State Examination tool. Logistic regression analysis was applied for an inferential purpose. Adjusted odds ratios (AORs) and 95% confidence interval were computed. Extent of cognitive impairment in geriatric participants was 22.4%. AORs were maximum in ≥80 years (21.23; 95% Confidence Interval: 7.05–63.94), in illiterate and just literate participants (13.71; 95% Confidence Interval: 6.49–28.98) and in homemakers (17.0; 95% Confidence Interval: 4.28–67.49). Nine out of 40 urban geriatric participants had cognitive impairment. Adversities of cognitive impairment were more with advancing age, nonengagement in gainful employment, and low literacy levels.
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Exploring the status of iodine deficiency disorders control program in Nagaland p. 508
Globally, 1.9 billion individuals have inadequate iodine nutrition, of whom 285 million are school-aged children. Universal salt iodization is the favored preventive strategy for iodine deficiency disorders (IDD), the single largest cause of preventable mental retardation. Two thousand and twenty estimates show nearly 1 billion people do not consume iodized salt. When at least 90% of households consume adequately iodized salt (≥15 ppm), a country is said to have attained USI. Only 23 countries had household coverage of 90% or higher. India has a household coverage of 76.3%. One 67 million people are at risk of IDD, 54 million suffer from goiter, and 2 million from cretinism. Yearly, 9 million pregnant women and 8 million newborns are at risk. Nagaland, with the second highest coverage of iodized salt in India, the study aims to assess the state-specific approach, track various mitigating measures that effectively sustained the gains of the program.
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Significance of Laboratory Markers in Predicting the Severity of COVID-19 in the Central Reserve Police Force Front-line Workers with a Review of Literature p. 512
CH Krishna Reddy, PK Achari, B Nisha, AR Radha
COVID-19 disease has variable clinical presentations, ranging from asymptomatic to mild symptoms to severe manifestation with pneumonia, acute respiratory distress syndrome, septic shock, disseminated intravascular coagulation, and/or multiple organ failure. The real-time reverse transcription–polymerase chain reaction is gold standard test for severe acute respiratory syndrome-coronavirus-2 detection. In the present study, we aimed to predict the significance of various hematological and biochemical markers for early identification of complications and assessing the severity of the disease. A total of cases were divided into two study groups, namely, severe and nonsevere based on clinical presentation. Out of 210 cases, 186 (88.5%) cases were nonsevere and 24 (11.5%) cases were severe. Among various hematological and biochemical markers studied, hemoglobin, total leukocyte count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, albumin, lactate dehydrogenase, C-reactive protein, ferritin, D-dimer, and interleukin-6 are found to have P < 0.05 and significantly correlated with the severity of disease.
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Community-based approach to combat micronutrient deficiencies among irular tribal women: An education intervention p. 516
Jancirani Ramaswamy, Tharanidevi Natarajan, Soorya Haridas, Kirthika Palanisamy, Prema Nedungadi
Tribal women may suffer from poor nutritional health, lack of awareness of micronutrients, reduced dietary diversity, underutilization of micronutrient supplements and locally available food resources, poor hygiene, and sanitation. This study aims to examine the impact of educational intervention on the micronutrient status of the tribal women (n = 714, 15–60 years) in 15 hamlets of Coimbatore district, Tamil Nadu, by census sampling method. Self-structured pretested questionnaires, participatory learning methods, and focus group discussions were adopted to record the background information (anthropometry, clinical signs of micronutrient deficiency, hemoglobin, and dietary assessments). Even though there was no increase in body mass index (BMI), there was a significant change in age, income, and BMI with hemoglobin levels. Impact analysis showed significant behavior change in the utilization of locally available micronutrient-rich foods, improved access to supplements, and dietary diversity. Sustained attempts to educate tribal women proved to be effective in attaining their nutritional security and in the families.
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Epidemiological triad of COVID-associated mucormycosis and the ABCD of its management p. 520
K Devaraja, Sufyan Ibrahim, Aarthi Venkataramanan, Shreyanka Matapatti Doreswamy
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Malaria hemozoin: A target for point-of-care diagnosis p. 522
Shrikant Nema
The challenges in malaria diagnosis continue to threaten the malaria elimination goal in India and other malaria-endemic countries. A rapid diagnostic test (RDT) kit is widely used in resource-constrained areas where microscopy and molecular methods are not easily deployable. Considering the problems associated with the currently available RDT kit, such as histidine-rich protein 2 gene deletion and prolonged stability of the protein in the blood, it suggests that new potential biomarkers are urgently needed. Hemozoin (Hz) is an important biomarker for malaria diagnosis, which is the by-product of a detoxification mechanism in the malaria parasite. This article highlights the importance of “Hz” for point-of-care malaria diagnosis when India and other countries are moving toward the goal of malaria elimination.
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Coproducing tobacco control knowledge: Using virtual platforms to strengthen implementation in India p. 524
Pragati B Hebbar, Vivek Dsouza, Tshering Bhutia, Prashanth Nuggehalli Srinivas
Tobacco control is complex and multidimensional. In India, 266.8 million adults use tobacco in some form, with local contextual factors shaping its consumption, production, and trade. Actors have a stake in tobacco represent different sectors; with varying priorities, responding to different ideas, and exerting varying levels of influence often make it difficult to work collaboratively on tobacco control-related issues. Through online networking platforms such as webinars, we emphasize how coproduction of tobacco control knowledge enables participation, prioritizes multisectoral strategies, and enhances tobacco control leadership among policymakers and implementers in their settings. Coproduction of knowledge between and across stakeholders with a focus on “how to” implement tobacco control policies can leverage in negotiating and supplementing the policy implementation process.
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Video consultations with “Paper and Pen” health record: A path-breaking solution to troubleshoot acceptability of telemedicine practice in developing countries p. 527
K Rakesh Chander, Narayana Manjunatha, Channaveerachari Naveen Kumar, Suresh Bada Math
Telemedicine is the delivery of health care from a distance. It also includes research and evaluation of such services using health data which are stored in “Electronic Health Record” (EHR) platforms. EHR has proved to be useful in monitoring health care delivery but setting up of such platforms is tedious and resource-consuming in developing countries. With the recent surge of telemedicine utility during the COVID-19 pandemic, telemedicine has emerged to be pivotal in reaching stranded patients needing care without EHR-based practice. The practice of patient health record (PHR)-based teleconsultations in India has demonstrated how a conventional “paper and pen” method can be combined to popularise telemedicine utility. Thus, use of PHR-based system to maintain health records would prove to be a pragmatic solution for physicians in low-resource settings to improve their reach to a larger population in need for the future.
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An outbreak of acute gastroenteritis attributed to consumption of contaminated rice-flakes-jaggery in a religious festival, Coimbatore, Tamil Nadu p. 529
Abishek Stanislaus, Polani Rubeshkumar, Manickam Ponnaiah, TS Selvavinayagam
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Modified B. G. Prasad classification for socioeconomic scale updated-2022 Highly accessed article p. 530
Jahanvi Kapadiya, Naganandini Sampath, Kumar Gaurav Chhabra, Pankaj Chaudhary
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Correlation of vitamin D levels with low gestational age and low birth weight in babies developing retinopathy of prematurity p. 531
Debolina Deb, Radha Annamalai, M Muthayya
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Unintended pregnancies during cancer therapy requiring pregnancy termination: Can these be avoided? p. 533
P Sivaranjani, Aashima Arora, Vanita Suri
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Advocacy for large-scale food fortification ignores pertinent evidence and safety concerns p. 534
Anura V Kurpad, Santu Ghosh, Tinku Thomas, Harshpal Singh Sachdev
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Guillain–Barre syndrome after the first dose of Anti-SARS-CoV-2 vaccination is a rare side effect and the second jab is controversial in these cases p. 535
Anurug Biswas, Sanjay Kumar Pandey
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