Baseline Assessment of Evidence-Based Intrapartum Care Practices in Medical Schools in 3 States in India: A Mixed-Methods Study.

INTRODUCTION: Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty. METHODS: A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data. FINDINGS: Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor. CONCLUSIONS: Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact.

Relation between dysmenorrhea and body mass index in adolescents with rural versus urban variation.

OBJECTIVES: To find out the relation between the frequency of dysmenorrhea and body mass index in adolescents and to assess the impact of socio-demographic factors, especially rural/urban variation in the frequency of dysmenorrhea. METHODS: Cross-sectional study of 200 urban and 200 rural school going adolescent girls at Udaipur and Bedla Districts, Rajasthan. RESULTS: Of the 400 girls, the prevalence of dysmenorrhea was found to be very high (81.5 % rural and 76 % urban). In the rural setup, of the total girls with mild dysmenorrhea, 71.84 % had BMI < 16.5, with 27.18 % underweight. All girls with moderate and severe dysmenorrhea had BMI < 16.5. In the urban setup, of all girls with mild dysmenorrhea, 38.05 % had BMI < 16.5 and 54.86 % were underweight. All girls with severe and 80 % with moderate dysmenorrhea had BMI < 16.5. All girls with no dysmenorrhea had normal BMI. There was significant rural versus urban variation. CONCLUSIONS: Relation between dysmenorrhea and BMI was found to be significant (p < 0.01) with increased prevalence in the low BMI group. Hence, improving the nutritional status of adolescent girls may reduce dysmenorrhea.