Developmental delay in a community setting: Role of a primary care physician.

The early part of childhood especially the first 1000 days plays an essential role in the growth and development of the child. Various internal and external factors affect the child's development, including genetic factors, socioeconomic status, sociocultural environment, maternal mental health, and the parenting environment. There is a high prevalence of developmental delay 17.6% globally, whereas in India, it is around 6.6%. Numerous screening tools are available to detect developmental delay in the child early. Early identification and intervention are crucial because we can have a better outcome for the child if intervention is performed on time. The children can be identified during the postnatal follow-up period. Literature has shown that few parents take their children for regular developmental assessment after delivery. Identifying the developmental impairment early from a primary care physician's point of view is essential. In India under the Rashtriya Bal Swasthya Kariyakram (RBSK), the children are screened at home, Anganwadi centers, and schools to detect at-risk children under 4D's, so that early intervention can be planned by linking them to District Early Intervention Center.

Screen Time Among Medical and Nursing Students and Its Correlation With Sleep Quality and Attention Span: A Cross-Sectional Study.

BACKGROUND:  Screen time is increasing among students and is also known to affect their lifestyle and health. The study investigated the correlation of screen time with sleep quality and attention span. METHODS: A cross-sectional study was conducted among undergraduate medical and nursing students in November 2021. A total of 192 students were selected randomly and investigated using a structured questionnaire. Sleep behavior was assessed using the Pittsburg Sleep Quality Index. Screen time and attention span were measured for each participant. The screen time data was reported as the median with an IQR. Pearson's correlation was performed to assess the correlation between screen time and sleep behavior and screen time and attention span. RESULTS:  The median screen time for 28 days was 260 (192.2-326.7) hours, and the median non-academic screen time was 250.0 (172.3-328.0) hours. Subjective sleep quality was good among 163 (84.9%) of the study participants. Global sleep quality was poor among 91 (42.2%) participants. The median score of the digit span forward was 6.00 (IQR: 5.00-7.00), and the median score of the digit span backward was 5.00 (IQR: 4.00-6.00). The global sleep score had a strong positive correlation with screen time, with a Pearson's correlation coefficient of 0.86. Forward and backward attention spans were not correlated with sleep scores, with correlation coefficients of 0.037 and 0.071, respectively. CONCLUSION:  Screen time is increasing significantly among medical and nursing undergraduate students, and their sleep is also getting affected. Emphasis should be given to the balance between digitalization and health.

Impact of COVID-19 Pandemic on Routine Immunization Among Tribal Children in Odisha: A Rapid Epidemiological Survey.

OBJECTIVE: To assess the impact of COVID-19 on immunization coverage and delayed vaccination among tribal children in the Khordha district of Odisha state. METHODS: A cross-sectional rapid epidemiological survey was conducted using a standard WHO (30 × 7) cluster survey with 30 tribal villages under the Community Health Centre (CHC), Mendhasala, Odisha, as clusters and seven children from each cluster. A total of 14 children from each cluster; seven each born in 2019 (2019 cohort) and 2020 (2020 cohort), amounting to 420 children were included. The dates of vaccination and related details were obtained from the mother and child protection cards alongside a pretested, semi-structured questionnaires administered to the mothers or primary caregivers. Immunization coverage and delayed vaccination rates were compared between the two cohorts. RESULTS: Full immunization coverage was 81.9% and 77.6% in the 2019 and 2020 cohorts, respectively. A significant decline in full immunization coverage was seen for 14 weeks (Pentavalent-3) vaccine in 2020 cohort (P = 0.01). The proportion of delayed vaccination for scheduled vaccines at birth, 6 weeks, 10 weeks, 14 weeks, and 9-12 months for 2019 cohort and 2020 cohort were 8.6%, 6.7%, 18.1%, 19.5%, 22.4%, and 21.9%, 26.7%, 30.5%, 19%, 16.2%, respectively. However, delayed vaccination rates among the 2019 and 2020 cohorts were not statistically significant. CONCLUSION: Our study findings showed a little decline in immunization coverage in tribal areas during the pandemic.

Organizing Health Camp: Opportunities for Building Public Health Skills.

Health camps are one of the commonly performed activities by different organizations with different intentions. The purpose ranges from reaching out to unreached populations to increasing client base and thus increasing revenue generation. A multi-speciality health camp was organised at Rural Health & Training Centre (RHTC), Mendhasala, Khurdha. We describe the camp profile and utilization of different specialties in this study. The camp was attended by mostly adults and elderly (90.3%) and inhabitants of the same village (80.5%). General medicine (30.6%) and orthopedics (31.9%) were the two specialties most consulted at the said camp. The success of a health camp is described by the number of attendees, which looks only at resource utilization. We have documented the lessons learned from organizing a health camp from a public health learning point of view. A 10-point checklist is recommended for the successful organization of a health camp.

Evidence of Knowledge, Attitude, and Practice Regarding Human Papilloma Virus Vaccination at the Community Level in India: A Systematic Review and Meta-analysis.

BACKGROUND: Effective vaccines for the prevention of cervical cancers are available in India. The existing knowledge and attitude regarding the Human Papillomavirus (HPV) vaccine varies widely among available studies. Our study aimed to estimate pooled prevalence related to knowledge, attitude, and practice of HPV vaccination in India. METHODOLOGY: We conducted systematic searches in PUBMED, EMBASE, CINHAL, PROQUEST, and Cochrane Library databases using database-specific search strategies. The random effects model was used for estimating the pooled proportion of knowledge, attitude, and practice. The outlier studies were identified using the Baujat test. Egger's regression test and funnel plots were used to identify publication bias. RESULTS: Database-specific search strategies yielded 2,377 records from five databases. We identified 48 studies for full-text retrieval after screening titles and abstracts. Finally, 27 studies were included in the meta-analysis. The pooled prevalence of knowledge regarding HPV vaccines in India was 0.22 (CI;0.14-0.31, I2 =99.5%). The pooled prevalence of positive attitudes towards the uptake of HPV vaccines in India was 0.45 (CI;0.33-0.57, I2 =100%). The pooled prevalence of coverage of HPV vaccines in India was 0.04 (CI;0.02-0.07, I2 =96%). Significant publication bias was present for the studies' reported knowledge and coverage. CONCLUSION: The knowledge, attitude, and coverage of the HPV vaccine were low in India. It suggests effective strategies to improve knowledge and attitudes towards HPV vaccination in India.

Development and Validation of the ScAbIeS Tool for Diagnosing Scabies by Community Healthcare Workers in Resource-Limited Settings.

Introduction Scabies can lead to community outbreaks if not diagnosed early. Developing and validating a relevant tool for diagnosing scabies at the community level is essential to bridging the early diagnosis and treatment gap. Objective The objective of this study is to develop and validate a newer tool to diagnose scabies at the community level by Community Healthcare Workers (CHWs) in resource-limited settings. Methods The developed "ScAbIeS" tool comprised five items divided into two major and three minor criteria. After its development, a longitudinal descriptive study validated the "ScAbIeS" tool. The eligible participants were included in the study through active screening in villages under the Rural Health Training Center (RHTC) Mendhasala. Those villages' Accredited Social Health Activists (ASHS) were included as CHWs for diagnosing scabies using the "ScAbIeS" tool. The participants with skin lesions and/or itching were diagnosed with scabies by CHWs using the "ScAbIeS" tool. The diagnosis of CHWs using the "ScAbIeS" tool was compared with those of physicians, including expert dermatologists, to determine the sensitivity and specificity. Results Kappa's agreement is found to be 0.896 for CHWs and trained physicians regarding the diagnosis of scabies by the "ScAbIeS" tool. Cronbach's alpha is 0.738 for major criteria and 0.565 for minor criteria. 0.778 is found to be Cronbach's alpha for the total scale. The "ScAbIeS" tool is 85% sensitive and 100% specific to diagnose scabies when used by CHWs. Conclusion The "ScAbIeS" tool can be used to diagnose scabies at the community level by CHWs with appropriate training. It will lead to the prevention of complications and community outbreaks of scabies.

Association between Gestational Diabetes Mellitus and Postpartum Depression among Women in Eastern India: A Cohort Study.

Background: The study was planned to evaluate the association between Gestational Diabetes Mellitus (GDM) and Postpartum Depression (PPD) in a rural population of Odisha, Eastern India. Material and Methods: Pregnant women in the first trimester were recruited and followed up till six weeks of postpartum. Gestational Diabetes Mellitus was assessed with 75 grams glucose challenge test and PPD was assessed at six weeks after delivery with Edinburgh Postnatal Depression Scale. Statistical difference between variables was assessed using Chi-square test, Fischer's exact test, and unpaired T-test. Covariates were adjusted using bivariate and multivariate logistic regression to estimate the association between GDM and PPD. Results: Out of 436 pregnant women recruited, 347 (89.6%) remained in the study. Prevalence of GDM was 13.9% (95% CI: 10.7-17.3) and PPD was 9.8% (95% CI: 6.6-12.9). Incidence of PPD in the GDM group was 14.58% (95% CI: 4.2-24.9) and in women without GDM was 9.06% (95% CI: 5.76-12.3). However, the association was not significant on multivariate logistic regression (Risk Ratio (RR) = 1.56, 95% C.I: 0.61-6.16; P-value = 0.35). Conclusion: This study demonstrated that women with GDM were at higher risk of developing PPD suggesting that an "at risk" approach should be implemented for screening.

Hypothyroidism in Pregnancy: An Alarming Concern in a Rural Community of Eastern India.

Introduction: Hypothyroidism exerts a multitude of effects on pregnant women and newborns. This study aimed to estimate the prevalence of hypothyroidism and its associated factors among pregnant women. Material and Methods: This cross-sectional study was done at a community health center in Tangi, Eastern India. A total of 436 pregnant women ≤24 weeks gestation attending the ante-natal clinic were recruited by consecutive sampling after obtaining written informed consent. Those who were a known case of any psychiatric disorder and were not able to comprehend interview questions were excluded. Estimation of serum thyroid stimulating hormone levels was done at the central laboratory of the All India Institute of Medical Sciences, Bhubaneswar. Analysis was done using STATA 17.0 and presented as means or proportions. The association of hypothyroidism with various sociodemographic factors was analyzed with bivariate logistic regression. Results: Mean age of the study participants was 23.9 years (SD: 3.65). About 31.4% of participants were found to have hypothyroidism. On bivariate logistic regression, the presence of hypothyroidism was not associated with any variable. Conclusions: Hypothyroidism is widely prevalent in pregnant females in rural India. Screening of high-risk pregnant females followed by appropriate management is essential.

Intimate partner violence in India: Need for renewed corollary during COVID-19 pandemic.

Intimate partner violence (IPV) is considered any type of behavior involving the premeditated use of physical, emotional, or sexual force between two people in an intimate relationship. The prevalence of health-seeking attitude towards IPV in India is very low among victims affected by it. The chances of facing violence or even in their maternal life were substantially high among women having lesser education or without any financial empowerment. Data have been quite supportive whenever elevated odds of risk of experiencing controlling behavior from their spouses were concerned. Safety strategies for violence programming could increase monitoring and evaluation efforts to reduce violence. Women with vulnerabilities like being marginalized, least resourced, and disabled are likely to suffer violence in an intimate relationship. Primary care physicians have a definitive role and involvement of other stakeholders like ward members and self-help groups to mitigate such occurrences.

Role of Nutrition and Diet during COVID-19 pandemic: A narrative review.

COVID-19 has impacted mankind drastically; whether it be physical and mental health, global economy, or social disruption, everyone has sustained losses. To prevent the spread, strict containment measures and stay at home guidelines were issued by officials. Due to this, an unanticipated and rapid change has occurred in the daily routine and lifestyle of the people. Physical distancing and quarantine measures strongly impacted people's lives, their eating habits and everyday ablutions. A comprehensive search of recent literature related to nutrition and diet during the pandemic was undertaken using electronic databases like MEDLINE, PubMed, Google Scholar, and ResearchGate. This review deals with the effects of COVID-19 on malnutrition, the foods that help in boosting the immune system, and on specific, vulnerable, age groups. Although there are various health concerns that has come up during the pandemic, through this review, we investigate some aspects related to nutrition as the recovery of every individual who was affected by COVID-19 was influenced by their nutritional intake.

Prevalence of Anxiety Disorder in Adolescents in India: A Systematic Review and Meta-Analysis.

Anxiety is one of the most common mental disorders in the adolescent age group due to both physiological and psychological changes along with substance use in this age group. Generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social phobia (or social anxiety disorder) constitute anxiety disorders as per the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. In India, the National Mental Health Survey was conducted to estimate the burden of different mental health disorders, but the adolescent age group was not included in that survey. A comprehensive search strategy was used to find out articles from PubMed and ProQuest, along with a risk of bias assessment using two components of the Quality in Prognosis Studies (QUIPS) tool. The 13 articles included in the meta-analysis were divided into two groups depending on sampling strategy and outcome measurement. Due to more than 99% heterogeneity, the random effect model is used to find the pooled estimate. The pooled prevalence of anxiety disorder among adolescents in India is found to be 0.41 (CI: 0.14-0.96) for studies with more than low risk and 0.29 (CI: 0.11-0.46) for studies with low risk. The Begg and Mazumdar rank correlation test revealed no publication bias in the included studies. One study was found to be an outlier using the Baujat test, but pooled estimate and heterogeneity did not change significantly after its removal from analysis. The weight of individual studies calculated using the random effect model did not show any gross difference. A significant burden of anxiety was found in adolescents in India. Effective intervention should be planned to reduce this burden.

Noise Pollution in Intensive Care Unit: A Hidden Enemy affecting the Physical and Mental Health of Patients and Caregivers.

Background: Noise in intensive care units (ICUs) has always been a problem, but noise above the recommended range affects not only the patient but staff as well. It is clear that some noise in the ICU is inevitable, but exceeding the normal range brings various physiologic and psychologic changes, which directly affect health. This review presents a synthesis of noise sources in the ICU and the potential interventions designed to attenuate noise and protect patients. Materials and Methods: An extensive literature search, using electronic databases such as MEDLINE, PubMed, Google Scholar, and Research gate to understand the noise in ICU, effects of noise, and noise reduction interventions were undertaken. Results: Findings were such as noise enhances the release of cortisol, increases oxygen consumption, increases sleep disturbances, increases the need for analgesia and sedation, and disrupts circadian rhythm. Many studies reported that measurement was always higher despite implementing noise reduction interventions. Conclusions: ICU survivors always recall their memories, and for them, ICU admission becomes a negative experience for life. However, the sustainability of any single intervention did not show awe-inspiring results, whereas a bundle kind of interventions did show some effects. However, high-quality evidence demonstrating the benefit of any intervention on patient outcomes is still lacking.

Cost of Ambulatory Care in Diabetes: Findings From a Non-Communicable Disease Clinic of a Tertiary Care Institute in Eastern India.

BACKGROUND: This study was conducted to evaluate the cost of ambulatory care of diabetes in a non-communicable disease (NCD) clinic in eastern India. METHODS: This hospital-based cross-sectional cost description study was conducted from July to August 2018. A total of 192 diagnosed cases aged 18-70 years with a minimum history of one year since diagnosis attending the NCD clinic for the first time were included. Information was collected using a pre-tested schedule based on the cost of illness approach that consisted of socio-demographic details, disease status, and cost of ambulatory care. Cost of the drugs was calculated using a standardized repository of drug costs. The estimated expenditure of previous three months was calculated and extrapolated to one year to calculate yearly expenditure. RESULTS: The mean age of the study participants was 43.93±10.41 years and the mean duration of diabetes was 6.64±6.08 years. The median direct cost due to diabetes was Rs 9560 (136.57 USD) annually. It was higher in females (Rs 10,056, 143.45 USD) than in males (Rs 9020, 128.85 USD). In direct medical costs, a major part was constituted by the drugs, oral hypoglycemic agents, and/or insulin (approximately 70%). CONCLUSIONS: In an ambulatory framework too, diabetes causes a substantial financial burden on the individual in India. In the wake of resource constraints in Indian health settings, the public health system needs to be adequately strengthened by policymakers to address the growing number of diabetics and long-standing complications.

Learning innovation in community medicine teaching: A-Z of job responsibilities of anganwadi worker, accredited social health activist, and auxiliary nurse midwife.

The interaction between medical students and frontline healthcare workers is one of the crucial components of community medicine. The interaction of medical students with frontline healthcare workers provides multiple opportunities. Medical students like to understand their job responsibilities and their involvement in implementing the various national health programs at the community level. Innovation is required to train our medical students better and enhance their learning. A learning and teaching innovation was developed by us to provide insight into the various roles and involvement of frontline healthcare workers in the community. One innovation is the A-Z activity calendar of frontline healthcare workers in teaching and learning in medical education.

Neonatal dermatitis neglecta---Neglect by health system: A case report.

A 29 days old female child presented to the general outpatient department of Community Health Center with greenish black crusting over left ear for 7-8days duration without any other signs and symptoms. We report the diagnosis and management of the condition through ad-hoc store and forward tele-dermatology. This is the first reported case of dermatitis neglecta in neo-natal period.

New National Tuberculosis Elimination Program(NTEP) logo: Observation and comments.

The new National Tuberculosis Elimination Program (NTEP) launched with its new logo in early 2020. Logo have been launched is circular with yellow and red colour. Name of program is in circular and with caption "TB Harega Desh Jeetega". There is red colour joyful person surrounded by National Flag with image of lung in the logo. Present letter highlights observation and comments on the new NTEP logo.

Prevalence and Psychosocial Correlations of COVID-19-Related Worries in People with Diabetes Mellitus Seeking Services from East Indian Tertiary Care Center: A Cross-Sectional Survey Results.

Context: Patients with diabetes are more prone to psychosocial problems which are known to adversely impact clinical outcomes of diabetes. COVID-19 is understood to further worsen the psychosocial problems of patients with diabetes. Aims: We carried out this cross-sectional telephonic survey of COVID-19-related worries in patients with diabetes mellitus to understand the prevalence and correlates of COVID-19-related worries. Settings and Design: This was a telephonic survey of patients seeking care from noncommunicable disease clinic of a tertiary care medical center. Subjects and Methods: We used a structured questionnaire to assess sociodemographic, clinical, psychological variables and COVID-19-related worries. Statistical Analysis Used: We used SPSS 20.0 for descriptive statistics keeping significance levels at 0.05. Between-group comparisons of continuous variables were made with independent t-test and two-way ANOVA; correlations were carried out with Pearson correlation test. Results: Two hundred and nine patients completed the telephonic survey conducted from September to November 2020. The prevalence of diabetes-related worries in our sample was 80%. Younger age (P < 0.001), unemployment (P = 0.029), and the presence of mental disorder (P < 0.001) were associated with higher diabetes-related worries. Poor glycemic control (0.008) and symptoms of COVID-19 (0.03) were associated with diabetes-related worries. Diabetes-related worries correlated with diabetes distress (ρ =0.441, P < 0.001), social isolation (ρ =0.401, P < 0.001), and perception of social support (ρ = -0.158, P < 0.001). Conclusions: A large proportion of our patients with diabetes are at high risk to experience COVID-19-related worries especially, younger people, unemployed and those with mental illness. Furthermore, the presence of diabetes distress and the perception of social isolation increase COVID-19 worries.