Accessibility and availability of maternal and reproductive health care services: ensuring health equity among rural women in Southern India.

INTRODUCTION: The health of women is of particular concern because they often have greater health needs than men and many women still lack access to quality healthcare services, preventing their ability to attain the best possible level of health. Hence, this study aimed to assess the accessibility and availability of health services among rural women. METHODS: A household survey was conducted by using a multi-stage sample with 407 married women aged 18-45 years, having at least one child and living in Tiruchirappalli District, Tamil Nadu were recruited for this study. A semi-structured questionnaire was used to collect data about the demographic status, and accessibility and availability of health services. RESULTS: Of the 407 respondents, 70% were aged between 26 and 40 years, 73% were working as farmers and labourers and 77% were living in nuclear families. 71% of them had enjoyed hospital facilities near their residence and 83% of the hospitals were run by the government. In village health nurse service (VHN), 34% of the respondents had received all services from VHN and 86% did not face any kind of gender inequality and almost all of them were satisfied with the service provided by the VHN. Almost all the respondents (98%) were satisfied with the availability of health services and 92% of them benefited from the government scheme related to childbirth. CONCLUSION: This study showed that overall, the women were satisfied with the availability of healthcare services and reproductive health services. Moreover, almost all of them benefited from the government scheme related to childbirth.

Early detection of sensory nerve function impairment in leprosy under field conditions.

AIM: To assess the fine sensation of palms and soles in field conditions, to enable early detection of nerve function impairment before the loss of protective sensation, thus preventing the development of disability. METHODS: A cross-sectional descriptive study was conducted at seven tertiary referral hospitals located in different states in India. This study included all newly diagnosed patients affected by leprosy, who were registered during the period between March 2011 and April 2012. A detailed history was taken along with charting and voluntary muscle testing /sensory testing (VMT/ST) for the diagnosed patients. The sensation was measured using 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles first, followed by 2 gm Semmes-Weinstein filaments for palms and 10 gm for soles. RESULTS: Among the 374 patients, 106 were identified with sensory nerve function impairment. Of the 106 patients, 84 were identified with absence of both fine and protective sensation and 22 patients had a loss of fine touch sensation with protective sensation intact. LIMITATION: This study was conducted only among patients who were newly diagnosed with leprosy. Hence, future longitudinal studies in a larger population will add more validity to the study. CONCLUSION: The patients who had loss of fine sensation would have been missed by the normal leprosy programme protocol which uses 2 gm and 10 gm filaments for testing sensory loss before initiating steroid therapy. Further research is needed to determine whether testing for fine sensation with 0.2 gm Semmes-Weinstein filaments for palms and 4 gm for soles can be introduced at all specialized leprosy centres to detect nerve function impairment at an earlier stage followed by steroid therapy.

Evaluating the effectiveness of an online faculty development programme for nurse educators about remote teaching during COVID-19.

OBJECTIVE: Engaging learners during the COVID-19 pandemic is a significant challenge for educators. The pandemic has propelled the popularity of online learning, with Google Classroom being widely used by educational institutions as a remote learning platform. This study aimed to evaluate the impact of an online faculty development programme on nurse educators' perceived competency in creating and delivering e-content using Google Classroom and other freely available digital tools. METHODS: A pre-experimental design was adopted for the research. A six-module online faculty development course was conducted for 24 nurse educators of an affiliated nursing college, over a period of eight days. A debriefing session was held on ninth day after the completion of the course. A 10-item rating scale was used to assess the participants' perceptions of their competency in using Google Classroom and other digital tools for online teaching before and after the online faculty development course. RESULTS: Out of 24 trained participants, 18 completed the post-evaluation rating scale, giving a response rate of 75%. In the post-evaluation phase, a high level of competency was perceived by 83.3% of participants for using Google Classroom and 66.7% for creating video lectures and using an online grade book. A statistically significant difference (p < 0.001) between pre- and post-course evaluations was observed. CONCLUSION: This study shows that the online faculty development programme enhanced the perceived skills of faculty members in effectively delivering online teaching using various digital tools during the pandemic.

Estudio de convivientes de lepra con un elevado índice bacteriológico / No disponible

OBJETIVO: El objetivo del estudio es cribar convivientes de personas diagnosticadas de lepra con un elevado índice bacteriológico en un centro de referencia. MÉTODOS: El estudio hospitalario incorporo a 334 personas recién diagnosticadas de lepra con un elevado índice bacteriológico. El hospital de referencia es el de Champa, Chhattisgarh, India. Se anotaron todos los convivientes de estos casos registrados de lepra y se les ofreció ser examinados. RESULTADOS: De 334 casos con un índice bacteriológico elevado (IB), 252 (75%) eran varones y 82 (25%) mujeres, con edades comprendidas entre los 12 y los 75 años. Sesenta y dos (18%) presentaron discapacidad Grado 2 y un 32% presentaron un índice bacteriológico mayor de 5 en el momento del diagnóstico. Se registraron un total de 1,397 convivientes para cribaje y 678 (49%) fueron examinados clínicamente para detectar lepra. Ciento dieciséis convivientes presentaron signos de lepra y, de entre ellos, 57 (44%) se identificaron como nuevos casos, 11 (10%) como casos conocidos en tratamiento y 48 (41%) habían sido tratados anteriormente por la enfermedad. CONCLUSIÓN: El estudio revela que el cribaje de convivientes de pacientes con elevados IB es un método efectivo para la detección de posibles nuevos casos y enfatiza la necesidad continua de cribaje y seguimiento. La educación sanitaria y la motivación de los convivientes incrementara su presentación voluntaria para ser cribados y así detectar nuevos casos

OBJECTIVE: The study aimed to screen household contacts of persons diagnosed with leprosy having a high bacterial index, at a tertiary referral centre. METHODS: This hospital based study involved 334 persons who were newly diagnosed as leprosy with a high bacterial index, attending a tertiary referral hospital, Champa, Chhattisgarh, India. We enumerated all the household contacts of registered cases and invited them to be screened for leprosy. RESULTS: Of 334 high BI cases, 252 (75%) were male and 82 (25%) were female, with ages ranging from 12 to 75 years. Sixty two (18%) had Grade 2 disability and 32% had a bacterial index of above 5+ at the time of diagnosis. A total of 1,397 household members were enrolled for screening and 678 (49%) were examined for leprosy. One hundred and sixteen household members were found to have signs of leprosy, and among these, 57 (49%) were identified as new cases, 11 (10%) were known cases on treatment and 48 (41%) had been previously treated for leprosy. CONCLUSION: This study showed that screening of household contacts of high BI cases is an effective method of leprosy case detection and emphasizes the continuing need to screen and follow up. Continued health education and motivation of household contacts will enhance voluntary reporting for periodical screening

Quality of Life of Persons Affected by Leprosy in an Endemic District, West Bengal, India.

INTRODUCTION: Leprosy still remains a public health problem in India. Stigma and associated psychosocial problems are common in leprosy and may affect the quality of life (QoL). This study aimed to assess the QoL of the person affected by leprosy living in Purulia district, West Bengal. METHODS: A cross-sectional study was conducted among 358 persons affected by leprosy above the age of 18 years and who were reporting at tertiary leprosy referral hospital, Purulia, West Bengal, from April to July 2017. The World Health Organization QoL (WHOQOL-BREF) scale was used to measure the QoL and the scale had four domain; physical health, psychological health, social relationship, and environmental health. RESULTS: Of the 358 respondents, 41% were female, 60% were aged between 18 and 45 years, and 58% were literate. Half of the participants (55%) were farmer and labor, and 75% of the participants' family income was below Rs. 5000 per month. One hundred and forty-four (40%) participants had physical disability. There was a highly significant difference seen among the person affected by leprosy between those with visible deformity and no deformity in four domains. The participants with visible deformity had lower QoL than the person without deformity. CONCLUSION: The study observed that the person affected by leprosy with visible deformity had lower QoL. Early detection and management would prevent the deformity and might improve the QoL of persons affected by leprosy.

Perception toward the disease of the people affected by leprosy.

Background: This study aimed to explore the disease severity perceived by people affected with leprosy reporting at leprosy referral center, Purulia, West Bengal, India. Methods: A cross-sectional study was conducted among 358 persons affected by leprosy above the age of 18 and married who were reporting at tertiary leprosy referral hospital, Purulia, West Bengal, India. A semistructured questionnaire was prepared to collect the demographic profile, disease profile, and perceived severity of the disease. Results: Among the participants, 41% of them were female, 60% were aged between 18 and 45 years, 58% were literate, and 40% of the participants had physical disability. The participants had multiple feelings of fear, anxiety and sorrow when first diagnosed as leprosy affected. Majority (69%) of the participants had fear of the disease. A significant association was present among males and females feeling fear of leprosy and the female feared more than male. Conclusion: The present study emphasizes the need for continuous counseling and health education for persons affected with leprosy to avoid or minimize the psychological problems. Periodical screening and counseling will improve their psychosocial well-being and quality of life.

Progressive muscle relaxation technique on anxiety and depression among persons affected by leprosy.

Anxiety and depression have been found to be increasing among people with leprosy and it may lead to decreased social participation. The progressive muscle relaxation technique (PMRT) is widely used today in choice of treatment for reducing the anxiety and depression. This study aimed to assess the effectiveness of PMRT in reducing anxiety and depression among the hospitalized leprosy affected person in a tertiary care centre. This study is a case series of 50 leprosy affected people aged between 18-60 years who were admitted for leprosy complications in tertiary leprosy referral hospital. The Anxiety-Depression scale was developed and validated by the investigators and administered before intervention of PMRT and after 2 weeks. The follow-up assessment was done at 6 weeks after the initial intervention. The finding shows that a statistically significant difference was observed on anxiety domain before and after application of PMRT. The anxiety means score showed steady decline from 6.76 at pretest to 3.0 (t=25.068, P≤0.001) at post test and 1.12 (t=22.679, P≤0.001) at follow-up. In depression domain, a statistically significant difference was seen in before and after application of PMRT. The depression means score showed steady decline from 6.92 at pre test to 3.28 (t=16.082, P≤0.001) at post test and to 1.16 (t=18.918, P≤0.001) at follow-up. This study proved that the PMRT as a valid treatment option for hospitalized person with leprosy in minimizing the anxiety and depression related symptoms and to benefit the psychosocial wellbeing of leprosy affected patients.

Estudio de niños afectados de lepra sin tartar y con discapacidades de grado 2, registrados en un centro de referencia de bengala occidental, India / No disponible

Antecedente: Estudio observacional de niños diagnosticados con lepra y discapacidades Grado 2 en un centro de referencia en Bengala Occidental, India. Métodos: Se llevó a cabo un estudio descriptivo de 21 niños, diagnosticados como nuevos casos de lepra con discapacidad Grado 2 (G2D) y registrados para el tratamiento en el Leprosy Mission Hospital, Purulia, Bengala Occidental, India. Los detalles socio-demográficos y médicos se obtuvieron de las gráficas de los pacientes. Se entrevistaron tanto a padres como a niños para inquirir sobre los factores responsables del retraso en el diagnóstico. Resultados: Durante un período de 3 años (2013-15), se diagnosticaron 1938 personas como nuevos casos activos de lepra en nuestro centro de referencia; entre los pacientes registrados, 319 (16·5%) eran niños con edades comprendidas entre los 4 y los 15 años, de los cuales 159 (50%) fueron diagnosticados de tipo multibacilar y 21 (6·6%) presentaron ya discapacidades G2D. El porcentaje de discapacidad era menor en niños comparado con los adultos y mayor en niños MB que PB. Se detectó parálisis del músculo intrínseco de la mano en 15 niños y de entre ellos, 10 con parálisis del cubital de la mano derecha y tres con parálisis mediano-cubital bilateral. Varios niños habían detectado una mácula como primer síntoma y en 15 alguno de los padres estaba afectado. Conclusión: Este trabajo pone de manifiesto que todavía hay un problema con niños que desarrollan G2D antes del diagnóstico y señala algún de los factores sociales responsables del retraso en el diagnóstico e implementación de la MDT. Se necesita mejorar la comunicación y los métodos para persuadir a las familias a que se presenten pronto e implementar el tratamiento cuanto antes

Setting: An observational study of children diagnosed with leprosy and Grade 2 disability at a referral centre in West Bengal, India. Methods: A descriptive study was conducted of 21 children, diagnosed as new cases of leprosy with Grade 2 disability (G2D), and registered for treatment at The Leprosy Mission Hospital, Purulia, West Bengal, India. The socio-demographic and medical details were obtained from the patients’ charts. In-depth interviews were carried out with both the children and their parents to inquire about the factors responsible for the delay in diagnosis. Results: During a 3-year study period (2013-15), 1938 people were diagnosed as new active cases of leprosy at our referral centre; among the registered patients, 319 (16·5%) were children aged between 4 and 15 years, of whom 159 (50%) were diagnosed with multibacillary disease and 21 (6·6%) were reported with G2D. The disability proportion was lower in children compared with adults and higher in MB children compared with PB children. Paralysis of the intrinsic muscles of the hand was seen in 15 children and of these, 10 children had right hand ulnar paralysis and three had bilateral ulnar-median paralysis. Several children had noticed a patch as the first symptom and 15 had a leprosy-affected parent. Conclusion: This study shows that there is still a problem of children developing G2D before the diagnosis of leprosy is made, and points to some of the social factors responsible for delayed reporting and prompt starting of MDT. Better communication and innovative methods of persuading the families to report early need to be tested and urgently implemented

AZALEP a randomized controlled trial of azathioprine to treat leprosy nerve damage and Type 1 reactions in India: Main findings.

BACKGROUND: Leprosy Type 1 reactions are difficult to treat and only 70% of patients respond to steroid treatment. Azathioprine has been used as an immune-suppressant and we tested its efficacy in treating leprosy T1R. METHODOLOGY: Randomised controlled trial adding azathioprine to steroid treatment for leprosy reactions. This trial was conducted in four leprosy hospitals in India. Patients with a new leprosy Type 1 reaction affecting either skin or nerve were recruited. They were given a 20 week course of oral prednisolone either with placebo or azathioprine 50mg for 24, 36 or 48 weeks. Outcomes were measured using a verified combined clinical reaction severity score (CCS) and the score difference between baseline and end of study calculated. An intention to treat analysis was done on the 279 patients who had an outcome. PRINCIPAL FINDINGS: 345 patients were recruited, 145 were lost due to adverse events, loss to follow up or death. 36% needed extra steroids due to a recurrence of their skin and/or nerve reaction. 76% of patients had improvements in their CCS the end of the study, 22% had no change and 1.1% deteriorated. Adding azathioprine to steroid treatment did not improve CCS. So the improvements were attributable to treatment with steroids. We analysed the skin, sensory and motor scores separately and found that skin improvement contributed most with 78.9% of patients having skin improvement, azathioprine treatment for 48 weeks improved sensory scores it also improved motor scores but so did treatment with prednisolone alone. We identified significant adverse effects attributable to steroid treatment. When azathioprine and Dapsone were given together significant numbers of patients developed significant anaemia. CONCLUSIONS: Azathioprine is not recommended for the treatment of leprosy reactions and does not improve steroid treatment. Recurrent reactions are a major challenge. We have also identified that 65% of patients with sensory and 50% with motor nerve damage do not improve. Future studies should test giving azathioprine in the treatment of nerve damage and giving a higher dose for 48 weeks to patients. These findings highlight the difficulty in switching off leprosy inflammation and the need for better treatments for reactions and nerve damage. There is also a research need to identify patients who have recurrences and optimize treatments for them. Patients with recurrences may benefit from combined treatment with steroids and azathioprine. We have also shown that significant numbers of patients treated with steroids develop adverse effects and this needs to be highlighted in leprosy programmes. Research is needed to identify patients who do not respond to steroid treatment and develop alternative treatments for them. TRIAL REGISTRATION: ClinicalTrials.gov This trial was registered with the Indian Council of Medical research clinical Trial register as a clinical trial Number-REFCTRI/2016/12/007558.

Experiences with Thalidomide for Erythema Nodosum Leprosum­ a retrospective study.

Background: Thalidomide is well known as a steroid sparing drug in Erythema Nodosum leprosum (ENL) reaction in leprosy. There is no guideline as to when it should be offered to patients. Documentation of ENL presentation with its morbidity before and after with patient profile can be a baseline to develop a selection criteria as to when thalidomide should be started to reduce steroid related morbidly. Method: Chart and electronic record review was done. Result: 427 ENL patients attended the hospital from 2010 to 2014. 73 patients (67 males six females) were treated with thalidomide. 77% (56) patients were in the age group of 16­45 yrs. 16% (12) were dependent and 39% (29) were taking steroids at presentation. 82% (60) became dependent while on treatment. Ninety five percent were chronic or recurrent ENLs and 73% (53) had moderate to severe ENLs over 49 median months. Steroid induced morbidities were (Cushingoid features 42%, diabetes 21%, infections GI 42%, genitourinary 26%, cataract 23%). There was 11% mortality. Conclusion: Further studies are recommended to diagnose steroid dependence early to prevent serious adverse effects.