A comparative study of vision-related quality of life (VRQoL) among glaucoma and nonglaucoma patients at a tertiary care center of North India.

Purpose: Glaucoma influences vision-related quality of life (VRQoL) of an individual in various ways. There are very limited studies on the Indian population and the northern part of India. Therefore, we conducted the present study to evaluate VRQoL in glaucoma patients as well as the association between the severity of glaucoma and VRQoL. Methods: An institution-based, cross-sectional, analytical study was conducted from August 2022 to October 2022 involving 190 participants (95 glaucoma patients and 95 controls). The glaucoma quality of life-15 (GQL-15) questionnaire was explained in their vernacular language by the interviewer. The scoring was given according to the validated scoring algorithm for the questionnaire. Results: Mean GQL score in the control group was 19.66 ± 5.5 and in glaucoma cases was 32.8 ± 10.2, whereas the mean score of mild glaucoma cases was 22.3 ± 4.83, moderate glaucoma cases was 36.3 ± 4.09, and severe glaucoma cases was 47.24 ± 3.03. Therefore, as the severity of glaucoma increases, the GQL score also increases, indicating poorer quality of life. Visual field loss was strongly positively correlated (correlation coefficient = 0.759, P < 0.01) with the GQL-15 score, while a weaker positive correlation was found with best corrected visual acuity (BCVA), cup disc ratio, and duration of treatment. Conclusion: Besides controlling or reducing intraocular pressure (IOP) to the target level, the goal of glaucoma treatment should be to provide an individual with good functional vision to maintain an acceptable quality of life. It would also help in providing patients with the best possible treatment, not only in terms of good vision but also in maintaining or improving their overall quality of life.

Perceptions regarding child care and perinatal depression during COVID-19 pandemic - A cross-sectional community-based survey from Uttar Pradesh.

Background: High levels of stress among pregnant women have been reported during the coronavirus disease 2019 (COVID-19) pandemic because of various infection-related and lockdown measures. Concerns about safe delivery, breastfeeding, and child care may increase the risk of depression in vulnerable women during the perinatal period. Aim: To study the perceptions regarding child care and prevalence of perinatal depression during the COVID-19 pandemic. Materials and Methods: A cross-sectional community-based survey was conducted among 750 lactating mothers post delivery between September 2020 and February 2021 in 51 districts of Uttar Pradesh. A convenient purposive sampling technique was used. A semi-structured questionnaire was used to collect the socio-demographic details and perceptions regarding child care during the COVID-19 pandemic. Assessment of depression symptoms was performed with the help of patient health questionnaire 9 (PHQ-9). Results: A total of 440 participants were suffering from some form of depression symptoms; the majority had mild depression. Depression was found to be higher among homemakers and young mothers (age <25 years). Depression was found in more than 40% of the respondents who felt fear of COVID infection during breast feeding and hospital stay. Similarly, more than 50% of the respondents who feared unavailability of timely health services and social ignorance had depression. More than 60% of the mothers who did not have any knowledge about safe breast-feeding and child care practices had some form of depression, and the results were statistically significant. Conclusions: Perinatal depression is highly prevalent during the ongoing pandemic. Hence, regular screening, psychoeducation, awareness regarding safe breast feeding, and child care practices are recommended.

Mental Health Impact of COVID-19 Infection on Postpartum Women from Lower and Middle-income Backgrounds in India and its Effects on Early Mother-infant Bonding: An Observational Study.

The study was designed to examine the mental health impact of COVID-19 infection in postpartum women and its effects on mother-infant bonding during the first eight weeks postpartum. Fifty-seven consenting eligible postpartum women were recruited for the study. They were assessed at two time points using standardized rating scales to measure distress and uniquely designed scales assessing COVID-19-specific outcome fears and bonding. Almost half [42%] of postpartum women with COVID-19 suffered from a probable anxiety disorder, and one-third [33.3%] suffered from probable depression. The overwhelming majority [91.2%] experienced COVID-19-specific fear. There was an inverse relationship between one dimension of maternal caregiving and self-report depression and anxiety scores, respectively. Additionally, despite discharge, 25% of the mothers had not breastfed the infants till the 8th-week postpartum period, which is in discordance with the World Health Organization (WHO) recommendation of exclusive breastfeeding up to 6 months of age that is widely practiced in India. The novel COVID-19 pandemic was associated with anxiety and depression, impacting mother-infant bonding. Therefore, there is a need for specialized mental health services and individualized breastfeeding interventions for this vulnerable population to ensure positive outcomes.

Awareness of diabetic retinopathy among diabetes mellitus patients visiting a hospital of North India.

Context: Diabetic retinopathy (DR) is a major cause of visual disability leading to irreversible blindness. Awareness of diabetes and its ocular co-morbidities may help in preventing vision loss. Aim: To assess the awareness of diabetic retinopathy among diabetic mellitus patients visiting a hospital in North India. Setting and Design: Cross-sectional study conducted at an outpatient clinic of ophthalmology department of a hospital. Materials and Methods: An interviewer-administered, pre-tested, semi-structured questionnaire was used to evaluate the awareness of DR for the period from July 2020 to January 2021. Results: A total of 272 patients with diabetes mellitus (44.4% females and 55.5% males) were included in the study. The mean age of the study population was 53.4 ± 10 years. Of the 272 patients, 79% were aware that diabetes can affect the eyes, and 69.5% knew that DR can lead to blindness. Regarding prevention and treatment of DR, 58.1% of patients were aware that good glycemic control prevents DR and 52.6% knew that DR can be treated. Physicians were the main source of information in 47.4% of patients. The participants were not compliant with a routine retinal assessment with only 26.5% of them having previous fundus examination for DR screening. Conclusion: Most of the participants were aware of DR but there existed major deficits in the knowledge and behavior of diabetic patients toward management of DR. There is a need to create awareness about DR and emphasize the importance of retinal screening to reduce visual disability caused by diabetes.

Are the labour rooms of primary healthcare facilities capable of providing basic delivery and newborn services? A cross-sectional study.

OBJECTIVES: The study aimed to assess the functionality of labour rooms by evaluating the labour room infrastructure with reference to the standard guidelines, the status of the availability of human resources, the availability of essential equipment and consumables in the labour room and by documenting the knowledge of the healthcare provider in terms of labour room practices. The study also explored the facility parameters associated with its delivery load taking the facility as a unit of analysis. DESIGN: A cross-sectional analytical study. SETTING: India has realised the importance of improving the quality of care in public health facilities, and steps are being taken to make healthcare more responsive to women's needs. With an increase in the proportion of institutional deliveries in India, the outcome of the delivery process can be improved by optimising the health facility components. PARTICIPANTS: The study was conducted in 52 health facilities and healthcare providers involved in the delivery process in the selected facilities. RESULTS: The infrastructure of the facilities was found to be the best for medical college followed by district hospitals, Community Health Centres (CHCs), Primary Health Centres (PHCs) and subcentres. Similar findings were observed in terms of the availability of equipment and consumables. Lack of healthcare providers was observed as only 20% of the posts for health personnel were fulfilled in CHCs followed by PHCs, subcentres and district hospitals where 43, 50 and 79% of the available vacancies were fulfilled. The level of knowledge of healthcare providers in terms of partograph, active management of the third stage of labour and post-partum haemorrhage ranged as per their designation. The specialists were the most knowledgeable while the Auxiliary Nurse Midwife (AMNs) were the least. All the components of structural capacity, i.e. infrastructure (r 2 = 0.377, P value < 0.001), equipment and consumable (r 2 = 0.606, P value < 0.001) and knowledge of healthcare providers (r 2 = 0.456, P value < 0.001) along with the overall facility score were positively correlated with the average delivery load of the health facility. The results from multivariate linear regression depict significant relation between the delivery load and availability of equipment and consumables (t = 4.015, P < 0.01) and with the knowledge of healthcare providers (t = 2.129, P = 0.039). CONCLUSIONS: The higher facilities were better equipped to provide delivery and newborn care. A higher delivery load was found at high-level facilities which can be attributed to better infrastructure, adequate supply of equipment and consumables and availability of trained human resources.

Comparative study of the mental health impact of the COVID-19 pandemic on health care professionals in India.

Aims: This study aimed to investigate how the psychological health of health care professionals (HCP) on COVID duty was different from those who were not directly in contact. Methodology: Of 473 (76%) randomly selected respondents (doctors and nurses) to a WhatsApp request message, 450 subjects' data were finally analyzed. Result: The prevalence of stress, anxiety and depression among HCP was 33.8, 38.9 and 43.6%, respectively. Compared with nonexposed professionals, COVID-19-exposed professionals had roughly double the score of these morbidities (t = 6.3, p < 0.001; t = 6.9, p < 0.001; t = 6.0, p < 0.001). Most worry (71.11%) was about the health of their family, followed by themselves (35.55%). Conclusion: The level of exposure, feelings of uncertainty and fear of infection emerged in our study as possible risk factors for psychological morbidities among HCP.

Impact of Nonpharmacological Public Health Interventions on Epidemiological Parameters of COVID-19 Pandemic in India.

Background Public health interventions are epidemiologically sound and cost-effective methods to control disease burden. Non-pharmacological public health interventions are the only mode to control diseases in the absence of medication. Objective To find the impact of public health interventions on the epidemiological indicators of disease progression. Methods This is a secondary data analysis done on COVID-19 data. The median doubling time and R0 were calculated for a rolling period of seven days. Interventions were scored from zero to three with an increasing level of stringency. Multivariate linear regression was performed to find the role of individual interventions on R0 and the median doubling time. Results The highest intervention score was reported in the lockdown phase, which gradually decreased to the lowest level of 22. The R0 values settled to a level of 1.25, and the median doubling time increased to 20 days at the end of the study. Public awareness and public health laws were found to be related to both R0 and the median doubling time in the pre-lockdown phase only. Conclusion The implementation of interventions at the ground level is one of the key factors in the success of public health interventions. Post implementation, poor effectiveness of many interventions is evident from the study. Further, studies related to the sequence of interventions are required to further analyze the poor effect of the interventions.

Assessment of Biomedical Waste Management in Health Facilities of Uttar Pradesh: An Observational Study.

Background Biomedical waste management has recently emerged as an issue of major concern for every health facility and healthcare provider due to human and environmental hazards. As per government guidelines, every health facility, either large medical institutes or small clinics, should ensure appropriate biomedical waste management at their facilities level. Objective To assess biomedical waste management in various health care facilities of Etawah district. Methodology It was a facility-based cross-sectional assessment that included government and private health facilities. The selection of facilities was done based on a simple random sampling method. All the people in charge of concerned health care facilities were interviewed to know the current biomedical waste management situation concerning health facilities and the problems they face in biomedical waste management. Health care professionals' knowledge was also assessed. Results A total of 56 health care facilities (HCFs) from both government and private sectors were selected. Biomedical waste guidelines are mainly available at tertiary care centers (93%) and secondary care centers (51.5%). Awareness among doctors related to hazards and prevention of hazards (<0.001), knowledge of unused sharps (0.048), contact with a blood-related product (0.003), hazardous waste (<0.001), and need for training (<0.001) are statistically significant with respect to nurses. Conclusions Government of India guidelines on biomedical waste management (BMW) are in place, but the use of guidelines currently is not up to the mark or at a satisfactory level. Spreading awareness of the BMW guidelines and their strict implementation is the need of the hour.

Japanese encephalitis in Uttar Pradesh, India: A situational analysis.

INTRODUCTION: Japanese encephalitis (JE) is a vector-borne, viral illness caused by the Japanese Encephalitis Virus. Permanent neurologic or psychiatric sequelae can occur in 30%-50% of those with encephalitis; hence, JE is a cause of major public health concern. For the ease of diagnosis and facilitation of surveillance, National Vector Borne Disease Control Programme uses the term Acute Encephalitis Syndrome (AES). In this study, an attempt has been made to ascertain the status and trends of AES and JE in Uttar Pradesh, India. METHODOLOGY: This is a record-based retrospective study. The data were obtained from the Directorate of Medical and Health Services of Uttar Pradesh and analyzed using software SPSS version 24.0. RESULTS: In Uttar Pradesh, there were 47,509 reported cases of AES from 2005 to 2018,. With yearly fluctuations, the average Case Fatality Rate of AES was 17.49% with highest in 2005 (24.76%) and lowest in 2018 (8%). Among the patients with AES, 9.98% were found positive for JE. The most commonly affected age group is 1-5 years for both AES and JE, closely followed by the age group of 5-10 years. Peak occurrence of both AES and JE was recorded in month of September. Among the AES-affected patients 53.8% were males and 46.2% were females. CONCLUSION: The most commonly affected age group was 1-5 years with peak occurrence in the month of September. Though there was a downward trend in CFR, awareness activities like "Dastak" campaign and intersectoral preventive activities, needs to be strengthened.

COVID-19 pandemic in India: A Comparison of pandemic pattern in Selected States.

The COVID-19 pandemic currently expanded its roots to the 206 countries in the world. The morbidity and mortality are not only threat to humans but also its impact on economy is indirectly affecting us. The current review was done to find trend in various states of India. Data was collected from Ministry of Health and Family Welfare and descriptive analysis of the distribution of COVID-19 cases in different states of India. First case of COVID-19 was diagnosed in southernmost state Kerala and after that it has spread to all other states, but situations are more worsen in states with high international migration. Maharashtra is now the most affected state followed by Delhi. Among epidemic curve of all these states, Maharashtra has rapidly growing epidemic curve with highest slope, whereas Kerala has the lowest. When we compared the day wise cumulative case fatality rate, it was found that the case fatality rate of the states like Maharashtra, Madhya Pradesh & Rajasthan showed decrease in the case fatality rate over the period. Population density is also one of the key determinants of social interaction and thus the spread of disease specifically in communicable diseases. Government of India had taken many strong initiatives e.g. 40 days nation-wide lockdown, thermal screening at airport, announcement of relief packages for poor and quarantine of outsiders but still there are many missed opportunities like, early stoppage of international traffic, compulsory quarantine for all international travellers, better contact tracing, strong law and order and better preparedness plan.

Analysis of risk factors contributing to road traffic accidents in a tertiary care hospital. A hospital based cross-sectional study.

PURPOSE: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them. METHODS: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward. RESULTS: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motorcyclists (54.2%) followed by pedestrian (25.1%). CONCLUSION: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India.

BACKGROUND: Low/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models. METHODS: We conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for 'months of intervention'. RESULTS: The intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities. CONCLUSION: A multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India. TRIAL REGISTRATION NUMBER: CTRI/2016/05/006963.

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.

Pre-treatment practices among patients attending an Animal Bite Management clinic at a primary health centre in Haryana, North India.

A cross-sectional study was carried out at the Animal Bite Management (ABM) clinic in a primary health centre in the Faridabad district of Haryana. Information about socio-demographic characteristics, animal bite exposure and pre-treatment practices was obtained. Clinical examination determined the severity of the bite. All 619 patients who reported to the ABM clinic during January 2011 to December 2012 were included. Out of the total, 38% had applied chilli-oil paste, and 4% antiseptics to the wound as pre-treatment; only 30.6% had washed the wound with water. There was a direct association between traditional pre-treatment practices and delay in seeking treatment for animal bites which was statistically significant (P = 0.01). Health education of the general population with culturally appropriate Information, Education and Communication material is therefore a necessary strategy to reduce delay in seeking appropriate treatment.

Psychiatric morbidity at secondary level health facility in Ballabgarh, Haryana.

BACKGROUND: There is dearth of information about psychiatric morbidity at secondary level health facility in India. AIM: To study psychiatric morbidity amongst patients attending psychiatry clinic in secondary level health facility. SETTINGS AND DESIGN: Present study is based on hospital record review of psychiatry clinic at secondary care hospital in Ballabgarh, Haryana. MATERIALS AND METHODS: Service record of psychiatry clinic at civil hospital Ballabgarh was reviewed. Diagnosis of psychiatric morbidity was done according to DSM IV and ICD 10 classification. STATISTICAL ANALYSIS: Descriptive analysis of data was carried out. RESULTS: A total of 724 (0.7%) new OPD patients consulted psychiatry clinic. Common Mental Disorders comprising of mood disorders, neurotic stress -related and somatoform disorders were the most commonly diagnosed disorders (60.5%) amongst reported psychiatric morbidity in the hospital. CONCLUSION: Substantial burden of psychiatry morbidity highlights necessity of psychiatry clinic at secondary care hospital in India.