Assessing contrast sensitivity change in retinal diseases with use of yellow-amber NoIR glasses.

Purpose: The purpose of this study was to assess change of contrast sensitivity (CS) in subjects having retinal diseases with yellow-amber no infrared (NoIR) glasses used as low vision aid (LVA). Methods: We examined CS in 82 low vision (LV) subjects having retinal diseases with Pelli Robson Chart at 1 m distance before and after wearing yellow-amber NoIR glasses. We also found type of retinal affection and macular optical coherence tomography (OCT) features. Results: The distance and near best-corrected visual acuity (BCVA) was, respectively, 0.68 ± 0.17 (median = 0.70) and 0.72 ± 0.25 (median = 0.70) logmar units. The pre-LVA CS was 0.52 ± 0.29 (median = 0.3) and post- LVA was 0.52 ± 0.28 (median = 0.45) logunits (mean reduction = -0.002 ± 0.24; Median reduction = 0; P = 0.909). The pre-LVA and post-LVA CS showed a negative correlation with logmar distance BCVA [r = -0.090; P = 0.317 and r = -0.152; P = 0.090 respectively]. The pre-LVA and post-LVA CS showed a negative correlation with logmar near BCVA [r = -0.114; P = 0.207 and r = -0.054; P = 0.549 respectively]. The CS did not improve in subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy. The macular OCT features like fluid, exudates, scars, drusens, traction, and hole did not significantly influence CS both at pre-LVA and post-LVA stage. Conclusion: This is the first study with yellow-amber NoIR glasses which blocks "both ultraviolet and infrared light." The subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy did not improve in CS with filters. The correlation values showed that filters may improve CS in subjects having good baseline BCVA.

Multi-dose vials versus single-dose vials for vaccination: perspectives from lower-middle income countries.

The choice of the vaccine packaging type either as single- or multi-dose vial is a crucial determinant of vaccine coverage. The experience of vaccination strategies in lower-middle-income countries suggests that multi-dose vaccine vials translate into greater economic-logistic advantages due to lower packaging and storage costs with significant environmental benefits accrued from reduced medical waste generation. However, the use of multi-dose vials is associated with a theoretical risk of contamination particularly from human error. Moreover, the overall economic advantage of multi-dose vials is contingent on the reduction of the extent of vaccine wastage associated with their use. Robust data collection for monitoring of vaccine wastage rates and adverse effects following immunization is therefore needed to understand the extent of economic benefit and risks involved with multi-dose vial use.

The seroprevalence of severe acute respiratory syndrome coronavirus 2 in Delhi, India: a repeated population-based seroepidemiological study.

BACKGROUND: Three rounds of a repeated cross-sectional serosurvey to estimate the change in seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were conducted from August to October 2020 in the state of Delhi, India, in the general population ≥5 y of age. METHODS: The selection of participants was through a multistage sampling design from all 11 districts and 280 wards of the city-state, with multistage allocation proportional to population size. The blood samples were screened using immunoglobulin G (IgG) enzyme-linked immunosorbent assay kits. RESULTS: We observed a total of 4267 (N=150 46), 4311 (N=17 409) and 3829 (N=15 015) positive tests indicative of the presence of IgG antibody to SARS-CoV-2 during the August, September and October 2020 serosurvey rounds, respectively. The adjusted seroprevalence declined from 28.39% (95% confidence interval [CI] 27.65 to 29.14) in August to 24.08% (95% CI 23.43 to 24.74) in September and 24.71% (95% CI 24.01 to 25.42) in October. On adjusted analysis, participants with lower per capita income, living in slums or overcrowded households and those with diabetes comorbidity had significantly higher statistical odds of having antibody positivity (p<0.01). CONCLUSIONS: Nearly one in four residents in Delhi, India ≥5 y of age had the SARS-CoV-2 infection during August-October 2020.

Second Wave of the COVID-19 Pandemic in Delhi, India: High Seroprevalence Not a Deterrent?

Background We report the findings of a large follow-up, community-based, cross-sectional serosurvey and correlate it with the coronavirus disease (COVID-19) test-positivity rate and the caseload observed between the peaks of the first and the second wave of the COVID-19 pandemic in Delhi, India. Methodology Individuals aged five and above were recruited from 274 wards of the state (population approximately 19.6 million) from January 11 to January 22, 2021. A total of 100 participants each were included from all wards for a net sample size of approximately 28,000. A multistage sampling technique was employed to select participants for the household serosurvey. Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (IgG) antibodies were detected by using the VITROS® (Ortho Clinical Diagnostics, Raritan, NJ, USA) assay (90% sensitivity, 100% specificity). Results Antibody positivity was observed in 14,298 (50.76%) of 28,169 samples. The age, sex, and district population-weighted seroprevalence of the SARS-CoV-2 IgG was 50.52% (95% confidence interval [CI] = 49.94-51.10), and after adjustment for assay characteristics, it was 56.13% (95% CI = 55.49-56.77). On adjusted analysis, participants aged ≥50 years, of female gender, housewives, having ever lived in containment zones, urban slum dwellers, and diabetes or hypertensive patients had significantly higher odds of SARS-CoV-2 antibody positivity. The peak infection rate and the test-positivity rate since October 2020 were initially observed in mid-November 2020, with a subsequent steep declining trend, followed by a period of persistently low case burden lasting until the first week of March 2021. This was followed by a steady increase followed by an exponential surge in infections from April 2021 onward culminating in the second wave of the pandemic. Conclusions The presence of infection-induced immunity from SARS-CoV-2 even in more than one in two people can be ineffective in protecting the population. Despite such high seroprevalence, population susceptibility to COVID-19 can be accentuated by variants of concern having the ability for rapid transmission and depletion of antibody levels with the threat of recurrent infections, signifying the need for mass vaccination.

Utilization of antenatal care services and its sociodemographic correlates in urban and rural areas in Delhi, India.

INTRODUCTION: Timely and quality antenatal care (ANC) is an essential element of universal health coverage and a key determinant for the prevention of maternal mortality. Nevertheless, evidence from large-scale health surveys in developing countries highlight a lack of access and utilization of antenatal care especially among socioeconomically disadvantaged populations. METHODS: A total of 200 women were recruited from urban and rural primary care service provision areas of a government medical college in Delhi during April 2016-2017. Women with infants were interviewed to assess the antenatal care received by them during their recently concluded pregnancy. RESULTS: The mean (SD) age of the participants was 25.6 (3.9) years. A total of 63 (31.5%) participants were primigravida, and 137 (68.5%) were multigravida. The knowledge of ANC was significantly higher in the participants that were more educated (p<0.001) but it was similar in both the urban and rural sites. Only 107 (53%) participants reported receiving comprehensive antenatal care defined as early registration of pregnancy (within 12 weeks), at least four ANC visits, two doses of tetanus toxoid, and at least 100 days of iron/folic acid supplementation (IFAS). The participants lacking knowledge of ANC had three times higher odds of suboptimal ANC utilization during their previous pregnancy (p=0.018). Furthermore, the ANC content was adequate in terms of medical service provision but deficient in terms of educational and counseling services. CONCLUSIONS: A high prevalence of suboptimal ANC utilization was observed despite the availability of government-funded primary care.

The effectiveness of a dose based reporting tool in reducing vaccine wastage at primary care clinics in Delhi, India: an operational research study.

Minimizing vaccine wastage and associated costs is considered a key target for appropriate vaccine management. In India, the Rotavirus Vaccine (RVV) (2019) and the fractionated injectable polio vaccine (f-IPV) (2016) are more prone to wastage with high procurement costs.In this operational research study, we determined the effectiveness of a (self-designed) dose based reporting tool (DBRT) in reducing vaccine (f-IPV and RVV) wastage at primary care facilities in India during December 2019 to March' 2020.Data reports of all the immunization sessions conducted at three primary care facilities were analyzed to calculate the wastage rates of the RVV and the f-IPV for the following periods: (1). Period of initiation (August-November' 2019) (2). Pre-intervention with sensitization of healthcare providers (December' 2019-January' 2020) (3). Post-intervention after application of the DBRT.Intervention: The DBRT is a paper-based reporting format that assigns a unique code to each RVV and IPV vial. The health facility is required to report the total doses administered from each coded vial during every immunization session by updating it on the assigned reporting format.Pre-intervention, the average monthly wastage of f-IPV was 23.5% and of the RVV ranged from 18%-31%. Post-intervention, on using the DBRT, the monthly wastage of both RVV and f-IPV dropped significantly to 8.6% and 11.4%, respectively. During the subsequent month, the IPV wastage further decreased to only 4.7%.In conclusion, the DBRT reduces vaccine wastage in government primary care facilities by enabling a paper audit trail that promotes responsiveness and accountability among healthcare workers directly involved in vaccine administration.

Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study.

BACKGROUND: Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. OBJECTIVE: The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. METHODS: We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. RESULTS: A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic. CONCLUSIONS: Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.

Measuring addiction to internet gaming among Indian medical students: Development and preliminary psychometric properties of a new scale.

BACKGROUND: Internet gaming disorder (IGD) is emerging as an important source of behavioral addiction in young people globally. OBJECTIVE: The aim of this study was to assess addiction to internet gaming in medical students using a self designed research instrument. MATERIALS AND METHODS: We conducted a cross-sectional study and enrolled 264 male and 160 female MBBS students (n = 424) in Delhi, India. The study instruments included: a 2-item Internet gaming screening questionnaire (IGSQ), a 14-item self-designed Internet gaming addiction scale (IGAS) to measure addiction-like behavior associated with multiplayer Internet gaming, and the Pittsburgh Sleep Quality Index to measure sleep quality. RESULTS: After preliminary screening, 91 male and 6 female participants were found to be multiplayer Internet gamers, and were further assessed using the 14-item IGAS. The Cronbach's alpha of the IGAS was 0.879. Principal component analysis revealed a three-component IGAS structure based on eigenvalue cutoff (>1), loading score >0.4, and inspection of the scree-plot that explained 66.71% of the total variance. The IGAS score and the average weekly gaming time of the participants showed a moderate positive correlation (r = 0.45, P < 0.001). Only 17 (4.0%) participants reported agreement/strong agreement across ≥5 domains of addiction. The mean (standard deviation) IGAS score was significantly higher in the participants reporting poor sleep quality (PQSI > 6) (P = 0.047). CONCLUSION: IGD has low prevalence among medical students, and the problem is negligible among female students. The 14-item IGAS, in conjunction with the 2-item IGSQ, are reliable and valid tools for the assessment of IGD.

Effect of Intimate Partner Violence on Maternal and Birth Outcomes of Pregnancy among Antenatal Clinic Attendees in Delhi: A Prospective Observational Study.

CONTEXT: Violence against women is a major public health problem and a violation of their human rights. Intimate partner violence (IPV) during pregnancy has been linked to various adverse maternal health outcomes and birth outcomes. AIMS: The aim of this study is to assess the magnitude of maternal complications and adverse birth outcomes in relation to IPV. SETTINGS AND DESIGN: Prospective observational study was conducted from April 2015 to May 2018 in the antenatal clinic of a Tertiary Care Hospital in Delhi. SUBJECTS AND METHODS: Sample of 1500 pregnant women (≤20 weeks gestation) were recruited and followed up at regular intervals, up to the birth outcome. STATISTICAL ANALYSIS USED: Data were analyzed using the Statistical Package for the Social Sciences version 25. Value of P < 0.05 was considered statistically significant. RESULTS: Prevalence of IPV at baseline was 29.7%. Significantly higher proportion of IPV victims (47.2%) had poor weight gain during the pregnancy. Subjects reporting violence at any of the study contacts had a higher incidence of preterm delivery (12.7%), and a significantly higher incidence of low birth weight in the newborns (32.1% vs 22.3%) (P < 0.05). CONCLUSIONS: The findings reveal that IPV during pregnancy is common and significantly associated with adverse maternal and birth outcomes. The findings stress need for research and development of a screening tool to identify violence early in pregnancy and thus prevent its consequences.

Magnitude of domestic violence and its socio-demographic correlates among pregnant women in Delhi.

CONTEXT: Domestic violence is violation of basic human rights, and poses a threat to the physical, mental, and social health aspects of women and her children. The causation of domestic violence is precipitated by many risk factors. AIMS: Aim was to estimate the magnitude of domestic violence overall, and its sub-types, among pregnant women. The study also aimed to find the associated socio-demographic determinants of domestic violence among the subjects. SETTINGS AND DESIGN: The study was designed as a cross-sectional study to estimate the prevalence of domestic violence and to find socio-demographic correlates in its causation. A total of 1500 apparently healthy pregnant women, with gestation up to 20 weeks were interviewed. METHODS AND MATERIALS: A pre-tested semi-structured interview schedule was used to collect data on socio-demographic variables and details of domestic violence, after explaining the purpose of study to the subjects and obtaining informed consent. STATISTICAL ANALYSIS USED: Data was entered in Ms-Excel and IBM SPSS Version 25 was used for statistical analysis. RESULTS: The findings revealed overall prevalence of domestic violence to be 29.7%, with emotional and verbal type of violence being most common type. Caste, religion, literacy status of study subjects, and occupational status of spouses of study subjects were reported as significant correlates affecting the causation of domestic violence among the subjects. CONCLUSIONS: The findings highlight the burden and thus, stress for the need for effective involvement of all sectors in the elimination of domestic violence against women as a public health issue and develop zero-tolerance towards it.