Oral domperidone versus placebo for enhancing exclusive breastfeeding among post-lower segment cesarean section mothers - a double-blind randomized controlled trial.

OBJECTIVE: To assess whether oral domperidone compared to placebo increases the rate of exclusive breastfeeding for 6 months among post-lower segment cesarean section (LSCS) mothers. METHODS: This double-blind Randomized Controlled Trial, conducted in a tertiary care teaching hospital in South India, included 366 post-LSCS mothers with delayed initiation of breastfeeding or with subjective feelings of not having enough milk. They were randomized to two groups - Group A: Standard lactation counseling and oral Domperidone and Group B: Standard lactation counseling and a placebo. The primary outcome was an exclusive breastfeeding rate at 6 months. Exclusive breastfeeding rates at 7 days and 3 months and serial weight gain of an infant were assessed in both groups. RESULTS: Exclusive breastfeeding rate at 7 days was statistically significant in the intervention arm. The exclusive breastfeeding rates at 3 months and 6 months were higher in the domperidone arm compared to placebo but not statistically significant. CONCLUSION: Oral Domperidone along with effective breastfeeding counseling showed an increasing trend of exclusive breastfeeding rate at 7 days and at six months. Appropriate breastfeeding counseling and postnatal lactation support are important in enhancing exclusive breastfeeding. TRIAL REGISTRATION: The study was prospectively registered with CTRI - Reg no. CTRI/2020/06/026237.

Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?

BACKGROUND: In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs). METHODS: We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as 'eligible' for primary care management. RESULTS: Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3-48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR = 1.16), people with diabetes for more than 10 years (APR = 1.23), and the presence of comorbidities (APR = 1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness. CONCLUSIONS: About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.

Experiences of Volunteers and Patient Satisfaction in Home Based Palliative Care, Puducherry, South India-A Descriptive Qualitative Study.

Background: Increasing burden of non-communicable diseases and ageing population has parallely increased the need for Palliative care. Unavailable, inaccessible, and inadequate palliative care services in our setting increased the need for volunteers. In Puducherry, palliative care programme was implemented through trained volunteers in 2015. Objectives: To explore the experiences of volunteers who provide palliative care and also to get feedback on volunteering from the patients who received care. Settings and Design: A descriptive qualitative study was carried out at two Non-Governmental Organizations (NGO) working for palliative care in and around Puducherry. Methods and Material: Participants were selected purposively to include seven volunteers and eight patients to attain information saturation. The time period of this study was between September and October 2018. Analysis Used: Manual thematic analysis was done to identify codes, which were grouped to form categories and themes. Results: Factors that facilitated participants to take up the role of volunteers were witnessing the death of family members with unmet palliative care when required and experiences in organizations working for elderly and disabled children. Improvement in patients' condition and patient satisfaction motivated them to continue, despite lack of resources and social support. Their perception was of having become bolder and empathetic by working as palliative care volunteers. Patients reported satisfaction with the provision of drugs and other materialistic support like clothes and sweets during festivals; however, their basic and financial needs remained unmet. Conclusion: The palliative care programme or the National programme for elderly should focus on components that would improve the quality of palliative care by reducing patients' dissatisfaction. Support in terms of provision of drugs, financial help and nutrition is necessary to improve both the patients' and volunteers' satisfaction in palliative care services.

Glycemic control and its associated factors among women with gestational diabetes mellitus in a tertiary care Centre, Puducherry, South India.

BACKGROUND: Worldwide, one in ten pregnancies is related with diabetes; 87.6% of which are gestational diabetes mellitus (GDM). Maternal hyperglycaemia affects the successful progression of pregnancy. OBJECTIVES: To determine the proportion and the factors associated with poor glycaemic control among women with gestational diabetes. METHODS: This hospital-based cross-sectional study was conducted in a tertiary care hospital, Puducherry, South India from September to October 2019. Pregnant women diagnosed as GDM and on treatment for at least one month were approached consecutively for the study. A fasting blood sugar (FBS) ≥92 mg/dl and postprandial blood sugar (PPBS) 1 hour ≥180 mg/dl or PPBS 2 hour ≥153 mg/dl were considered as poor glycaemic control. RESULTS: A total of 301 women with GDM were included and the mean (SD) age was 27 (5) years. Of total, 29 (10%) reported GDM during their previous pregnancy and 95 (32%) got diagnosed before reaching the tertiary care hospital. Lifestyle modifications (77%) were the most common mode of management for GDM. Of total, 116 (38.5%; 95% CI 33%-44.3%) had poor glycaemic control. Multigravida women (46.9%) and those on pharmacological treatment for GDM had poor glycaemic control. CONCLUSION: One-third of women with GDM at a tertiary care centre had poor glycaemic control. Therefore, a novel approach to improve awareness about GDM control both among pregnant women and the medical fraternity is needed.

Prevalence of suicidal ideation, plan, attempts and its associated factors in selected rural and urban areas of Puducherry, India.

BACKGROUND: The Union Territory of Puducherry has a high rate of suicide in India. This study aims to find the prevalence of suicidal ideation, plan and suicide attempts and the risk factors of suicidal behaviours. METHODS: This community-based cross-sectional study was conducted among adults aged 18 years and above in rural and urban areas of Puducherry, India. Columbia Suicide Severity Rating Scale questionnaire was used. Prevalence ratio was estimated to assess the factors associated. RESULTS: The 12-month and lifetime prevalence of suicidal ideation was reported to be 12.5% (95% CI: 10.4-15.0%) and 20% (95% CI: 17.4-22.9%), respectively. About 0.7% (95% CI: 0.3-1.5%) and 2.1% (95% CI: 1.2-3.3%) of the participants had suicide plan in past 12 months and ever in their lifetime, respectively. Around 1% (95% CI: 0.5-2.0%) and 5.7% (95% CI: 4.3-7.6%) of the participants had attempted suicide in past 12 months and ever in their lifetime, respectively. Family issues, physical abuse, unemployment and place of residence were significantly associated with suicidal ideation in multivariable analysis. CONCLUSION: Prevalence of suicidal ideation and suicide attempt were very high in the study area. Unemployment, physical abuse and family issues were significantly associated with suicidal behaviour.