Evaluation of community-based care delivered by primary healthcare providers in management of hypertension in a rural area of West Bengal.

Background: Lifestyle modifications and medication compliance are key strategies. Objectives: To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension. Materials and Methods: A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician's discretion. A total of 227 patients in the "study" group and 230 patients in the "control" group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16. Results: Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group. Conclusion: The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.

A phase 2 single center open label randomised control trial for convalescent plasma therapy in patients with severe COVID-19.

A single center open label phase 2 randomised control trial (Clinical Trial Registry of India No. CTRI/2020/05/025209) was done to assess clinical and immunological benefits of passive immunization using convalescent plasma therapy. At the Infectious Diseases and Beleghata General Hospital in Kolkata, India, 80 patients hospitalized with severe COVID-19 disease and fulfilling the inclusion criteria (aged more than 18 years, with either mild ARDS having PaO2/FiO2 200-300 or moderate ARDS having PaO2/FiO2 100-200, not on mechanical ventilation) were recruited and randomized into either standard of care (SOC) arm (N = 40) or the convalescent plasma therapy (CPT) arm (N = 40). Primary outcomes were all-cause mortality by day 30 of enrolment and immunological correlates of response to therapy if any, for which plasma abundance of a large panel of cytokines was quantitated before and after intervention to assess the effect of CPT on the systemic hyper-inflammation encountered in these patients. The secondary outcomes were recovery from ARDS and time taken to negative viral RNA PCR as well as to report any adverse reaction to plasma therapy. Transfused convalescent plasma was characterized in terms of its neutralizing antibody content as well as proteome. The trial was completed and it was found that primary outcome of all-cause mortality was not significantly different among severe COVID-19 patients with ARDS randomized to two treatment arms (Mantel-Haenszel Hazard Ratio 0.6731, 95% confidence interval 0.3010-1.505, with a P value of 0.3424 on Mantel-Cox Log-rank test). No adverse effect was reported with CPT. In severe COVID-19 patients with mild or moderate ARDS no significant clinical benefit was registered in this clinical trial with convalescent plasma therapy in terms of prespecified outcomes.

Trend, morbidity profile and immunization status of diphtheria admitted cases: A 5-years review from a sentinel centre in Kolkata.

Despite strengthening of the universal immunization program, diphtheria remains endemic in India. Diphtheria is under surveillance for vaccine-preventable diseases of the World Health Organization and also in India. The present record-based retrospective study was conducted on 241 confirmed diphtheria patients admitted in an infectious disease hospital of Kolkata over 5 years (2015-2019) with the objectives of assessing the admission trend, immunization status, and outcome of patients. Among the patients, majority (57.3%) were female; 50.6% were ≥15 years; 49.0% resided in rural areas. Five-year admission rate did not show any declining trend. Major number of cases occurred in 2016; another peak observed in 2019. Only 27.4% fully immunized rest either partiality immunized (44.4%) or nonimmunized (28.2%). Overall, 54% of the patients developed any complications, and case fatality was 9.5%. Gradual age shift toward adults reiterated the widespread use of adult immunization with Td vaccines. Early reporting to the hospital is necessary to reduce complications and case fatality.

Development and Validation of a Tool to Assess Perceptions and Practices Regarding Hypertension and Associated Comorbidities among Primary Health Care Providers of a Rural Community in India.

BACKGROUND: Primary health-care providers can play a crucial role in the prevention and early detection of non-communicable diseases. Knowledge, attitude, and practice (KAP) survey of primary health-care providers is needed to assess their gaps in knowledge, and identify barriers for effective implementation of the national program. However, such KAP instruments are lacking. OBJECTIVE: The aim of this study is to develop, validate and assess the reliability of a questionnaire to determine the KAPs of primary health-care providers about hypertension and associated comorbidities. MATERIALS AND METHODS: This study was conducted in the following steps: item construction and psychometric testing, by validity and reliability analysis. RESULTS: The final KAP questionnaire comprised 25 knowledge items, 12 attitude items, and 8 practice items. Exploratory factor analysis using principal axis factoring with varimax rotation revealed four dimensions in the attitude section explaining 35.93% and two dimensions in practice sections explaining 65.96% of the total variance. Cronbach's alpha coefficient for attitude and practice session measured 0.65 and 0.85, respectively. A Kuder Richardson value of 0.70 was obtained for the knowledge section. ICC coefficients were 0.56 (P < 0.00) for knowledge, 0.77 (P < 0.00) for attitude and 0.88 (P < 0.00) for practice sections indicating moderate-to-good correlations. Overall, the instrument developed had acceptable validity and reliability. CONCLUSION: Overall, the instrument developed had acceptable validity and reliability to assess the perceptions and practices of primary healthcare providers about prevention and control of hypertension and associated comorbidities in the community.

An Epidemiological Study on Empathy and its Correlates: A Cross-sectional Assessment among Medical Students of a Government Medical College of India.

BACKGROUND: Empathy is a desirable quality in every clinician. It is a crucial determinant of patient-physician communication and relation. There are very few existent Indian studies on empathy of medical students and its correlates. AIM: The aim of the study was to assess empathy level of medical students and its correlates. METHODOLOGY: It was a cross-sectional, hospital-based, analytical observational study conducted from July to November 2017. In total, 249 undergraduate medical students of a medical college of Kolkata were interviewed with a structured schedule. The schedule comprised of the sociodemographic questionnaire, career satisfaction, future career choice, and Jefferson Scale of Empathy. RESULTS: The mean empathy score was 98.5 ± 12.5. Third-semester students had higher empathy scores (102.4 ± 12.4) compared to fifth (97.2 ± 12.9) and seventh semester (95.0 ± 10.9) students. The difference between the mean scores of different semesters was statistically significant. Female students were more empathic than male students. In the multivariable linear regression model, sex, semester, residence, career satisfaction, future career choice, and current place of living were significant predictors of empathy scores. CONCLUSION: Empathy level of medical students of our study was quite low compared to other studies conducted outside India. Empathy eroded with semester, which supports earlier pieces of evidence in this regard.

A study on fertility perception: an experience from west bengal, India.

BACKGROUND: Fertility pattern has some influence on health of mother and child as well as it can resist population growth. METHODS: A cross sectional study on fertility perception among married women of reproductive age group, was carried out in 3 blocks and 2 municipality areas of Howrah District of West Bengal, India, covering 12 villages and 4 wards, selected by stratified multistage random sampling, for a period of 6 months from April to September 2009. Two thousand married women were the respondents. RESULTS: Respondents were mainly belonged to poor and below poverty line groups (86.7%), one third (33.4%) were illiterate and just literate group, 66.8% of the respondents belonged to Hindu by religion and 63.4% had history of teen age pregnancy and more than 50% of the respondents were married early (below 18 years). The study revealed that perception about age of marriage, interval between marriage and 1(st) pregnancy and spacing were incorrect in case of 45.8%, 37.6% and 23% of the respondents, respectively. 22.3% and 13.1% of the respondents had no proper idea regarding desired no of children and Family Planning methods, respectively and their knowledge varied with literacy status, age and religion. Majority (67.5%) of the study population received information about family planning methods from health personnel. CONCLUSIONS: Correct Knowledge regarding different components of fertility among Eligible Couples to be enhanced by intervention through Information, Education and Communication (Interpersonal Communication and Mass Media).

Critical appraisal of mass DEC compliance in a district of west Bengal.

A cross sectional study was carried out to assess drug compliance after Mass Drug Administration of DEC and the factors responsible for poor compliance among the population of Murshidabad district of West Bengal during Jan 2009. Total study unit were 120 families covering 3 villages and one municipality ward area (30 families from each area). As a part of Revised Filaria control strategy, MDA programme was implemented in Murshidabad district from 29th-31st December 2008. Result revealed that total covered population were 601, out of which 571 were eligible population for Mass drug administration (6 Pregnant women and <2 years age groups (24) were excluded). Drug distribution rate was 91.8%. Overall drug compliance was 42.3%. Total number of defaulters was 330 (57.7%). Non compliance was highest (75.5%) in urban area. Defaulters was more among male than female. Factors responsible for defaulters were no motivation (24.7%), drugs not supplied (22.5%), absence at home (13.5%), no faith (10.1%), fear of side effects (10.1%) and others (Forgotten, lack of prior IEC etc), illness, wrong information were 7.8%, 7.3%, 3.9% respectively. Majority has no side effects, only dizziness (3.3%), headache (1.7%), vomiting and others (4.1%) were experienced by the people after consumption of drugs. On an average 40% families were aware about ELF & transmission of disease. Only 43.7% of community members were informed about MDA by Health Workers prior to the implementation of MDA programme.

Reproductive tract infection and health seeking behaviour of eligible couples--an appraisal.

A community-based cross-sectional study was conducted in Paschim Midnapur district of West Bengal during March 2009 to August 2009 to find out the prevalence of reproductive tract infection and the health seeking behaviour. The respondents were 2000 currently married women (15-49 years age group) selected by stratified multistage random sampling. House to house visit and data collection by interview technique was done by faculty members of community medicine of Calcutta National Medical College and other medical colleges through predesigned and pretested schedule. The prevalence of reproductive tract infection was 11.7%, which was higher in 30-35 years age group (19.4%). Reproductive tract infection was indirectly proportional to literacy status. Prevalence of reproductive tract infection was significantly higher among those who did not use sanitary napkin / clean sun-dried domestic clothes. The occurrence of reproductive tract infection was lower who used to practise barrier method of contraception. Majority of symptomatic females complained about vaginal discharge (29.2%). Information, education, communication regarding small family norms, reproductive hygiene and contraceptive practice to be enhanced in the community through intervention (interpersonal communication and mass media) in future to reduce the reproductive tract infection morbidities.

Perceptions of couples about contraception in eastern India.

This community-based, cross-sectional study was conducted in sampled villages and municipal wards of Paschim Medinipur District of West Bengal, India among 2,000 respondents, 3/4 were from rural and 1/4 from urban areas, to determine perceptions of couples about contraception. Decision-making about fertility and contraception was mostly made by the husband. Forty-four point three percent of rural and 77.6% of urban women preferred a birth spacing of > or = 3 years. The ideal interval between marriage and first pregnancy was considered to be > or = 3 years in nearly two thirds of women. With increasing literacy level among women, the ideal birth interval between pregnancies also increased. Eighty-nine point four percent of women had correct knowledge of family planning. Only 49.4% of women knew about the Copper-T contraceptive device.

Critical appraisal of healthcare delivery services by multipurpose workers in rural West Bengal.

This cross-sectional study of 35 multipurpose workers (MPWs) of Goalpokhar--II (Chakulia) block selected by random sampling in the district of Uttar Dinajpur showed that 30 respondents were female mostly in the age group less than 30 years and rest were male in the age group of above 30 years. Majority of respondents (65.7%) were educated up to the level of higher secondary. On an average each MPW used to spend only 5.8 hours per week for home visit. During referral of the patients, the problems faced by the health workers were due to non-availability of vehicles (71.4%), difficulties in the means of communication ie, long distance, road problems, etc (85.7%), and lack of awareness about referral centre (2.8%). Only 5.5% of the MPWs stated absence of difficulty during referral to the higher facility. Regarding difficulties faced during transmission of health related information, 25.7% of MPWs were unaware of the location of the reporting centre; 17.4% of MPWs were unaware of authority to be informed and 14.3% of MPWs complained about social barrier and 22.8% experienced non-availability of manpower. However 42.9% of MPWs did not face any problem while transmitting health related events/information to the higher authority. Most of the respondents (23.5%) opined that their performance may be enhanced by increasing community awareness.

Community perception of Dengue in slum areas of metropolitan city of West Bengal.

Dengue is one of the major public health problems which can be controlled with active participation of the community. A cross sectional study was conducted in urban field practice area of Calcutta National Medical College to determine perception of general population on the disease Dengue. A total 161 individuals were interviewed regarding the different aspects of the Dengue fever. The result showed that out of total respondents, majority (68.9%) had knowledge that fever is the main symptom of the disease, though only 6.2% knew of retro-orbital pain as the pathognomic symptom of the disease. Out of total respondents 83.3% were unaware regarding modes of transmission of disease and the level of awareness is significantly higher among educated group (p < 0.05). 69.6% were unaware about the prevention of disease but there is no significant variation in relation to literacy status. Regarding awareness about vector control 60% of the respondents belonging to the lower socio economic class were unaware followed by 58.6% of the upper lower class. Only 39.1% had knowledge about breeding places of Aedes aegypti. The main source of information was found to be mass media (65%) and 7% of the respondents did not get any information about Dengue. Specific intervention measures such as Information Education Communication to be provided to the urban slum community for prevention and control of Dengue/Dengue haemorrhagic fever.

Life events as risk factors for myocardial infarction: a pilot case-control study in Kolkata, India.

This case-control study was conducted in the Cardiology Department of Medical College, Kolkata, India, during 2000-2001, to explore the link between stressful life events and subsequent myocardial infarction (MI). One hundred consecutive confirmed MI patients were selected as a case group. One hundred age-, sex- and income-matched controls were selected from visitors other than relatives who attended these patients. The subjects were interviewed and asked to rate 61 life events with a number between 0 and 20. They also noted which of these they had experienced in the last one year. The main exposure variables included life events as per E.S. Paykel, smoking, alcohol consumption, chewing of tobacco, marital status, literacy, employment, and monthly per-capita income. The results showed that an MI patient was likely to experience 4.16 stressful life events, which were twice as much as the control group (2.24). The total stress score was the highest for serious personal illness followed by illness of family members and unemployment for the MI patients. For the controls, conflict between husband and wife, death of friends, and personal illness had the highest total stress score. The mean stress score for the MI patients was 35.5 compared to 17.35 among the controls. The MI subjects were more likely to have experienced stressful life events than the controls.

Perception of general population about hepatitis B: a cross-sectional study.

Hepatitis B, is one of the major public health problems can be controlled with the active participation of the community. A descriptive cross-sectional study was conducted in the immunization clinic of Burdwan Medical College to identify the level of people's perception on the diseases Hepatitis B. A total of 210 individuals accompanying the children for routine immunization were interviewed. The study result showed that majority (65.3%) of the respondents were unaware that the diseases is caused by virus and 46.2% were unaware on transmission of disease. 38% of the respondents were unaware regarding the future consequences of the diseases. The knowledge on the preventive measures against Hepatitis B was high (76.2%) among the respondents. Incorrect knowledge in relation to vaccination like interval of vaccination, necessity of re-vaccination was 88.6%, 86.7% respectively. 49% had no idea about ideal age for vaccination. Significant difference of knowledge was found between illiterate and just-literate group with primary, secondary & above group (p< 0.05). Receipt of vaccine (15.6%) also significantly more (p< 0.05) in case of higher income group.

Acute lower respiratory tract infection among under- fives in urban eastern India--an appraisal of risk factors.

200 under-fives children diagnosed as having ALRTI in pediatric OPD and indoor ward were sampled using standard case definition, and bodyweight was noted for each. All relevant factors of ALRTI were studied using pre-designed and pre-tested proforma. 90 (45%) were underweight and 143 (71.5%) had >5 episodes of ALRTI. Socio-economic status was inversely related to the percentage having >5 ALRTI episodes. 93.0% of children whose parents were up to primary education level suffered from >5 episodes of ALRTI as compared to 55.3% whose parents had higher literacy levels (Z=7.0, P<0.05). Odds ratio for absence of exclusive breastfeeding (14.1), absence of measles vaccination (6.1), attached kitchen (6.9) were very high.

A medico-social appraisal of commercial sex workers in a metropolitan city from eastern India.

This cross-sectional study of 146 commercial sex workers (CSWs) selected by stratified sampling, in a red light area of Kolkata, showed that 25.3% were teenagers and 37.0% were forced into the profession due to poverty. White discharge was present in 42.5% of the CSWs. Only 65.1% had the proper knowledge of the causes of disease, but 49.3% preferred to go to "quacks" for treatment, while 42.5% preferred traditional medicine. Knowledge of the prevention of sexually transmitted infections by condom use was correct in 44.2% of the CSWs, but 17.8% used condoms regularly. One fourth of the CSWs having 5 or more clients per day used condoms regularly.

Intensified pulse polio immunisation coverage in slums of a metropolitan city: an appraisal.

A study was conducted by house-to-house visit during 2nd and 3rd round of IPPI in Nov and Dec 2000 in two slums adjacent to Medical College Kolkata. Total houses visited in these two rounds were 2836 and 611 children were immunised at home. Mothers of 503 children (who did not receive IPPI dose at booth on NIDs) were interviewed. For rest 104 children, mothers were not available during the time of visit. The result showed that infants were the largest group (30.6%) to receive vaccine at home. Majority (84.1%) was permanent residents of the locality. Only 4.2% were Bengali-speaking Hindus while most other were Hindi or Urdu speaking Muslims. "Health workers will bring vaccine at door steps" was the reason of non-attendance at booth by 30.2% parents. No routine immunisation was received by 14.9% children. The source of information regarding IPPI was, 45.4% from medical students, 28.5% from health workers, 15.1% from TV, 5.6% from relatives and neighbours, 3.6% from miking and 1.8% from newspapers respectively.