Status of coverage of MR vaccination, after supplementary immunization activities in a rural area of South India: a rapid immunization coverage survey.

INTRODUCTION: After a commendable achievement on polio-free status for the South-East Asian Region (SEAR), WHO is now focusing towards measles elimination, which is still a major contributor of under-five mortality in SEAR. India has introduced measles and rubella (MR) vaccination throughout the country through supplementary immunization activity, followed by introducing the same in the routine vaccination. Health indicators and public health system functioning in the southern states of India are good, so India introduced the MR campaign in the southern high-performing states as phase 1 on 5 April 2017. The aim of the campaign was to vaccinate more than 95% of eligible children (aged 9 months to 15 years). At the same time, rumors and negative campaigning about this initiative started in social media. This study aimed to measure the coverage of MR vaccination among the target population in South India. METHODS: Data was collected immediately after phase 1 of the MR vaccine campaign in April 2017. Data was collected based on the WHO-recommended 30/7 rapid monitoring method. Thirty villages around the Rural Health Training Centre of Pondicherry Institute of Medical Sciences were selected and seven children aged 9 months to 5 years and seven children aged 6 to 15 years from each village were included. Children were classified as 'vaccinated' or 'not vaccinated' based on the WHO 'card or history' method. RESULTS: Among the total sample of 420 children, 380 children (90.5% (range 87.4-93.0%)) were found to be vaccinated and 40 children (9.5% (range 7.0-12.6%)) were found to be unvaccinated. Most of the people came to know about the MR vaccination through auxiliary nurses and midwives, followed by school teachers. The main reasons for not getting vaccinated was fear of an adverse event following vaccination or fear of injection. Reasons for not getting vaccinated were significantly associated with usage of smartphone by at least one of the parents (adjusted odds ratio (OR) 2.1 (1.1-4.2)), better literacy level among mothers (adjusted OR 5.2 (1.1-24.8)) and poor literacy level among fathers (adjusted OR 3.6 (1.1-11.5)). CONCLUSION: Despite the negative propaganda by social media, the coverage of vaccination by the public healthcare providers was near optimal in phase 1, which shows the strength of the public health system in this rural area of southern India. In accordance with the modern technology, public health policymakers should think about and plan information education and communication activities.

Social capital as a mediator of the influence of socioeconomic position on health: Findings from a population-based cross-sectional study in Chandigarh, India.

BACKGROUND: Social capital has been recognized as part of the WHO's Social Determinants of Health model given that social connections and relationships may serve as resources of information and tangible support. While the association between socioeconomic position and health is relatively well established, scant empirical research has been conducted in developing countries on the association between social capital and health. OBJECTIVE: Based on the WHO's Social Determinants of Health framework, we tested whether social capital mediates the effect of socioeconomic position on mental and physical health. METHODS: A population-based study was conducted among a representative sample (n = 1563) of men and women in Chandigarh, India. We used standardized scales for measuring social capital (mediator variable) and self-rated mental and physical health (outcome variable). RESULTS: A socioeconomic position index (independent variable) was computed from education, occupation, and caste categories. Mediation model was tested using path analysis in IBM SPSS-Amos. Participants' mean age was 40.1 years. About half of the participants were women (49.3%), and most were relatively well educated. The results showed that socioeconomic position was a significant predictor of physical and mental health. Social capital was a significant mediator of the effect of socioeconomic position on mental health but not physical health. CONCLUSION: Besides removing socioeconomic barriers through poverty alleviation programs, interventions to improve social capital, especially in economically disadvantaged communities, may help in improving population health.

Level, causes, and risk factors of stillbirth: a population-based case control study from Chandigarh, India.

BACKGROUND: Globally, India ranks first in the absolute number of stillbirths. Hence, the level, causes, and risk factors of stillbirths were estimated to facilitate designing of prevention strategy. METHODS: Capture and recapture method was used to identify 301 stillbirths from 1st July 2013 to 31st August 2014 in Chandigarh Union Territory of India. Verbal autopsies (n = 181) were done at household level to identify causes of stillbirths. Risk factors were determined using case-control approach. Women who had a stillbirth in the past 3 months were enrolled as cases (n = 181) and those who had live-birth in same neighbourhood were included as controls (n = 181). Statistical differences in the distribution of characteristics of cases and controls were tested by t test and chi square test respectively for quantitative and categorical variables. In logistic regression models adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated for various risk factors. RESULTS: Stillbirth rate was estimated to be 16/1000 birth. Antepartum causes were more common (68%) than intrapartum causes (32%). Among maternal conditions, hypertension (18.2%) and chorio-amnionitis (13.8%), and among foetal conditions, growth restriction (19.9%) and congenital anomalies (18.8%) were the leading causes. In about half of the stillbirths foetal (48%) and maternal (44.7%) causes were unidentifiable. Risk factors of stillbirths were: higher maternal age (aOR 1.1, 95%CI 1.0-1.2), vaginal delivery (aOR 8.1, 95%CI 2.6-26), induced labour (aOR 2.6, 95%CI 1.5-4.5), green or light brown liquor (aOR 2.0, 95%CI 1.1-3.8), preterm delivery (aOR 6.4, 95%CI 3.7-11) and smaller household size (aOR 1.2, 95% CI 1.1-1.3). CONCLUSIONS: Stillbirth rate was high in Chandigarh Union Territory of India. Major causes and risk factors amenable to interventions were infections, hypertension, congenital malformations, foetal growth restriction, pre-maturity and household size. Therefore, better maternity ante-natal and intra-natal care is required to achieve a single digit stillbirth rate.

The chunampet community health information management system: A health and demographic surveillance system from a rural South India.

BACKGROUND: Developed countries have strong health and demographic surveillance system (HDSS), whereas there is a dearth of such system in developing countries like India. India depends on national surveys and individual studies for public health information. At present All India Institute of Medical Sciences - New Delhi HDSS and Vadu HDSS are well established HDSS in India. MATERIALS AND METHODS: We developed a HDSS in a remote rural area of South India and named as Community Health Information Management System (CHIMS) This covered 20 villages around Rural Health Training Centre - Chunampet. We collected the family and demographic information from March 2018 to October 2018. Pregnancy, birth, under-five and mortality data were collected once in every 3 months with the help of interns, Medical Social Workers. Data collection done using CHIMS Guide and entered in EpiData software. EpiAnalysis, Quantum Geographic Information System, Dropbox were the other freely available software used in this program. RESULTS: CHIMS HDSS covered 14924 individuals belonging to 4486 households in the surrounding twenty villages. Population density was 213/km2. CHIMS consumed very limited resources in terms of workforce, materials, and transport. CHIMS database was used as a baseline database for many other studies. This CHIMS HDSS helped in many publications, postgraduate thesis dissertations and mainly attracted many extramural research funds from leading government Research Institutes from India. CONCLUSION: CHIMS proved to be a robust surveillance system in providing vital public health information about the community and attracted more extramural funds to the institute.

Association of kidney functions with a cascade of care for diabetes and hypertension in two geographically distinct Indian cohorts.

AIM: Type 2 diabetes (T2DM) and hypertension (HTN) are the main modifiable risk factors of chronic kidney disease (CKD), among the known traditional and non-traditional risk factors. METHODS: We determined the prevalence and care-cascade of these modifiable CKD-risk factors and their association with socioeconomic status in adjoining Lucknow and Puducherry cities of India. RESULTS: 439 participants reported no CKD were recruited. Serum analysis revealed an Estimated Glomerular Filtration Rate (eGFR) ≥ 90 ml/min/1.73 m2 in 60.36% of the population. Of them, 55.85% had HTN and/or T2DM as CKD-risk factors; however, less than half of this population was unaware of their CKD-risk status. Awareness and treatment were significantly higher in Puducherry and were associated with literacy, occupation, and residence place. Although the CKD-risk population was about two times higher in Puducherry than Lucknow, the populations with mild-low eGFR were comparable in the two regions. Moreover, in Lucknow, mild-low eGFR and low awareness were more prevalent among the younger participants (<30 years), relative to Puducherry. CONCLUSIONS: Despite a higher prevalence of CKD-risk factors in Puducherry, populations with mild-low eGFR were comparable to Lucknow. More heightened awareness and better care cascade for CKD-risk factors in Puducherry may prevent or delay eGFR reduction.

Prevalence and determinants of Alcohol use in a remote rural area in South India: A community-based cross-sectional study.

INTRODUCTION: Alcohol use is a major public health problem in India. We sought to study the use of alcohol and its risk factors in a rural area in South India. METHODS: This study was conducted in 20 villages surrounding a Rural Health Training Centre, located in South India. The study was done from March 2018 to October 2018 with the help of Medical Interns and Medical Social Workers using a pretested questionnaire. RESULTS: In a total population of 14,925, 11,995 individuals are in the age group of 15 years and above, among whom 1,005 were reported to be using alcohol. The prevalence of alcohol among 15 years and above is 8.4% (7.9-8.9) and the overall prevalence in the total population is 7% (6.3-7.1). Prevalence of alcohol use among males and females are 16% and 1%, respectively. The alcohol use is higher among those who prefer open defecation (adjusted Odds Ratio (aOR) 1.2 (1.0-1.4)), Kutcha house (aOR 1.7 (1.4-2.2)) or semi-pucca house (aOR 1.3 (1.121.6)), lower caste (Most Backward Castes (MBC) aOR 1.7 (1.2-2.2), Scheduled Castes (SC) aOR 2.1 (1.6-2.9)), male gender (aOR 41 (29-59)), Married 5.0 (3.7-6.8), or Separated 2.6 (1.5-4.4) and Diabetes 1.6 (1.1-2.3). CONCLUSION: Alcohol use in a remote rural area is high among socially deprived communities who live in kutcha and semi-pucca houses and belong to a lower caste. This needs serious public health interventions to improve their socioeconomic status.

Cardiovascular risk using WHO-ISH chart among Diabetes and Hypertensive patients in a remote rural area of South India.

INTRODUCTION: Cardiovascular diseases (CVDs) are major problems in India and many other developing and developed countries. As India is committed to provide universal health care for the population, there is a need to find out the prevalence and determinants of CVD risk among high-risk individuals (Diabetes and Hypertensive patients) in the remote rural area of India to deliver appropriate services, as they are considered as neglected population. METHODS: We screened high-risk individuals (Hypertension and Diabetes patients) for CVD risk using WHO/ISH chart, in a remote rural area of south India, covering ten villages surrounding the Rural Health Training Centre (RHTC), in August-September 2017. After line-listing the participants from the electronic database of RHTC, screening with questionnaire and biochemical tests was done at village level as the first step. Thereafter, the participants were invited to the hospital on a particular day where electrocardiography (ECG) and echocardiography (ECHO) were done with special consultation. RESULTS: Among the total of 303 individuals screened at the village level, 64 [21%(CI 17-25)] had a higher risk for CVD. 235 people attended the special consultation; among them, 212 underwent ECG and 88 underwent ECHO. Among those screened with ECHO, 18 had some cardiac pathologies. The relationship between CVD risk and other factors is shown in. After final adjustment, illiteracy [adjusted prevalence ratio (aPR) 1.8 (0.1-3.1)], anemia [aPR 1.8 (1-3.6)], and chronic renal diseases [aPR 1.8 (1.0-3.4)] were found to be associated with high risk for CVD among hypertension and diabetes groups. CONCLUSION: Cardiovascular disease risk assessment using WHO/ISH chart showed an association with poor education, anemia, and chronic kidney disease.

Feasibility and outcome of community-based screening for cardiovascular disease risk factors in a remote rural area of South India: The Chunampet rural-Cardiovascular health assessment and management program.

BACKGROUND: As committed by India in Global Action Plan, Sustainable Development Goals and National Health Policy 2017, India has the responsibility to provide accessible, affordable noncommunicable disease care to the people. Our study aimed to find out the burden of cardiovascular risk factors among hypertension and diabetic patients, through a community-based screening, in a remote rural area of South India. METHODS: A special program named "Chunampet Rural-Cardiovascular Health Assessment and Management Program" (CR-CHAMP) was launched in August and September 2017 in a Rural Health Training Center (RHTC), functioning under a private medical college in South India. In this program, participants with hypertension (HT) and diabetes (DM) were line listed from 10 remote villages, and then history, initial biochemical, hormonal, and hematological screenings were done to assess the cardiovascular diseases (CVDs) risk factors among these patients, following which special consultation was offered in RHTC. RESULTS: Out of 415 eligible patients with HT and DM, 389 were approached; among them, 328 were willing to participate and were screened initially; among them, 235 were attended special consultation. Higher CVD risk was found in 21%. Prevalence of chronic kidney disease was 14%, deranged lipid profile was more than 50%, metabolic syndrome was 49%, anemia was 68%, abnormal waist-hip ratio was 56%, abdominal obesity was 59%, and overweight and obesity using body mass index (BMI) was 59%. Females' participation was more in our community-based screening procedure (66%) than male participation (34%). CONCLUSION: CR-CHAMP demonstrated feasibility and value of implementing a screening program for high-risk individuals with HT and DM for CVD risk through existing primary care in a remote rural area of South India. This will help the National Program and policymakers to plan for interventions in the remote rural area in future.

Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India.

INTRODUCTION: Xpert MTB/RIF was implemented in 2016 as the initial diagnostic test for extrapulmonary, pediatric, and human immunodeficiency virus-associated tuberculosis (TB) and as an add-on test for sputum microscopy-negative patients under Revised National TB Control Programme, Puducherry, India. We intended to study the change in TB case notification rates (CNRs) after 2015 and explore the enablers and barriers for implementation of Xpert. MATERIALS AND METHODS: Sequential mixed-methods study, quantitative phase followed by a descriptive qualitative phase (key informant interviews with healthcare providers in the program). RESULTS: The TB (all forms) CNR increased in 2016 followed by a drop to 2015 levels in 2017. There was a reduction in patients notified as sputum-negative pulmonary TB and pediatric TB during 2016-2017. Healthcare providers used a negative Xpert result in ruling out TB among patients who would previously get diagnosed clinically. Perceived benefits of Xpert were efficiency, rapid results, and detecting resistance. Barriers included poor awareness among medical colleges and the private sector, difficulty in motivating sputum microscopy-negative patients for Xpert, and incompletely filled referral forms. CONCLUSION: Xpert-negative results should be interpreted cautiously after clinical assessment. Identified barriers should be addressed to ensure that all eligible undergo testing.

Factors Associated with Physical Inactivity among Adult Urban Population of Puducherry, India: A Population Based Cross-sectional Study.

INTRODUCTION: Physical inactivity is the fourth leading cause of death worldwide. Increase in physical activity decreases the incidence of cardiovascular diseases, Type 2 diabetes, stroke, and improves psychological wellbeing. AIM: To study the level of physical inactivity among the adult population in an urban area of Puducherry in India and its associated risk factors. MATERIALS AND METHODS: This cross-sectional study was conducted among 569 adult participants from an urban area of Pondicherry. The level of physical inactivity was measured by using WHO standard Global Physical Activity Questionnaire (GPAQ). RESULTS: Overall prevalence of physical inactivity in our study was 49.7% (CI: 45.6-53.8). Among the physically active people, contribution of physical activity by work was 77.4%, leisure time activities were 11.6% and transport time was 11%. Both men and women were equally inactive {Physically inactive among women was 50% (CI:44.1-55.9)} and {Physically inactive among men was 49.5% (CI:43.8-55.2)}. Prevalence of physical inactivity was increasing with increasing age. Non tobacco users were two times more active than tobacco users {Adjusted Odds Ratio: 2.183 (1.175- 4.057)}. Employed were more active as compared to retired {Adjusted Odds Ratio: 0.412 (0.171-0.991)}, students {Adjusted Odds Ratio: 0.456 (0.196-1.060)}, house wives {Adjusted Odds Ratio: 0.757 (0.509-1.127)} and unemployed {Adjusted Odds Ratio: 0.538 (0.271-1.068)}. Non alcoholics were only 0.34 times as active as alcoholics. CONCLUSION: Level of physical activity was found to be insufficient among adult urban population of Puducherry. Working adult population found to be active, that too due to their work pattern. There is a need to promote leisure time and travelling time physical activity.