Knowledge of Private Practitioners Regarding Revised National Tuberculosis Control Program- A Cross-Sectional Study from the Haryana state of India.

Background: India's aim to achieve tuberculosis (TB) eradication by 2025 necessitates the engagement of all stakeholders, encompassing both private and public sectors, across all phases of the TB program - spanning from diagnosis to the curative outcome. However, certain private practitioners pursue an individualized approach instead of adopting a collective strategy, thereby contributing to the emergence of multidrug-resistant tuberculosis. Consequently, in order to formulate an enhanced strategy that fosters improved collaboration and professional behavioral change among all partners, it is imperative to comprehensively assess their level of knowledge. This study aims to assess the knowledge level of private practitioners with regard to the diagnosis and management of pulmonary tuberculosis cases within the framework of the Revised National Tuberculosis Control Program (RNTCP). Methodology: A descriptive cross-sectional study was conducted among 78 selected private practitioners located in seven towns within the Sonepat district of Haryana State, India. The study was approved by the ethics committee of Bhagat Phool Singh Government Medical College for Women, Sonepat, Haryana. Data collection involved the utilization of a self-administered, pre-tested, semi-structured questionnaire. Descriptive analysis was applied, utilizing proportions and percentages. Results: The collective understanding of private practitioners concerning Tuberculosis and RNTCP was found to be deficient. Around one-third of the practitioners reported that they had not received any visits from health workers in relation to RNTCP. A mere 33% of the practitioners had attended any Continuing Medical Education (CME) sessions, and only a quarter of the participants expressed an intention to collaborate with the RNTCP program. Conclusions: In conclusion, this study underscores the necessity for RNTCP to focus on fostering the willingness of private practitioners to engage with the program, while simultaneously enhancing their knowledge about Tuberculosis and RNTCP.

Prevalence and correlates of sexual health disorders among adult men in a rural area of North India: An observational study.

BACKGROUND AND OBJECTIVES: Sexual health disorders are an important but less researched public health issue in India. We aimed to estimate the prevalence of sexual health disorders and their associated factors among adult men in a rural community of Haryana, India. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among adult men aged 18-60 years using a multistage stratified random sampling. Information pertaining to sociodemographic characteristics, lifestyle and sexual practices, and self-reported sexual problems were collected. Sexual health disorders were defined based on International Statistical Classification of Diseases-10 classification of mental and behavioral disorders. Step-wise logistic regression was carried out to identify factors independently associated with sexual disorders. RESULTS: At least one sexual health disorder was reported by 81% of the men. The most commonly reported disorder was self-perceived defect in semen (64.4%), followed by loss of libido (21%), masturbation guilt (20.8%), erectile dysfunction (5%), and premature ejaculation (4.6%). Factors significantly associated with sexual health disorders among all men were being never married (odds ratio = 2.04; 95% confidence interval: 1.51, 2.77), smoking (1.57; 1.16, 2.14), cannabis use (4.20; 1.68, 10.48), diabetes (2.40; 1.22, 4.73), and hypertension (3.17; 1.12, 8.92). INTERPRETATION AND CONCLUSIONS: A high burden of sexual health disorders was identified among the rural men. Wider recognition of this issue is needed among the health-care providers and policymakers.

Comparative morbidity profile of patients attending an Ayurveda clinic and a modern medicine clinic of a primary health center in rural Haryana, India.

CONTEXT: There is a paucity of data on the profile of patients accessing traditional systems of medicine. A comparison of profile of patients attending an Ayurveda clinic with that of modern medicine clinic will help in better understanding of utilization of services and preference for system of medicine by the patients seeking health care. AIM: The aim was to study the morbidity profile of patients who attended the Ayurveda clinic of a primary health center (PHC) in rural Haryana over 1 year and compared it with that of the modern medicine clinic attendees at the same facility. MATERIALS AND METHODS: The study site was PHC, Dayalpur in block Ballabgarh, district Faridabad, Haryana, India. All new patients who attended the Ayurveda clinic of PHC Dayalpur in the year 2012 were included in the study. New attendees of modern medicine clinic of the same PHC in the year 2012 were used for comparison of profile of patients. RESULTS: In year 2012, of the total new patients registered at PHC, 26% attended Ayurveda clinic. The male-to-female ratio (0.8:1) was similar in both clinics. The representation of children up to 5 years and elderly was significantly higher (12.0% vs. 6.7% and 19.5% vs. 11.0%) in modern medicine clinic as compared to Ayurveda clinic. The most common morbidities seen in Ayurveda clinic were twak vikar or skin disease (12.3%), sandhivata or osteoarthritis (10.3%), and kasa or cough (8.5%). Three most common morbidities in modern medicine clinic were acute respiratory infection (35.7%), hypertension (10.6%), and acute febrile illness (9.2%). CONCLUSIONS: The study provided evidence that Ayurveda was popular among rural population in North India. Therefore, the Government of India's initiative of setting up Ayurveda clinic in PHCs is well founded.

Barriers to Early Initiation and Continuation of Breastfeeding in a Tertiary care Institute of Haryana: A Qualitative Study in Nursing Care Providers.

INTRODUCTION: Ever increasing institutional deliveries in India has shifted the responsibility of timely initiation and continuation of breastfeeding from peripheral health workers and families to the nursing care providers of health facilities where the births take place. While institutional deliveries have increased to 72.6%, only 44.6% of the newborns enjoy early breastfeeding in India. AIM: To study the barriers to early initiation of breastfeeding in institutional delivery. MATERIALS AND METHODS: A total 34 nursing care providers were selected randomly and five Focus Group Discussions (FGDs) were carried out. This Qualitative Study was conducted through FGDs among the nursing care providers of a tertiary care institute in the Indian State of Haryana, India. STATISTICAL ANALYSIS: The analyses continued throughout the group discussions as the newly emerged themes were tested in the subsequent discussion. FGDs transcripts were analysed to enhance the robustness of the emerged domain. RESULTS: Major barriers to initiation of breast feeding identified included: lack of awareness regarding proper technique of breastfeeding and benefits of colostrum; breast abnormality like inverted/retracted nipples; obstetric/neonatal complications requiring specialised care; and cultural practices like giving pre-lacteals and gender discrimination. It was further reported that the manpower has not been rationalised with ever increasing number of institutional deliveries. The respondents though willing to promote early initiation and continuation of breastfeeding felt excessive workload as one of the major barriers due to multi-tasking nature of their job. CONCLUSION: The new challenges to the early initiation and continuation of breastfeeding are emerging due to change in the place of delivery which needs to be addressed at the policy level.

Efficacy of combined hormonal vaginal ring in comparison to combined hormonal pills in heavy menstrual bleeding.

OBJECTIVE: To compare the efficacy, acceptability and compliance of combined hormonal vaginal ring (CVR), with combined hormonal pills (CHP) in patients with heavy menstrual bleeding (HMB). STUDY DESIGN: This prospective study was conducted in 50 women with HMB in age group of 25-40 years. Patients were divided in two groups of 25 each and followed for six treatment cycles. In each group, cycle comprised of three weeks of CVR (releases 15µg of EE and 120µg of the etonogestrel per day) or CHP (containing 30µgm of EE and 150µgm of LNG) use, followed by one ring or pill free week. After each cycle, patients were evaluated about the amount of blood loss and duration of bleeding by the pictoral blood assessment chart (PBAC), early bleeding (EWB), continued bleeding (CWB), intermenstrual bleeding, intended bleeding, compliance, and user acceptability. The collected data were analyzed using the Chi square test, t-test and ANOVA test. RESULT: Reduction in PBAC score for CVR (70.73%) and CHP group (70.02%), duration of bleeding and incidence of EWB was comparable among the two groups. The incidence of intermenstrual bleeding was lower in CVR than in CHP group in cycle 3 and 4 with significant p value. The incidence of CWB was significantly lower and the incidence of intended bleeding pattern in CVR group was significantly higher in cycle 3, 4, 5 and 6, signifying better cycle control. Compliance was also higher in CVR (88%) than CHC (75.33% of all cycles). CONCLUSION: This trial suggests that both the CVR and CHP are very effective short-term treatments for HMB in reproductive age group. However, women had better cycle control and compliance with CVR. This may be an attractive option among the wide variety of medications used to treat HMB.

Menstrual Disorders and Its Determinants Among Married Women of Rural Haryana.

INTRODUCTION: Disorders of menstruation are common problems among women. They have several psychological effects on women's health. AIM: This study aimed to estimate prevalence of menstrual disorders, usage of sanitary pads and their determinants among married women in selected villages of rural Haryana. MATERIALS AND METHODS: A cross-sectional study was conducted during September 2011 in 10 villages of PHC (Primary Health Centre) Mandi, Haryana, using a systematic random sampling technique. Currently married women in the age group of 18-45 years living in study area for more than 1 year were included in the study while those who were pregnant and unable to understand questions were excluded. Informed verbal consent was obtained from all participants. RESULTS: A total of 344 women were interviewed. The mean (SD) age of participants was 28.0 (5.4) years. Majority of women were housewives (78.8%) and most had education up to middle school (22.7%). Mean (SD) age at menarche was 14.3 (1.2) years. Nearly one-tenth of women had married before 18 years of age. Prevalence of all menstrual disorders was 20.3% and most common disorder was excessive pain. About one fifth reported irregularity of menstrual cycles. Almost half were not using sanitary pads during menses. Menstrual disorders were more common among non-users of contraception (OR=1.7, p = 0.04) and housewives (OR = 2.4, p= 0.03). CONCLUSION: Disorders of menstruation were fairly common among women surveyed. Usage of sanitary pads was quiet low. Awareness generation among women regarding menstrual problems and Behaviour Change Communication to promote usage of sanitary pads are important measures to reduce related morbidity.

Evaluation of state-run STI/RTI clinics in the state of Haryana, India through a supportive supervision approach.

INTRODUCTION: Sexually transmitted infections (STIs) are an important public health problem because of their adverse effects on reproductive health of men and women. About 5% of adult population in India suffers from STIs. To tackle this issue the government has set up reproductive tract infection (RTI) clinics across the country. AIMS: To assess the effect of supportive supervision on the quality of services provided in STI/RTI clinics in the state of Haryana, India. SETTINGS AND DESIGN: Selected state-run STI/RTI clinics, facility-based pre- and post evaluation study. MATERIAL AND METHODS: Sixteen STI/RTI clinics were selected for the study, including six from government facilities and 10 from targeted intervention sites across five districts of Haryana. From each of the selected sites one physician in-charge was interviewed twice with an interval of 2-3 months using pretested formats. Scores were given in selected domains of STI/RTI management for each visit and the improvement was assessed. STATISTICAL ANALYSIS: Wilcoxon signed rank test. RESULTS: A total of 16 physicians one from each site were interviewed. Improvement in mean score of the physicians for knowledge about STI/RTI was 3.6 points. Similarly for skills score, which measured the physicians' skill in various domains of running STI/RTI clinics, the mean improvement was 3.1 points. Both the improvements were statistically significant (P < 0.001). CONCLUSIONS: Supportive supervision proved to be a useful tool for monitoring and improving the quality of services provided by the STI/RTI clinics.

Determinants of underutilisation of free delivery services in an area with high institutional delivery rate: a qualitative study.

BACKGROUND: There has been an increase in institutional delivery rates in India in the recent years. However, in areas with high institutional delivery rates, most deliveries (>50%) occur in private institutions rather than in government facilities where zero expense delivery services are being provided. AIM: This study aimed to understand, from the community health volunteers' viewpoint, the reasons for underutilization of zero expense delivery services provided in government health facilities. MATERIALS AND METHODS: Five Focused Group Discussions (FGD) were conducted among Accredited Social Health Activist (ASHAs) of a Primary Health Centre (PHC) in Dayalpur village, Haryana in December 2012. Participants were asked to articulate the possible reasons that they thought were responsible for expectant mothers not choosing to deliver in government health facilities. Verbal informed consent was obtained from all participants. RESULT: The commonly stated reasons for underutilization of government health facilities for delivery services were lack of quality care, abominable behaviour of hospital staff, poor transportation facilities, and frequent referrals to higher centres. CONCLUSION: This study reflected the necessity for new policies to make government health facilities friendlier and more easily accessible to clients and to make all government hospitals follow a minimum set of standards for providing quality care.

HIV Risk Behavior Among Men Who Have Sex with Men.

BACKGROUND: Sentinel surveillance reported high human immunodeficiency virus positivity rates among men who have sex with men. The current study has described the high-risk behavior and self-reported sexually transmitted infection(s) among self-identified men who have sex with men. AIMS: The present study was to find out the extent of high-risk behavior and prevalence of self-reported sexually transmitted diseases among self-identified men who have sex with men, registered with selected nongovernmental organizations in Delhi. MATERIALS AND METHODS: A facility-based cross-sectional study was done among 250 men who have sex with men during March 2009 to February 2010, through consecutive sampling strategy. RESULTS: Majority (80%) were anal-receptive, received money for sex (61%) and were involved in all types of sexual intercourse with men (oral-86%, manual-97%, and anal-94%). Consistent condom use with male partner was low (46%), most common reason (52%) for not using condom was, that either the condoms were not available or the partner objected. Self-reported sexually transmitted infection(s) was 41% in the past 12 months. CONCLUSIONS: This study underscores the increased vulnerability of men who have sex with men of Delhi and need for sustained interventions.

High neonatal mortality rates in rural India: what options to explore?

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as "m-health" and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well.