Assessment of Educational Environment of Newly Established Medical College by UG Medical Students: A Mixed Method Study

Introduction: Educational environment always play a crucial role in the development of students as well as faculty of any institution. In India, there is a continuous increase in the number of medical colleges and the number of MBBS seats, but the quality of education with quantity is questionable. To answer this question, the present study was planned to know the educational environment in a new Medical Institution that ejected its alumni in 2018. Aim: To analyze the educational environment of a newly established Medical College in eastern Uttar Pradesh. Materials and Methods: The present study was a descriptive cross-sectional which took six months to complete. This study used the Dundee Ready Education Environment Measure (DREEM) questionnaire, open-ended questions and focus group discussions (FGDs). The study was conducted on MBBS students in Government Medical College, Azamgarh, UP. Results: The batch-wise Global DREEM scores were 169.08 (alumni), 156.23 (interns), 168.76 (2015), 164.16 (2016), 176.23 (2017), 176.94 (2018). This demonstrates that the educational environment is satisfactory in all domains and comes under the 3rd category of the educational environment index. The FGDs showed a positive response in all batches but with high variability in scores, which indicates lack of standardization in Medical Education. The open-ended questions’ responses revealed many merits and demerits about five domains. Conclusion: The variability of DREEM score, FGDs and open ended questions denotes the lack of standardization in the Medical Education system and the scores of the Education Environment Index (all domains) must move from category III (satisfactory) to category IV (excellence).

Quality of routine immunization service: Perception of clients

Background: Immunization prevents over 2�million deaths each year worldwide. In India, even though vaccines are offered free of cost at public health facilities the coverage remains low. Limited scrutiny has been conducted at health service and client interface for routine immunization (RI) services, which may have been affecting the acceptance of vaccines. This emphasizes the importance of assessing the level of satisfaction and perceived quality of clients regarding RI services. Objectives: This study aimed to assess the perceived quality and level of overall general satisfaction with RI services of clients. In addition, determine the association of factors influencing clients perceived quality and overall general satisfaction with RI services. Methods: A community-based cross-sectional study was conducted in an urbanized village of Delhi from November 2015 to April 2017. A total of 279 RI visits were covered in the study, and the clients were interviewed at their residence using a pretested tool. Results: The dissatisfaction toward the domains of perceived quality of RI services was reported to be 3.2% for vaccine availability, 9.7% for vaccine information, 3.2% for staff behavior, 6.1% for doctor behavior, and 7.5% for infrastructure. Multivariable-regression analysis indicated that distance to health facility, literacy and age of the client, doctor behavior, staff behavior, and infrastructure had an effect on overall general satisfaction of client toward RI services. Conclusions: The client's perception is multidimensional; improvement in one domain is likely to strengthen the other. By understanding the client's perspective toward quality of RI service, the health-care mangers may improve the level of overall satisfaction.

Diabetes self care activities among adults 20 years and above residing in a resettlement colony in East Delhi

Background: Self-care activities are the cornerstone of diabetes care that ensures patients participation to achieve optimal glycemic control and to prevent complications. Objective: The aim of this study is to find the level of self-care activities among diabetics aged ?20 years residing in a resettlement colony in East Delhi and its association with sociodemographic factors, disease, and treatment profile. Methods: Using cross-sectional survey, 168 known diabetic patients were selected from Nand Nagri, a resettlement colony in East Delhi. Data were collected using Hindi translation of revised version-Summary of Diabetic Self Care Activities along with a pretested semi-open-ended questionnaire. Self-care was assessed on six parameters as follows: (a) general diet, (b) specific diet, (c) exercise, (d) blood sugar testing, (e) foot-care, and (f) smoking. The study period was from November 2014 to April 2016. Results: Nearly 35.1% of respondents belonged to 60� years age group. About 52.4% of respondents were female. Fifty-two diabetics (31%) reported having practised diet control on all 7 days in the past 1 week. Nearly 39.3% of patients did not perform any physical activity. The blood test was not practised by 92.3% of respondents. Foot-care was practised by only 19% of patients. There was a significant association between general diet among diabetics with family support (P = 0.020), place of diagnosis (P = 0.033), and treatment funds (P = 0.017). The exercise score among diabetics who were below the poverty line was higher than those above poverty line (P = 0.029). Younger age (P = 0.005) and treatment with insulin (P = 0.008) were positively associated with blood glucose testing. The foot-care practice was better in patients aware of complications and foot-care practices (P < 0.001). Conclusion: Self-care activities among diabetic patients were very poor. Self-management educational programs at hospitals along with information, education, and communication activities at the community level and one-to-one counseling are recommended.

Monitoring the durability of long-lasting insecticidal nets in field conditions in Nepal.

Understanding and improving the durability of long-lasting insecticidal nets (LLINs) in the field is critical for the success of malaria prevention using mosquito nets, as well as contributing to procurement decisions based on the number of years of protection, rather than the current practice of unit cost. Using the recently published guidelines from the World Health Organization (WHO) some progress has been made in the monitoring and assessment of performance of nets in the field. This paper describes the protocol of an ongoing retrospective study of the attrition rate, physical integrity and bioefficacy of three polyester LLIN products that were distributed during 2010 to 2013 in Nepal. It is hoped that robust and auditable data on net survival (physical integrity and bioefficacy) of these three brands in different environments will assist the Nepal National Malaria Control Programme in planning future LLIN-replacement strategies, including behaviourchange communication about LLIN care and maintenance. The advantages and disadvantages of prospective and retrospective cross-sectional approaches are discussed, including appropriate strategies to validate the timing for mass distribution of nets. Similar studies should be done in other countries to (i) track LLIN durability to support management of resupply, and (ii) inform procurement decisions at the global level. New, more predictive, textile laboratory testing is also urgently needed.

Hypocalcemia in the newborn.

Healthy term babies undergo a physiological nadir in serum calcium levels by 24-48 hours of age. This nadir may be related to the delayed response of parathyroid and calcitonin hormones in a newborn. This nadir may drop to hypocalcemic levels in high-risk neonates including infants of diabetic mothers, preterm infants and infants with perinatal asphyxia. This early onset hypocalcemia which presents within 72 hours, requires treatment with calcium supplementation for at least 72 hours. In contrast late onset hypocalcemia usually presents after 7 days and requires long term therapy. Ionized calcium is crucial for many biochemical processes and total serum calcium is a poor substitute for the diagnosis of hypocalcemia.

Seroepidemiological study of Toxoplasma infection in central and western regions in Nepal.

The present study was carried out to ascertain the seroprevalence rate in different geographical areas in Central and Western Regions in Nepal. A total of 1,237 serum samples collected from Nuwakot (217), Kathmandu valley (402) and Chitawan (159) districts in Central Region, and Mustang (143), Surkhet (64) and Banke (252) districts in Western Region in Nepal were included in this study. Toxoplasma antibodies were detected by micro-latex agglutination (MLA) and enzyme linked immunosorbent assay (IgM-ELISA) methods. The seropositive rate in Central and Western Regions were found to be 48% and 49%, respectively; with an overall positive rate of 48 percent. Districtwise, the seropositive rate in Nuwakot, Kathmandu valley, Chitawan, Mustang, Surkhet and Banke districts were 38, 46, 64, 51, 67 and 44%, respectively. Interestingly, the relatively newly inhabited Surkhet district in Western Region and Chitawan district in Central Region showed significantly higher seropositive rate compared with those of two other districts in the respective Regions (p < 0.05). Ethnically, Tibeto-Burmans showed higher seropositive rates in Central Region (p > 0.05). In contrast, Indo-Aryans showed higher seropositive rate in Western Region (p > 0.05). Age related increase in seropositivity was observed only in Central Region. One percent of Toxoplasma antibody positive samples also showed Toxoplasma IgM antibody positivity.