WHO-Point Prevalence Survey of Antibiotic Use Among Inpatients at a Core National Antimicrobial Consumption Network Site in North India: Findings and Implications.

Data on Point Prevalence Surveys (PPSs) in India are limited yet. We report findings of a PPS conducted in a core "National Antimicrobial Consumption Network site" under National Centre for Disease Control - WHO project "Point prevalence survey of antimicrobial consumption at healthcare facilities." A cross-sectional survey was conducted as per the "WHO methodology for PPS on antibiotic use in hospitals" in a tertiary care hospital in India in December 2021. Data were collected using predesigned and pretested questionnaire in separate hospital, ward, and patient forms. Eight hundred two inpatients (excluding ICUs) were covered out of whom 299 (37.3%) were on antibiotics with 11.7% receiving 3 or more antibiotics. Surgical prophylaxis (SP) (42.5%) and community acquired infections (32.8%) were the most common indications for antibiotic use. Of the patients, 92.5% received SP for more than 24 hrs. Most commonly prescribed antibiotics were penicillins with beta-lactamase inhibitors (22.3%). Of the total antibiotic prescriptions, 81.5% were from WHO essential medicines list and 12% from "not recommended" WHO AWaRe classification. Of the antibiotic prescriptions, 84.6% were parenteral. Few prescriptions complied with standard treatment guidelines (1.9%), documented indication for antibiotic use (11.6%), and stop/review date (4.4%) in notes. Double anaerobic cover accounted for 6.8% of the total prescriptions. Some identified areas for improvement were: formulation of hospital antibiotic guidelines, promoting culture of sending cultures, improvement in surgical antibiotic prophylaxis, decreasing use of antibiotic combinations and double anaerobic cover, fostering IV to oral switch of antibiotics, and ensuring effective communication among health care workers by documenting adequate information in medical notes.

Linguistic adaptation and validation of All Aspects of Health Literacy Scale (AAHLS): A health literacy assessment tool for use in Hindi-speaking population.

Background Health literacy plays an important role in determining healthcare and medication outcomes. There is a lack of an appropriate, validated scale to assess health literacy status among the Hindi-speaking population. We translated and validated the English version of the All Aspects of Health Literacy Scale (AAHLS) into Hindi. Methods We translated the scale as per WHO guidelines on translation and adaptation of instruments. We did preliminary pilot testing in 30 bilingual subjects and evaluated cross-language concordance of the scale. The final translated scale so obtained after cross-cultural adaptation was tested in a validation study on 130 subjects from the outpatient department of internal medicine in which test-retest repeatability, construct validity, discriminant validity and internal consistency were assessed. Analysis was done using paired t-test, one-way ANOVA, Cronbach α and intra-class correlation coefficient. Results An excellent correlation between Hindi and English versions of the scale for various factors ensured cross-language concordance. Hundred percentage response rate was observed in the validation study. The scale showed good internal consistency (Cronbach α=0.99). The difference in total mean AAHLS score was not statistically significant across different age groups, genders and educational levels. Factor analysis showed a positive correlation among four factors/components of health literacy. For test-retest reliability, the intra-class correlation coefficient for all the items in different factors was significant (range 0.88-1.00; p<0.0001). Significant association of critical literacy sub-scores with functional (r=0.274, p=0.002) and communicative (r=0.283, p=0.001) sub-scores revealed a good construct validity. Conclusion The Hindi translated version of the AAHLS scale is a valid and reliable tool to assess health literacy in the Hindi-speaking population.

Assessment of social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur.

BACKGROUND: In developing countries, dental caries is the most common disease of the early childhood. Its increased prevalence in younger age group have been predictive of oral health problems in future, affecting oral health and development leading to several morbid conditions of oral and general health. Prevalence and incidence of dental caries is highly influenced by a number of risk factors such as gender, age, socioeconomic status, dietary patterns, and oral hygiene habits. AIM: To assess social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending Anganwadis of Hingna, Nagpur. MATERIALS AND METHODOLOGY: A cross sectional study in 27 Anganwadis of Hingna, Nagpur was carried out over a period of two months and a total of 324 subjects attending the Anganwadis were enrolled. Social, demographic and oral hygiene practices in relation to dental caries were assessed in the study population. RESULTS: Out of 324 subjects, 206 had dental caries and 38 were found to be malnourished. A significant association was found among age, malnutrition, parent's educational status, oral hygiene practices, total number of siblings, and dental caries. CONCLUSION: Anganwadis should be addressed routinely on effective oral and general health promoting strategies which must include education of parents, oral and general health issues, risk factors for dental caries, and malnutrition in children below 5 years of age.

Assessment of association between molar incisor hypomineralization and hypomineralized second primary molar.

BACKGROUND: The term molar incisor hypomineralization (MIH) has been described as a clinical entity of systemic origin affecting the enamel of one or all first permanent molars and also the incisors; less frequently the second primary molars have also been reported to develop hypomineralization of the enamel, along with MIH. AIM: To scrutinize the association between hypomineralized second primary molars (HSPMs) and MIH and their prevalence in schoolgoing pupils in Nagpur, Maharashtra, India and the associated severity of dental caries. DESIGN: A sample of 1,109 pupils belonging to 3-12-year-old age group was included. The entire sample was then divided into Group I (3-5 years) and Group II (6-12 years). The scoring criteria proposed by the European Academy of Pediatric Dentistry for hypomineralization was used to score HSPM and MIH. The International Caries Detection and Assessment System II (ICDAS II) was used for appraising caries status in the hypomineralized molars. The examination was conducted by a single calibrated dentist in schools in daylight. The results, thus obtained, were statistically analyzed using Chi-square test and odds ratio. RESULT: Of the children examined, 10 in Group I (4.88%) had HSPM and 63 in Group II (7.11%) had MIH in at least one molar. In Group II, out of 63 subjects diagnosed with MIH, 30 subjects (48%) also had HSPM. Carious lesions with high severity were appreciated in hypomineralized molars. CONCLUSION: The prevalence of HSPM was 4.88% and of MIH was 7.11%. Approximately half of the affected first permanent molars were associated with HSPM. The likelihood of development of caries increased with the severity of hypomineralization defect.

Assessment of psychological effects of dental treatment on children.

AIM: The aim of present study is to investigate the various psychological effects on children due to dental treatment. MATERIALS AND METHODS: One hundred and eighty school going children, age range between six and twelve years, were recruited into the study and divided into two groups (Group I included six to nine-year-olds and Group II included nine-to-twelve year olds). Only those children were included who underwent a certain dental treatment seven days prior to the investigation. Each child was asked a preformed set of questions. The child was allowed to explain and answer in his own way, rather than only in yes or no. The answers were recorded. After interviewing, the child was asked either to draw a picture or to write an essay related to his experience regarding the dentist and dental treatment. RESULTS: A majority of the children (92.22%) had a positive perception. The number of children having negative and neutral perceptions was comparatively much less. Younger children (Group I) had a more negative experience than the older children (Group II). Only one-fourth of the children complained of some pretreatment fear (23.83%); 72.09% of the children did not have any pain during dental treatment and a majority of children (80.23%) remembered their dental treatment. CONCLUSION: A majority of children had a positive perception of their dental treatment and the children in the younger age group had more negative perceptions than the children in the older age group.

Assessment of vaccine wastage during a pulse polio immunization programme in India.

A study to assess the wastage factor of oral polio vaccine (OPV) in the Pulse Polio Immunization (PPI) programme of the Government of India was undertaken by the Indian Council of Medical Research (ICMR) at approximately 31,000 immunization booths all over the country. The study was conducted through the network of 31 Human Reproduction Research Centres (HRRCs) and other ICMR institutes. Wastage at the point of administration of OPV was estimated to be 14.5% with a wastage factor of 1.17 which is well below the assumed wastage of 33% and the corresponding wastage factor of 1.5 in the PPI programme. The wastage and wastage factor as estimated in the present study were also less than the wastage of 25% and the wastage factor of 1.33 recommended by the World Health Organization. Minimum wastage (6.3%) at Kanchipuram and maximum wastage (22.1%) at Kanpur were observed. Further, the wastage of unopened vials and vials during use was also observed following colour changes on the vaccine vial monitor (VVM), indicating poor cold-chain maintenance at the immunization site. In total, 13 booths reported wastage of nine or more unopened vials, whereas 19 booths reported wastage of nine or more vials during use because of colour changes on VVM. Other reasons for wastage of vaccine were also observed from a sample of booths. The technology of introducing VVM on OPV vials for monitoring the cold-chain proved useful in situations in which mass vaccination programmes such as PPI are carried out.