Prevalence and associated factors of impaired kidney functions among children and adolescents in India: insights from the Comprehensive National Nutrition Survey (CNNS) 2016-18.

BACKGROUND: Chronic kidney disease (CKD) is a significant public health problem. The burden of CKD in children and adolescents in India is not well described. We used data from the recent Comprehensive National Nutrition Survey (CNNS) to estimate the prevalence of impaired kidney function (IKF) and its determinants in children and adolescents between the ages of 5 and 19. METHODS: CNNS 2016-18 adopted a multi-stage sampling design using probability proportional to size sampling procedure after geographical stratification of urban and rural areas. Serum creatinine was tested once in 24,690 children and adolescents aged 5-19 years. The estimated glomerular filtration rate (eGFR) was derived using the revised Schwartz equation. The eGFR value below 60 ml/min/1.73 m2 is defined as IKF. Bivariate analysis was done to depict the weighted prevalence, and multivariable logistic regression examined the predictors of IKF. RESULTS: The mean eGFR in the study population was 113.3 + 41.4 mL/min/1.73 m2. The overall prevalence of IKF was 4.9%. The prevalence in the 5-9, 10-14, and 15-19 year age groups was 5.6%, 3.4% and 5.2%, respectively. Regression analysis showed age, rural residence, non-reserved social caste, less educated mothers, Islam religion, children with severe stunting or being overweight/obese, and residence in Southern India to be predictors of IKF. CONCLUSIONS: The prevalence of IKF among children and adolescents in India is high compared to available global estimates. In the absence of repeated eGFR-based estimates, these nationally representative estimates are intriguing and call for further assessment of socio-demographic disparities, genetics, and risk behaviours to have better clinical insights and public health preparedness.

Assessment of psychological distress pattern & its correlates among people receiving COVID-19 vaccination during the COVID-19 pandemic: A cross-sectional study.

Background & objectives: There is a possibility that vaccinated people may experience lesser psychological distress due to the sense of safety felt by them against getting the COVID-19 infection as compared to those who are not vaccinated. However, there is a paucity of research examining the mental health status of this important sub-group of population. Thus, the present study was aimed to examine the pattern of psychological distress and its correlates among people receiving COVID-19 vaccine. Methods: This cross-sectional study assessed individuals receiving COVID-19 vaccine at a tertiary care hospital. Psychological distress and COVID-19-related anxiety were assessed using the Depression Anxiety Stress Scale (DASS-21) and the COVID-19 Anxiety Scale-7, respectively. Results: The study comprised 728 individuals with a mean age of 44.8 yr. Moderate levels of depression, anxiety and stress were reported by about 50, six and 15 per cent of the participants, respectively, as assessed on DASS-21. Generalized linear model and quantile regression analyses revealed COVID-19-related anxiety, and being a healthcare worker or front-line worker as significant correlates of psychological distress. Interpretation & conclusions: About half of the study participants receiving COVID-19 vaccine reported moderate to severe symptoms of depression. Strategies focusing on alleviation of COVID-19-related fear and anxiety might be effective in improving the symptoms of psychological distress.

A qualitative study regarding menstrual hygiene in a rural community of Haryana, India.

INTRODUCTION: Adolescent girls face challenges in menstrual hygiene in routine patterns which impacts their education and health. A qualitative study was undertaken to assess the knowledge and practices regarding menstruation in a rural community of Haryana and to identify the barriers to menstrual hygiene. METHODOLOGY: The study was conducted in the month of September 2019 among various stakeholders i.e. adolescent females, adolescent males, Accredited Social Health Activist (ASHA) workers, Anganwadi workers, school teachers and Medical Officers. The stakeholders were mapped with the help of a Multi-Purpose Health Worker and ASHA of the village. Interview guides for focus group discussion (FGD) and in-depth interview (IDI) were prepared from previous literature to understand menstrual health management among the stakeholders. RESULTS: After IDI and FGD, we found that there is a barrier to accessibility of regular sanitary pads, a lack of education on menstrual hygiene among adolescent girls. School absenteeism was a concern due to the unavailability of mechanisms for the disposal of sanitary pads in school and poor maintenance of toilets. CONCLUSION: Proper implementation of the Adolescent Reproductive Sexual Health program and Menstrual health education can improve the use and reduce stigma and ignorance. Free uninterrupted supply of sanitary pads through school and Anganwadi will help improving accessibility and separate toilets for girls would lead to a reduction in absenteeism.

Use of information on pre-packaged foods among residents of an urban village of South Delhi, India.

Background: With rapid urbanization and hectic lifestyle, there is a growing demand of pre-packaged food items. 'Food label', present on most packaged food items provides information about the contents, their nutritive value and other information that can help the consumer to make an informed choice. Few studies in India have assessed the consumer's knowledge and practices related to information on a food label. Methods: We assessed the awareness, perceptions and practices related to the use of information on food labels among residents of an urbanized village of south Delhi. House-to-house visits were made and information gathered using a pre-designed, pre-tested, semi-structured questionnaire. Descriptive analysis was done and logistic regression performed to document the determinants of 'reading food label' by the study participants. Results: A total of 368 individuals were interviewed. The mean (SD) age of the participants was 29.1 (9.7) years. Around one-fourth (97/368; 26.4%) of all participants reported buying pre-packaged foods daily. A majority (222/ 368; 60%) of participants bought pre-packaged foods because they liked the taste, and also because they were easily available (153/368; 41.7%). A total of 64.1% (236/368) reported that they read food labels, but a majority checked only for the manufacture and expiry dates (203/236; 86%). Educational status, socioeconomic status and body mass index of the study participants were found to be significantly associated with reading of labels. Conclusions: The intention of promoting healthy food choices through the use of food labels is met inadequately at present. Awareness generation activities would be required to improve this behaviour.

Geospatial Analysis of Parental Healthcare-Seeking Behavior in the Vicinity of Multispecialty Hospital in India.

Background and Objective: The healthcare-seeking behavior of vulnerable groups, such as children under five, depends on a multitude of factors, including the caregiver's decision making. Approximately 60% of Indians seek care from private hospitals. Recent health policy in India has favored the establishment of multispecialty hospitals. However, it remains unclear to what extent this policy has changed the number of Indians seeking healthcare from these government-established multispecialty hospitals. The study aims to assess the health-seeking behavior of parents of children under five in the vicinity of a public multispecialty tertiary care hospital. Methods: This was a community-based cross-sectional survey with geospatial mapping conducted among the parents of children under five using a semi-structured questionnaire in Epi-collect mobile app. The study site was an urban slum in a catchment area [within five kilometers (km)] of a multispecialty tertiary care public hospital in the central Indian state of Chhattisgarh. The study was conducted for one year duration from February 2019 to January 2020. A questionnaire was administered to the parents of the children under five (N = 353) after their household confirmation from the nearby Anganwadi center, the community level service providing center under the Integrated Child Development Scheme by the Ministry of Women and Child Development (WCD). The questionnaire included sections for demographic characteristics, the illness pattern among their children, health-seeking decision-making, and more. Descriptive analysis was presented with numbers and percentages. Univariate analysis was used to assess the association between sociodemographic variables and health-seeking characteristics. Statistical significance was considered at p value less than 0.05. We used geospatial mapping using coordinates collected and compiled using the Microsoft Excel version 2021 and analyzed using QGIS (Quantum Geographic Information System) software. Results: Among the parents interviewed patients (N = 353), maternal literacy rates were over 85%. Approximately 54% of the families were below poverty line. Among 95.2% of the families, mothers were part of decision-making regarding their children's health-seeking. Over 92% of the families opted for consultation in a nearby private hospital or dispensary. Geospatial mapping of private hospitals was a favored place for healthcare-seeking by mothers, irrespective of their socioeconomic status or education rather than multispecialty hospital. Conclusion and Global Health Implications: The majority of the parents in the vicinity of public multispecialty hospitals seek care from private clinics for ailments for children under five. The establishment of public multispecialty tertiary care hospitals, which are mandated for tertiary level of care and research, cannot replace primary-level healthcare institutions, showed that private hospitals were the favored places healthcare seeking by mothers. These primary-level institutions are critical for the management of common ailments for children under five near home and reducing the financial burden on the family, even in the vicinity of a multispecialty hospital.

Content quality and reliability of YouTube videos on oral appliance therapy for obstructive sleep apnea: A systematic analysis.

INTRODUCTION: YouTube's popularity as a health information source raises concerns about credibility due to the absence of peer review. Therefore, this study assessed the content quality and reliability of YouTube videos related to oral appliance therapy for obstructive sleep apnea (OSA). METHODS: Videos were systematically searched on August 20, 2023, using terms determined through Google Trends. Videos were included based on predefined criteria and independently assessed by two researchers. Video demographics were extracted. Video quality was evaluated using audio-visual (AV) quality, video information and quality index (VIQI), global quality score (GQS), and reliability using a modified DISCERN tool (mDISCERN). High and low-content videos were defined based on the customized 10-point scoring system. Inter- and intra-examiner reliability of scoring system were calculated. RESULTS: Most videos were educational (46.3%), presented by dental sleep medicine specialists (42.6%), and aimed at laypersons (63%), with the majority originating from the United States (79.6%). The final 54 videos were categorized as high-content (n = 29, 54%) and low-content (n = 25, 46%). High-content videos had more views, comments, and longer video durations (7.07 ± 6.04 min). Significant differences (p < .05) were observed among high and low-content videos in total VIQI, mDISCERN, GQS, and TCS. Moderate correlations were found between GQS and TCS (r = 0.721), mDISCERN and VIQI (r = 0.649), GQS and VIQI (r = 0.601), and AV quality and VIQI (r = 0.531). CONCLUSION: The study highlights variable content quality and reliability of YouTube videos on oral appliance therapy for OSA, emphasizing the need for guidelines to enhance their educational value and deliver reliable, evidence-based information to patients.

How much do we follow birth preparedness? A community-based snapshot study from rural Delhi, India.

Introduction: Maternal healthcare remains a challenging public health problem in low and middle-income countries like India. The comprehension and services regarding practices related to birth preparedness and its complications in rural areas of India remain poor and underused. In view of this, we conducted this study to explore the preparedness of the pregnant women in the community residing in rural settlements of Delhi. Methods: This cross-sectional community-based study was carried out in 165 currently pregnant women selected through proportionate sampling from rural Delhi. A semi-structured questionnaire adapted from Birth Preparedness and Complication Readiness (BPCR) tool kit was used. Binary and multivariate regression analysis was applied to identify the predictors of BPCR. Results: In our study, BPCR index was found to be 25.78%. Only 17.6% pregnant women were well prepared. Multigravida, literacy, and higher socioeconomic status were found significant predictors for well preparedness for child birth and complication readiness in bivariate analysis. In multivariate logistic regression, multigravida and literacy were found to be predictors for well preparedness. Conclusion: The skill and knowledge level of the mother-in-laws and other women along with husband in the family needs to be improved in context of pregnancy and child birth. Frontline health workers can assist the to-be mothers and their family members in informed decision-making for better feto-maternal outcomes.

Undiagnosed hypertension and associated factors among adults in the urban field practice area of AIIMS Raipur: A community-based screening survey.

Introduction: Undiagnosed hypertension (HTN) increases the risk of severe consequences such as chronic kidney disease (CKD), hypertensive retinopathy, heart failure, and stroke. Population-based screening can be used to expose the hidden diseased mass with active disease. Thus, a screening survey was conducted to estimate the proportion of people with HTN among apparently healthy adults of age ≥30 years residing at the urban field practice area (UHTC) of AIIMS, Raipur, and also determine the predictors of undiagnosed HTN among the study participants. Methodology: This was a community-based cross-sectional study conducted over 2 months duration in the Ramnagar area, which comes under the urban field practice area of AIIMS Raipur using the STEPS tool is an acronym of study tool provided by WHO i.e. STEPwise approach to NCD risk factor surveillance consisting of three steps viz. questionnaire for behavioural risk factors, physical measurements and biochemical measurements. Results: In this study, 24.2% (95%, confidence interval [CI]: 20.1-28.2) of participants screened positive for HTN. The proportion of males who screened positive for HTN was 28.8% (95% CI: 22.6-35), whereas the proportion of females who screened positive for HTN was 19.6% (95% CI: 14.3-25). In this study, elderly (>60 years), male gender, daily tobacco use, greater waist circumference (male >90 cm and female >80 cm), and daily salt intake of more than 5 g were found to have higher odds of having HTN. Conclusion: The prevalence of undiagnosed HTN in the UHTC of AIIMS Raipur was quite high.

Analysis of Maternal and Infant Death Reporting System (MIDRS) in a North Indian State during 2013-2018.

Background: Haryana launched the Maternal and Infant Death Reporting System (MIDRS) in 2013 to report deaths and their causes. We evaluated the system in terms of its data quality, accuracy, and timing of reporting. Methods: Secondary data analysis of data about the maternal, infant, and child deaths from the state level MIDRS portal from 2013 to 2018. The portal combines infant and maternal deaths and stillbirths reported through passive and active surveillance. We used the descriptive measure of statistics (proportion) to describe the characteristics and causes of neonatal, post-neonatal, and maternal deaths. Results: Of 1,18, 028 neonatal deaths, 39% (46,140) neonates died at a government facility. Gender was not recorded in 7,093 (6.0%) deaths. "Others" was a predominant category (14,664, 53%) of death. Of 2,842 maternal deaths, the cause of death was unknown in 465 (16.4%) deaths and mentioned as "others" in 1,618 (56.9%) instances. Nearly 60% of maternal deaths occurred at a health facility. Stillbirth was published as a cause of death in 228 (7.8%) child deaths (1-5 years). Missing data were observed in critical variables such as the timing of maternal mortality (50, 1.8%) and sex of child (4884, 4.3%). Conclusion: Delay in reporting, inconsistencies in data, and missing information were some challenges. Ascertainment of the exact cause of death needs to be improved through better training.

Impact of COVID-19 on the patients' income and work in Delhi, India.

BACKGROUND: Currently, there is no data on the impact of COVID-19 on patients' income and work in India. METHODS: We conducted a cross-sectional study at a tertiary hospital in New Delhi. We included all the patients who were ≥18 years of age and consecutively diagnosed with COVID-19 between the 1st of May 2020 to 31st July 2020. Patients were interviewed by a physician using a semi-structure questionnaire. Data were collected on socio-economic status, occupation, income loss, leaves taken, decrease in work efficiency (self-perceived) and about-facing any stigma/discrimination at the workplace. RESULTS: Out of 245 patients, 190 patients were employed. A total of 126 patients (66.3%) self-reported their work was affected due to COVID-19 disease. A total of 30.5% of patients (n = 58/190) reported deduction in their salary. The median amount of salary loss was INR 10,000 (IQR 9000-25000). Decrease in income and work efficiency (self-perceived) was found to be 37.3% (n = 71) and 12.1% (n = 23), respectively. A total of 47 patients (37.3%) took personal leaves (median number - 17 days (IQR 14-25), and discrimination/stigma related to the COVID-19 at the workplace was faced by 22.6% of patients. CONCLUSION: Income and work of a substantial number of patients was affected due to COVID-19, as there was a decrease in income and work efficiency. Patients also had to take personal leaves and face stigma in the workplace. This will inform the policymakers to formulate strategies to mitigate the impact of COVID-19.

Hepatitis B vaccine birth dose in India: time to reconsider.

Viral hepatitis is increasingly being recognized as a public health problem in India with 96% of all hepatitis mortality attributed to hepatitis B and C combined. It has been recognized that hepatitis B vaccination has resulted in substantial reductions in the incidence of acute and chronic hepatitis B infections and carriage. Although coverage of third-dose hepatitis B vaccine has reached 86%, the birth-dose coverage was only 45% in 2015 despite high rates of institutional deliveries (79%). With the target set at 90% coverage of birth-dose hepatitis B vaccine by 2030, it is imperative to immediately incorporate WHO/SAGE recommendations of administering the hepatitis B vaccine birth dose until 7 d into the National Immunization Schedule (NIS).

Determinants of online health information-seeking behavior: A cross-sectional survey among residents of an urban settlement in Delhi.

BACKGROUND: In health care, the rapid proliferation of health information on the internet has resulted in more patients turning to the digital media as their first source of health information and acquiring knowledge. The present study was conducted to assess use of the digital medium as a medical information resource in health-related states and to determine their experience and perceptions about the quality and reliability of the information available among the participants. METHODOLOGY: The study was done in an urban settlement of Delhi among adults who use any digital media. A sample of 321 were selected though convenient sampling. The information was collected through a semi-structured, self-administered, pre-tested questionnaire which contained questions on socio-demographic profile, internet usage and awareness about Digital India. Bivariate analysis was done to determine the association between various socio-demographic variables associated with internet usage for health information. RESULTS: In the present study, 88.2% (283/321) were using the internet for health information through digital media. This study found out that younger age group (18-30 years), literate and higher socioeconomic group (upper middle and above) population were more likely to access health information via digital media which was found out to be statistically significant. CONCLUSION: Access to health information through digitization can improve health literacy among the population and help in promoting a preventive aspect to health problems and disease. They can be the building blocks to build "Swasth Bharat (Healthy India)".

Covid-19 chemoprophylaxis: Ethics of prevention based on anecdotal evidence.

The ongoing pandemic of Covid-19 caused by the SARS-CoV-2 virus has infected more than 6 million all over the world and has caused more than 3.8 lakh fatalities till date(1) Health workers are the frontline responders and are exposed to a plethora of health hazards. Recently, an advisory by the Indian Council of Medical Research for the use of hydroxychloroquine as post-exposure prophylaxis was hailed as an outstanding initiative for the protection of healthcare workers and high risk contacts of patients. But the evidence of effectiveness available is only from in vitro studies and non-randomised control trials of insufficient sample size. Several ongoing large scale clinical trials are focused on the same research questions, the preliminary results of which are still awaited. The present study discusses the ethics of the introduction of therapeutic or preventive interventions based on limited available evidence during the ongoing pandemic of Covid-19.

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Inadequate awareness of cervical cancer and its prevention among young women of Delhi, India: public health policy implications.

BACKGROUND: The increasing burden of cancer is a cause of concern worldwide including in India. Cervical cancer is amongst the most common cancers among women associated with high morbidity and mortality. Younger women are at risk of acquiring human papilloma virus (HPV) infection that can lead to cervical cancer later in life. The present study is an attempt to assess awareness about cervical cancer, its prevention and HPV among young women so that future policies can be designed accordingly. METHODOLOGY: This was a cross-sectional study conducted among college-going women students of Delhi. Data was collected using a pre-designed, pretested semi-structured tool followed by descriptive statistical analysis. RESULTS: Although 83% women students had heard of cervical cancer, the signs and symptoms were known to less than half (41.9%) of the students. HPV vaccine availability was known to 56.0% of the students, but very few students were vaccinated (15.0%). Similar disparity was also found in screening knowledge and practices. CONCLUSION: With poor knowledge about risk factors, and preventive strategies among young women, this study highlights the need for health education programmes related to cervical cancer targeting young women. As most of the risk factors of cervical cancer are modifiable, awareness generation at a young age could bring about a paradigm shift in incidence and the mortality associated with it.