Genesis of People's Medicine Centre (PMC) for popularisation of generic medicine: A critical qualitative inquiry.

Introduction: The concerns of inaccessibility to essential medicines in India are well-studied and documented. Pradhan Mantri Bhartiya Janaushadhi Priyojana (PMBJP) is one of the policy initiatives to address the inaccessibility of essential medicine. Janaushadhi Kendra (People's Medicine Centre), which is part of PMBJP is being enquired in a limited way to understand its effectiveness. The province of Odisha has been chosen as the study area for the evaluation of People's Medicine Centres. Objective: The present study intends to inquire into the nature of People's Medicine Centre ownership, pharmacists' motivations and incentives to engage in business, perceived customers' trust and satisfaction, scheme beneficiaries, and challenges. Methods: A qualitative research approach has been adopted to evaluate the broader subjective accounts of the pharmacists and People's Medicine Centre. An open-ended interview guide was used. The topics of ownership, motivation, incentives, trust, satisfaction, perceived benefits, and challenges has been recorded from the participants. A total of seventeen in-depth interviews were conducted in the province of Odisha, India. Results: The study found that the ownership of People's Medicine Centre was of two types in the province of Odisha: public-NGO-owned People's Medicine Centres and public-private-owned People's Medicine Centres. The financial incentive provisions in the scheme attracted the private pharmacists. Pharmacists highlighted about the lower price of generic medicines compared to branded medicines, which is very popular among patients. They also pointed out that there is no difference in the efficacy of both medicines. The attitude of physicians, especially private physicians, were considered problematic for popularity and acceptance. Conclusion: The People's Medicine Centres in Odisha established themselves as trusted outlets despite physicians' unfavourable attitudes. Although the centres have not reached the required geographical coverage, economically developed regions have large number of centres, while backward regions have minimal presence. The scheme needs to be more conducive to the welfare of the masses living in remote and rural areas.

Examining toilet use and menstrual hygiene practices among beneficiary households of Swachh Bharat Abhiyaan (Clean India Mission) in rural areas of Mayurbhanj district of Odisha, India.

Background: Basic sanitation and waste management have always remained a central issue in India. The country launched its flagship sanitation program - Swachh Bharat Abhiyan (SBA) (Clean India Mission) in 2014 to abolish open defecation and achieve universal sanitation coverage. Objective: This study aimed to examine barriers to toilet use and women's menstrual hygiene practices in relation to the availability of toilets among rural residents. Materials and Methods: Using a cross-sectional design and multi-stage sampling method, 120 households were selected from rural villages of the Mayurbhanj district of Odisha. Structured questionnaires and direct observation methods were used for data collection. Results: All the houses had SBA latrines, yet 25% population defecated outside. About 40% households reportedly never cleaned their toilets. Most menstruating women (86.2%) preferred to change their menstrual pads/cloths in their bedroom instead of bathrooms. Incomplete construction was reported as the major reason for not using toilets. Large family size and low caste were found to be other predictors of non-use of toilets. Rural women did not use toilets for menstrual purposes as they do not consider these places as clean and safe. Conclusion: This study clearly suggests that constructing toilets without adequate behaviour change interventions would not solve the problem of hygiene and sanitation in India, particularly in rural areas. There must be adequate monitoring of SBA scheme and utilization of funds for toilet usage. Development and implementation of suitable behaviour change strategies for toilet use in rural areas are essential to achieve the goal of open defaecation-free India.

Perinatal depression and its associated risk factors during the COVID-19 pandemic in low- and middle-income countries: a systematic review and meta-analysis.

PURPOSE: Perinatal depression significantly impacts maternal and child health, with further complexities arising during the COVID-19 pandemic. This review is the first to comprehensively synthesize evidence on the prevalence of perinatal depression and its associated risk factors in Low- and Middle-Income Countries (LMICs) during the pandemic period. METHODS: The study protocol was registered in PROSPERO (CRD42022326991). This review followed the Joanna Briggs Institute (JBI) guideline for prevalence studies. A comprehensive literature search was conducted in six databases: PubMed, Scopus, Web of Science, PsycInfo, CINAHL, and ProQuest. Pooled prevalence estimates were computed for both prenatal and postnatal depression. Identified risk factors were summarized narratively. RESULTS: A total of 5169 studies were screened, out of which 58 were included in the narrative review and 48 [prenatal (n = 36) and postnatal (n = 17)] were included in the meta-analysis. The pooled depression prevalence for prenatal women was 23% (95% CI: 19-27%), and for the postnatal women was 23% (95% CI: 18-30%). Maternal age, education, perceived fear of COVID-19 infection, week of pregnancy, pregnancy complications, and social and family support were identified as associated risk factors for depression. CONCLUSIONS: Our review demonstrates an increased prevalence of perinatal depression during the COVID-19 pandemic in LMICs. It sheds light on the significant burden faced by pregnant and postnatal women and emphasizes the necessity for targeted interventions during the ongoing and potential future crisis.

Social reintegration of fistula survivors in North Central Nigeria: A case for rehabilitation.

Obstetric fistula remains one of the neglected forms of chronic maternal morbidity that occurs mainly in low- and middle-income countries. We explored the rehabilitation and reintegration experiences of 15 fistula survivors in North Central Nigeria. We employed a qualitative research design, guided by Constructivist Worldview, involving narrative interviewing technique in conducting in-depth interviews. Key benefits of rehabilitation reported by the participants included socioeconomic-financial empowerment and autonomy, improved social status, and freedom from self-isolation. Additionally, participants experienced positive psychological effects, such as increased self-worth and self-confidence. However, prolonged recovery periods and stigmatization issues were noted as barriers to successful reintegration post rehabilitation. On the other hand, the presence of family and community support, along with the resolution of stigma, were found to be facilitators of social reintegration. Considering the holistic benefits of rehabilitation, we recommend implementing a comprehensive care management program for fistula survivors to facilitate successful social reintegration.

Assessment of sanitation and drinking water facilities among slum households in Bhubaneswar, Odisha - A cross-sectional study.

Aim: The study aims to assess the practice of using unsafe drinking water and sanitary practices among the population dwelling in slum settings of Bhubaneswar city, Odisha, India. Subjects and Methods: A cross-sectional study was conducted among 288 households in the Bhubaneswar slums of Chandrasekharpur, Neeladri Vihar, and Trinatha basti. A questionnaire was administered face to face. Descriptive statistics were used to define the participants' sociodemographic characteristics, household information, drinking water, latrine characteristics, and waste disposal. Results: The majority (59.7%) resided in kutcha households in notified slum areas, and 89.6% were reportedly illiterate. About 92.7% resided in a deplorable condition, relying on piped water (79.5%) from the community sources and 20.5% used it for drinking and household purposes. Around 83% of the respondents stated they did not treat water before consumption. Bathroom facilities were found to be inadequate, and 74.3% used pit latrines. The majority of household wastes (83%) were managed by directly letting them to the drainage system untreated. As a consequence, 91% reported breeding of flies and mosquitoes near their household premises and 70.5% stated having fever in the past 6 months. Conclusion: Despite the government's initiatives to improve water, sanitation, and hygiene (WASH) strategies, an extensive gap in practice was observed. As a result, Bhubaneswar municipality must strictly enforce policy and regulatory guidelines concerning WASH to improve the sanitation practices, particularly in the areas of drinking water and household waste management.

Water, Sanitation, and Hygiene Practices and Their Association With Childhood Diarrhoea in Rural Households of Mayurbhanj District, Odisha, India.

INTRODUCTION: Diarrhoeal disease is one of the major causes of childhood morbidity and mortality in India. It affects all ages, yet very few studies have been found regarding the young and older children affected by diarrhoea and its etiology. About 2.2 million deaths are attributed to diarrhoea alone in India every year. However, a large number of diarrhoeal cases may be avoided with proper sanitation and hygiene practices. The primary aim of this study was to assess the current water, sanitation, and hygiene (WASH) practises among mothers and diarrhoea among their children (6 months to 11 years) in rural households of the Mayurbhanj district, Odisha. Further, the association between WASH practises and childhood diarrhoeal disease was assessed. METHODS: A community-based cross-sectional survey was conducted among 430 mothers by using a pre-tested structured questionnaire adapted from previous studies. Data collection was done using the software Epicollect5 by the trained data collector. The data were further transformed to Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY) version 23 for analysis to find out potential risk factors. A multistage sampling technique was used to find subjects. RESULTS: Out of 430 households, 21.6% of respondents reported that their children were suffering from diarrhoea in the last two weeks from the day of the survey. Nearly 63.8% of respondents mentioned that they used to supply water as a principal source for household purposes. This study found that children of households near waste piles are more at risk of having diarrhoea than those households living far from the waste pile [AOR: 4.996; 95% CI: (2.173, 11.487)]. In the management of household wastes, households who are throwing waste here and there are 3.276 times more at risk of having diarrhoea than households who are managing the wastes by themselves by burning them outside the home [AOR: 3.276; 95%CI: (1.463, 7.042)]. In the disposal of child faeces, it was found that the household children's faeces disposed of in the garbage or dumping site are 2.438 times more at risk of having diarrhoea than those who are flushing the faeces in the latrine [AOR: 2.438; 95%CI: (1.284, 4.631)]. Also, using footwear less often was found to be highly associated with an increase in the incidence of diarrhoea (AOR: 1.634; 95% CI (.815, 3.276). CONCLUSION: Findings indicate that creating awareness about the benefits of proper management of household waste and using footwear on a regular basis is the priority to avoid childhood diarrhoea. Further, area-specific planning and programme allocation of resources is necessary to prevent childhood diarrhoea.

Burden of depression and its predictors among prisoners in a central jail of Odisha, India.

Background: Mental illness disproportionately affects the physical, psychological, and social well-being of prisoners worldwide at a far higher rate than the general population. Depression is one of the common mental illnesses. However, in low- and middle-income countries, relatively little research has been undertaken to assess the prevalence and the factors that contribute to depression among prisoners. Aim: This paper aims to assess the burden and predictors of depression among male inmates in a central jail in Odisha. Method: This cross-sectional study was conducted among male prisoners in one of the central jails of Odisha. A total of 146 samples were selected using a random sampling method and 105 completed the interview. The socio-demographic characteristics and PHQ-9 scale were used for data collection. Descriptive and inferential statistics were applied for data analysis. Result: In the overall study sample, 25.7% of inmates were diagnosed with moderately severe depression, and 27.6% were diagnosed with severe depression. Binary logistic regression showed that higher education, being accused of a crime, and having low social support are all significant predictors of depression in prisoners. Conclusion: The study emphasizes the significance of understanding the role of social support in prison and assisting policymakers in developing policies that make it more inmate-oriented, resulting in increased prisoner mental well-being and health.

Integrated Management of Diabetes and Tuberculosis in Rural India - Results From a Pilot Study.

Introduction: The World Health Organization and International Union against Tuberculosis (TB) recommends screening patients with TB for Diabetes Mellitus (DM) at the initiation of treatment. There are few pilot studies which screen TB patients for DM, but none of them have documented the feasibility of managing TB patients with DM in the Indian healthcare setting. Operational research is needed to determine the best way to manage individuals with both conditions. This pilot study aimed to develop, and field test an integrated, multidisciplinary program addressing the management of individuals with TB and DM and other associated chronic conditions in the Indian primary healthcare setting. Methods: This pilot study used a randomized controlled trial design with mixed-methods evaluation and was conducted in Guntur district of Andhra Pradesh, a southern state of India. All the 120 patients newly diagnosed with TB from 10 participating villages were screened for DM and associated cardiovascular risk factors. Non-physician health workers were trained to follow-up patients for a period of 8 months to encourage treatment adherence, monitor treatment response including blood glucose levels and provide lifestyle advice. Results: The intervention was well-accepted by the providers and patients. However, there were no statistically significant variations observed for mean blood glucose levels (mean [SD]: 5.3 [-23.3 to 33.8]) of patients for both intervention and control group participants in this feasibility study. Awareness about diabetes and tuberculosis comorbidity and cardiovascular risk increased among the non-physician health workers in the intervention arm of the study. Discussion: The co-management of TB-DM is acceptable to both the health providers and patients. With appropriate training, availability of infrastructure and planned intervention implementation, it is feasible to co-manage TB-DM within the existing primary health care system in India.

Achievements and challenges of India's sanitation campaign under clean India mission: A commentary.

Universal access to safe sanitation is yet to be accomplished in India. Although Clean India Mission (named as "Swachh Bharat Mission (Gramin)" for rural India) claims that the sanitation coverage in rural India has increased from 39% to 100% of households from 2014 and 2019, yet open defaecation continues in India in large numbers. This article discusses the achievements on Swachh Bharat Mission (Gramin) and identifies the existing challenges that need to be acted on to achieve the success of India's Swachh Bharat Mission. We searched international database mainly Google scholar, Pubmed, Medline, Scopus, and Science direct using "Clean India," "Swachh Bharat," "Sanitation," "Open defecation," "Environmental heath," and "India" as search keywords in different combinations. In addition, websites of relevant United Nations (UN) agencies, Government of India and leading newspaper and national agencies were also searched manually for related publications and reports. In the last 5 years (2014-2019), significant efforts have been made for the Swachh Bharat Mission by creating various social movements and awareness program to improve toilet coverage throughout India. Over 100 million, latrines have been built as of the end of the first phase of Swachh Bharat Mission (Gramin) as on October 2, 2019 and all villages across the districts of India have been declared Open Defaecation Free. Still, nearly half of the rural population (52.1%) defecate in the open. Lack of piped water supply, poor construction of toilet substructures and misconception among people about toilet use remain as key challenges in the achievement of India's sanitation mission. Sanitation-related behavioral change and improvement in toilet facilities must be prioritized to ensure usage of built toilets and eventually can accelerate the universal access to sanitation and meet Sustainable Development Goals.

Protecting Indian health workforce during the COVID-19 pandemic.

Rapidly growing rate of infection among health workers during the current COVID-19 pandemic, is posing a serious challenge to global health systems. Lately, India is also witnessing an intensifying COVID-19 disease burden and its impact on health workers. This paper aims to discuss the challenges to health worker protection in India and the possible ways forward. Given the inadequate and unequally distributed healthcare workforce, it is highly essential for the country to strategize prompt measures for ensuring occupational health and safety of its health workers. Information for this paper were gathered by searching PubMed and Google Scholar databases using "COVID-19", "Infection Control", "Health worker", "India" as search keywords in different combinations. In addition, websites of Government of India, relevant UN agencies and leading news agencies were also searched manually for related reports and publications. India must take timely measures in rapid manufacturing and procurement of essential personal protective equipment (PPE) to ensure adequate stockpiling to meet the rising demands. Comprehensive and repeated training with sharply focussed content including usage of PPE kits as well as active surveillance of adherence to recommended protocol are critical in protecting health workers especially the primary care physicians and frontline health staff from the deadly COVID-19 infection. The provision of psychological and financial support for health workers and their families is absolutely critical in building trust and dedicated work efforts by the health workforce for a continuous fight against the deadly disease.

Planetary health and the role of community health workers.

In this era, grand challenges lies in biodiversity loss, climate change, and global noncommunicable diseases signify that planet and humanity are in crisis. Scholarly evidence from human and animal kingdom suggest that there is an optimism in planetary health which can provide a unique and novel concept where efforts toward survival and remediation can be made. With accurate navigation, the current challenges can be mitigated leading to a new reality, one in which the core value is the well-being of all. This paper discusses the drivers of planetary health and the role of community health workers (CHWs) in making health-care system more resilient that can produce multiple benefits to community and overall planetary health. A web-based international database such as Google, Google Scholar, SCOPUS/MEDLINE/PubMed, and JSTOR was searched relevant to a planetary health framework. The study findings suggest that CHWs can offer health care interventions through environmental health cobenefits across the spectrum of health effects of climate change cause and effects. These actions have been divided into four major categories (i. health care promotion and prevention, ii. health care strengthening, iii. advocacy, and iv. education and research) that CHWs perform through a variety of roles and functions they are engaged in protecting planetary health. CHWs contribute toward achieving sustainable development goals such as planetary health and focus on environment sustainability and well-being of entire mankind.

Intention toward optimal breastfeeding among expecting mothers in Angul district of Odisha, India.

This paper aims to assess the prenatal breastfeeding intention and its predictors in Odisha, a state in India. Data were collected from 218 rural pregnant women of Angul district of Odisha, India in 2012. About 33% of the women lacked the intention to exclusively breastfeed their babies for 6 months. Prelacteal feeding was intended by one-third of the women while 61.5% of the women intended to feed water during the first 6 months of birth. Women of an older age [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.09-1.55], with more education (OR = 1.14; 95% CI = 1.08-1.32), belonging to lower castes [other backward caste (OBC)-OR = 21.33; 95% CI = 4.29-106.0, scheduled caste (SC)-OR = 22.77; 95% CI = 2.47-199.1, scheduled tribe (ST)-OR = 26.16; 95% CI = 4.10-174.8), and lesser number of living sons (OR = 0.59; 95% CI = 0.22-0.94) were more likely to have a higher intention for optimal breastfeeding than those of a lower age, with less education, belonging to a higher caste, and with more number of living sons. Awareness generation programs need to be strengthened to educate pregnant women with appropriate and recommended breastfeeding guidelines to establish optimal breastfeeding practices.

Induced Abortion Practices in an Urban Indian Slum: Exploring Reasons, Pathways and Experiences.

OBJECTIVE: To explore the context, experiences and pathways of seeking abortion care among married women in a minority dominated urban slum community in Mumbai city of India. MATERIALS AND METHODS: A mixed-method study was conducted using a systematic random sampling method to select 282 respondents from the slum community. One fifth of these womenreported undergoing at least one induced abortion over past five years. A quantitative survey was conducted among these women (n = 57) using structured face-to-face interviews. Additionally, in-depths interviews involving 11 respondents, 2 community health workers and 2 key informants from the community were conducted for further exploration of qualitative data. RESULTS: The rate of induced abortion was 115.6 per 1000 pregnancies in the study area with an abortion ratio of 162.79 per 1000 live births. Frequent pregnancies with low birth spacing and abortions were reported among the women due to restricted contraception use based on religious beliefs. Limited supportfrom husband and family compelled the women to seek abortion services, mostly secretly, from private, unskilled providers and unregistered health facilities. Friends and neighbors were main sources of advice and link to abortion services. Lack of safe abortion facilities within accessible distance furtherintensifies the risk of unsafe abortions. CONCLUSION: Low contraception usage based on rigid cultural beliefs and scarcely accessible abortion services were the root causes of extensive unsafe abortions.Contraception awareness and counseling with involvement of influential community leaders as well as safe abortion services need to be strengthened to protect these deprived women from risks of unwanted pregnancies and unsafe abortions.

Predictors of exclusive breastfeeding intention among rural pregnant women in India: a study using theory of planned behaviour.

INTRODUCTION: Documentation on prenatal intention for exclusive breastfeeding in rural India is scarce. The objective of this study was to examine exclusive breastfeeding intention and its predictors among rural pregnant women in Odisha state of India. METHODS: A cross-sectional survey was conducted involving 218 pregnant rural women in Odisha. A structured data collection tool was developed to measure knowledge, attitude, subjective norm, perceived control and intention for exclusive breastfeeding using continuous assessment scales. Bivariate and multivariate regression analysis was carried out. RESULTS: Only 29.8% of pregnant women reported a high intention for exclusive breastfeeding. Higher age (odds ratio (OR) 3.84, 95% confidence interval (CI) 1.48, 9.96), being literate (OR 1.46, 95% CI 1.06, 3.54), lower caste category (OR 6.85, 95% CI 1.88, 24.91) and receipt of breastfeeding education (OR 2.68, 95% CI 1.27, 5.65) had a significant relationship with exclusive breastfeeding intention. Breastfeeding education was positively associated with knowledge, attitude and subjective norm, but inversely related with perceived control (all p<0.05). High knowledge (OR 116.87, 95% CI 35.24, 387.56), positive attitude (OR 3.18, 95% CI 1.46, 6.62), supportive norm (OR 2.61, 95% CI 1.54, 4.77) and greater perceived control (OR 5.37, 95% CI 1.22, 16.61) among pregnant women had potential effects on their exclusive breastfeeding intention. CONCLUSIONS: The study implies that appropriate breastfeeding education sessions need to be tailor-made for prenatal stage to improve exclusive breastfeeding intention and practice in rural Odisha.