Screening Vaccinees for Non-Communicable Diseases and Risk Factors at a Covid-19 Vaccination Center in Vadodara, Gujarat.

Context: Adult population visiting COVID vaccination center is a potential teachable moment for screening and preventive advice on non-communicable diseases. Objectives: The objective of this study was to assess the proportion of vaccinees volunteering for screening and to know the proportion of newly detected hypertensives and diabetics among the screened vaccinees at COVID-19 vaccination center. Setting and Design: This descriptive, cross-sectional, operational research study was carried out at the COVID vaccination center at a medical college in central Gujarat from July to September 2021. Methods: After receiving the vaccine, the vaccinee was offered screening through a community-based assessment checklist for risk factors of non-communicable diseases, blood pressure, and blood sugar measurement. Those volunteering for this screening received a slip mentioning their risk score, blood pressure and blood sugar reading, and relevant health information and disease prevention advice. The study variables were acceptability (proportion of vaccinees volunteering for screening) and yield (newly detected hypertensives and diabetics among those screened). Results: Among vaccinees, 27.7% volunteered for risk scoring and blood pressure measurement, whereas 8.3% volunteered for blood sugar measurement. Around 15.5% of vaccinees had high-risk scores as per the community-based assessment checklist. The yield of freshly detected high blood pressure and high blood sugar was 19.3% and 10.5%, respectively. The yield was similar even among vaccinees under 30 years of age. Conclusions: Vaccinees demonstrated interest in undergoing screening for non-communicable diseases. Yield indicates that such screening is worth the effort.

Clinical features and outcome of COVID-19 among PLHIV in Gujarat, India: A case series.

Information on people living with HIV (PLHIV) and current COVID-19 pandemic is still scarce in Indian setting. This case series of PLHIV with COVID-19 describes clinical characteristics and outcome in this special group of patients. This case series included 11 confirmed cases of COVID-19 among PLHIV admitted at a tertiary care hospital in Gujarat, India during April-December 2020. This retrospective study was conducted by doing secondary data analysis from case records of patients for various variables including demographic, clinical characteristics, HIV-related parameters, and outcome (discharged/death). The mean age of patients was 39.2 years ranging from 20 to 55 years. Nearly, 18% (2/11) of patients had major comorbidities like diabetes and hypertension. All were taking antiretroviral therapy drugs with >95% drug adherence and had CD4 count ranging from 79/cu.mm. to 1189/cu.mm. Majority (91%) of patients recovered and were discharged while only one patient (9%) died during course of COVID-19 treatment. COVID-19 showed a similar clinical and epidemiological profile among PLHIV like other group of people. Further studies with large-sample size are recommended to find risks of COVID-19 among PLHIV and its impact on treatment outcomes.

'We are not aware of notification of tuberculosis': A mixed-methods study among private practitioners from western India.

BACKGROUND: Implementing the Standards for tuberculosis care in India (STCI) guidelines in the private sector is vital. This study attempted to estimate the knowledge and practices regarding STCI guidelines among private practitioners and to explore the reasons and solutions for low tuberculosis (TB) notification rates. METHODS: We conducted a cross-sectional study for assessing the knowledge and practices of the STCI guidelines among 100 full-time allopathic private practitioners in Bhavnagar (in western part of India) from September 2018 to January 2019. Knowledge and practice were categorised as good or poor by assigning scores to the responses to a questionnaire based on the STCI guidelines. It was followed by two focus group discussions to explore the reasons and solutions for low notification rates of TB as perceived by private practitioners. RESULTS: Among the 100 private practitioners, 55% had good knowledge, and 41% had good practice regarding the STCI guidelines; 69% knew about the gazette notification of mandatory notification of TB, and 58% were notifying TB cases to the government. Lack of awareness about the process as well as incentives for notification, time constraints and infrequent visits by health workers were the main reasons perceived by private practitioners for not notifying TB cases to the government. The critical solutions suggested by them were creating awareness regarding the notification process as well as incentives, increasing health worker visits and use of social media for notification. CONCLUSION: Only about half of private practitioners follow the STCI guidelines for TB care, and the notification rates are low in our setting. Regular sensitisation programs need to be arranged for private practitioners to create awareness on TB notification.

Stigma, Discrimination, and Domestic Violence Experienced by Women Living with HIV: A Cross-sectional Study from Western India.

BACKGROUND: In India, social issues such as stigma and discrimination are still experienced by many women living with HIV (WLHIV) at various levels such as family, community, or health care settings even after a decline trend in HIV prevalence. OBJECTIVES: To assess stigma, discrimination, and domestic violence among WLHIV attending an antiretroviral therapy (ART) center and its association with unsafe sexual practices. MATERIALS AND METHODS: This cross-sectional study was carried out among WLHIV attending an ART center of a tertiary care hospital after obtaining approval from the institutional ethics committee. An interview schedule was used to collect data from WLHIV selected by systematic random sampling method on the day of interview. Data were collected after taking their written informed consent using a semistructured validated study instrument. Stigma and discrimination was assessed by a set of 7 and 11 closed-ended dichotomous-response questions, respectively. We measured self-reported occurrence of domestic violence and unsafe sexual practice. RESULTS: A total of 135 WLHIV were enrolled in this study. As high as 81% perceived stigma in their daily life while 41% reported to be discriminated. Domestic violence was experienced by 50.3% of the respondents. Majority of them (three-fourths) reported the type of violence to be physical as opposed to a quarter reporting sexual violence. Stigma, discrimination, and domestic violence were significantly associated with unsafe sexual practices. CONCLUSION: Social evils in the form of stigma, discrimination, and domestic violence are still faced by a remarkable proportion of WLHIV, and it has been found to be associated with unsafe sexual practices.

Do primary care physicians require training in core clinical dermatology? A cross sectional needs assessment study from Western India.

BACKGROUND: Primary care physicians play a crucial role in managing patients with common skin disorders who form around one-third of outpatient attendees. AIM: This study aimed to assess the need for dermatology training among primary care physicians by assessing their knowledge, self-perception of ability to diagnose and manage skin disorders, and their difficulties in managing these patients. METHODS: A descriptive, cross-sectional, needs assessment study was done among primary care physicians (n = 61) of rural (n = 34) and urban (n = 27) areas of Vadodara district. A pre-validated semi-structured questionnaire (for self-rating of the ability to diagnose/manage skin disorders and difficulties faced in managing patients) was used along with a photo-quiz (for knowledge assessment) while approaching primary care physicians during their monthly review meeting with prior permission. Data were analyzed by Epi InfoTM software and manual content analysis. RESULTS: The mean score on the photo-quiz was 4.1/10. Forty-three (70.5%) participants rated their ability to diagnose/manage skin disorders as 'average' on a five-point Likert scale. Various difficulties (n = 89) narrated by participants were related to their knowledge/skill, disease factors, patients and administrative aspects. Three-fourths of the participants managed difficulties by referring patients to dermatologists. One-third suggested conducting training in common skin disorders. LIMITATIONS: The study population included primary care physicians from the government healthcare setup only. Knowledge assessment was done using a short ten-item photo-quiz instead of actual patients. CONCLUSIONS: Primary care physicians had poor knowledge of skin disorders, and a majority overrated their own ability for clinical management of these disorders. Most common difficulties faced were related to clinical management. There is a need for training on common skin disorders.

Sputum Smear and Culture Conversion in Multidrug Resistance Tuberculosis Patients in Seven Districts of Central Gujarat, India: A Longitudinal Study.

OBJECTIVES: To know the sputum smear and culture conversion among multidrug resistance tuberculosis (MDR-TB) patients. MATERIALS AND METHODS: The longitudinal cohort study was conducted for 142 MDR-TB patients registered in 2010 under Revised National Tuberculosis Control Programme of Vadodara region. Three follow-ups were taken for sputum and culture examination, at completion of 6, 12, and 24 months of treatment. Individuals were interviewed to know the reasons for missed dose and default. RESULTS: The sputum smear and culture conversion rate was 43.4%, 47.7%, and 57% at 6 months, 12 months, and 24 months of follow-up, respectively. Treatment default rate was highest (15.2%) within initial 6 months of therapy. The mean time to sputum smear and culture conversion was 120.27 days and 125.02 days, respectively. CONCLUSIONS: Most of patients who were culture positive at 6 months remained so even after 12 months. There was not much difference in the time taken for culture and sputum conversion.

Drug adherence rate and loss to follow-up among people living with HIV/AIDS attending an ART Centre in a Tertiary Government Hospital in Western India.

INTRODUCTION: National AIDS Control Organization (NACO) has expanded the reach of anti retroviral therapy (ART) to combat the epidemic of HIV/AIDS in India which has one of the largest populations of people living with HIV/AIDS (PLWHA) in the world. One of the major challenges related to ART is a lifelong commitment by patients to adhere diligently to daily medication dosing schedules and scheduled visits to the ART center. Hence, the current study is carried out to assess the drug adherence rate and loss to follow-up (LFU) among PLWHA attending ART centre of a tertiary care hospital in Western India. MATERIALS AND METHODS: The current cross-sectional study was carried out using medical records of all patients registered at ART Center, Shree Sayaji General Hospital, Vadodara after taking Ethical Clearance from Local IRB. LFU was classified according to NACO guidelines. Data were collected using a standardized data extraction form as per NACO treatment card. Data entry and analysis were performed using Epi Info software. RESULTS: Of 755 PLWHA registered at ART center, 534 (70.7%) subjects were alive on ART, 61 (8%) were transferred out, 68 (9%) died, and 92 (17%) were LFU. Nearly, 57% PLWHA have drug adherence rate of more than 95%. Education status of the participant showed independent and significant association with drug adherence. CONCLUSION: This study showed 57.3% were adherent to ART among PLWHA, whereas 17.22% were lost to follow-up. Hence, there is a need to emphasize on increasing drug adherence rate and on outreach activities to combat LFU.

Predictors of unsafe sexual behavior among people living with human immunodeficiency virus/AIDS attending antiretroviral therapy center in Western India.

BACKGROUND: As more and more people with human immunodeficiency virus (HIV) live longer and healthier lives because of antiretroviral therapy (ART), an increasing number of sexual transmissions of HIV may arise from these people living with HIV/AIDS (PLWHA). Hence, this study is conducted to assess the predictors of unsafe sexual behavior among PLWHA on ART in Western India. MATERIALS AND METHODS: The current cross-sectional study was carried out among 175 PLWHAs attending ART center of a Tertiary Care Hospital in Western India. Unsafe sex was defined as inconsistent and/or incorrect condom use. A total of 39 variables from four domains viz., sociodemographic, relationship-related, medical and psycho-social factors were studied for their relationship to unsafe sexual behavior. The variables found to be significantly associated with unsafe sex practices in bivariate analysis were explored by multivariate analysis using multiple logistic regression in SPSS 17.0 version. RESULTS: Fifty-eight percentage of PLWHAs were practicing unsafe sex. 15 out of total 39 variables showed significant association in bivariate analysis. Finally, 11 of them showed significant association in multivariate analysis. Young age group, illiteracy, lack of counseling, misbeliefs about condom use, nondisclosure to spouse and lack of partner communication were the major factors found to be independently associated with unsafe sex in multivariate analysis. CONCLUSION: Appropriate interventions like need-based counseling are required to address risk factors associated with unsafe sex.

Predictors of overweight and obesity among school going adolescents of Vadodara city in Western India.

BACKGROUND: Obesity among adolescents is escalating as a global epidemic which is associated with various lifestyle disorders in later life. OBJECTIVE: To assess the factors influencing overweight and obesity among school going adolescents of Vadodara city in Western India. METHODS: The study was carried out among 1050 school going adolescents from 15 schools selected by systematic random sampling after taking written informed consent from the participants. A predefined pretested semi-structured questionnaire was used to collect dietary information and physical activity. Anthropometric measurements such as height, weight, triceps skin fold thickness, waist and hip circumferences was measured using standard techniques. Adolescents were classified as overweight (>+1SD) and obese (>+2SD) with respect to their age and sex by using WHO reference charts. Factors found to be statistically significant in bivariate analysis were considered in the multiple logistic regression model. RESULTS: Among 1050 school going adolescents, 7.8% were overweight and 2.7% were obese, making the combined prevalence of overweight and obesity as 10.5%. Among socio-demographic predictors: early and mid adolescence, male gender, English medium of instruction, positive family history of obesity were found to be the significantly associated with overweight/obesity among the study population. Whereas consumption of outside food, meal skipping habit, infrequent consumption of staple healthy food items were found to be significant diet related predictor variables for overweight/obesity. Among the physical activity predictors: sedentary activities, less outdoor games and sleep deprivation were also found to be significant predictors of overweight/obesity. CONCLUSION: Adolescents should be motivated to take adequate amount of healthy staple food like dal-rice at home and to engage in outdoor sports related activity to prevent overweight and obesity.

Treatment outcome among cases of multidrug-resistant tuberculosis (MDR TB) in Western India: A prospective study.

Multidrug-resistant TB has become a significant public health problem in a number of countries and an obstacle to effective TB control. Therefore, the present study sought to determine the treatment outcome in patients with MDR TB in seven districts and to examine the factors affecting the treatment outcome. A prospective cohort study was carried out by enrolling all the registered patients in DOTs Plus center of Vadodara district from February 2010 to December 2010. A total of 142 patients were interviewed using a pre-tested semi-structured questionnaire at the DOTS centers of seven districts of Gujarat or at their homes in cases of defaulters/death. After 24 months, of those 145 patients, 48 (33.10%) were declared cured, 8 (5.50%) had completed their treatment, 43 (29.70%) patients died during the treatment, and 32 (21.10%) patients defaulted during treatment. Factors associated with a significant difference in the outcomes were income, marital status, and education. Only education significantly affected treatment outcome upon applying logistic regression. Therefore, proper counseling on drug adherence should be applied at the programmatic level.