Access to Maternal and Child Health Services during the COVID-19 Pandemic: An Explorative Qualitative Study in Odisha, India.

Background: Maternal and child health (MCH) care is one of the essential routine healthcare services, which got affected during the coronavirus disease 2019 (COVID-19) pandemic. Modeled projections had anticipated an 8.3%-38.6% rise in maternal mortality from different countries globally. In view of limited studies pertaining to issues related to accessing MCH services in the event of a pandemic, this study was carried out on pregnant and postnatal mothers in Odisha, India. Methods: An explorative qualitative study through 36 in-depth interviews (IDIs) was conducted among 16 (44.4%) antenatal and 20 (55.5%) postnatal mothers in six of thirty districts of Odisha, India, from February to April 2021. The districts and blocks were randomly selected for better representativeness. The IDIs were conducted using a predesigned and pretested guide among mothers who had undergone delivery or availed of antenatal, postnatal, or child health services from October 2020 to April 2021. The IDIs were conducted till data saturation. The data were analyzed using MAXQDA software. Results: The average age of mothers was 27.6 (+/- 2.2) years. Among the participants, 16 (44.4%) were antenatal and 20 (55.6%) were postnatal mothers; 19 (52.8%) were primipara and 17 (47.2%) were multipara. The majority explained that they received enormous support including door-to-door services from the community health workers (CHWs) even during the difficult times of the pandemic. Reduced transportation facility and fear of contracting the infection were reasons behind the unwillingness to visit health facilities and preference for home delivery. Furthermore, the pandemic had physical, mental, social, and financial impacts among pregnant and postnatal women. Conclusion: The unprecedented COVID-19 pandemic has affected access to MCH services by antenatal and postnatal mothers. Health system preparedness and appropriate strategies including better community engagement and participation could avert such challenges in the future.

Health research in the state of Odisha, India: A decadal bibliometric analysis (2011-2020).

Background: Bibliometric analyses are an important tool for evaluating health research outputs in terms of their distribution, trends, contributors, focus, and funding sources. The transition from millennium to sustainable development goals has led to a gradual shift in the health policy, and possibly, research priorities of low-income settings in the Empowered Action Group (EAG) states lagging in socioeconomic and health parameters, and also ranking low on innovations and research. In this study, we depict the recent trends, quantity, type, focus, and sources of health-related research in the EAG state of Odisha, India. Methods: Peer-reviewed published original research articles related to human health published between 1 January, 2011 and 31 December, 2020 and where the study population was the residents of Odisha, or the study site was in Odisha, exclusively or partially, were analyzed. The publication characteristics were tabulated, including the title, journal name, open access, date of publication, number of authors, designation of the authors, number of institutes involved, and name of the institute of the first author. The details of the study setting, study site, ethical clearance, and funding source were also analyzed. Results: The study identified 2,285 articles from database searches and included 666 articles after screening for bibliometric analysis. Most of the manuscripts had between three and six authors (43.5%). Two institutes from the state, the Regional Medical Research Center (ICMR-RMRC) and Kalinga Institute of Industrial Technology (KIIT), together contributed to 22.4% of the published manuscripts. Nearly 45.9% of the studies were community-based while 45.3% were hospital-based. While most of the published work was on infectious diseases, the proportion came down with time. An overwhelming majority of the studies were observational and less than 10% were experimental in design. Conclusions: The analysis shows a substantial increase in the number of publications in this decade. Priority setting of healthcare problems, increased funding, and capacity-building can give a much-necessitated impetus to more quality- and evidence-based research for aiding policy implementation and improvement of the overall health.

Effectiveness of introduction of JEV vaccination into routine immunization program in a tribal district of Odisha.

Background: A severe outbreak of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) with high case fatality among tribal children was reported from Malkangiri district of Odisha, during September to November 2016 affecting 336 children with 103 deaths. Following the outbreak, a mass vaccination campaign was introduced in Malkangiri district in2017. In 2018, the JE vaccine was introduced into the routine immunization program as per National Immunization Schedule. Our study surveys the JE vaccination coverage among children of Malkangiri and the incidence of JE cases for a period of three years. Methodology: The current study was conducted by establishing prospective and retrospective AES surveillance system and household vaccine coverage surveys in Malkangiri district. In the target population, the vaccination coverage survey was undertaken and also additional immunization coverage data from sub-centers was collected. Results: After 2016 JE outbreak, a mass vaccination campaign was carried out in children up to 15 years of age, where 96% of children were covered in the district in 2017 and only four AES cases were detected. Under routine immunization program, the vaccine coverage for the year 2018 was 68% for JE-1 dose and 37% for JE-2 dose. There were 8 AES cases detected in 2018 out of which four children died. Vaccination coverage for 2019 was 97% for JE-1 dose and 84% for JE-2 dose. The AES cases detected in 2019 was nil. Conclusion: Vaccination against JEV and AES surveillance systems has an important role in prevention and control of AES outbreaks.

Saliva for diagnosis of SARS-CoV-2: First report from India.

There are very few studies in search of an alternate and convenient diagnostic tool which can substitute nasopharyngeal swab (NPS) specimen for detection of SARS-CoV-2. In the study we analyzed, the comparison and agreement between the feasibility of using the saliva in comparison to NPS for diagnosis of SARS-CoV-2. A total number of 74 patients were enrolled for this study. We analyzed and compared the NPS and saliva specimen collected within 48 h after the symptom onset. We carried out real-time quantitative polymerase chain reaction, gene sequencing for the detection and determination SARS-CoV-2 specific genes. Phylogenetic tree was constructed to establish the isolation of viral RNA from saliva. We used the Bland-Altman model to identify the agreement between two specimens. This study showed a lower cycle threshold (CT ) mean value for the detection of SARS-CoV-2 ORF1 gene (mean, 27.07; 95% confidence interval [CI], 25.62 to 28.52) in saliva methods than that of NPS (mean 28.24; 95% CI, 26.62 to 29.85) specimen although the difference is statistically nonsignificant (p > .05). Bland-Altman analysis produced relatively smaller bias and high agreement between these two clinical specimens. Phylogenetic analysis with the RdRp and S gene confirmed the presence of SARS-CoV-2 in the saliva samples. Saliva represented a promising tool in COVID-19 diagnosis and the collection method would reduce the exposure risk of frontline health workers which is one of the major concerns in primary healthcare settings.