Perception and Acceptance of the Newly Introduced COVID-19 Precaution (THIRD) Vaccination Dose among Health Workers at an Indian Medical College.

INTRODUCTION: India has run a nationwide vaccination campaign against COVID-19, which has recently introduced a precaution (third) dose for health workers. This study assessed the perception and attitude of health workers toward the Indian vaccination campaign against COVID-19, with an emphasis on this major change. MATERIALS AND METHODS: A printed questionnaire was distributed among health-care workers at the Medical College of West Bengal. The completed forms were analyzed. RESULTS: Most of the participants were doctors (83.7%). Although all had received two doses of vaccine before, 44.4% were unwilling to be vaccinated with the third dose in the present scenario. The majority (63.8%) of the patients were concerned about side effects. The emergence of new COVID strains (65.6%) was viewed as a threat to the effectiveness of the vaccines. Participants with higher age, comorbidities, and those with the perception that the third dose was being introduced appropriately and would be effective against newer strains of the vaccine tended to be more willing to get vaccinated with the precaution dose compared to their counterparts. CONCLUSION: A dilemma regarding the acceptance of precaution doses was noted among health workers. This warrants the availability of more comprehensive information to increase acceptance of these vaccines.

Evaluation of the rashtriya bal swasthya karyakram (RBSK): A national children healthcare program in a health district of West Bengal, India.

Background: The Rashtriya Bal Swasthya Karyakram (RBSK) was launched in 2013 to screen and manage birth defects, deficiencies, diseases, and developmental delays including disabilities in Indian children, with the help of designated mobile health teams and grassroot workers across the country. Objectives: Performance of the RBSK program in three selected blocks of a health district of a large Indian state (West Bengal) was assessed. Methods: The performance assessment was based on input, process, and output performances, using checklists based on RBSK operational guidelines. Results: While some essential evaluation tools were available in required numbers at the block level, many were unavailable. There were deficiencies in the number of health staff appointed. Although most screening camps were conducted as per microplan, some were not. Anthropometric measurements were not done in some camps; Information, Education, and Communication (IEC) materials were not used adequately. Issues with fund management were also noted. The intervention rate at higher centers (District Early Intervention Centre) was low with regard to the children referred for management. Involvement of grassroot workers such as ASHA was also found to be lacking. Conclusion: Frequent orientation training of medical officers and staff is needed along with the efforts to strengthen the referral system and the patient tracking system. Sensitizing the children and their guardians regarding the importance of the relevant health issues is also needed with the help of the proper implementation of IEC services.

Realistic personal exposure assessment of air pollutants and health outcomes - A cross-sectional study among Kolkata slum dwellers.

Background: Rapid, unplanned, and unsustainable patterns of urban development can result in many emerging environmental and health hazards. One of the important public health problems of urban environment is regular exposure to dust and pollutants and consequence of such exposure in the form of changes in the pulmonary function. Being the immediate environment, indoor pollution poses a higher risk to human health than the ambient environment. Realistic personal exposure assessment gives the actual idea about the exposure status. Objectives: This study determined the household principal environmental exposures (Dust, SO2, NO2, and total volatile organic compound) among urban slum dwellers and assessment of the respiratory function to determine any possible relationship between those exposures and outcomes. The study also described the knowledge, attitude, and practice of these urban slum people regarding air pollution and its effect. Methods: A cross-sectional study was carried out among 442 urban slum people residing in the slums of the Kolkata Municipal area. Household environmental exposures were collected by standardized methods and outcome was observed by conducting a pulmonary function test. Finally, knowledge, attitude, and practice regarding air pollution were carried out with the help of a questionnaire-based survey. Results and Discussion: Almost all the pollutants exposure was associated with impairment of lung function. Younger age and female gender were statistically associated protective factors for the development of any lung disease. Those who had an overall good awareness regarding the means and effects of air pollution were found to be protected from developing lung disease. Using exhaust ventilation, relocation to inner side of slums, using personal protective measures, and adequate pollution awareness can help the slum citizens to overcome the problem.

Domestic migrant workers in India returning to their homes: emerging socioeconomic and health challenges during the COVID-19 pandemic.

Domestic migrant workers were stranded far from home when India declared nationwide lockdown to combat the pandemic of novel coronavirus (COVID-19). A large number of these workers were left with no economic support, no food and in many cases nowhere to live. The pandemic posed a serious health threat to these people, and the socioeconomic insecurity pushed them towards the edge of sustainability. Many of the migrants began walking home and accepted an uncertain fate if they could not return back home. The Government of India initiated efforts to provide transport support with special train services from the beginning of May 2020. While the migrants have started to return to their villages and towns, the states are facing the challenges of preventing the spread of COVID-19. The point-of-entry screening, quarantine and isolation facilities have increased substantially in capacity, although the quality of care remains a point of concern. Back at their homes, the migrants are enduring stigma, discrimination and poor social security. In order to avert the brewing humanitarian crisis, empathetic administration combined with political will is a must. Prudent, evidence-based decision-making in the economic and health sectors is also necessary.

Elders suffering recurrent injurious falls: causal analysis from a rural tribal community in the eastern part of India.

INTRODUCTION: Falls among the elderly are prevalent but preventable. There is a knowledge gap regarding the factors causing recurrent injurious falls among the elderly, especially in tribal areas. The aim of the present study was to find out the incidence of injurious falls among elderly participants and measure the effect of selected predictors on recurrent injurious falls. METHODS: A longitudinal observational study was conducted among 536 community-dwelling elderly individuals residing in 16 tribal dominated villages under two community development blocks of North 24-Parganas, West Bengal, India from December 2017 to January 2019. Participants were followed up for 1 year. The predictors of recurrent injurious falls were assessed through Prentice, Williams and Peterson Gap Time hazard model. RESULTS: The mean age of the participants at the baseline was 69.16 (±2.95) years. The majority were male (55.60%), with sedentary physical activity (49.63%). At baseline, history of injurious fall in the preceding 1 year was present in 37.69% of participants. At baseline, 53.17% had malnutrition and 54.29% were dependent on caregivers for activities of daily living. During the follow-up period there were 153 episodes of injurious falls. The incidence of fall was 29.88 episodes per 100 person-years. History of fall had a hazard ratio of 2.33 (95% confidence interval (CI): 1.01-5.38). The hazard ratios for malnutrition, impaired balance and faster walking speed respectively were 1.20 (95%CI: 1.01-3.60), 5.96 (95%CI: 3.52-6.34) and 3.23 (95%CI: 2.12-5.26), and were statistically significant. CONCLUSION: Physical status indicators such as nutritional status, balance and walking speed appeared to be key factors contributing to recurrent injurious falls. Proper nutrition, and regular check-up and rehabilitative measures, are needed to reduce recurrent falls.

Psychometric validation of geriatric depression scale - Short form among bengali-speaking elderly from a rural area of West Bengal: Application of item response theory.

BACKGROUND: The geriatric depression scale - short form (GDS-SF) considered an important preliminary screening tool, requires translation in different regional languages and validation, to become of utmost use in Indian context especially in the field level. OBJECTIVE: The current study aimed to evaluate the psychometric validity of the GDS-SF translated into Bengali among rural elderly population. METHODS: The 15-item GDS-SF translated to Bengali language was administered to 206 Bengali speaking geriatrics selected maintaining predecided inclusion and exclusion criteria from villages under a rural block in West Bengal. Latent trait modelling was used to evaluate the psychometric properties of this translated tool. Differential item functioning (DIF) was assessed to measure invariance. RESULTS: The mean age of the participants was 68.77 years (standard deviation 6.81 years). Majority being female (57.77%), Hindu (87.38%), from a joint family background (90.78%). The highest discrimination was observed with item 8 (coefficient 3.682, P < 0.001) followed by item 14 (coefficient 3.020, P < 0.001). Question 2 had least coefficient for difficulty (-1.344, P = 0.013) while item 15 had highest (0.775, P = 0.001). The questionnaire provided maximum information (discrimination) around mean value of latent trait. The total cutoff score of 5 was related nearly to mean latent trait (-0.111). Items 10 and 13 showed consistent DIF across different demographic groups. CONCLUSION: Psychometric properties of GDS-SF (Bengali) established overall construct and content validity of the tool in this community-based study. Despite some degree of DIF the tool can be used as a preliminary screening method in rural community.

Effect of light pollution on self-reported sleep quality and its components: Comparative assessment among healthy adult populations in a rural and an Urban area of West Bengal, India.

BACKGROUND: Light pollution is inappropriate or excessive use of artificial light. Nighttime sky radiance is an effective measure to study its effects on individual sleep quality. OBJECTIVES: The study is aimed to measure the effect of light pollution on the sleep quality and compare among people residing in selected rural and urban areas of West Bengal, India. METHODS: A comparative cross-sectional study was conducted during September-October 2018 in 10 villages of Barasat II block and 10 wards of Kolkata Municipal Corporation. Two hundred and sixty-three participants from urban and 249 participants from rural areas were selected through multi-stage sampling. Data regarding sleep quality and other selected factors were geotagged along with the radiance data. Multi-level linear regression models were built. RESULTS: The mean age of the participants from rural and urban areas were respectively 37.65 (±10.77) years and 38.10 (±11.02) years. Gender-wise the participants were distributed almost evenly in urban and rural areas. Among the urban and rural population, the observed mean global Pittsburgh Sleep Quality Index scores were 12.63 (±3.04) and 9.23 (±2.27), respectively. Poorer sleep quality was observed to be statistically significant with increasing level of exposure. Multi-level models show that, at an exposure of >40.0 nW/cm2/sr the adjusted coefficient was 11.52 (95% confidence interval [CI]: 9.65, 13.40) in the overall model and 12.84 (95% CI: 12.31, 13.37) for urban participants. CONCLUSION: The disturbance in sleep is associated with higher levels of night-time radiance of the sky strongly observed among the urban population.

Effectiveness of preventive measures against COVID-19: A systematic review of In Silico modeling studies in indian context.

BACKGROUND: In the absence of any approved treatment or vaccine against novel Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) infection, Non-Pharmaceutical Interventions (NPIs) are the cornerstone to prevent the disease, especially in a populous country like India. OBJECTIVES: To understand the effectiveness of NPIs reported in the contemporary literatures describing prediction models for prevention of the ongoing pandemic of SARS-CoV-2 specifically in Indian population. METHODS: Original research articles in English obtained through keyword search in PubMed, WHO Global Database for COVID19, and pre-print servers were included in the review. Thematic synthesis of extracted data from articles were done. RESULTS: Twenty-four articles were found eligible for the review - four published articles and twenty pre-print articles. Compartmental model was found to be the most commonly used mathematical model; along with exponential, time varying, neural network and cluster kinetic models. Social distancing, specifically lockdown, was the most commonly modelled intervention strategy. Additionally, contact tracing using smartphone application, international travel restriction, increasing hospital/ICU beds, changes in testing strategy were also dealt with. Social distancing along with increasing testing seemed to be effective in delaying the peak of the epidemic and reducing the peak prevalence. CONCLUSION: Although there is mathematical rationality behind implementation of social distancing measures including lockdown, this study also emphasised the importance of other associated measures like increasing tests and increasing the number of hospital and ICU beds. The later components are particularly important during the social mixing period to be observed after lifting of lockdown.

Effect of dietary habit and physical activity on overnutrition of schoolgoing adolescents: A longitudinal assessment in a rural block of West Bengal.

BACKGROUND: Overweight among adolescents has high prevalence on the eastern part of India, especially West Bengal. OBJECTIVES: The current study was conducted to estimate and compare the effects of different dietary habits and habits related to physical activity in the development of overweight and obesity among rural schoolgoing adolescents. METHODS: A prospective repeated measures study was conducted on 645 schoolgoing adolescents from selected rural government-aided schools from June 2017 to December 2017. Dietary habits of the students and physical activity-related factors were the major predictors. Adjusting for the age and sex of the participants, effect of these factors on the development of overweight and obesity was analyzed by generalized estimating equations for 2 repeated measures, taken 6 months apart. RESULTS: Most of the respondents were aged ≥16 years (56.90%), female (52.87%), Hindu (76.74%), from a nuclear family (76.74%), and studying in the secondary level (57.68%). There was a stark rise in proportion of overweight from 0.93% to 7.44%. The prevalence of unhealthy dietary habits was 68.99% at the baseline, and 66.82% on follow-up. The overall prevalence of inadequate physical activity increased to 48.68% from 47.91%. Female gender and older age group were at higher risk of being overweight or obesity. Overall fast food showed highest risk (3.04, 95% confidence interval [CI]: 1.86-4.95), while among the boys, it was with less vegetable consumption (4.64, 95% CI: 1.84-11.69). CONCLUSIONS: Strong evidence was generated of dietary practices being more rigidly related to overweight among the adolescents. Healthy dietary practices coupled with physical activity should be promoted to mitigate the risk of obesity.

Risk behaviors contributing to recent serious unintentional injuries among school-going adolescent boys in Kolkata: Application of zero-inflated count model.

BACKGROUND: Unintentional injuries have become a major noncommunicable disease burden, especially among the adolescents. OBJECTIVE: The current study was conducted to estimate the effect of different aspects of daily activities of adolescence for sustaining serious unintentional injuries in the past 1 year. METHODS: A cross-sectional survey with multistage sampling with validated pretested questionnaire was done among the school-going adolescent boys in Kolkata. Poisson regression was used to model the counts of serious injuries. To account for the excess of zero in the outcome, zero-inflated Poisson regression was performed. RESULTS: Among the participants, 73.5% did not report any serious unintentional injury sustained in the past 1 year, 11.9% reported to have sustained serious unintentional injury once in the past 1 year, and rest had more than one count. Statistically significant higher chance of sustaining an episode of injury was found among frequent users of motorbike (incidence rate ratio [IRR]: 1.183), frequently walking on roads (IRR: 1.910), and frequently crossing major roads on bicycle (IRR: 2.181) were observed. A statistically significant protective rate ratio was also obtained for those frequently obeying traffic signals while crossing roads (IRR: 0.493) and frequent users of bicycles (IRR: 0.384). Significantly lower rate ratio for sustaining a serious injury was observed with frequently getting into fight at home (IRR: 0.343) and getting beaten up at school (IRR: 0.595). CONCLUSIONS: The study revealed traveling in a car and obeying traffic rules were protective from sustaining serious injury. However, walking and participation in sports appeared to be risky, especially for sustaining another episode of serious injury.

Classroom intervention to improve behavioral intention toward regular physical activity among adolescents.

Background: During adolescence, a critical phase in human life, the groundwork for a healthful future is established. Physical inactivity poses a significant risk factor for non-communicable diseases (NCDs) and related mortality worldwide. To assess adolescents' behavioral intentions regarding regular physical activity, the Theory of Planned Behavior (TPB) examines 'Attitude,' 'Subjective norm,' and 'Perceived behavioral control.' Utilizing TPB, this study focuses on evaluating the impact of a school-based health promotion intervention on behavioral intentions toward physical activity among urban adolescents in West Bengal, India. Methods: A school-based nonrandomized controlled interventional study with parallel group design was conducted among adolescents aged between 12 and 16 years. Behavioral intention towards performing regular physical activity was determined with the measurements of the constructs from the TPB. Cluster analysis was conducted using measurements from both the intervention and control groups. Participants with higher mean scores in the constructs were classified as intenders, while the rest were considered non-intenders. The intervention's impact was evaluated by calculating the Relative Risk (RR) through a generalized linear model with robust standard error estimates, to ascertain the probability of belonging to the higher intention cluster. Result: Following the intervention, construct-wise scores improved significantly, particularly the perceived behavioral control mean score in the intervention group. The Relative Risk (RR) of becoming an intender for regular physical activity in the intervention group was 1.24 (95% CI: 1.04-1.48) when compared to the control group. Conclusion: Health Promoting Schools has been recognized as a strategic and cost-effective vehicle to promote positive development and healthful living, and the current evidence suggests they can effectively reduce the emergence of significant NCD risk factor like physical inactivity. Schools must establish strong partnerships with diverse stakeholders to address barriers beyond the school environment and enhance their control over critical issues.

School-based intervention on behavioral intention of adolescents regarding healthy diet in India.

Introduction: Adolescence is a distinctive period of life when intense physical, psychological, and cognitive development occurs. A healthy diet helps prevent various forms of malnutrition and non-communicable diseases (NCDs) like diabetes, heart disease, stroke, and cancer. The current study aimed to assess the change in behavioral intentions (measured based on the TPB) toward healthy dietary practices through health promotion intervention among adolescents studying in selected schools in an urban area of West Bengal, India. Methods: The current study was a non-randomized controlled interventional study conducted among adolescents in either seventh, eighth, ninth, or tenth grades and aged between 12 and 16 years. Two-step cluster analysis with maximum likelihood estimation identified the intenders of a healthy diet. The intervention effect was measured using Relative Risk (RR) for being in the higher intention cluster through Generalized Linear Model (GLM) with a log-linear link under Poisson distribution assumptions and robust standard errors. A P-value of 0.05 or lesser was considered statistically significant. Results: There was no statistically significant difference in the mean score of "Attitude" in both groups. The mean score of "Subjective Norm" among the intervention group increased after intervention, and the difference was statistically significant. The mean score of "Perceived behavioral control" in the intervention group increased after the intervention, but the difference was statistically not significant. The intervention group's post-intervention proportion of intenders increased, and the difference was statistically significant. The relative risk of becoming an intender for healthy diet consumption in the Intervention group compared to the Control group was 2.07 (1.44-2.97). Conclusions: The intervention package effectively brought about a positive change in behavioral intention toward healthy dietary practices among adolescents. Model-based and construct-oriented intervention packages can be adopted in school-setting to promote behavioral intention toward a healthy diet.

Addiction habits in a rural cohort of injection drug users and effects on serum lipid profile: Analysis of a repeated measures study from an eastern state of India.

Background Injecting drug use (IDU) is associated with several cardiometabolic risks. We aimed to measure the independent effects of IDU behaviour and related factors on serum lipid profile among people who inject drugs (PWIDs). Methods We did a longitudinal study with six follow-up measurements at an interval of 2 months among 104 PWIDs from 11 selected hotspots under two blocks in West Bengal, India. Generalized estimating equations with robust standard errors analysed the effect of addiction habits on lipid profile parameters. Results The mean (SD) age of the participants was 27.6 (5.24) years, 36.5% married and 44.3% were unemployed at the time of recruitment. At the baseline, the mean (SD) body mass index (BMI) and fasting blood sugar (FBS) were 20.0 (1.82) kg/m2 and 112.0 (15.90) mg/dl, respectively. The mean duration of drug use was 2.5 (1.20) years. While 62.5% had normal triglyceride (TG), 14.4% had high total cholesterol (TC) and 69.2% had dyslipidaemia at the baseline. Adjusted for age, BMI, FBS and other addiction-related variables, models showed that longer duration of drug use (>3 years) resulted in higher levels of TG, higher TC-to-high-density lipoprotein ratio and dyslipidaemia. Tobacco use and high FBS level were also risk factors for dyslipidaemia. Conclusions Higher duration of IDU, tobacco use and higher FBS were associated with deranged lipid profile among PWIDs.

Home-Isolation Care in Newly COVID-19-Positive Elderly Patients: A Caregiver-Centric Explanatory Framework.

Objectives: This community-based study aimed to identify the effect of different behavioral factors of family caregivers on the decision for home-isolation-based treatment of a new COVID-19-diagnosed elderly individual. It also explored the facilitators and barriers contributing to the decision-making process. Methods: A mixed-methods design was adopted to study the role of behavioral constructs such as risk tolerance, risk aversion, regret aversion, loss aversion, self-efficacy, and risk perception in healthcare-seeking decisions. By integrating the findings from the quantitative and qualitative parts, a framework was developed. Results: Self-efficacy, risk perception, and risk tolerance related to different issues were crucial factors behind the healthcare decision. However, regarding the various issues under consideration, risk perception followed by risk tolerance were the significant predictors for decision-making. Conclusion: To enhance appropriateness and equity in emergency healthcare-seeking, interventions should target risk tolerance and risk perception, taking into account the awareness levels of caregivers and the target population's risk and regret aversion. Such integrated approaches can improve the quality of care for elderly patients in home-based settings.

Perceived behavioral control regarding regular physical activity and healthy diet: An observational study among school-going adolescents in an urban area of West Bengal, India.

BACKGROUND: Healthy children are the foundation for a healthy and developing nation. Perceived behavioral control (PBC), comprising control belief and perceived power, is a person's perception of the ease or difficulty of performing the behavior of interest. For facilitating regular physical activity and regular healthy dietary practices among the adolescents, PBC is an important construct to develop and implement appropriate interventions. The aim is to assess PBC to perform regular physical activity and regular healthy dietary practices and measure their statistical relationship among the school-going adolescents in an urban area in West Bengal. MATERIALS AND METHODS: A school-based cross-sectional study was conducted among 251 adolescents aged 12-16 years after taking consent and assent for participation in the study. Data were collected with self-administered questionnaire on sociodemographic variables and the two domains of PBC, i.e., control beliefs and perceived power, related to regular physical activity and regular healthy dietary practices. Each PBC total score was calculated by multiplying control belief score and perceived power score for each respondent. Partial correlation coefficient was calculated between regular healthy dietary practices and regular physical activity. RESULTS: Among the total 251 responses analyzed, 34.7% and 27.5% students belonged to age group 14 and 15, respectively. It was observed that the mean (± standard deviation) score of PBC regarding regular healthy dietary practices was 100.7 (±27.7) and for regular physical activity was 106.0 (±21.4). The correlation between PBC of regular healthy dietary practices and regular physical activity was 0.421 and was statistically significant. CONCLUSION: In case PBC score over any behavior is higher, behavioral intention and ultimately chances of performing that particular behavior increases. Designing appropriate school-based health promotion strategies can lead to healthier children fostering regular healthy dietary practices and regular physical activity in their homes and communities.

Cumulative Noise Exposure and Perceived Effects: A Comparative Study Among Different Occupational Groups in Kolkata.

Background: Adverse short-term and long-term health effects following a high level of noise have been established. The current study aims to find the relationship of these effects with an environment-specific level of noise exposure. Materials and Methods: A comparative cross-sectional study was conducted among 50 auto-rickshaw drivers and 51 age-matched service-sector employees. The peak average noise exposure in decibels (dB) was measured. The duration of exposure and response regarding perceptions following noise exposure was assessed through a pre-designed pre-tested semi-structured questionnaire. Results: The mean age of the participants was 42.24 (±13.72) years. Among the auto-rickshaw drivers, 82% perceived stress, 64% had hearing difficulty, and 74% complained of lack of sleep following exposure to a high level of noise. However, the perceptions were comparable among the comparison group and the differences were not statistically significant. The mean average peak level of noise exposure among drivers and their comparison group was 91.64 (±7.37) dB and 91.98 (± 8.06) dB, respectively, but were not different statistically. Around 52.94% of the service-sector respondents and 48% of the drivers were exposed to the lower cumulative noise levels. Those having a higher level of cumulative noise exposure, had a higher odds of feeling irritated (Odds ratio [OR]: 2.182, 95% confidence interval [CI]: 0.845-5.636), feeling stressed (OR: 5.805, 95% CI: 1.552-21.708), having palpitation (OR: 3.694, 95% CI: 1.264-10.793), and lack of sleep (OR: 3.020, 95% CI: 1.006-9.066). Conclusion: Stress and lack of sleep were the most important perceived effects of noise exposure. The exposures to the higher cumulative noise level in specified groups were more important in relation to quantifying perceived symptoms than the average peak noise level.

Changing patterns of household transmission of tuberculosis in an eastern state of India: The impact of COVID19 pandemic.

BACKGROUND: The COVID-19 Pandemic has affected many components of the Tuberculosis (TB) control program. Due to lockdown and restrictions, people, including TB patients, might have spent more time in the household. There might be an increased TB transmission among the household contacts (HHC). The current study was conducted to measure the household transmission of TB and also find out the relationship with several clinico-social factors. METHODS: Contact tracing data of West Bengal, India, was extracted from Nikshay portal of Central TB Division, Government of India. The anonymized data was divided into two parts, firstly before the lockdown initiation in India and secondly during the lockdown. A modified Poisson regression model was developed to determine the statistical association between clinico-social variables and the pandemic with household-level secondary TB cases. RESULTS: There was a 30% reduction in daily TB case notification, but the proportion of HHC screened was 4% higher during the pandemic than the pre-pandemic period. The secondary attack rate of household TB disease transmission was 34% lower during the pandemic period. Index TB patients aged under ten years, microbiologically positive, Drug-Resistant TB, having three or more HHCs, treatment delay more than seven days, notified from the private sector, and diagnosis during the pre-pandemic period was found to be independently associated with a higher risk of having a secondary TB case at household. CONCLUSION: The risk of household TB transmission was significantly lower during the pandemic period compared to the pre-pandemic period, which may be due to better infection prevention and control practices.

Contributing factors of willingness and hesitancy regarding acceptance of COVID-19 vaccine in primary care settings: A qualitative study in an eastern state of India.

BACKGROUND: For any effective vaccination strategy, the willingness of the beneficiaries and its contributing factors are important. This study was conducted among the health-care workers (HCWs) and community members to find the perceptions regarding the COVID-19 vaccine and understand the influencers and the barriers of vaccine acceptance. MATERIALS AND METHODS: A qualitative study was conducted from October 2020 to December 2020 in two primary care settings in an urban area. Eighteen in-depth interviews (IDIs) after taking consent were conducted with the help of IDI guide developed and validated beforehand by the experts. IDIs were done among the ten community members and eight HCWs selected conveniently. Data collection were continued till data saturation when no new information yielded from the interviews. Thematic analysis was performed. RESULTS: All the participants were hopeful about availability of the vaccine. The key influencers identified for promoting willingness to accept the vaccine among both the groups were opinion of the health-care providers, colleagues' and other people's acceptance of the vaccine, effectiveness of vaccine on other people, and perceived risk of the disease. Fear of adverse reactions was the most important barrier among all the respondents. The prevalent perception was that other preventive practices and vaccine together can only be the best solution to prevent COVID-19 illness. The HCWs perceived that acceptance of vaccine among the community members would be good overall but apprehended some initial difficulties. Mass campaign to promote COVID-19 vaccination and sensitization events are the need of the hour. CONCLUSIONS: Since opinion of health-care personnel emerged as an important influencer of vaccine acceptance, mass campaign and sensitization programs spearheaded by the health-care providers can bring about change by increasing the vaccine acceptance among the beneficiaries at large. Re-enforcement regarding practice of preventive measures should be made among the population irrespective of the vaccination status.

Quality of Life, Sexual Health, and Associated Factors Among the Sexually Active Adults in a Metro City of India: An Inquiry During the COVID-19 Pandemic-Related Lockdown.

Background: Sexual dysfunction (SD) and its effect on our life is an important but less studied topic especially during post-COVID era. This study examines the extent of SD and other mental health predictors and their effect on quality of life. Methods: A cross-sectional survey of sexually active adults was conducted in an Indian metro-city. Along with sociodemographic data, sexual dysfunction, depression, anxiety, stress, and quality of life were assessed by Arizona Sexual Experience Scale (ASEX), Depression Anxiety and Stress Scale (DASS), and WHOQOL-BREF, respectively. Structural equations modeling was used to understand their relationship. Results: Out of the total 1,376 respondents, 80.52% were male, 65.98% were married, and 48.54% were graduates. The mean age of the participants was 34.42 (±9.34) years. Of the participants, 27.18% had sexual dysfunction. Majority of the respondents did not have depression (59.30%), anxiety (52.33%), or stress (44.48%). Mild and moderate levels were the commonest findings among those who had depression, anxiety, or stress. Among the respondents, 27.18% had sexual dysfunction as per the ASEX instrument. Increase in age and female gender were associated with sexual dysfunction overall and also all its components. Presence of depression adversely affected ease of achieving orgasm and satisfaction from orgasm and was associated with sexual dysfunction overall. The respondents had a mean score of 73.57 (±13.50) as per the WHO-QOL. Depression and stress emerged as statistically significant factors for poor quality of life, while sexual dysfunction was not associated statistically. Conclusion: More than one-fourth of the study population reported sexual dysfunction during the first wave of the pandemic in India. The study findings highlight the role of poor mental health issues in this regard. In fact, issues like depression and stress were associated with poor quality of life as well. The current findings unequivocally warrant specific interventions to improve mental health of the respondents.

Treatment adherence status of the TB patients notified from private sector and its associated factors: Findings of a secondary data analysis from West Bengal, India.

INTRODUCTION: In India, each year, estimated one million TB cases are missing from notification, most of them being diagnosed treated in private sector. The large number of patients in private sector has raised concerns about suboptimal quality of care; lack of systems for treatment adherence thus raising the risk of drug resistance. The current analysis was conducted to find out the status of TB treatment adherence in private sector & to identify the factors associated with poor TB treatment adherence. METHODS: Analysis of secondary data obtained through adherence monitoring house visit by THALI (an USAID funded project) field workers during July 2018-June 2019, was done. RESULTS: Default rate among the private patients was 5%. Among the private TB patients 81.6% & among the defaulter 87.3% were in the age bracket of 15-59 years. Reasons stated for being a defaulter were 'Medicine is not working' (30%), 'Travel' (28.6%), 'Cost involved in the treatment' (21.8%), 'Side effects of ATD' (11.6%), 'Anxiety or Depression' (7.2%) & 'Feeling of completely cured' (0.8%). Despite best of efforts only 36.9% defaulter could be retrieved. Factors associated with increased risk of lost to follow-up were 15-59 years age, male sex, earning member of the family,tobacco user, alcohol user, DR-TB, continuation phase of treatment, previous history of TB, presence of symptoms & inability to walk. CONCLUSION: Privately treated TB patients are vulnerable for non-adherence. Once defaulted, it is difficult to retrieve them. Economically productive age group is at higher risk of being defaulter. Commonest reason for lost to follow up is wrong impression about TB medicine. Program should think of extensive engagement & sensitization drive for the private providers; Strict adherence monitoring of private TB patients, extensive advocacy communication & social mobilization program in the community & workplaces/institutions.