Promotion of toilet construction and usage in rural Tamil Nadu: A mixed-methods evaluation study.

Background: Open defecation is the leading cause for malnutrition and diarrhoeal deaths in low- and middle-income countries. The negative public health impacts of open defecation could be neutralized by toilet usage. However, the usage of improved sanitation facilities is unsatisfactory in rural India. Objectives: The study was carried out to find the psycho-social barriers among households for not having toilets and for not using the owned toilets and to develop and find out the effect of Behaviour Change Communication (BCC) strategy on toilet construction and usage. Methods: A community-based Embedded Experimental Mixed Methods study was undertaken in the four field practice villages of Urban Health Training Centre, Villupuram. For baseline and end-line surveys, 422 independent sample households who were not having or not using the toilets were selected by Simple Random Sampling. After IEC clearance, interviews and direct observation of the toilets were undertaken. Context-specific multi-faceted BCC strategy was employed through community participation. The data were analyzed in SPSS software. Chi-square test was used to determine the significance of difference and effect size was calculated to estimate the size of the difference between the baseline and end-line data. Results: Toilet ownership and utilization improved by 21.3% and 23.3% points, respectively. There was a significant reduction in households' perceived psychosocial barriers in toilet adoption. Conclusion: Our intervention demonstrated considerable improvements in both toilet construction and usage surpassing the psycho-social barriers. Future sanitation promotion interventions should focus more on community participation and the key messages should be reinforced multiple times using different channels.

Health insurance coverage and its determinants among middle-income households in Urban Puducherry: A mixed methods study.

BACKGROUND: In India, there exists public health insurance for government employees and poor people. However, the middle-income households (MIHs) remain neglected. OBJECTIVES: The study was conducted to find out the coverage of health insurance and its determinants among MIH. METHODS: It was a community-based sequential exploratory mixed methods study. Group interview and key informant interview were conducted among various stakeholders related to insurance coverage. The quantitative survey was done among 400 randomly selected head of households (HoHs) in an urban area of Puducherry. Manual content analysis was done for qualitative data. Generalized linear model with Poisson distribution was used to calculate the adjusted prevalence ratio (aPR) using Stata software. RESULTS: The coverage of health insurance among the MIH was 41% (95% confidence interval [CI]: 36.1-50). The major reasons reported for not having insurance were poor financial status (63.7%) and lack of felt needs (59.4%). The significant determinants for the lack of health insurance among MIH were unskilled occupation (aPR: 1.62, 95% CI: 1.13-2.34) and lower education status (aPR: 1.79, 95% CI: 1.22-2.64) of HoH and less monthly family income (aPR: 2.19, 95% CI: 1.18-4.08). CONCLUSION: The health insurance coverage of 41% among MIH is better despite the fact that there was no public insurance scheme available for them in Puducherry. The MIH with the identified determinants might be considered in future for including them under publicly sponsored health insurance scheme.

Process of Developing Palliative Care Curriculum for Training Medical Interns in a Tertiary Care Teaching Hospital in Puducherry, India.

OBJECTIVES: The department of community medicine (DCM) has been training medical interns for palliative care in the hospital and community setting. There was no specific curriculum or course material available for training them. This study aims to develop, implement and evaluate the palliative care curriculum for training medical interns. MATERIALS AND METHODS: The present program development and evaluation of palliative care curriculum was done in the DCM, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. We followed the Kern's six steps for curriculum development. It was done during July 2016 and May 2017. We framed expected outcomes from literature review and interviews with experts. The curriculum was delivered through small group sessions followed by hands-on exposure to hospital- and community-based palliative care programs guided by a workbook. Medical interns were given feedback on their field assignments on history taking, followed by reflection using structured template incorporated in the workbook. The reaction to the curriculum was collected from various stakeholders. RESULTS: Medical interns found the curriculum useful for them to acquire basic skills of pain management, communication skills and teamwork. Patients and family felt satisfied with the quality of care provided. CONCLUSION: The new palliative care curriculum was well received by all the stakeholders involved. This can be adopted in similar context for training medical interns in palliative care.

A critical review of new competency-based curriculum for community medicine using various curricular review frameworks.

The purpose of the present review is to examine the new competency-based undergraduate curriculum in community medicine against the established frameworks and criteria and suggest the way forward for achieving competencies expected of the Indian Medical Graduate (IMG). The new Graduate Medical Education Regulations, 2018, is based on Harden's concept of the curriculum. Hence, we reviewed the components of new curriculum against Harden's conceptualization of various components of the curriculum, and since it claims it is competency-based, we used Tyler's Goal/Objective-Based Evaluation. The new undergraduate curriculum has shown a move toward integration of course content and defined the competencies in more measurable terms. However, it appears that the earlier information-based curriculum corresponding to book chapters ("topics") has been modified to specify higher cognitive domains with no explicit link between the IMG level curriculum outcomes to subject level intended learning outcomes (ILOs). The mechanism to link ILOs to assessment is also not clear and so needs more clarity. The assessment system hinted at in the current document is mostly based on the existing conventional system of 50% as pass cutoff, etc., against criterion-referenced assessment applicable to competencies that need to be performed. Furthermore, there is no guidance on the creation of educational opportunities and environment for students and faculty - perhaps it is left to "Curriculum Implementation Support Programme (CISP) Workshops." Hence, the need for preparing a roadmap/blueprint to learning experiences and assessment methods and levels and milestones to be reached at various phases of MBBS and during internship is required.

Identifying People in Need of Palliative Care Services in Rural Tamil Nadu: A Survey.

BACKGROUND: As a part of initiating community-based palliative care program in the field practice areas of Urban Health Training Centre (UHTC), Villupuram, it was necessary for us to identify people who need palliative care to plan our services. AIM: This study aims to assess the need for palliative care and its determinants in the villages under the UHTC, Villupuram, and to know their sociodemographic characteristics and morbidity profile. MATERIALS AND METHODS: A community-based cross-sectional survey was conducted in the four villages under UHTC between April and September 2016. A house-to-house survey was conducted by a trained team using a structured questionnaire. The available member of the households was interviewed about the need for palliative care and the morbidity profile among all the members of their household. Written informed consent was obtained before the interview. Data were entered and analyzed using EpiInfo (version 7.2.2.6) software. Prevalence ratio, age- and gender-wise prevalence of people in need of palliative care was calculated. RESULTS: The overall prevalence of people in need of palliative care was found to be 4.5/1000 population (95% confidence interval: 3.2-6.3). Among them, 73.5% were elderly people. The most common condition requiring palliative care was old age-related weakness (41.2%). CONCLUSION: The need for palliative care services among elderly people was found to be high. This data can be used for planning and implementing community-based palliative care services for the people in our field practice areas.

Evaluation of Community-based Palliative Care Services: Perspectives from Various Stakeholders.

BACKGROUND: As a part of Memorandum of Understanding with Tamil Nadu Institute of Palliative Medicine, community-based palliative care services have been initiated 2 years back in our urban field practice areas. AIM: The aim of this study was to evaluate the home care service, a major component of our community-based palliative care, with a view to identify the unmet needs of the services rendered for decision-making about the program. MATERIALS AND METHODS: It was a descriptive qualitative design carried out by the authors trained in qualitative research methods. In-depth interviews were done among four patients, seven caregivers, two social workers, six nursing staffs, and six medical interns for a minimum of 20 min. Interviews were audiorecorded, transcribed verbatim, and content analysis was done manually. Ethical principles were adhered throughout the study. RESULTS: Descriptive coding of the text information was done; later, similar codes were merged together to form the categories. Five categories under the theme of strengths and five codes under the theme of challenges of the home care services emerged out. Categories under strengths were physical management, psychological care, social support, efficient teamwork, and acceptance by the community. Codes for felt challenges were interdisciplinary collaboration, volunteer involvement, training enhancement, widening the services, and enhancing the community support. CONCLUSIONS: This review revealed the concerns of various stakeholders. There is a need for more interprofessional collaborations, where team members understand each other's roles for effective teamwork, as evident from the framework analysis.

Social Determinants of Dementia and Caregivers' Perspectives in the Field Practice Villages of Rural Health Training Centre, Thiruvennainallur.

OBJECTIVES: (1) To find out the prevalence of dementia in the study population and its social determinants. (2) To explore the family caregivers' perceptions and their support needs. MATERIALS AND METHODS - STUDY SETTING: This study was undertaken in the field practice area of 55 villages of three Primary Health Centres in Villupuram District of Tamil Nadu. STUDY DESIGN: An exploratory mixed-methods study design, where a qualitative method (key informant interview) was followed by a quantitative method (survey). SAMPLE SIZE: A representative sample of 1300 respondents was selected by two-stage sampling. ANALYSIS: Manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. RESULTS: The prevalence of dementia among study sample was found to be 3.1%. The determinants for dementia were age, sex, socioeconomic status, and previous involvement in family decision making and cardiovascular risk factors. The family caregivers strongly felt that caregiving interferes with their personal and professional life; they also felt that caregiving is an integral part of Indian culture, and the elderly prefer home-based care. Caregivers preferred government owned public health facility for medical care. All the responding caregivers strongly felt that they are not adequately trained in caregiving. CONCLUSIONS AND RECOMMENDATIONS: Routine screening of elderly for early identification of dementia and its medical and social risk factors should be initiated in primary health care facility. Care of caregivers should be seen as an integral part of dementia care program.

Role of social, cultural and economic capitals in perceived quality of life among old age people in kerala, India.

OBJECTIVE: To find out the relationship of collective social, economic, and cultural properties of a population on the perceived quality of life (QOL) among old age people. MATERIALS AND METHODS: In a community-based cross-sectional study, we analyzed information on a representative sample of 900 old age (aged > 60 years) from 28 villages in Kollam district of Kerala. WHO-Quality of Life - BREF questionnaire was used. Ethical clearance from Institutional Ethics Committee was obtained. The mean scores for perceived QOL for domains such as physical health, psychological health, social relations, and control of environments were calculated. The three scales (social capital, cultural capital, and economic capital) were standardized using z-score transformation to make them comparable. Using multiple linear regression, we calculated the independent effect of economic capital, social capital, and cultural capital on perceived QOL among old people adjusted for age, sex, and the presence of chronic disease. RESULTS: For overall QOL, only cultural capital contributed significantly. An increase of one unit z-score cultural capital led to three units increase in overall QOL score (ß = 3.362; 95% CI: 2.645-4.078). Social capital and cultural capital contributed significantly to the physical health domain of QOL. With one z-score increase in social capital and cultural capital, QOL score of physical health domain increased by 0.2 units (ß = 0. 227; 95% CI: 0.020-0.434), and 0.5 (ß = 0. 596; 95% CI: 0.384-0.808) units, respectively. Psychological health domain and environmental domain were affected by all three capitals significantly. But, the social relations domain was significantly affected only by cultural capital (ß = 0. 576; 95% CI: 0.373-0.779). CONCLUSION: Hence, the policies for old people should envision retaining our cultural and social norms along with the economic interventions for a better palliative care.

Social determinants of stunting in rural area of Wardha, Central India.

BACKGROUND: Stunting is a consequence of long term, cumulative inadequacies of health and nutrition. Health system uses underweight for growth monitoring for its simplicity. Lately there is renewed interest in stunting and especially severe acute malnutrition. Stunting is a relatively neglected indicator. It is therefore imperative to understand the causes of stunting early in infancy and childhood, so that preventive measures can be taken. Hence, the present study was undertaken to study the social determinants of stunting in rural Wardha. METHODS: The present cross-sectional study was undertaken in three Primary Health Centres (PHCs) of Wardha district with total population of 88,187. The sample was drawn from three PHC areas by 30-cluster sampling technique. Stunting was defined using WHO Child Growth Standards for 'height-for-age'. 'Height-for-age' values below 2 standard deviations were considered as stunted while below 3 standard deviations were considered 'severe stunting'. RESULT: Prevalence of stunting was observed to be 52.3% and severe stunting was 25.1%. The significant determinants of stunting were found to be age, father's education, fathers' occupation, low income, not receiving Vitamin-A supplement during last 6 months and having anaemia. Sex, caste, mother's education and mothers' occupation did not contribute significantly to the stunting. CONCLUSION: Low income and related factors such as father's education and his occupation are important determinant of the stunting. Father being the decision maker, his education is of importance. Vitamin-A supplementation and anaemia as surrogate indicators for access to health care also found out to be significant determinants of stunting.

Implementation of Pediatric Allergic Rhinitis Module as a Part of AETCOM among First-Year Medical Undergraduates: Mixed Methods Evaluation.

Background: Children suffering from allergic rhinitis (AR) in their earlier days of life, not receiving proper treatment, subsequently develop asthma. To sensitize the first-year medical undergraduates about AR by implementing pediatric allergic rhinitis (PAR) module as a part of their attitude, ethics, and communication (AETCOM) curriculum. Materials and Methods: Triangulation type of mixed method study was conducted from January 2021 to June 2021 among 125 first-year medical undergraduate students. The PAR module communication checklist was developed and validated by an interprofessional (IP) team. Twenty multiple-choice questions (MCQs) were framed for both pretest and posttest cognitive assessment of the students. The pretest assessment was done (first 15 min) followed by the teaching of the PAR module (30 min), and lastly the posttest assessment along with open-ended feedback (last 15 min). Objective Structured Clinical Examination (OSCE) communication checklist along with the guidelines was given to the observer during the student-patient encounter to score the learner and to assess the communication skill. Apart from descriptive analysis, paired t-test and content analysis were done. Results: A statistically significant difference in the mean scores before and after the PAR module and communication checklist (P < 0.001). Majority (78/81, 96%) of the students favored this module, while (28/81) 34.6% suggested modifications. Most of the parent's feedback was good about the student's communication skill in terms of empathy (118), behavior (107), and greet (125); however, 33 parents were about the opinion of difficulties in closing the session, 17 parents commented about student's language problem and 27 about feedback. Conclusion: The PAR module should be taught in the current medical curriculum as a part of AETCOM in the foundation course as early clinical exposure with some modifications in the existing module.

Social determinants of quality of elderly life in a rural setting of India.

OBJECTIVE: The aim of this study is to understand the social determinants of quality of elderly life in rural central India and describe their perspectives on various issues related to their quality of life. MATERIALS AND METHODS: It was a community-based mixed-methods study in which quantitative (survey) method was followed by qualitative (Focus Group Discussion, FGD). The study was done in field practice area of a Rural Health Training Centre. We decided to interview all the elderly (>60 years) in two feasibly selected wards of village Anji by using the "WHO-Quality of Life (WHOQOL)-brief questionnaire." We used WHOQOL syntax for the calculation of mean values of four domains. Following survey, four FGDs were carried out. RESULTS: The determinants of perceived physical health, amenable for intervention were their currently working status, not being neglected by the family, and involvement in social activities. The determinants for psychological support were health insurance, and their current working status. The determinants for social relations were membership in social group and their present working status. The determinants for perceived environment were membership in social groups and relationship with the family members. In qualitative research, factors such as active life, social activity, spirituality, health care, involvement in decision making, and welfare schemes by the Government were found to contribute to better quality of elderly life. Problems or conflicts in family environment, lack of shelter and financial security, overtapped resources, and gender bias add to negative feelings in old age life. CONCLUSIONS: There is a need for intervention at social and family level for elderly friendly environment at home and community level.

The effect of community-managed palliative care program on quality of life in the elderly in rural Tamil Nadu, India.

BACKGROUND: HelpAge India has been facilitating community-managed palliative care program in the villages of Tamil Nadu, India. OBJECTIVE: To evaluate the effect of perceived quality of life in the elderly in the project villages in rural Tamil Nadu. MATERIALS AND METHODS: It was a community-based evaluation study. Considering the mean difference of 0.6, design effect-2, precision-5%, power 80%, and 10% non-response, a sample size of 450 elderly persons (more than 60 years) was adequate. Sample was selected by two-stage cluster sampling. Tamil version of "WHO-Quality of Life-brief questionnaire" was used. Trained interviewers made house-to-house visits and obtained information by personally interviewing the subjects. RESULTS: The mean score for perceived physical quality of life in the project area was (10.47 ± 1.80 SD) high than the mean score (10.17 ± 1.82 SD) in the control area (P = 0.013) and the mean score for psychological support (10.13 ± 2.25 SD) in project area was high than the mean score (9.8 ± 2.29 SD) in control area (P = 0.043). There was no effect on domain of social relationship and environment. CONCLUSIONS: In the project villages, the perceived physical quality of life and psychological support among elderly persons was significantly better than the control villages.

Evaluation of e-learning in a department of Community Medicine as a response to COVID-19 pandemic.

BACKGROUND: COVID-19 pandemic pushed all educational institutions to rely exclusively on technology-based learning. As this was done for the first time, it is ideal to evaluate the e-learning program to refine and consolidate the learned experience. Hence, the current study was undertaken to evaluate the online learning and teaching experiences of students and teachers. MATERIALS AND METHODS: This program evaluation on e-learning was carried out in the department of Community Medicine (DCM) in a private medical college using context/input/process/product framework among IV, VI, and VII semester undergraduate students and faculties in DCM who were exposed to e-learning for the period of 2 months since April 2020. Google Forms was used to design a survey questionnaire that was conceptualized as per the needs of the evaluation framework. Ethics Committee approval was obtained. Descriptive analysis was done for quantitative variables and manual content analysis using Lewin's force field framework was performed for the qualitative data. RESULTS: Out of 301 undergraduates contacted, 196 (65.1%) responded to online survey. Their mean age was 19.9 years and 128 (65.3%) were females. Mobile phone was used by 93.4% to access e-learning. Combined modality of learning was preferred by 58.2% of them in future. Six "for" and "against" factors on e-learning emerged out of content analysis pertaining to three main stakeholders, namely administrator, faculty, and student. CONCLUSION: Our evaluation conveys that for effective e-learning in any subject, the students, educators, and institutional factors that were identified need to be considered throughout all phases of program development with careful assumptions about its acceptance by the millennial.

How to reduce Domestic Violence against married women? a mixed methods study from rural Tamil Nadu.

BACKGROUND: Despite government legislations for protection of women, domestic violence (DV) continues to remain as a public health problem in India. Objectives 1. To find out the prevalence of various types of self-reported DV among married women of 18-45 years of age and to identify its social determinants and their help-seeking behavior. 2. To understand the solutions from key informants' point of view. METHODS: It was a sequential explanatory mixed methods study design, which consisted of quantitative (Survey) followed by qualitative (Interviews) phase. A representative sample of 360 married women was chosen by two-stage cluster sampling from villages in Tamil Nadu, South India. The female investigator conducted the survey by house to house visit. Post-survey, six key informant interviews were conducted to explore the solutions and suggestions from experts' point of view. Bivariate and multivariate regression analysis was carried out to identify the significant predictors of DV. Manual content analysis of qualitative data was done. RESULTS: The overall prevalence of spousal DV was 49.5% [95% CI: 44.3-54.6] in the last one year. In multivariate analysis, two factors namely 'current alcoholism in husband' and 'controlling behavior of husband' were found to be the significant predictors of DV. In order to prevent alcoholism in husband, the key informants suggested deaddiction services and measures to limit access to alcohol. Furthermore, to prevent controlling behavior of husband, the key informants suggested women's empowerment, employment, helplines, responsible parenting, social change in dowry practice and gender equality. CONCLUSIONS: The prevalence of spousal DV was found to be high. Current alcohol consumption and controlling behavior of the husband were the important determinants of domestic violence. Key informants suggested interprofessional approach consisting of deaddiction services, women empowerment and strengthening of family life to address the problem of DV.

Effect of a community-based intervention on self-care among diabetes patients in rural Tamil Nadu: A mixed-method study.

INTRODUCTION: Peer support models for the management of diabetes self-care have been hailed as a promising solution to strengthen a formal health system to support diabetes patients. Diabetes self-care in patients can truncate the risk factors and reduce the complications. OBJECTIVE: To identify self-care level (adherence to the diet, exercise, treatment) and depression among known diabetes patients and to find the effect of the support group intervention on diabetes self-care. METHODS AND MATERIAL: A Sequential type Embedded Mixed-Method study (qual→QUAN(qual)→qual) was conducted in three phases in 168 known diabetes adults aged ≥ 30 years in a rural setting. After obtaining IEC clearance, the intervention was carried out over eight months, forming peer support groups in four villages. Each group comprises between six to 12 participants. Assessment of self-care, treatment adherence and depression with standardized scales. DATA ANALYSIS: A manual content analysis was performed on the qualitative data. The Wilcoxon rank test was used to compare the quantitative data before and after intervention and analyzed using SPSS (Version_24) software package. RESULTS: In this study, we found improved self-care practices and treatment adherence among study participants (p < 0.001). About 88.7% of participants said that the support group was useful and provided moral support for diabetes. CONCLUSION: We found an improvement in treatment adherence, self-care among diabetes patients' and marginal improvement in depression status through support group intervention. Also the peer support group was well accepted, and it provided the low-cost, feasible intervention respect to the chronic conditions like diabetes, by addressing their behavioral changes and support from community. By sustaining the support group, might able to achieve the efficient health care in high quality even at resource-poor settings. KEY MESSAGES: A Community-Based intervention for the diabetes self-care using peer support group among the diabetes patients will improve the self-care practices in the area with limited access to healthcare and financial resources, it provides a low-cost, flexible, culturally sensitive approach to support self-care management and reduce the further complications among It also imporve the problem-solving capacity and social support from families and peers patients.

Breastfeeding Positioning and Attachment among Postnatal Mothers: A Mixed Methods Study in a Tertiary Care Hospital in Puducherry, South India.

Introduction: Proper positioning and attachment play a key role in exclusive breastfeeding. Whereas incorrect breastfeeding techniques lead to poor milk transfer and early discontinuation of breastfeeding. Objectives: 1. To assess the breastfeeding techniques among postnatal mothers and to identify the factors associated with improper positioning and poor attachment. 2. To prioritize the action points to improve the poor breastfeeding practices according to the viewpoint of the staff nurses. Materials and Methods: A hospital-based mixed-methods study was carried out in Puducherry for 6 months. In quantitative phase, 99 postnatal mothers were interviewed consecutively and breastfeeding techniques were observed based on Baby Friendly Hospital Initiative and Integrated Management of Neonatal and Childhood Illness guidelines. In qualitative phase, 45 staff nurses ranked the action points to improve the poor breastfeeding practices. Bivariate and multivariate analyses were employed. Mean rank and Kendalls' Concordance Coefficient were calculated for the ranked data. Results: About 28.3% and 27.3% of mothers demonstrated improper positioning and poor attachment, respectively. Young mothers, housewives, <10 days old infants, and failure to receive breastfeeding counseling were associated with poor breastfeeding techniques. Poster displays, healthcare workers' training, targeted counseling, and assistance were the priority action points suggested by the staff nurses. Conclusion: Maternal age, maternal occupation, infants' age, and breastfeeding counseling influenced breastfeeding techniques. The prioritized action points need to be implemented to achieve the level of Baby Friendly Hospital.

Early initiation of breastfeeding and factors associated with its delay among mothers at discharge from a single hospital.

BACKGROUND: According to the National Family Health Survey- 4, in India, 78.9% of deliveries occur in institutions, although only 42.6% of new mothers initiate breastfeeding within 1 hour of delivery. PURPOSE: To estimate the proportion of early initiation of breastfeeding (EIBF) among new mothers at discharge from a tertiary care hospital and identify the determinants of delayed initiation of breastfeeding among them. METHODS: This was a hospital-based analytical cross-sectional study of 108 new mothers. After obtaining Institutional Review Board approval and informed consent, we interviewed the new mothers on the day of discharge. Multivariate logistic regression was performed using IBM SPSS Statistics ver. 24. RESULTS: The median breastfeeding initiation time was 90 minutes (interquartile range, 30-180 minutes). Overall, 43.5% of the mothers practiced EIBF, 77.4% practiced exclusive breastfeeding, and 43.5% were rooming in at discharge. Reasons for breastfeeding delays included extended recovery time from spinal anesthesia, maternal lassitude, and uncomfortable breastfeeding position due to post-cesarean pain. In the multivariate analysis, a birth weight less than 2,500 g (adjusted odds ratio [aOR], 4.33; 95% confidence interval [CI], 1.12-16.82; P=0.03), cesarean section delivery (aOR, 4.68; 95% CI, 1.57- 13.92; P=0.005), and mother's poor knowledge of breastfeeding (aOR, 4.61; 95% CI, 1.44-14.72; P=0.010) were more likely to delay the initiation of breastfeeding. CONCLUSION: EIBF was practiced by less than half of the new mothers as determined by the cesarean section, baby's birth weight, and mothers' awareness of breastfeeding. Thus, it is vital to improve breastfeeding and nutritional counseling among mothers during the antenatal period and improve healthcare professionals' training to facilitate EIBF, even in circumstances such as cesarean section.

Quality, Equity and Partnerships in Mixed Methods and Qualitative Research during Seven Years of Implementing the Structured Operational Research and Training Initiative in 18 Countries.

Introduction: Qualitative studies are often inadequately reported, making it difficult to judge their appropriateness for decision making in public health. We assessed the publication characteristics and quality of reporting of qualitative and mixed-method studies from the Structured Operational Research and Training Initiative (SORT IT), a global partnership for operational research capacity building. Methods: A cross-sectional analysis of publications to assess the qualitative component using an adapted version of the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: In 67 publications involving 18 countries, 32 journals and 13 public health themes, 55 were mixed-methods studies and 12 were qualitative studies. First authorship from low-and-middle-income (LMIC) countries was present in 64 (96%), LMIC last authorship in 55 (82%), and female first authorship in 30 (45%). The mean LMIC institutions represented per publication was five (range 1-11). Sixty-three (94%) publications were open access. Reporting quality was graded as 'good' to 'excellent' in 60 (89%) publications, 'fair' in five (8%) and 'poor' in two (3%). Conclusion: Most SORT IT publications adhered to COREQ standards, while supporting gender equity in authorship and the promotion of LMIC research leadership. SORT IT plays an important role in ensuring quality of evidence for decision making to improve public health.

Health-promoting school initiative in Ashram schools of Wardha district.

BACKGROUND: We studied the effect of a health-promoting school-based intervention for disadvantaged children in the residential Ashram schools of rural Wardha, Maharashtra. METHODS: At baseline, 1287 children in 10 Ashram schools were examined using a locally adapted Global School-based Student Health Survey questionnaire. The haemoglobin level of all children was estimated using the haemoglobin colour scale. Body mass index and physical activity score for each child were calculated. The intervention was carried out through school health committees. After 1 year, 1226 children were examined using the same questionnaire. RESULTS: There was significant improvement in personal hygiene and reduction in hygiene-related morbidity among the children. The median haemoglobin level of the children increased from 10.7 g/dl to 11.4 g/dl. There was also a significant increase in the proportion of children with body mass index that was normal for age (5th-85th percentile) from 32.2% to 38.5%. CONCLUSION: The need-based participatory health-promoting school initiative for disadvantaged children in Ashram schools led to an improvement in their personal hygiene and health.