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.

Malaria situation in India with special reference to tribal areas.

BACKGROUND & OBJECTIVES: In India, malaria is a major public health problem in States having predominantly tribal population. The objective of this analysis was to find out the incidence of malaria in various States/districts having varied proportions of tribal population using National Vector Borne Disease Control Programme (NVBDCP) data. METHODS: States and districts were classified into three categories based on proportions of Scheduled Tribes (ST) population as <10, 10-29.9 and 30 per cent + ST population. Five year average (2008-2012) of all important malaria indicators collected by NVBDCP was taken to normalize the effect of annual fluctuations in malaria incidence. RESULTS: State level analysis revealed that ten States/UTs with 30 per cent or more tribal population comprising only three per cent of total population, contributed 14 per cent of total malaria, 21 per cent Plasmodium falciparum and 29 per cent of deaths due to malaria. Similarly, district level analysis showed that districts with 30 per cent or more tribal population comprising about eight per cent country's population contributed to 46 per cent of total malaria cases, 70 per cent P. falciparum and 47 per cent malarial deaths in the country. INTERPRETATION & CONCLUSIONS: Our analysis showed that the neglect of the ethnic communities in tribal areas would be detrimental to the overall reduction of morbidity and mortality due to malaria. The fight against the increasing burden of malaria in tribal belt requires adoption of multiple approaches and socio-economic development of the tribal communities.

Exploring knowledge and healthseeking behaviour related to sexually transmitted infections among the tribal population of Madhya Pradesh, central India.

This community-based cross-sectional study was carried out in the tribal population of randomly selected villages of Jabalpur district, Madhya Pradesh, central India. A total of 200 married men and women aged 15­49 years were interviewed to explore their knowledge, experience and health-seeking behaviour related to sexually transmitted infections (STIs). Though 91% of respondents were aware of STIs, the sexual route was mentioned by only 19%as the route of transmission. Around 18% reported a need for social isolation from persons with STIs. Though 88% of the respondents felt modern medicine was the best remedy for STIs, only a few of them used medical treatment while suffering from an STI. Twenty-seven per cent of respondents resorted to traditional healers, and 30% utilized home remedies for STI treatment. The study highlights a need for generating STI awareness amongst the tribal population of the region through a needs-based behaviour change communication (BCC)strategy.

Reproductive rights in contraceptive practices.

PIP: In India, impoverished and illiterate women suffer from such low social status that they are unaware of their right to 1) experience a fulfilling sexual relationship free from fear of infection and disease; 2) choose whether or not to have children; and 3) receive family planning services, including safe abortion services. With only 37% married women of reproductive age using contraception, unwanted pregnancy is a major public health problem that leads to 5-6 million abortions each year, with many procedures carried out in unhygienic conditions. India's maternal mortality rate is 1/50 (as compared to 1/2700 in developed countries), and children under age 5 years have a doubled chance of death if their mothers die. Also, in order to promote healthy birth spacing and delay first births in young mothers, the practice of prolonged breast-feeding must be encouraged while appropriate contraceptives to increase birth intervals are introduced and new methods are developed for lactating women. Another challenge is to increase the use of male methods and develop a vaccine for male fertility regulation. Unmet need for contraception exists among 80% of married women in India, and efforts should be made to understand and respond to barriers to contraceptive adoption. In light of the rapid spread of sexually transmitted diseases and HIV/AIDS, it is also important to study sex behavior, especially among adolescents, in order to devise appropriate prevention policies and programs.^ieng

An overview of the socio-economic and demographic transition among the Santal: a census analysis.

The Santals are described as the largest most integrated and possibly the most resilient tribe in eastern India. "The paper aims at looking into the parameters that set Santals in the process of socio-economic and demographic transformation and subsequently search for, the plausible explanation for the underlying mechanism for such changes.... The paper discusses the growth of their population and finds that Santals are growing below national average with increase in concentration in some of the pockets in Bihar and West Bengal, while it is spreading towards evenness in Orissa. In the absence of 1991 census data on the tribe wise breakdown the analysis has been restricted to the 1961, 1971 and 1981 census returns and availability of the literature on the tribe."