Qualitative exploration for the under-foot fall in utilization of health services at Primary Health Center of Shahdol, Madhya Pradesh.

Background: Despite efforts to improve healthcare infrastructure and service delivery, significant disparities in healthcare utilization persist, leading to suboptimal health outcomes and hindering progress toward achieving universal health coverage. This research article aims to conduct a qualitative exploration of the under-foot fall in utilization of health services, shedding light on the barriers and challenges faced by individuals in accessing and utilizing health care to inform targeted interventions and improve health service utilization. Methods: This qualitative study employed free listing, pile sorting, and focus group discussions (FGDs) as data collection methods. Representatives from various stakeholders involved in the primary healthcare delivery system were selected based on their vocalness, knowledge, willingness to participate, and heterogeneity of responses. Subsequently, FGDs and key informant interviews (KIIs) were conducted to further explore the identified barriers. The collected transcripts underwent manual thematic analysis using coding rules and theme generation procedures. Results: A total of 30 participants, including healthcare providers, community leaders, and individuals from the local community, took part in the qualitative exploration. The themes encompassed limited awareness and knowledge, geographical and infrastructural barriers, socioeconomic constraints, trust and perceptions of the healthcare system, and cultural and social factors. These findings provide valuable insights into the multifaceted barriers hindering healthcare utilization and can guide the development of targeted interventions and policies to improve healthcare access and delivery in the study area. Conclusion: The identified barriers, including limited awareness and knowledge, geographical and infrastructural challenges, socioeconomic constraints, trust and perceptions of the healthcare system, cultural and social factors, and gender disparities, are consistent with the existing literature.

Empty stomach together with menstrual bleeding as predictors of committed suicides among women of reproductive age: What a primary physician must know.

Background: Women of reproductive age group (WoRAG) are among the most vulnerable groups to suicide in India. The present study intended to develop a mathematical model to differentiate suicides from homicides among WoRAG. Methods: It was a cross-sectional study based on a record review of autopsy at Patna, India, from 2016 to 2021. The cause of deaths was ascertained by autopsies and other records independently by two investigators to reduce the interobserver bias. Independent variables were tested with confirmed suicides to calculate statistically significant association. These variables were further used for developing prediction models for the suicides by multivariate logistic regression analysis. Results: Out of total of 520 autopsies of WoRAG performed by investigators, the cause of death has been confirmed for 62. Of them, 30 were confirmed as suicides. In univariate analysis, suicides were associated with the menstrual bleed (OR 35 CI 6.9,179), gastric emptying (OR 3.9 CI 1.2,12.8), hanging, poisoning, and drowning as mode of death (OR 435 CI 37.4,5061.9). By logistic regression, three prediction models were built to predict suicide; Model I: gastric emptying, Model II: menstrual bleed, and Model III: including both. The area under the curve (AUC) for Models I, II, and III was 0.67 (95%CI 0.34,0.99), 0.92 (95%CI 0.75,1.00), and 0.94 (95%CI 0.82,1.00), respectively. The AUC of Model III differs significantly from that of Model I (P value 0.03) but not with Model II (P value 0.11). Conclusion: Menstrual bleed, gastric emptying, and mode of death may be used as a supplement tool in ascertaining the cause of death among WoRAG in medical and legal proceedings.

Barriers perceived by researchers in pursuing medical research in an evolving medical college of tribal Madhya Pradesh, India.

Introduction: Doing quality medical research that improves patient care, improves medical education, reduces expenditures, and benefits society at large is an important responsibility, though often underrated. Appropriate measures are required to be taken when a medical college is new. Hence, this provided an opportunity to conduct a study at a current medical institution with the aim of identifying the barriers faced by research in various domains. Methods: This cross-sectional study included currently working faculties, including senior residents and demonstrators, as subjects. A structured questionnaire with close-ended responses was used, which covered the baseline characteristics of subjects and perceived research barriers among researchers. After obtaining institutional ethical approval, the study was initiated. During the analysis of the data, an association between variables was significant for P value < 0.05. Results: In the present study, out of 105 eligible subjects, only 98 of them participated. The mean age of the subjects was 36.06 ± 6.48 years. The most frequent barriers expressed were a lack of research training facilities to solve individual research problems (45.9%) and a lack of a sufficient financial budget for research activities (57.1%). The organizational-managerial level domain was significantly associated with the subject's age, designation, and gender (P < 0.05). Conclusions: The present study identified the barriers faced by the researcher at various levels. Despite the presence of a young workforce, it was surprising to notice that more than half of the faculty members had poor research barrier scores in each of six domains, probably due to a lack of mentorship and acknowledgement, and a lack of skill in using computer-based hardware and software.

Clinical features and haematological parameters associated with COVID-19 severity among hospitalized patients: A retrospective observational study from Tribal Central India.

Background: Reports describing demographics, clinical characteristics, hospital course, morbidity, and mortality in patients in the Indian setting have been published, but they are based on limited numbers of cases. The present study among the patients with known outcomes enabled us to better understand the disease process and progression of COVID-19 cases and to correlate the factors affecting the outcome. Methods: This was a record-based, retrospective observational study of patients admitted to COVID-19 Hospital. We have retrieved medical records for all the hospitalized patients with a laboratory confirmed COVID-19 diagnosis with a known outcome (discharged or died) between April 1, 2020 and February 28, 2021. The extracted data included basic demographics, signs and symptoms, duration of hospitalization, and laboratory parameters. Categorical variables were analysed using either the chisquare test or Fisher's exact test. The level of significance was set at P < 0.05. Results: The mean age of severe and moderate patients was 38.71 years, compared to 34.95 years for mild patients. No gender difference was observed for the severe/moderate, and mild cases. The mortality rate among severe/moderate cases was 11.6%, whereas it was 3.9% in mild patients. Laboratory parameters which were significantly (p < 0.05) raised among the dead compared to discharged patients included CT score, D-dimer, CRP, ALT, AST, and alkaline phosphatase. Conclusion: Clinical and laboratory characteristics reflect the pathophysiology of disease and thus help clinicians recognise the severity of medical illness. They also facilitate the creation of management protocols for clinical care that results in improvement in patient related outcomes.

Are we expecting too much for too long from the vaccinators? A qualitative study on perceived challenges of COVID-19 vaccinators of district Shahdol, India.

Background: There is a paucity of knowledge regarding challenges faced by the coronavirus disease 2019 (COVID-19) vaccinators in resource constraint settings like district Shahdol, Central India. Hence, the present study was planned to explore the perceived challenges of vaccinators regarding COVID-19 vaccination. Methods: In October 2021, district health authorities conducted a one-day workshop with the auxiliary nurse midwives, staff nurses, and lady health visitors who work as vaccinators. It had three distinct but mutually connected phases. In the first phase, a free listing exercise was performed to list out their perceived challenges that are prominent and representative of their cultural domain. In the second phase, the pile-sorting exercise with the challenges mentioned in the above step was performed to produce similar data in the form of a matrix, based on a perceived similarity between them by multi-dimensional scaling analysis. In the final phase, the transcripts generated during the discussion on the free listing and pile sorting exercises was used for the thematic analysis to find plausible explanations for the findings. Result: A total of 15 vaccinators took part in the workshop. In the free listing exercise, a total of 14 items were identified as perceived challenges for COVID-19 vaccinators. The three items with the highest Smith's S value were overtime duty, no holidays, and lack of monetary incentive. The analysis of pile-sorting suggested that participants clustered their 14 perceived challenges into five groups; 1) beneficiaries related, 2) vaccination schedule related, 3) lack of facilities at vaccination site, 4) lack of monetary incentive, and 5) issues related to digital data handling. Thematic analysis suggested that their main challenges were overtime duty, no monetary incentive, and lack of toilet, food, and transport facility at the session site. Conclusion: Vaccinators perceive overtime duty and lack of holidays as their top two challenges and expect monetary incentives for this. The study recommends better basic amenities like toilet facility, sustained and effective community engagement, a monetary incentive, and a better ecosystem for digital data handling for the vaccinators.

Prevalence of hypertension and associated cardiovascular risk factors in Central India.

OBJECTIVES: To study the difference in the prevalence of hypertension and associated risk factors in urban and rural populations and the association of hypertension with various determinants. MATERIALS AND METHODS: A community-based cross-sectional study was conducted in 48 villages and 15 urban wards of Jabalpur District of Central India. Nine hundred and thirty-nine individuals aged 20 years and above (624 from rural areas and 315 from urban areas) were included in the study. The prevalence of hypertension and associated cardiovascular risk factors was assessed in the urban and rural populations. A pretested questionnaire was used to collect data on socio-demographic, behavioral, and dietary factors. Anthropometric measurements of weight, height, waist and hip circumference, and blood pressure measurements were taken using the standard methodology. The glucose oxidase-peroxidase and cholesterol oxidase-cholesterol peroxidase methods were used to measure plasma glucose and serum cholesterol, respectively. Bivariate analysis was followed by multivariate analysis to detect the odds of getting hypertension with various risk factors for the urban and rural populations separately. Hypertension was defined as per Joint National Committee (JNC) - VII criteria. RESULTS: The response rate was 97%. Overall prevalence of hypertension was 17%, with 21.4% in the urban population and 14.8% in the rural population. Significantly higher mean values of weight, height, body mass index (BMI), hip circumference (HC), waist circumference (WC), waist hip ratio (WHR), systolic blood pressure (SBP), fasting blood sugar (FBS), and serum cholesterol levels were mapped in the urban population in comparison with the rural population. Multivariate logistic regression analysis identified increasing age, parental history of hypertension, tobacco smoking, tobacco chewing, physical inactivity, high estimated per capita salt consumption, and BMI ≥27.5 kg/m(2) as independent predictors for hypertension in the urban population, while in the rural population, increasing age, physical inactivity, central obesity, tobacco chewing and tobacco smoking were independent predictors for hypertension. CONCLUSION: The prevalence of hypertension and other cardiovascular risk factors was high in both urban and rural communities. Therefore, there is a need for comprehensive health promotion programs to encourage lifestyle modification.