Depression among tuberculosis patients attending a DOTS centre in a rural area of Delhi: A cross-sectional study.

BACKGROUND: Studies have shown that the prevalence of psychiatric disorders, particularly depression, is high among tuberculosis (TB) patients, and may adversely affect treatment compliance. A person suffering from TB can develop depression in due course of time owing to a number of factors, namely the long duration of treatment for TB, stigmatization faced by the patient due to the disease and lack of family support to name a few. OBJECTIVES: The present study aimed to determine the prevalence of depression and its correlates among TB patients enrolled at a Directly Observed Treatment Short-course (DOTS) center in a rural area of Delhi. METHODS: The study was a DOTS center-based, cross-sectional study, among 106 patients of pulmonary and extrapulmonary TB, above 18 years of age. An interviewer-administered questionnaire in Hindi was used to collect basic sociodemographic data and the Patient Health Questionnaire (PHQ)-9 was used for detecting depression. Those with a score of 10 or more were considered to be suffering from depression. Data analysis was done using SPSS licensed version 20. Chi-square was used to test for association between qualitative variables, and a P < 0.05 was considered statistically significant. RESULTS: A total of 106 patients participated in the study, of which 61 (57.5%) were males. The median age was 30 years (inter-quartile range 24-40 years). Depression was found to be present in 25 (23.6%) participants. A higher proportion of patients with depression were unemployed currently, and also belonged to middle or lower class (P < 0.05). Depression was not found to be associated with religion, gender, marital status, HIV status, presence of diabetes, DOTS category nor with the phase of treatment. CONCLUSION: Depression among TB patients is common, affecting almost one in four TB patients. Physicians and DOTS providers should have a high index of suspicion for depression when assessing TB patients.

Prevalence and Determinants of Child Maltreatment among School-Going Adolescent Girls in a Semi-Urban Area of Delhi, India.

The study examines family characteristics that put adolescent girls at increased risk of abuse, mainly physical, sexual and emotional abuse and neglect. Stratified random sampling was done among classes 7th to 12th of government girls' schools of a semi-urban area of Delhi, and a total of 1060 adolescent girls participated. Majority were in mid-adolescence. Approximately 70% study subjects faced at least one form of maltreatment. Physical abuse was faced by 42.6%, sexual abuse by 26.6%, emotional abuse by 37.9% and neglect by 40.1% of study subjects. The most frequent perpetrator of physical and emotional abuse was mother, and of sexual abuse were friends, relatives or neighbours. No or low education of father increased odds of physical and emotional abuse, while odds of physical abuse and neglect were lower if mothers were housewives. Excessive arguments between parents and history of maltreatment in parents increased odds of child maltreatment in study subjects.

Perceptions regarding second wave of coronavirus disease 2019 (COVID-19) pandemic among Indian adults: A cross-sectional study.

BACKGROUND AND AIMS: A massive surge in coronavirus disease 2019 (COVID-19) cases and deaths occurred in India during March-April 2021, and this was considered as second wave of the pandemic in the country. This study was conducted to find out the perceptions about second wave of the COVID-19 pandemic among Indian adults. METHODS: An online-survey-based cross-sectional study was conducted over 3 weeks from April 21, 2021 to May 11, 2021. Information regarding sociodemographic profile, perceptions about COVID-19 during second wave, perceptions and practices related to COVID-19 vaccination, COVID-19 appropriate behavior, and government's response to the pandemic was collected. Descriptive analysis was performed. RESULTS: A total of 408 study participants were included. Mean age of the study participants was 29.2 ± 10.4 years. Around 92.6 percent (378) of respondents agreed that COVID-19 in 2021 is different from 2020. Perceived reasons for increased severity and cases were change in virus characteristics; social, religious, and political gatherings; and complacent behavior by people. Three-fourth (311, 76.2 percent) of the study participants agreed that vaccines have a positive role against COVID-19. Majority of the study participants (329, 80.6 percent) concurred that lockdown restrictions help in control of the pandemic. About 60.3 percent (246) of respondents had less trust on government post this pandemic compared to pre-COVID-19 times. CONCLUSION: The public perception about reasons for second wave in India acknowledges both human and virus factors and highlights the importance of shared responsibility between citizens and government for controlling the pandemic.

Perceptions regarding second wave of coronavirus disease 2019 (COVID-19) pandemic among Indian adults: A cross-sectional study.

BACKGROUND AND AIMS: A massive surge in coronavirus disease 2019 (COVID-19) cases and deaths occurred in India during March-April 2021, and this was considered as second wave of the pandemic in the country. This study was conducted to find out the perceptions about second wave of the COVID-19 pandemic among Indian adults. METHODS: An online-survey-based cross-sectional study was conducted over 3 weeks from April 21, 2021 to May 11, 2021. Information regarding sociodemographic profile, perceptions about COVID-19 during second wave, perceptions and practices related to COVID-19 vaccination, COVID-19 appropriate behavior, and government's response to the pandemic was collected. Descriptive analysis was performed. RESULTS: A total of 408 study participants were included. Mean age of the study participants was 29.2 ± 10.4 years. Around 92.6 percent (378) of respondents agreed that COVID-19 in 2021 is different from 2020. Perceived reasons for increased severity and cases were change in virus characteristics; social, religious, and political gatherings; and complacent behavior by people. Three-fourth (311, 76.2 percent) of the study participants agreed that vaccines have a positive role against COVID-19. Majority of the study participants (329, 80.6 percent) concurred that lockdown restrictions help in control of the pandemic. About 60.3 percent (246) of respondents had less trust on government post this pandemic compared to pre-COVID-19 times. CONCLUSION: The public perception about reasons for second wave in India acknowledges both human and virus factors and highlights the importance of shared responsibility between citizens and government for controlling the pandemic.

Out-of-pocket expenditures and catastrophic expenditures on inpatient care among households of an urban village in Delhi.

Background: Out-of-pocket expenditure (OOPE) for inpatient care has been known to cause maximum impoverishment. It can have debilitating consequences for urban poor households. It is necessary to study inpatient care costs and the related factors among the households of an urban village to determine their vulnerability to catastrophic expenditure and to protect them from it. Objective: The study aimed to calculate the mean OOPE on inpatient care, and catastrophic health expenditure among households of an urban village in Delhi. Design: This was a cross-sectional study conducted over 18 months among urban village households of Delhi who have been residing for the last 1 year. Methods: A sample size of 188 was calculated based on another study, and households were selected using systematic random sampling. A pre-designed, pre-tested, semi-structured, and interviewer-administered questionnaire in Hindi was used to elicit and record relevant information. Data were recorded and coded, and analysis was done using licensed SPSS v.26 software. Tables were generated for relevant data, and cross-tables were used to assess statistical association with chi-square or Fisher exact tests, as required. A p-value of 0.05 was considered statistically significant. Results: The mean annual OOPE borne by a household on inpatient care was INR 6870.3 (SD ± 30,580.6), where 93.3% of OOPE was incurred while seeking treatment from public facilities. The OOPE on inpatient care had a statistically significant association with households having joint family, members from vulnerable population, and belonging to Delhi. Conclusion: The households of an urban village of Aliganj, Delhi, have high OOPE on inpatient care (60.6%) and catastrophic health expenditure (75.6%).

The Prevalence of Violence Against Resident Doctors and Its Subsequent Effects on Patient Management in a Tertiary Care Hospital in Delhi, India.

Introduction Workplace violence (WPV) is a significant problem for healthcare professionals across the world, regardless of whether they work in developed or developing countries. Studies have shown that in India, up to 75% of doctors have experienced some form of violence in the workplace. The purpose of the present study was to examine the extent of violence against doctors and its impact on patient management. Methodology This cross-sectional study was conducted in a tertiary care hospital in New Delhi in June 2022. A total of 326 resident doctors from six departments were selected using stratified random sampling. Data were collected using a semi-structured interview schedule and a pre-validated questionnaire. Statistical analysis was done using Stata 17, and ethical clearance was obtained from the Institute Ethical Committee. Result Workplace violence was prevalent among healthcare professionals, with 80.4% (95% confidence interval (CI): 75.6%-84.5%) experiencing verbal abuse and 21.7% (95% CI: 17.4%-84.5%) experiencing physical violence. Perceived delays in treatment and patient deaths were the most common causes of violence. Most participants were hesitant to report WPV due to time-consuming reporting processes and a lack of organisational support. WPV had a negative impact on doctors' mental and personal well-being, with 73.3% reporting its negative impact. WPV has led to a decrease in the provision of surgical and medical interventions. Conclusion The study findings suggest that a significant proportion of doctors in a tertiary care hospital in Delhi encounter some form of workplace violence. Despite the high incidence of WPV, reporting of these events remains low due to inadequate support and deficient reporting procedures within healthcare organisations. The negative impact of WPV is not limited to the physicians' psycho-social well-being but extends to their approach to patient care as well. Therefore, taking appropriate actions to prevent WPV is crucial for ensuring the safety and well-being of healthcare professionals and improving patient outcomes.

Willingness to Quit and Associated Factors Among Tobacco Users Attending Outpatient Departments of a Tertiary Care Hospital in Delhi, India.

Background: Tobacco use has become a modern-day epidemic which significantly impacts health, socioeconomic status, and environmental sustainability. The readiness to quit or stop using tobacco is a crucial first step in changing one's behavior. Hence, the current study sought to assess the prevalence of willingness to quit and associated factors among tobacco users. Methods: This study was conducted on 425 tobacco users selected using multi-stage random sampling from the outpatient departments (OPDs) of a tertiary care hospital in Delhi, India. A pre-designed, interviewer-administered questionnaire was used to elicit information. Logistic regression was performed to assess the effect of independent factors on the willingness to quit. Findings: The mean age of the study participants was 39.37 years (S.D.=±12.99). The majority of the participants were male (400, 94.1%), and 25 (6.9%) were female. Overall, the prevalence of willingness to quit in the current study was 70% among the study participants. The results of the multivariable analysis showed that those belonging to urban areas, tobacco users with a duration of≤10 years, and those who received advice from a doctor to quit had a significantly higher willingness to quit than their counterparts. However, age, gender, marital status, education, religion, age of initiation of tobacco use, and nicotine dependence were not found to have a statistically significant relationship with the willingness to quit tobacco products. Conclusion: Willingness to quit was high among the study participants. The data in this study suggested that belonging to urban areas, duration of tobacco use, and doctor's advice to quit are important factors which need to be considered when framing future tobacco cessation programs.

Satisfaction among patients seeking services at an urban health training center during the COVID-19 pandemic in South Delhi, India.

Background: The COVID-19 pandemic has posed challenges to the provision of routine health services. As we continue providing non-COVID services, it is essential that the community perceives them to be satisfactory and safe to ensure optimum uptake. The objective of the study was to determine the satisfaction and perceived safety among patients availing services at an urban health training center (UHTC) during the COVID-19 pandemic in South Delhi. Methods: UHTC, Aliganj caters to a population of over 6000, in an urbanized village of South Delhi. A pre-designed, semi-structured questionnaire incorporating the North Indian OPD Satisfaction Scale along with questions on sociodemographic details and perception of safety was used. Systematic random sampling was used to select the patients from the study population which included those above 18 years attending UHTC from November-December 2020. Exit interviews were done by a trained independent interviewer to reduce bias. Data were analyzed in SPSS using Chi-square and Fisher's Exact tests. Results: Out of 218 patients, 161 (73.7%) were satisfied, 174 (79.8%) felt safe to visit UHTC during the pandemic and 143 (65.6%) felt both satisfied and safe. Patients were dissatisfied with screening for COVID-19 (29.5%), amenities (47.1%), cleanliness (51.8%), and waiting and registration (62.9%). Conclusion: The majority of patients were satisfied and found the UHTC services safe. A large proportion of patients found location, doctor-patient interaction, and COVID-appropriate behavior at the center to be satisfactory, but there was scope to improve waiting and registration, cleanliness, and effectiveness of screening for COVID.

Risk factors and perceptions about coronavirus disease among tuberculosis patients in Delhi, India: A cross-sectional study.

BACKGROUND: Tuberculosis (TB) and Coronavirus disease (COVID-19) co-infection can increase the severity among affected patients. This study was conducted to study the burden, risk factors and perceptions of COVID-19 among TB patients. METHODS: This was a cross-sectional study conducted among TB patients at one of the Directly Observed Treatment Short Course (DOTS) centre of Urban Primary Health Centre (UPHC) of Delhi, India. Information regarding socio-demographic profile, TB disease profile, history of COVID-19 and perceptions about TB and COVID-19 co-infection was collected. Descriptive analysis was performed. RESULTS: A total of 107 study participants were enrolled. Twenty-two TB patients (20.6%) never got tested for COVID-19. Two TB patients out of 107 study participants had COVID-19 in past. Both were males in age group of 30-44 years, had drug sensitive TB and were having pre-existing co-morbidities. Transmission routes of TB and COVID-19 were not known to about half of the study participants. Approximately 42.1% study participants perceived TB patients to be at higher risk of COVID-19 and majority study participants agreed that they should follow COVID-19 appropriate behaviour. However, helpline numbers for COVID-19 were not known to most of the study participants. CONCLUSION: One-fifth of TB patients were never tested for COVID-19 inspite of the bi-directional screening guidelines for TB patients. Guidelines need to be practised stringently to find out true burden of co-infection. As the two TB patients who had COVID-19 in past already had other pre-existing co-morbidities as risk factors, whether TB enhances the risk for coronavirus infection independently needs further research.

Domestic Violence and Coping Strategies Among Married Adults During Lockdown Due to Coronavirus Disease (COVID-19) Pandemic in India: A Cross-Sectional Study.

BACKGROUND: There has been a reported increase in cases of domestic violence during the coronavirus disease 2019 (COVID-19) pandemic; however, systematic research data are still unavailable. This study was conducted to find out domestic violence prevalence and coping strategies among married adults during lockdown due to COVID-19 in India. METHODS: A cross-sectional study was conducted among married men and women in the month of April 2020. Data regarding socio-demographic profile, domestic violence, and coping strategies used during lockdown were collected thorough Google Forms. A total of 97.9% of the forms were completely filled by the respondents. A descriptive analysis was done. RESULTS: Of 94 study participants, approximately 7.4% (n = 7) had faced domestic violence during lockdown. Of these 7 participants, approximately 85.7% (n = 6) reported increased frequency of domestic violence during lockdown. Approximately half of the victims chose to ignore it (57.1%; n = 4) or used yoga/meditation (42.9%; n = 3) to cope. CONCLUSIONS: With approximately 7.4% study participants facing domestic violence during lockdown, it is necessary to study its detailed epidemiology in pandemics so that interventions like helpline numbers, screening of patients during tele-consultation, etc., which can be delivered even during lockdown with the help of health-care and frontline workers could be devised to address this problem.

Contraceptive use and its consistency among eligible couples in a peri-urban area of Delhi, India: A secondary data analysis.

Background: Contraceptive use is important to stabilize population growth by reducing the net reproduction rate. The effectiveness of a contraceptive method is decided mainly by its consistent and correct use. Methods: A record-based study was undertaken with the aim to study the contraceptive usage and its consistency among eligible couples in a peri-urban area of Delhi, India. Data of 946 eligible couples were analysed. Descriptive analysis was performed and odds ratios were calculated. Results: Mean age of females was found to be 30.3 ± 5.5 years and males was 33.5 ± 6.4 years. About 56.2% (532) eligible couples have used contraceptive at least once in the past 6 months and 54.7% (517) used them consistently for 6 months of the study period. There were 12.3 pregnancies per 100 non-users, 2.2 pregnancies per 100 ever users and 1.9 per 100 consistent users (1.7 for condoms and 0.2 for OCPs). Couples having two or more children, having two or more male children and with less than five years of age difference between husband and wife were found to have significantly higher odds of ever and consistent contraceptive use compared to other eligible couples (P < 0.05). Conclusion: More than half of the eligible couples were found to be using contraceptives ever in past 6 months, and 54.7% of eligible couples were using them consistently. There is a need to explore social, cultural factors, awareness levels associated with the ever and consistent use of contraceptives for improving overall couple protection rate and enhancing the consistency in usage.

Enrolment under of Nikshay Poshan Yojana among tuberculosis patients in a tertiary care hospital of Delhi.

To mitigate malnutrition among tuberculosis burden, Government of India launched Nikshay Poshan Yojana in 2018, providing incentive of INR500 per month to each enrolled patient. Our study tried to find out the status of the scheme and its target benefits amongst the beneficiaries in a tertiary care hospital in Delhi, and also the facilitating factors and barriers towards enrolment, and their knowledge, attitude and practice towards nutrition in TB. METHODS: A cross-sectional study was undertaken at a tertiary care hospital involving a calculated sample of 188 patients. The subjects were interviewed on a pre-designed, semi-structured, validated questionnaire and data was analysed on SPSS v.21. RESULTS: Enrolment rate for the scheme was 81.4%, of which only 10% of the participants received any benefit. Of the 35 participants who were not enrolled or were not aware of their enrolment status, 22 were interested in enrolment. The reason for non-enrolment by the 21 participants who were not enrolled were lack of awareness, lack of time or lack of a bank account. CONCLUSION: The study found that most of the patients attending DOTS treatment were enrolled under the scheme, but 90% were not receiving any incentive promised under it.

Prevalence of ear morbidities among school children in Delhi, India: a cross-sectional study.

OBJECTIVES: Hearing impairment and ear diseases are among the world's leading causes of years lived with disability. Ear disorders are a major health problem in developing countries like India. The present research had been planned to screen the primary school children for ear morbidity and to study the various factors associated with ear morbidities so that corrective intervention can be initiated at the earliest. METHODS: A cross-sectional study was conducted among all primary school children of two schools in Aliganj, Delhi. Complete enumeration of all the school children of these two primary schools was planned for this study. Modified version of World Health Organization's (WHO's) "Ten Question Plus" screening instrument was used, followed by Otoscopy examination, in all children for confirmation of ear disease, if any. Descriptive data analysis was performed. RESULTS: Out of the total 430 study subjects, ear morbidities were found in 198 (46.0%) study participants. Presence of ear morbidity showed significant association with overcrowding, absence of a separate kitchen, passive smoking, feeding young child in lying down position, upper respiratory tract infection (URI)˃3 episodes/year and allergy (p<0.05). CONCLUSIONS: This study has highlighted the need to detect ear diseases at the earliest thereby avoiding complications. The health examination in the schools must include screening students for ear diseases to reduce the burden of hearing disability. Inputs from the study may be used for effective prioritization and planning for prevention and management of ear diseases at the primary school level.

Effect of Information, Education, and Communication activity on health literacy of cardiovascular diseases among school-going adolescents in Delhi.

BACKGROUND: Heart attack and stroke account for >80% of deaths due to cardio-vascular diseases (CVDs) in India. Adolescents are the most susceptible group to adopt risky behaviors causing CVDs such as use of tobacco and alcohol, sedentary lifestyle, and unhealthy diet. This study was conducted to assess the health literacy of CVDs such as heart attack and stroke among school-going adolescents and change in health literacy after different information, education, and communication (IEC) activities. MATERIALS AND METHODS: It was a school-based interventional study conducted in two schools among students of classes 6, 7, and 8. The educational interventions were done in the form of pamphlets, posters, and lectures on heart attack and stroke. The postintervention data were collected 2 weeks after the first intervention and 3 months after the last intervention. RESULTS: There were a higher proportion of students with satisfactory level of knowledge of heart attack and stroke both at 2 weeks and 3 months after the interventions in both the schools, and the results were statistically significant (P < 0.05). CONCLUSION: The health literacy regarding CVDs has improved when compared to baseline after IEC activities among school-going adolescents.

Integrated counseling and HIV testing centers of Delhi: An evaluation.

BACKGROUND: HIV counseling and testing services are a key entry point in prevention of HIV infection, treatment, and care of people with HIV. Evaluation of counseling, testing, and referral services help to increase the effectiveness, efficiency, and quality of services delivered by providers by improving any deficiencies in availability, accessibility, and acceptability of testing and counseling services. The objective of this study was to evaluate the integrated counseling and testing centers (ICTC) in New Delhi. MATERIALS AND METHODS: The evaluation study was conducted among ICTCs during 2014-2015. Twenty ICTCs of New Delhi were selected on the basis of population proportion to the size of clients catered. The study tool was pretested structured tool for evaluating HIV voluntary counseling and testing (VCT). The evaluation tool consists of an assessment of components including the availability of infrastructure, laboratory services, referral services, and staff availability. Counseling sessions were also observed for assessing content and quality. Means and proportions were calculated. RESULTS: Twelve (60%) ICTCs had dedicated counseling rooms ensuring privacy for the clients. Waiting space was reported to be adequate in 16 (80%) ICTCs. Space within counseling room was observed to be adequate in 8 (40%) ICTCs. Counselors of both sexes were present in 12 (60%) ICTCs. Both external and internal quality assurance was observed in all ICTCs. Standard operating procedures were followed in 15 (75%) ICTCs. On observation of the counseling sessions, it was found that 67.4% of male counselors and 67.2% of female counselors addressed all the issues of content of counseling. CONCLUSION: ICTCs lack waiting area and adequate space in counseling room and required staff personnel. Records maintenance and laboratory quality control maintained by ICTCs were found to be adequate. The counseling rooms lack privacy that may compromise the confidentiality of clients. Few components of counseling need improvement.

Barriers to disclosure of child maltreatment among school-going adolescent girls of a semi-urban area of Delhi, India.

The study examines the barriers to disclosure of child maltreatment among adolescent girls. Stratified random sampling was done among classes 7 to 12 of government girls' schools of a semi-urban area of Delhi, and a total of 1060 adolescent girls participated. Almost 33% of victims of physical abuse, 50% of sexual abuse, 30% of emotional abuse, and 40% of neglect did not disclose their experiences to any support group. The most frequent confidante, in almost two-thirds of cases of all forms of abuse was a friend of the study participant. Among the study participants who did not disclose abuse, the most common reason for nondisclosure was a feeling of shame or embarrassment (40%-80% for physical abuse, 55%-80% for sexual abuse, and 55% for emotional abuse). Among the study participants who did not disclose neglect, 70% reported that they did not do so because they had no expectation of help from anyone.

Seasonality of tuberculosis in delhi, India: a time series analysis.

Background. It is highly cost effective to detect a seasonal trend in tuberculosis in order to optimize disease control and intervention. Although seasonal variation of tuberculosis has been reported from different parts of the world, no definite and consistent pattern has been observed. Therefore, the study was designed to find the seasonal variation of tuberculosis in Delhi, India. Methods. Retrospective record based study was undertaken in a Directly Observed Treatment Short course (DOTS) centre located in the south district of Delhi. Six-year data from January 2007 to December 2012 was analyzed. Expert modeler of SPSS ver. 21 software was used to fit the best suitable model for the time series data. Results. Autocorrelation function (ACF) and partial autocorrelation function (PACF) at lag 12 show significant peak suggesting seasonal component of the TB series. Seasonal adjusted factor (SAF) showed peak seasonal variation from March to May. Univariate model by expert modeler in the SPSS showed that Winter's multiplicative model could best predict the time series data with 69.8% variability. The forecast shows declining trend with seasonality. Conclusion. A seasonal pattern and declining trend with variable amplitudes of fluctuation were observed in the incidence of tuberculosis.

View point: How to make women familiar with their breasts?

There is a consensus among researchers about the fact that women should be familiar with their breasts but there is a lot of argument as to how to make them aware of what is normal for them. For over decades breast self examination (BSE) was advocated for the same but as an outcome of work conducted by researchers in various countires a controversy has been raised in the West. In a country like India, where breast cancer screening is not popular and limited resources are available we should question what would be the best strategy to make women familiar with their breasts to facilitate best use of BSE.

Effect of a training programme on knowledge of nurses from a missionary hospital in India regarding breast cancer and its screening.

A cross-sectional study was conducted among nursing staff of a missionary hospital of Delhi in June 2009. All the nurses were invited to participate in the training programme on breast cancer and techniques of breast self examination (BSE). A questionnaire was administered to all 259 participants seeking information on their level of awareness regarding breast cancer and relevant screening guidelines. With the help of 5 training workshops all the nurses were imparted training regarding the most appropriate technique of doing breast self exams. The mean age of the participants was 35.8 years. Out of a total of 259 nursing staff members 77.2% correctly answered all the 10 questions regarding high risk factors for breast cancer and after the training programme this increased to 100% (p<0.05). Only 65.2% of the participants gave correct responses to all the 8 questions regarding correct technique of performing a BSE, which after the training programme increased to 99.3% (p<0.05). At the baseline only 56.8% knew all the three screening methods correctly and after the intervention 98.7% could correctly mark the responses regarding screening (p<0.05). The actual practice of following the screening guidelines amongst the nursing staff was poor. Only 26 (10.03%) had ever done a BSE, none performed it monthly, 58 (22.4%) had ever gone themselves for a CBE and 18 (6. 94%) had ever undergone mammography.