Analysis of cesarean section rates and its indications using robson's classification at a tertiary care hospital, Manipur.

Context: The World Health Organization proposed the Robson's classification system as a global standard for assessing and comparing cesarean section (CS) rates within health-care facilities over time and between facilities. Aims: This study aims to assess the frequency and indications of CS and to identify the groups within the obstetric population contributing to CS using Robson's classification. Settings and Design: A retrospective chart review was conducted in a Tertiary Care Teaching Hospital in Imphal, Manipur. Methods: All women who delivered between January and December 2019 were classified using the Robson's Ten Group Classification System. The overall CS rate and the CS rate in each Robson's group were calculated. The indications for CS were also recorded. Statistical Analysis Used: Descriptive statistics, such as frequency, percentage, mean, and standard deviation, was used. Results: A total of 10,282 births were reported. The overall CS rate was 35.2%. Group 3 (multiparous women without previous CS in spontaneous labor) (27.6%) and Group 1 (nulliparous women in spontaneous labor) (23.7%) contributed to most of the obstetric populations. The majority of CS belonged to the women in Group 5 (multiparous women with previous lower segment CS) (11%), followed by Group 2 (nulliparous women with labor induced or prelabor CS) (8.6%) and Group 4 (multiparous women without previous CS were induced or taken for prelabor CS) (5.5%). Conclusions: The study revealed that Groups 5, 2, and 4 contributed to the high CS rate. Efforts to reduce the overall CS rate should be directed at increasing vaginal births after CS, performing effective pelvic examinations, and encouraging obstetricians to perform versions when indicated.

COVID-19 Vaccine hesitancy among pregnant women: A facility-based cross-sectional study in Imphal, Manipur.

Background: Vaccine hesitancy has been recognized as a public health issue which needs to be addressed urgently. Pregnant women with COVID-19 are at increased risk of adverse pregnancy outcomes. An assessment of the determinants of vaccine hesitancy will aid in the acceleration of vaccine administration among pregnant women. Objectives: The present study aimed to determine COVID-19 vaccine hesitancy among pregnant women in Imphal, Manipur and assess associated factors. Methods: Across-sectional study was conducted among pregnant women attending Obstetrics and Gynecology Department of a Tertiary Care Institute in Imphal, Manipur during August 2021. One hundred and sixty-three pregnant women were interviewed using a structured questionnaire over phone calls. Univariate analysis was carried out using the Chi-square test and multivariable logistic regression was performed to determine the factors significantly associated with vaccine acceptance. Results: The mean age of the participants was 28.3 ± 5.5 years and majority, 102 (62.6%) were multigravida and 27 (16.6%) had comorbidities. Vaccine hesitancy was found in 127 (77.9%) participants. Logistic regression analysis indicated that awareness on COVID-19 vaccine eligibility (P = 0.002), disagreement of vaccine being unsafe during pregnancy (P = 0.005), and agreement on vaccine benefiting the baby (P = 0.003) were the significant predictors of vaccine acceptance. Conclusion: Nearly four out of every five pregnant women had COVID-19 vaccine hesitancy. Pregnant women should be informed about the benefits and encouraged to take COVID-19 vaccine.

Preparedness of healthcare facilities of manipur in the management of noncommunicable diseases: A cross-sectional study.

Background: India is experiencing a rapid health transition with a rising burden of noncommunicable diseases (NCDs), causing significant morbidity and mortality. Cost-effective interventions for comprehensive NCD management can only be designed after assessing the readiness of various health facilities. Objectives: This study aimed to assess the preparedness of healthcare facilities of Manipur in the management of NCDs and to assess the knowledge of doctors regarding NCDs. Methods: A cross-sectional study was conducted in 21 public healthcare facilities in seven districts of Manipur during October 2021. Readiness of these facilities was assessed through observation and interview of doctors and nurses using a checklist adapted from the WHO Package of Essential NCDs. Knowledge of 153 doctors was also assessed using a self-administered, structured questionnaire. Data were entered in SPSS-26 and expressed using descriptive statistics. Results: General readiness index of primary health centers (PHCs), community health centers (CHCs), district hospitals (DHs), and tertiary care centers (TCCs) was 47%, 66.3%, 73.2%, and 70%, respectively. CHCs were ready in the domains of patient care services (80%), human resources (75%), and advocacy (91.7%). DHs and TCCs were ready in terms of patient care services, human resources, record maintenance, referral system, and advocacy. PHCs were not ready in any of the nine domains. Majority of the doctors (88%) had inadequate knowledge regarding NCDs. Conclusion: PHCs and CHCs were not adequately prepared, but DHs and TCCs were ready to manage NCDs. More than four-fifth of the doctors had inadequate knowledge. Strengthening PHCs and CHCs and training of healthcare workers are needed for integrated NCD management.

Sleep pattern, aggressive behavior and substance use among school students of Manipur: A cross-sectional study.

BACKGROUND: Adolescence is a vulnerable period of growth and development. This is the time when habits are inculcated which will carry forward to adult life. Sleeping patterns among adolescents have an impact on their overall health. Early substance use initiation is a serious concern because it is associated with significantly increased risks for developing substance use disorders. In general, aggressive behaviors progress from less to more severe over the course of adolescent development. OBJECTIVES: The objectives of this study are to determine the lifestyle behaviors of young adolescents focusing on sleep pattern, aggressive behavior, and substance use. METHODS: A cross-sectional study was conducted among 739 students of Class VII and VIII in both government and private schools in Imphal West and Kangpokpi districts of Manipur between August 27 and September 25, 2017. A pretested, structured questionnaire was used, which included the modified version of Buss and Perry Aggression Questionnaire. The data were analyzed using the IBM SPSS software (IBM SPSS for Windows, Version 21.0. Armonk, NY, USA). RESULTS: Only 56.2% of the students had adequate sleep. The proportion of adolescents using alcohol, tobacco, cigarettes, and Ganja was 4.6%, 9.5%, 5.7%, and 1.6%, respectively. Aggressive behavior was shown by 35.3%. Male students were getting more sleep (60.7%), were more aggressive (38.8%), and were using tobacco and cigarettes (82.4%) more than female students. CONCLUSIONS: Around two-fifth of the adolescents were not getting enough sleep. The association between aggressive behavior and substance use was found but needs further investigation for its temporal relationship.

High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India.

BACKGROUND & OBJECTIVES: It is well documented that the Northeast state of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection. METHODS: Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection. RESULTS: HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection. INTERPRETATION & CONCLUSIONS: The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.

A Review of Maternal Near Miss Cases in Selected Hospitals in North-East India.

BACKGROUND: The major causes of maternal near miss (MNM) and maternal death (MD) are similar, so review of MNM cases is likely to yield valuable information regarding severe morbidity, which, if untreated may lead to maternal mortality. OBJECTIVES: The objective is to determine frequency of near miss cases and identify the risk factors associated with MNM. MATERIALS AND METHODS: A cross-sectional study was done from June 2015 to October 2017 in three hospitals in Manipur and Nagaland. All cases of MNM, which occurred during this period, were included and were reviewed using their records. Family members and health care providers of 9 recent cases were interviewed. Data collected were coded and relevant themes were identified. RESULTS: There were 32,110 deliveries, 147 near miss cases and 12 MDs, resulting in maternal mortality ratio of 38/100,000 live birth (LB), severe maternal outcome ratio of 5/1000 LB and MNM ratio of 4.6/1000 LB. MNM to mortality ratio was 12.2:1 and mortality index was 7.5%. 83% of the cases of MNM were pregnancy related while 15.6% were related to preexisting disorders. The three delays remain the decisive factors in maternal mortality. CONCLUSION: Most of the near miss cases experienced delay in decision to seek health care, which resulted from underestimating the severity of various pregnancy-related conditions. Poor knowledge of the risk of warning signs of pregnancy plays a major part in the delay of management.

Diet, Physical Activity, and Screen Time among School Students in Manipur.

CONTEXT: Adolescence is a critical time in the development of lifelong healthy eating and exercise habits. The high prevalence of adolescents exposed to excessive screen time is a matter of concern because of its association with several health problems, such as overweight and obesity, alterations in blood glucose and cholesterol, poor school performance, decreased social interaction, and lower levels of physical activity. AIMS: The aim of this study is to identify the lifestyle behaviors of young adolescents focusing on physical activity, diet, and screen time. SETTINGS AND DESIGN: A cross-sectional study was conducted among 929 students of Class VII and VIII in schools in Imphal West and Kangpokpi districts of Manipur. SUBJECTS AND METHODS: Data collection was done by questionnaire method. STATISTICAL ANALYSIS USED: The data were analyzed using IBM SPSS for Windows, Version 21.0. Armonk, NY, USA. RESULTS: Seven in 10 of the students had inadequate physical activity at school and inadequate physical activity outside school. About 56.9% of the students have a smartphone, whereas one-third of them have Facebook and WhatsApp accounts. Only 5.8% were eating a healthy diet. Females and day scholars were less physically active. Males those staying in a nuclear family, less family income, and more number of siblings were found to have unhealthy dietary habits. CONCLUSIONS: Less than half of the students were physically active and only six out of 100 the students were eating a healthy diet.

National Mental Health Survey of India, 2016 - Rationale, design and methods.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Depression, Anxiety and Stress Among Higher Secondary School Students of Imphal, Manipur.

INTRODUCTION: Adolescence is a stressful period due to physical, psychological, sexual changes, and the presence of psychiatric disorders such as depression, anxiety, and stress at this stage of life is a matter of concern. OBJECTIVES: The objectives of the study were to determine the prevalences of depression, anxiety, and stress among higher secondary school students of Imphal and to determine the association between depression, anxiety, and stress and selected variables such as gender, standard, and religion. MATERIALS AND METHODS: From September 2014 to October 2014, a cross-sectional study was conducted among higher secondary school students of Imphal. The sample size was calculated to be 750. Seven schools were randomly selected, and all the students in that school were enrolled in the study. The study tool used was a questionnaire containing DASS (Depression Anxiety Stress Scale) and sociodemographic characteristics. RESULTS: The prevalences of depression, anxiety, and stress among 830 valid respondents were 19.5%, 24.4%, and 21.1%, respectively. In total, 81.6% of the respondents had at least one of the studied disorders and 34.7% of the respondents had all the three negative states. The prevalences of depression, anxiety, and stress were high among females and were significant for anxiety (P = 0.00) and stress (P = 0.04). The prevalences of depression and stress were significantly higher among 12th standard students with P-values of 0.00 and 0.02. CONCLUSION: The prevalences of depression, anxiety, and stress were high with anxiety and stress significantly higher among females, whereas prevalences of depression and stress were significantly higher among 12th standard students. More studies are recommended to determine the factors leading to these mental disorders.

Inhalant use among schoolchildren in northeast India: a preliminary study.

Inhalant use by children leads to poor performance in school and has been observed to precede substance use later in life. There is paucity of data on inhalant use among school children in India, particularly in the Northeast region of the country. We determined the prevalence and documented inhalant use characteristics among schoolchildren in the Northeast region of India. This cross sectional study was conducted in six states in the Northeast region of India. Schoolchildren between eighth and eleventh standards from the capital areas of the states were included in the study. Data were collected using a questionnaire. Analysis was done using descriptive statistics and Chi-square test. Of the 4074 enrolled students, data from 3943 students who responded to the inhalant use question were analyzed. Mean age was 14.8 ± 1.2 years and 51.2% of participants were male. The proportion of students who had ever used inhalants (ever user) was 18.8% and adhesive/glue was the inhalant misused by most of the students. A higher proportion of males than females were ever users (P ≤ 0.001) and the most common place of use was at home (33.1%). Being in the presence of an older person using an inhalant or tobacco was found to be associated with use of inhalants among students. Nearly one-fifth of the students had used inhalants and nearly half used inhalants in the past month. Sensitization of the parents and school authorities to the problem, as well as preventive and curative services, should be considered.

Seroprevalence of toxoplasma infection among primigravid women attending antenatal clinic at a secondary level hospital in North India.

A study was carried out among primigravid women attending a secondary level hospital in a district of North India. The objective of the study was to determine seroprevalence rate of Toxoplasma gondii infection using enzyme-linked immunosorbent assay (ELISA) test. Associations between toxoplasma seropositivity and selected variables (socio-demographic and biologically plausible variables) were also studied. Five hundred three women were enrolled from the antenatal clinic between August, 1996 and September, 1997. Of these, 210 women (41.75%) were seropositive for Toxoplasma gondii infection. These results indicate that a large number of the study subjects were vulnerable to toxoplasma infection. If these infections had occurred during the pregnancy, their foetuses would have been at high risk of infection. There was no statistically significant association between toxoplasma seropositivity and the variables studied except, in the case of type of meat usually consumed. There is a need to provide health education to pregnant women in order to prevent primary toxoplasma infection during pregnancy.