Seroprevalence of anti SARS-CoV-2 IgG antibodies among adults in Jammu district, India: A community-based study.

Background & objectives: Serology testing is essential for immunological surveillance in the population. This serosurvey was conducted to ascertain the cumulative population immunity against SARS-CoV-2 among adults in Jammu district and to understand the association of seropositivity with sociodemographic and clinical correlates. Methods: On September 30 and October 1, 2020, a household survey was done in 20 villages/wards chosen from 10 health blocks in district Jammu, India. Demographic, clinical and exposure information was collected from 2000 adults. Serum samples were screened for IgG antibodies using COVID Kavach MERILISA kit. Tests of association were used to identify risk factors associated with IgG positivity. Crude odds ratio with 95 per cent confidence intervals (CIs) was calculated during univariate analysis followed by logistic regression. Results: Overall adjusted seroprevalence for SARS-CoV-2 was 8.8 per cent (95% CI: 8.78-8.82); it varied from 4.1 per cent in Chauki choura to 16.7 per cent Pallanwalla across 10 blocks in the district. Seropositivity was observed to be comparatively higher in 41-50 and 61-70 yr age groups, among males and in rural areas. Fever, sore throat, cough, dyspnoea, myalgias, anosmia, ageusia, fatigue, seizures, history of exposure, medical consultation, hospitalization and missing work showed significant association with seropositivity on univariate analysis. On logistic regression, only sore throat, myalgia and missing work showed significant adjusted odds of IgG positivity. Extrapolation to adult population suggested that exposure to SARS-CoV-2 was 14.4 times higher than reported cases, translating into Infection fatality rate of 0.08 per cent. Interpretation & conclusions: Since a major part of population was immunologically naive, all efforts to contain COVID-19 need to be vigorously followed while these baseline results provide an important yardstick to monitor the trends of COVID-19 and guide locally appropriate control strategies in the region.

Perceptions of Healthcare Workers Regarding Palliative Care Services in a Tertiary Care Teaching Hospital in North India - A Mixed Methods Observational Study.

Objectives: Cancers and various terminal illnesses need integrated palliative care with curative management, but, unfortunately, our health care system mainly focuses on the treatment of disease. Lack of awareness, difficulty in pain management and untrained staff are some of the challenges in palliative care services.The study was done to explore the perception of healthcare workers regarding availability, utilisation and challenges in the delivery of palliative care services. Material and Methods: A mixed method study was conducted at tertiary care teaching hospital in North India. Qualitative approach using interviews and focus group discussions (FGDs) among healthcare workers was done to understand their knowledge, perception, barriers and challenges in implementing palliative care services. One hundred and thirteen healthcare workers were interviewed using a semi-structured questionnaire and FGD was conducted to gain more insight into the issues of palliative care. The data obtained was analysed with the help of computer software Microsoft Excel and SPSS version 23 for windows. The data was presented as proportion and mean (S.D.) as deemed appropriate for qualitative and quantitative variables respectively. Thematic analysis was done with the data of FGD. Results: The knowledge, attitude and practices regarding palliative care were poor across the HCW. During FGD with faculty and residents, the participants showed great concern about the absence of palliative care across many specialties while expressing an acute need for the establishment of a separate interdisciplinary unit on palliative care to improve the quality of life in patients. Conclusion: The study shows that there are gaps that need to be addressed to make palliative services available in our hospital.

Effect of Women's and Partners' Education on Maternal Health-care Services Utilization in Five Empowered Action Group States of India: An analysis of 13,443 Women of Reproductive Age.

BACKGROUND: Suboptimal utilization of maternal health-care services is a perennial problem in Empowered Action Group (EAG) states. This study examines role of women's and partners' education on usage of antenatal, postnatal care (PNC), and skilled birth attendance in these states. METHODOLOGY: National Family Health Survey-4 (2015-2016) data for 13,443 women in reproductive age group of 15-49 years in Bihar, Madhya Pradesh (MP), Odisha, Rajasthan, and Uttar Pradesh (UP) were analyzed using logistic regression. RESULTS: Increasing level of education had a significant impact on utilization of antenatal services in all states, highest and lowest odds being observed with higher and primary level of partner's education, respectively. Skilled birth attendance universally showed rising trend with increasing women education, while it remained substantially low even at higher level of partner's education. For PNC, utilization increased with increasing level of maternal education. While significantly lower odds of PNC were seen with primary level of partner education in Rajasthan and UP, partner's secondary education showed positive and significant association in Bihar, Rajasthan, and UP. At higher level of partner education, positive and significant effects on PNC were observed only in Bihar, MP, and UP. CONCLUSIONS: Universal education is vital to attain sustainable development goals at the grassroot level, which is happening relatively slowly in the EAG states.

Comparative study on maternal healthcare services utilisation in selected Empowered Action Group states of India.

The utilisation of maternal healthcare services is a principal indicator to measure the success of any maternal and child health programme. Suboptimal utilisation of maternal healthcare services is a vexatious problem in Empowered Action Group (EAG) states of India. This study aims to examine the currents status and socioeconomic determinants of antenatal services, skilled birth attendance and post-natal services in four infamous EAG states of India. This study used nationally representative, National Family Health Survey (NFHS, 2015-16) data for analysis. Descriptive statistics were used to depict the current status of maternal healthcare services utilisation and a discrete choice model was applied to examine the associated factors across the selected EAG states. The utilisation of maternal health services was higher in Rajasthan followed by Madhya Pradesh, Uttar Pradesh and Bihar respectively. Utilisation was consistently low among the socioeconomically disadvantaged women in all the selected EAG states. The study highlights that female education, mass media exposure, women's autonomy and economic status were significantly associated with the use of maternal healthcare services. The actualisation of our national and Sustainable Development Goals at the ground level is happening relatively slowly in the EAG states. Hence, achieving equitable distribution of resources, universal availability and access to information, counselling and reproductive services coupled with women empowerment are vital to the realisation of these goals.

Prevalence and determinants of geriatric depression in North India: A cross-sectional study.

CONTEXT: "Aging India" has become a phenomenon of public health importance. Old age is beset with physical, mental, and social challenges. Among these, mental health concerns are least prioritized in most of the developing countries with depression being the most common and easy to screen. AIMS: To assess the burden of geriatric depression and determine its association with sociodemographic factors such as religion, age, gender, education, marital status, and family type. SETTINGS AND DESIGN: A cross-sectional study was conducted in July-August 2018 in village Kirpind in north India. METHODOLOGY: 162 subjects aged 60 years or more, both males and females participated in the study. Depression was assessed using the 15-item Geriatric Depression Scale and those with a GDS score >=5 were categorized as depressed. STATISTICAL ANALYSIS USED: Pearson's Chi-square test and binary logistic regression were used for analysis. RESULTS: Nearly 59.3% of subjects had no depression, 33.9% were suffering from mild to moderate depression whereas 6.8% were severely depressed. The mean age of subjects was 69 (±7.4) years. Chi-square test was used to study the association of various factors with depression and only female gender showed a positive statistical association. On using binary logistic regression analysis, being female again emerged to be a significant predictor of depression while no other factor was significantly associated with the outcome. CONCLUSIONS: There is a need to sensitize primary care workers and physicians to identify and manage geriatric depression early. It also points towards the need for multicentric, longitudinal studies evaluating various aspects of geriatric depression.

Knowledge, attitude, and breast-feeding practices of postnatal mothers in Jammu: A community hospital based cross sectional study.

CONTEXT: In spite of convincing evidence of the benefits of breastfeeding, breast feeding rates are less than satisfactory, thus pinpointing large gaps, which need to be identified and addressed. AIMS: To examine the knowledge, attitude and practices of postnatal mothers towards breast feeding. SETTINGS AND DESIGN: Community Hospital-based CrossSectional study. METHODS AND MATERIALS: The study was done for a period of 4 months among 178 women attending outpatient department of paediatrics. Data collection was done with the help of face to face interview using pre-tested pre-designed structured questionnaire having information about demographic profile of study participants and knowledge, attitude and practices of breast feeding. STATISTICAL ANALYSIS USED: The data was presented as frequencies and percentages. RESULTS: Majority (89.9%) of the mothers were breast feeding, however, only 42.7% of the mothers exclusively breast fed their kids. 82.5% of the mothers believe that cow's milk can be substituted for breast milk. All the mothers continue to breast fed their babies during sickness. Almost all respondents were aware of the importance of colostrum, while 80.3% had the misconception that they should stop breast feeding once when weaning was started. CONCLUSIONS: Mothers should be counselled during antenatal period and all the misconceptions regarding breast feeding should be appropriately addressed.

Epidemiological determinants of low birth weight: A prospective study.

CONTEXT: Infant and child survival is recognized as an essential ingredient for the overall health of a society. AIMS: To study the magnitude and epidemiological determinants of LBW. SETTINGS AND DESIGN: Community-based longitudinal study. SUBJECTS AND METHODS: A prospective study was conducted for a period of 1 year in Block R.S Pura, Jammu where 364 pregnant women registered at four randomly selected PHCs were followed to assess the magnitude of LBW and to study its association with various determinants. STATISTICAL ANALYSIS USED: Data was analyzed using MS Excel and Open epi version 3.01. RESULTS: Severe anemia, heavy physical activity, low socioeconomic status, illiteracy, extreme ages, and short stature of women were found to be significantly associated with a higher incidence of LBW babies. CONCLUSION: There is a need to focus on the sensitization of grass-root level health workers as well as pregnant females and their families on the importance of antenatal care, good dietary practices, etc., Thus, strengthening the primary health care system is vital in ensuring optimum health of both mothers and newborns.

Surgical coverage of cataract in a rural area of north India: A cross-sectional study.

BACKGROUND: India has the highest number of blind people globally, unoperated cataract being the most common cause of blindness and low vision. Although safe and effective cataract surgical techniques are available, the cataract burden continues to increase annually, due to the backlog of patients to be operated upon, and a growing number of cataract cases due to increased life expectancy. AIM: To assess cataract surgical coverage (CSC) in a rural area of north India. METHODS: A population-based cross-sectional study of CSC among adults (40 years and above) was carried out in two villages of a block in north India using a predesigned questionnaire, visual acuity assessment, and distant direct ophthalmoscopy. Based on the data obtained, CSC (VA <6/60) for both "persons" as well as "eyes" was calculated. RESULTS: Overall, CSC (persons) of 43.20% was observed, 29.31% coverage among persons with unilateral cataract and 50.45% among persons with bilateral cataract while CSC (eyes) was found to be 37.14%, being significantly higher (43.56%) among females compared to males (28.21%) (P = 0.012). Around 50% of cataract surgeries were performed in private facilities, 41.35% in government facilities, and rest 8.65% in eye camps. Nearly 90.38% were implanted intraocular lens and 9.62% were non-intraocular lens surgeries. CONCLUSIONS: Surgical needs for cataract are currently not being met effectively. Reasons for inadequate cataract surgical services need to be sought and addressed to improve the uptake of existing services. Further, reasons for underutilization of government hospitals for cataract surgeries need to be examined.

Prevalence, risk factors, and health seeking behavior for knee osteoarthritis among adult population in rural Jammu - A Community based Cross Sectional Study.

CONTEXT: Osteoarthritis (OA) is a degenerative joint disease, having multifactorial etiology affecting mainly the articular cartilage. Knee OA with its physical symptoms affects daily activities thereby deteriorating the quality of life. Most of the patients delay their visit to health sectors for seeking medical care in musculoskeletal conditions. AIMS: To find the prevalence and determinants of osteoarthritis among the adult population in the rural area and to assess their health-seeking behavior. SETTINGS AND DESIGN: A community-based, cross-sectional study. METHODS AND MATERIAL: A community-based, cross-sectional study was conducted among 232 adults living in a rural area in village Kirpind of R.S. Pura block, Jammu. Knee OA was diagnosed using the clinical criteria laid down by the American College of Rheumatology (ACR). STATISTICAL ANALYSIS USED: Descriptive statistics, OR with 95% CI, and Chi-square test were used for the purpose of analysis. RESULTS: The overall prevalence of knee osteoarthritis was 35.7% (females: 44.5% Males: 23.1%). Age more than 60 years, female gender, history of trauma, BMI >30 were found to be significantly associated with higher odds of OA knee (P < 0.05). Descriptive statistics, OR with 95% CI and Chi-square test were used for the purpose of analysis. CONCLUSIONS: Strategies focusing on creating awareness among the rural elderly regarding the role of a balanced diet, exercise, and weight management along sensitization of primary health care providers concerning benefits of early screening, diagnosis, and referral should be undertaken to minimize this burden.

Trends, Differentials, and Social Determinants of Maternal Health Care Services Utilization in Rural India: An Analysis from Pooled Data.

Background: Millennium development goal 5 aimed at reduction of maternal deaths by three-quarters from 1990 to 2015: a target India commendably achieved, but this milestone remains overshadowed by inequalities in utilization of health services that are driven by determinants both at community and at individual level. Materials and Methods: We studied the utilization trends using descriptive statistics and analyzed the relative contribution of various socioeconomic predictors on the use of maternal health care services in rural India using binary logistic regression analysis on pooled data from three rounds of National Family Health Survey. Outcome variables included four or more antenatal care visits, skilled birth attendance, and postnatal care. Results: Although utilization of maternal health care services showed an upward trend from 1998-1999 to 2015-2016, factors such as illiteracy, female age ≥40 years, having five and more children, belonging to scheduled tribes, rural residence, and not possessing a health card were associated with significantly low utilization of maternal health care services. However, partner's education, good economic status, women's autonomy, and infrastructure at village level were associated with better odds of availing these services. Conclusions: The study generates evidence on the role of various socioeconomic determinants in maternal health care utilization and identifies gaps that must be strategically addressed to reach sustainable developmental goal maternal mortality target of 70 deaths per 100,000 live births by 2030. It reemphasizes the need for ensuring convergence among different stakeholders while structuring maternal health policies so that health reforms can be accomplished effectively at all levels of health care.