Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-A cross-sectional study.

BACKGROUND: COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. METHODS: A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers. RESULTS: Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66-3.41), income≥20000(AOR = 1.74, 95% CI, (1.16-2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09-2.46), contact tracing (AOR = 2.05, 95% CI (1.1-3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14-6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28-2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions). CONCLUSION: The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

Together let us confront it: An outbreak investigation of hepatitis B in Pathanamthitta district, Kerala.

INTRODUCTION: Hepatitis B is a potentially life-threatening liver infection caused by the Hepatitis B virus (HBV). The established routes of transmission are from mother to infant, sexual contact, and exposure to blood or body fluids. Though HBV is preventable by vaccine and robust infection control practices, outbreaks of HBV infection do occur in India. However, the state of Kerala with its health parameters, one among the best in the country, cannot afford to have continuing outbreaks. An unusual increase in the reported cases of Hepatitis B in a rural area of Pathanamthitta district of Kerala, called for an outbreak investigation. AIMS: To describe the epidemiological features, to determine the risk factors associated with HBV transmission, and to suggest measures to prevent future transmission. METHODS: A community-based case-control study (1:2) was undertaken. A total of 162 participants (54 cases and 108 age, gender, and neighborhood matched controls) took part in the study. Focus group discussions were conducted with subject experts to develop an interview schedule assessing 40 risk factors. It was further reviewed by the University of Sydney. Data was collected by trained Junior Health Inspectors and Junior Public Health Nurses of the Primary Health Centers. Data was analyzed using SPSS v. 20. Proportions were compared by Univariate analysis, sub-group analysis, and logistic regression. Population Attributable Risk (PAR) was also calculated. RESULTS AND CONCLUSION: More than 90% of the infections were IgM anti-HBc positive, suggesting a recent infection. Interventions during hospitalization [OR: 7.98 (95% CI - 2.17--29.4)], family history of Hepatitis B [OR. 4.14 (95%CI - 1.73--9.9)], and laboratory investigations [OR: 3.99 (1.72--9.31)] were found to be significant risk factors. PAR was highest for laboratory interventions (32%). Vaccinating household contacts and strict enforcement of infection control practices could substantially reduce the burden of this fatal disease.

Strategies for COVID-19 control among migrant labourers in a developing country setting: Pathanamthitta model from Kerala.

BACKGROUND: The ongoing pandemic of Covid-19 is a public health emergency with serious implications world-wide including India. Vulnerable population like migrants are often left out of epidemic preparedness planning and reaching out these marginalized population is a challenge. OBJECTIVE: To describe different strategies implemented for control and prevention of Covid-19 among migrants in Pathanamthitta. RESULTS: Strategies for Covid-19 control among migrant labourers were planned and implemented with intersectoral coordination and community participation. Line listing and risk stratification, mobilisation of community volunteers, contactless active symptomatic surveillance using technology, IEC activities for awareness generation in multiple languages, sample collection, testing and distribution of personal protective equipment's were initially implemented. Setting up of a call centre facility assisted with M health technology exclusively for addressing concerns of migrants was first and one of its kind in the country. In addition to that special measures were taken to improve adherence and wellbeing of migrants which included addressing medical needs of migrants including psychological needs, ensuring food security, migrant hostels for the providing shelter, basic health care, isolation facilities and arranging transportation facilities for more than 10,000 stranded migrants. The success of these strategies was evident from the fact that not even a single migrant labourer was tested positive in the district during this period. CONCLUSION: Pathanamthitta district being in a resource constraint setting showed a very effective model by implementing technology assisted strategies tailored to the needs of population.The success of these highly effective and replicable strategy underlines the need to incorporate principles of primary health care in crisis management.

Community-based burden, warning signs, and risk factors of cancer using public-private partnership model in Kerala, India.

BACKGROUND: According to the GBD report published in 2016, the burden of cancer in Kerala is 135.3/100,000 population in contrast to the national average of 100/100,000 population. Cancer is a complex disease that requires broad engagement of various departments and organizations to implement a community based health promotion strategy. OBJECTIVE: To estimate the prevalence of diagnosed cancers, warning signs and selected risk factors of cancer in Niranam Panchayath of Pathanamthitta district, Kerala. METHODOLOGY: A total of 13,736 population was covered by door to door survey using a structured questionnaire. The questionnaire collected information on the sociodemographic variables of the residents, source of water supply, warning signs of cancer and details of diagnosed cancer cases. RESULTS: The mean age of the population was 39.7 ± 21 years. The prevalence of diagnosed cases of cancer in our study was 652/100,000 population. Most common type of cancer identified was Breast cancer (37.3%). The prevalence of any warning sign among the study population was 400/100,000 population. Breast lump was the common warning sign identified. Increasing age, female gender and occupational status were the factors found to be significantly associated with cancer. RECOMMENDATIONS: Community based health education to increase awareness, screening for cancers and breast self-examination in the community could help in early diagnosis and prevention at primary level. Scientific study to assess the risk factors of cancers using case control design could be done in this population along with soil and water sample testing for carcinogens.