Epidemiologic correlates of malnutrition among under-three children in the rural community of Northern India.

Context: Worldwide malnutrition is identified as a major health and nutrition problem. Undernutrition contributes to an estimated 45% of child deaths globally. The prevalence of underweight among children in India is among the highest in the world. Our children also bear a tremendous double burden of malnutrition. Aims: To find out the prevalence and determinants of malnutrition among six months to three-year-old children in the rural community of Northern India. Settings and Design: A community-based cross-sectional study conducted among children aged six months to three years in a rural area of Ludhiana district, Methods and Material: A total of 662 children in the age group of six months to three years from a population of 30,000 were identified and included in the study. All the relevant information regarding these children was collected from family folders. Socioeconomic status was assessed using the modified Udai Pareek scale (MUP). Statistical analysis used: The data collected was entered in MS Excel and was analyzed using SPSS version 26 and WHO Anthro Survey Analyzer. Results: Out of 662 children, 16% were underweight. Almost 50% of the children in the two-three years category were underweight. The prevalence of stunting in the study population was 20.7% and that of overweight was 4.8%. The prevalence of underweight was higher in children of low socioeconomic status than in children from upper socioeconomic status (P = 0.000). There was a significant association between birth order and increasing cases of underweight (P = 0.000). Conclusions: The causes of malnutrition in children are complex and involve multiple factors. There is a need for vigorous monitoring for early detection of malnutrition for children aged two-three years. The improvement of maternal education will improve the nutritional status of the child.

Breakthrough COVID-19 Infection Among the General Community, Frontline Workers, and Healthcare Workers During the Second and Third Wave in North India: A Longitudinal Study.

BACKGROUND: Vaccination is among the most important public health tools for preventing the harm caused by communicable diseases. This was particularly true in the case of COVID-19 vaccination during the COVID-19 pandemic. However, no vaccine is 100% effective, and all carry the risk of breakthrough infection in vaccinated individuals. METHODOLOGY: This longitudinal observational study was done on COVID-19-vaccinated individuals at a vaccination site in a tertiary care hospital. The study participants were categorized into the general community, frontline workers, and healthcare workers and were followed up during the study period from June 2021 to May 2022 post-vaccination. They were interviewed by telephone regarding adverse effects and breakthrough infections post-vaccination during the second and third wave of the COVID-19 pandemic in India. Incidence of breakthrough infection was calculated in all three categories after they received their first, second, and booster doses of vaccination. RESULTS: Fever was the most common adverse effect among all the categories of participants after the first and second doses. Incidence of breakthrough infection after the second dose of vaccination among frontline workers (RR: 5.7, 95% CI: 0.7-44.2) and healthcare workers (RR: 18.9, 95% CI: 2.6-138.6) was observed to be higher compared to the general community, but no such difference was observed among the three categories after the first dose of vaccination. CONCLUSIONS: The incidence of breakthrough infection was found to be the highest in healthcare workers, followed by frontline workers compared to the general community, justifying their work profile and the risk associated with it.

Epidemiological correlates of hepatitis C infection- A case control analysis from a tertiary care hospital.

Background: Hepatitis C virus (HCV) infection is considered one of the growing public health problems. Identification of HCV-associated risk factors is pivotal for developing appropriate prevention strategies. Objectives: To determine the epidemiological variables of HCV infection in a tertiary care hospital. Methods: This hospital-based case-control study was conducted in a tertiary care hospital in Punjab on 320 subjects, including 160 cases and controls each. Cases and controls were matched by age (±5 years), gender, and residence. A patient ≥18 years of age fulfilling the biomarker criteria with or without clinical criteria diagnosed in the last 1 month was considered as a case. The information on socio-demographic characteristics and previous exposures to selected risk factors was collected through detailed interviews of the subjects. Analysis was performed using SPSS 20 statistical software. Odds ratio (OR) with 95% confidence interval (CI) was calculated to measure the strength of association between cases and controls for each risk factor. Results: Odds of having HCV infection was significantly higher among those with a history of blood transfusion (OR: 2.30, 95%CI: 1.14-4.63), dental procedure (OR: 4.82, 95%CI: 2.38-9.77) and intravenous injection/infusion from quacks (OR: 3.26, 95%CI: 1.47-7.19), injectable drug use (OR: 26.69, 95%CI: 3.55-200.24), non-injectable drug use (OR: 2.37, 95%CI: 1.44-3.90), tattooing (OR: 7.91, 95%CI: 2.31-27.08), and piercing from street hawkers (OR: 2.25, 95%CI: 1.18-4.29). Multivariate analysis identified history of blood transfusion, dental procedure, intravenous injection/infusion from quacks, injecting drug use, and piercing as independent risk factors for HCV infection. Conclusion: The study identified multiple risk factors for acquiring HCV infection and suggest appropriate interventions targeting high-risk populations.

From rapid antigen testing for COVID-19 to final outcome: An experience from industrial city of Ludhiana.

Context: The ongoing corona pandemic has created medical crises all over the world. An increased surge in the number of COVID-19 cases was observed in the month of August, September and October 2020. Punjab has around 10 Lakh migrant workers. Intensive rapid antigen testing was done during this surge among factory workers. With this background, the study aims to find out the positivity rate of rapid antigen testing and to find out the final outcome of the COVID positive cases in terms of morbidity. Materials and methods: Screening of factory workers working in various factories was done for COVID-19 by rapid antigen testing from 26th august to 31st October 2020. Those who tested positive were clinically examined, counseled, and followed up telephonically to get information regarding their course of illness. The collected information was entered in Microsoft excel sheet and analyzed using SPSS. Results: A total of 11045 factory workers were screened using the rapid antigen test. The mean age of subjects was 33.37 ± 10.97 years. The majority of them were males (88.3%) and migrants (who did not belong to Punjab) (97.3%). The majority of the subjects (97.3%) had no symptoms at the time of screening. COVID-19 positivity rate increased with age, was found to be higher in males (2.3%) as compared to females. Conclusion: The positivity rate was higher in asymptomatic males and local resident workers. Rapid antigen testing is an important public health measure to prevent the further spread of the disease during a pandemic due to its quick results and detection of asymptomatic patients.

Assessment of diabetes risk profile in a rural population of northern India using the Indian Diabetes Risk Score - A community-based study.

Background: Diabetes is one of the leading killers among noncommunicable diseases of the present time and poses a considerable burden to the society in terms of public health. The Indian Diabetes Risk Score (IDRS) can be used as a risk assessment tool to estimate the population at risk and plan appropriate interventions. The present study was conducted to assess the diabetes risk profile of a rural population of Punjab by using IDRS. Materials and Methods: This was a cross-sectional study conducted in two phases after obtaining approval from the Institutional Ethics Committee. Phase 1 was done in Rural Health Training Center (RHTC), Pohir, where every fifth patient attending the outpatient department was included in the study. Phase 2 was conducted in village Gopalpur, which is one of the villages in the field practice area of Department of Community Medicine, where participants were enrolled by conducting house to house survey after taking their informed consent. Sociodemographic characteristics, risk factor profile, and the IDRS of the participants were noted. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0 to calculate the percentages. Pearson's Chi-square test was used for qualitative variables, and mean, standard deviation and analysis of variance (ANOVA) were used for quantitative variables. A P value of less than 0.05 was considered significant. Results: A total of 252 subjects (99 male and 153 female) from RHTC and 213 subjects (71 male and 142 female) from village Gopalpur participated in the study, with their mean IDRS being 44.8 ± 15.7 and 46.6 ± 21.1, respectively. On calculating the IDRS of participants enrolled in RHTC, it was found that 15.5% had low, 56% had moderate, and 28.5% had high risk, whereas from village Gopalpur, 19.2% had low, 57.3% had moderate, and 23.5% had high risk for developing diabetes mellitus. The risk for developing diabetes was found to be higher among females, subjects living in joint families, and subjects with high body mass index (BMI). The mean systolic and diastolic blood pressure showed an increasing trend with increase in IDRS score of the participants. Conclusion: The present study showed that even in rural areas, nearly one-fourth of the adult population was at high risk, whereas more than half of the population was at moderate risk of developing diabetes mellitus. This corroborates the World Health Organization's (WHO's) stand to declare diabetes as a public health emergency and to devise ways to urgently mitigate this problem. Therefore, awareness and health education campaigns should be implemented in rural areas for early identification of risks, which will help in prevention and hence decreasing the burden of the disease.

Initial experiences regarding COVID19 mortality in Punjab-A mixed method analysis.

CONTEXT: The spread of COVID-19 pandemic poses a great challenge to health care organizations and unprecedented need for information. This study aims to identify possible factors causing delay and losing precious time during diagnosis and treatment of COVID-19 at home and health facility level. It also aims to highlight perceptions and experiences of family members of deceased regarding diagnosis and treatment of COVID-19 infection in hospital. METHODS: A retrospective study was done to review COVID-19 deaths from 18th March to 5th June 2020 in Punjab, India. A total of 48 laboratory confirmed (RT-PCR) COVID-19 deaths were reported during this period. Socio demographic profile, sequence of events including clinical symptoms, medical aid taken, time of confirmation of diagnosis and treatment before death were noted from the records on a predesigned proforma. Family members of deceased were also interviewed and asked open-ended questions regarding their experiences at various health facilities. Descriptive statistics was presented in percentages, mean, and median. RESULTS: Mean age of subjects was 56.3 ± 18.3 years. Majority (82.2%) had three or more than three comorbidities. Median time from appearance of first symptom to first medical contact and confirmation of diagnosis was 1 and 5 days, respectively. On the basis of interview with deceased's relative, various themes like delay in diagnosis and treatment, dissatisfied with hospital system and lack of communication between relative and patient were generated. CONCLUSION: Presence of comorbidities was the most important risk factor. Health seeking behavior of patients immediately after appearance of symptoms was found to be satisfactory.

Awareness and perceptions of anganwadi workers about female feticide and girl child discrimination in district Ludhiana, Punjab.

BACKGROUND: It is a matter of grave concern that a girl child continues to be insecure and vulnerable in the state of Punjab. To ingrain gender equality in social system, it is very important to make community an important stakeholder to deal with the situation. This study focuses on the awareness and perceptions of anganwadi workers regarding girl child discrimination and female feticide. MATERIALS AND METHODS: A total of 2206 anganwadi workers between the age group of 20-70 years of different blocks of Ludhiana district, Punjab, were enrolled. They had come for Anganwadi Worker (AWW) Training Workshop, organized at Urban Health Centre, Ludhiana, Punjab. Data were analyzed in terms of proportions. RESULTS: Study subjects showed high level of awareness about female feticide (98.8%). A majority of the subjects (93.3%) agreed to the fact that practice of discrimination is being followed between boys and girls. They were also of the opinion that this practice is harmful and it should be stopped (98.9%). Various contributing factors enumerated by them included sons are intelligent, carry on family lineage, and they take care of their parents in old age. Regarding perception of anganwadi workers for curbing this social evil, 70.7% of subjects were of the view that by giving equal opportunities, equal status to girls, and empowering girls, this practice can be stopped, while 42.4% of the subjects were of the view that increasing awareness among the rural women, parents, and family is the solution to stop this practice. CONCLUSION: The anganwadi workers had optimum level of awareness about female feticide and almost all of them strongly felt that this harmful practice should be stopped altogether.

Reproductive behavior of newly married women in rural Punjab, India: A longitudinal study.

INTRODUCTION: In India, little is known about the reproductive behavior during earlier years of married life of women, when they are more vulnerable to reproductive ill health and early child bearing with very few interventions available. OBJECTIVE: The objective of this study is to follow a cohort of newly married women immediately after marriage until their first pregnancy outcome to gain an insight into their reproductive behavior so that important opportunities could be identified for intervention. SUBJECTS AND METHODS: A community-based longitudinal study was carried out in 15 villages of Ludhiana District under the Rural Health Training Centre of Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab. All marriages of the male residents that took place in these villages from January 1, 2013, to December 31, 2013 were enrolled. Thus, a cohort of 195 newly married women was identified over a period of 1 year and followed every month till first pregnancy outcome. The analysis was performed using SPSS version 20 statistical software. RESULTS: Mean age at marriage for newly married women was 22.9 ± 3.0 years. Majority of them conceived within 1st year of marriage (79.5%) while 10.8% of women did not conceive till the end of follow-up period. Mean age at first pregnancy was 23.4 ± 3.1 years with mean interval between marriage and first pregnancy of 5.4 ± 6.1 months. Nearly, three-fourth of pregnancies resulted in live births while adverse pregnancy outcome including still births and abortions was seen in 15.9% of the study cohort. CONCLUSIONS: Overall findings indicate optimistic picture for married young women, but critical opportunities should be utilized to promote health of these women in a journey toward safe motherhood.

An Epidemiological Study of Overweight and Obesity Among Women in an Urban Area of North India.

BACKGROUND: Obesity is a complex, multi-factorial chronic disease. Overweight and obesity are the fifth leading risk for global deaths. OBJECTIVES: To find the prevalence and risk factors for obesity in women aged 20-60 years in Ludhiana city. METHODS: The present study is a community based cross sectional study carried out in an urban area of Ludhiana among women aged 20-60 years. Among the study population of 324 women, a pre-designed and pre-tested questionnaire was used to record the socio-demographic and anthropometric profile of women. Chi square test and logistic regression was used to find the association of obesity and hypertension with socio-demographic variables. RESULTS: The prevalence of overweight and obesity was 12.7% and 29.6% respectively. Obesity was found to be more common among middle-aged Punjabi housewives belonging to upper socio-economic strata. There was strong association between overweight/obesity and hypertension.

Factors Related to Non-Referral of Patients with Presumptive Pulmonary TB to Designated Microscopy Centers (DMCs) by Registered Private Practitioners in Urban Areas of Punjab, India.

BACKGROUND: Early diagnosis and proper treatment under RNTCP guidelines, forms the mainstay of management of a TB patient. A large proportion of patients with presumptive tuberculosis (TB) visit a Private Practitioner (PP) in the first place. Studies have shown that PPs rely more on X-rays and other diagnostic tools rather than referring the patient to the nearest Designated Microscopy Centre (DMC) for sputum microscopy. AIM: The present study was planned to look in to factors responsible for non-referral of patients with presumptive pulmonary TB to the DMCs for diagnosis by PPs. MATERIALS AND METHODS: Present study was a case-control study conducted over a period of one year among registered PPs in urban areas of Punjab. The study was carried out in five major cities which have approximately half of the urban population of Punjab. Forty three Private Practitioners per city for referral group and 43 matched PPs for non-referral group were selected. RESULTS: Knowledge regarding RNTCP was low in both the referral (38.1%) as well as non-referral (25.6%) group of PPs. Allopathic doctors had significantly higher knowledge regarding TB as compared to ayurvedic and homeopathy doctors, and Registered Medical Practitioners (RMP). Both the knowledge of PPs regarding nearest DMC as well as perception about accessibility of the nearest DMC for the patients were found to be significantly higher in the referral group. Only 15.3% of practitioners in the non-referral group said that they had been contacted by RNTCP staff. CONCLUSION: The main factors responsible for non-referral of pulmonary TB suspects to DMCs for diagnosis in the present study included low knowledge regarding RNTCP, lack of awareness regarding place and accessibility of nearest DMC, and inadequate sensitization of PPs by the RNTCP staff.

Impact of Health Education on The Knowledge, Attitude and Practices of Teachers Regarding Reproductive Health of Adolescents of Amritsar, Punjab.

CONTEXT: Teachers play an important role in guiding the adolescents. Adolescents are ill equipped to deal with the impending changes in their body which makes them vulnerable to STDs, HIV/AIDS and premarital sex. This study attempts to study the impact of reproductive health education on the knowledge, attitude and practices of teachers, about which only a few studies are available. AIMS: To study the impact of health education on the knowledge, attitude and practices of teachers regarding reproductive health of adolescents. SETTINGS: Senior Secondary schools of Amritsar and Department of Community Medicine, Government Medical College, Amritsar, Punjab, India. STUDY PARTICIPANTS: Male teachers of senior secondary schools of Amritsar teaching class 9th-12th. STUDY DESIGN: Educational intervention study. SAMPLING METHOD: Purposive sampling. MATERIALS AND METHODS: The study was started with 155 teachers (teaching class 9th -12th) who willingly participated from 50 senior secondary schools of Amritsar district. It was carried out in three phases. In first phase, after taking informed consent, the teachers filled a pretested questionnaire which was followed by an interactive session on reproductive health in second phase. In third phase, to study the impact of the interactive session and the sustainability of knowledge gained, they were again administered the same questionnaire after a period of 3 months. STATISTICAL ANALYSIS: Microsoft Excel, SPSS, Chi-square test. RESULTS: Maximum 74 (47.7%) teachers were aware of the psychosocial problems of adolescents. Majority 110 (71%) of the teachers had only partial knowledge about pubertal changes. 117 (75.5%) teachers were unaware about genital hygiene. Only 33 (21.3%) teachers had adequate knowledge about different STDs. 91 (58.7%) and 54 (34.8%) of teachers had adequate knowledge about routes of transmission and prevention of AIDS respectively. Only 37 (23.9%) teachers were imparting sex education to students. After intervention significant favorable changes were seen in their knowledge, attitude and practices regarding most of above mentioned topics. CONCLUSION: Although the baseline knowledge of teachers in most aspects of reproductive health of adolescents was found to be low, significant favourable changes were observed after health education.

Awareness and Perceptions of School Children about Female Feticide in Urban Ludhiana.

BACKGROUND: Although the Indian girl child's position is precarious throughout the country, she remains the most vulnerable in Punjab. OBJECTIVES: To assess the awareness and perceptions of school children regarding female feticide. STUDY DESIGN: Crosssectional study. MATERIALS AND METHODS: The study involved collection of information regarding knowledge and perception of school students about female feticide using multiple choice questionnaire. A total of 527 students between the age group of 11-18 years of various schools of district Ludhiana, Punjab were the study subjects. They had come to participate in the poster competition on organ donation (SAARC Transplant games), organized by Department of Community Medicine, D.M.C and H, Ludhiana. RESULTS: Out of total 527 students, 97.9% were aware of female feticide. Main source of information was TV (56%), followed by newspaper (33%). Majority of the students (65.2 %) felt that discrimination between boys and girls is prevalent in the society. Regarding perception of school students for curbing this social evil, 37.8% school students were of the view that awareness among the masses is the solution to stop this practice, while 25% of the students responded that equal status to girls will stop this practice of female feticide. CONCLUSIONS: The school students had optimum level of awareness about female feticide and almost all of them strongly felt that this harmful practice should be stopped altogether.

Twinning and its correlates: community-based study in a rural area of India.

A retrospective study was carried out to investigate the twinning rate and its correlates from January 1991 to December 2005 in 10 villages of the Rural Health Centre, Pohir, a field practice area of the Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. During this study period, 5070 deliveries took place. A total of 5017 singleton births and 53 sets of twins were recorded, giving a twinning rate of 10.45 per 1000 total deliveries. Monozygotic and dizygotic twinning rates were estimated as 2.96 and 7.49 per 1000 deliveries, respectively. The twinning rate was strongly associated with maternal age; the twinning rate for mothers between 30 and 34 years of age was about 10 times higher than the rate for mothers younger than 20 years. This variation was due to variation in dizygotic twinning; the rate of monozygotic twinning was almost constant for all ages. The twinning rate was highest at gestational order 4 or higher. The perinatal mortality rate among the twins was 173.1 per 1000 total twin births and was significantly higher among the group in which diagnosis of twins was not done during the prenatal period. We should expect 1 twin birth per 100 births, and because perinatal mortality is alarmingly high in undiagnosed twin pregnancies, early recognition of twin pregnancy during prenatal visits and delivering in a health facility with adequately trained personnel should be encouraged.