Birth preparedness and complication readiness among women of Bankura District, West Bengal.

BACKGROUND: Birth preparedness and complication readiness (BPCR) is the process of planning for normal birth and anticipating the actions needed in case of an emergency which is critical in averting maternal morbidity and mortality. OBJECTIVES: To find out awareness and practices regarding BPCR among pregnant and recently delivered women in Bankura, West Bengal. MATERIALS AND METHODS: A cross-sectional, community-based study was carried out among 120 pregnant women and 235 recently delivered women. Information on sociodemographic variables as well as awareness and practices regarding BPCR were collected through semi-structured interview. For statistical analysis Z-test was used. RESULTS: The majority of respondents (69.3%) had registered for antenatal care within the first 12 weeks of their pregnancy and 74.0% of the recently delivered women had four or more antenatal check-ups and 81.3% had institutional delivery. The BPCR index of pregnant women and recently delivered women was 45.2 and 59.0, respectively, whereas BPCR index of the total was 52.1. CONCLUSION: Although the BPCR indicators are satisfying, the health system should use the opportunity during visits to health institutions to increase awareness among the pregnant women and her family on how to plan for the pregnancy and identify danger signs.

A study on utilization of Janani Suraksha Yojana and its association with institutional delivery in the state of West Bengal, India.

BACKGROUND: India launched the Janani Suraksha Yojana (JSY) on the principles of conditional cash transfer providing monetary incentive to needy women to improve access to institutional childbirth. OBJECTIVES: This study was conducted among JSY-eligible women who delivered between April 2012 and June 2012 to assess the utilization of cash incentives toward institutional delivery, along with other associated factors influencing institutional delivery. METHODS: It was a cross-sectional, descriptive study conducted between July 2012 and May 2013 on 946 women selected through stratified random sampling of subcentres from better and worse performing districts of West Bengal. RESULTS: 74.7% of the study population was JSY-eligible. 90.2% of those who took three antenatal check-ups (ANCs) and 36.8% JSY-noneligible women received cash. Government institutions were preferred for childbirth among all groups irrespective of JSY eligibility, receipt of cash, and number of antenatal visits. Overall, 78.8% opted for institutional delivery if they had received cash, which was significantly more than those who did not (64.5%). JSY-eligible women were 1.5 times more likely to deliver in government institutions compared to JSY-noneligible women. With no incentive, the likelihood of institutional delivery was halved. The distance of a 24 Χ 7 delivery hub beyond 5 km (74.8% vs. 81.8%), the religion of Islam (62.7% vs. 83.2%), and multiparity (63.9% vs. 83.6%) were significant deterring factors. CONCLUSION: Despite some inclusion and exclusion errors, cash incentive under JSY was associated with increased institutional delivery, especially in government institutions though there were other factors influencing the decision as well.

Does Janani Shishu Suraksha Karyakram ensure cost-free institutional delivery? A cross-sectional study in rural Bankura of West Bengal, India.

BACKGROUND: Janani Shishu Suraksha Karyakram (JSSK) was launched in India to ensure cost-free institutional delivery. OBJECTIVES: 1) To assess the awareness of recently delivered women regarding JSSK 2) To estimate the cost of institutional delivery and its differentials. MATERIALS AND METHODS: A community-based, cross-sectional study was conducted in a rural community in Bankura, West Bengal, India in 2013, among 210 women who delivered babies in the last 12 months. Information regarding sociodemographic and health service-related variables as well as item-wise costs incurred for institutional delivery were collected. Costs were expressed in Indian National Rupee (INR). A nonparametric, bivariate analysis was performed to examine the difference in median cost. RESULTS: All components of JSSK were known to 12.9% women; the highest (77.1%) for admission and lowest (29.0%) for blood transfusion. The median (±IQR) costs of delivery in the Block level Primary Health Center (PHC), medical college, and private facilities were INR 205.0 (±825.0), 900.0 (±1013.0), and 6600.0 (±16195.0), respectively. Median cost of normal delivery in a private facility (INR 2750.0) was 3.6 times of that in a government facility (INR 765.0). Median direct cost of caesarian section (CS) in a government facility (INR 1100.0) was nearly one-fifteenth of that in a private facility (INR 16,350.0). Cash incentives under Janani Suraksha Yojana for poor and socially marginalized women could not cover the cost of CS delivery in a government facility. CONCLUSION: Gaps existed in the awareness of beneficiaries regarding entitlement under JSSK. Drugs and transport were two major causes of out-of-pocket (OOP) expenditure in public health facilities.

Depression among nursing students in an Indian government college.

BACKGROUND: Depression is a major public health threat that can affect anyone including health professionals and nursing students. OBJECTIVES AND METHODS: This analytical, cross-sectional study was conducted among 180 students of a nursing college to find out the burden of depression on them and possible contributing factors using the Beck Depression Inventory. RESULTS: 63.9% of the students were found to be depressed, the majority being mild in grade. First-year students were found to be significantly more affected (P=0.008). Binary logistic regression showed that familial disharmony, disinterest in the course and insecurity about future placement were statistically significant factors behind the development of depression. CONCLUSION: It is imperative that the psychological condition of nursing students be viewed as an important aspect to be considered, particularly within the Indian population and others in which there is a paucity of data.

Access to and utilization of voucher scheme for referral transport: a qualitative study in a district of West Bengal, India.

BACKGROUND: Lack of motorized transport in remote areas and cash in resource-constrained settings are major obstacles to women accessing skilled care when giving birth. To address these issues, a cashless voucher transport scheme to enable women to give birth in a health-care institution, covering poor and marginalized women, was initiated by the National Rural Health Mission in selected districts of India in 2009. METHODS: The access to and utilization of the voucher scheme were assessed between December 2010 and February 2011 through a qualitative study in the district of Purulia, West Bengal, India. Data were collected from in-depth interviews and focus group discussions with women, front-line health-care workers, programme managers and service providers. RESULTS: The main factors influencing coverage and utilization of the scheme were: reliance on ill-prepared gram panchayats (village councils) for identification of eligible women; poor birth preparedness initiatives by health-care workers; over-reliance on telephone communication; restricted availability of vehicles, especially at night and in remote areas; no routine monitoring; drivers' demand for extra money in certain situations; and low reimbursement for drivers for long-distance travel. CONCLUSION: Departure from guidelines, ritualistic implementation and little stress on preparedness of both the community and the health system were major obstacles. Increased enthusiasm among stakeholders and involvement of the community would provide opportunities for strengthening the scheme.

Status of birth preparedness and complication readiness in Uttar Dinajpur District, West Bengal.

CONTEXT: Birth Preparedness and Complication Readiness (BPCR) is crucial in averting maternal morbidity and mortality. OBJECTIVES: To find out awareness and practices regarding BPCR among pregnant and recently delivered women in Uttar Dinajpur, West Bengal. MATERIALS AND METHODS: This is a cross-sectional, community-based, mixed methods study. Two-stage, 40 cluster sampling technique was used to select three pregnant and six recently delivered women separately. Information on socio-demographic variables as well as awareness and practices regarding BPCR were collected through semi-structured interview. In-depth interviews with one respondent per cluster were also conducted. For statistical analysis Z test was used. RESULTS: Around 50% of the respondents planned for first antenatal check-up (ANC) within 12 weeks, four or more ANCs and institutional delivery. Proportion of women aware of at least one key danger sign each of pregnancy, labor, postpartum, and newborn ranged from 12.1% to 37.2%, whereas 58.3% knew at least one key component of essential newborn care. Around two-thirds and one-third of women, respectively, especially those from backward and below poverty line (BPL) families knew about cash incentive and referral transport schemes. Proportions of women with first ANC within 12 weeks, four or more ANCs, institutional delivery, saving money, identifying transport, and blood donor were 50.4%, 33.6%, 46.2%, 40.8%, 27.3%, and 9.6%, respectively. Hindu religion, backward castes, BPL status, and education ≥ 5 years influenced the practices except for two regarding ANC. Overall BPCR index of the study population was 34.5. CONCLUSION: Preparedness in health system, ensuring competence, and motivation of workers are needed for promoting BPCR among the study population.

Are the adolescent behaviors too risky? A school-based study in a district of West Bengal, India.

A cross-sectional study was undertaken among 2068 school-going adolescents of a subdistrict area of West Bengal, India for assessment of entire array of risk behaviors and their correlates. Aggressive, suicidal, substance use and sexual risk behaviors were measured using a self-administered, multi-item, validated questionnaire in the local vernacular. Prevalence of physical fights, weapon carrying in the last 30 days and gang fights in the last 12 months were 27.1%, 7.3% and 13.0%, respectively. Current users of tobacco, alcohol and illicit substances were 7.1%, 3.4% and 2.0%, respectively. Suicidal ideation and attempts were reported by 11.7% and 3.5% of students. Almost one-tenth of respondents had premarital sexual intercourse. Male gender, low subjective economic status, exposure to electronic media and poor academic achievements were associated with most of the studied risk behaviors, except that females showed more propensities to suicidal behavior. The magnitude and pattern of adolescent risk behaviors, though less studied in India, warrants urgent, coordinated actions.

Comparative Analysis of RNTCP Indicators in a Rural and an Urban Tuberculosis Unit of Burdwan District in West Bengal.

BACKGROUND: Data pertaining to managerial indicators of RNTCP are rare. The present study was done to analyze the RNTCP indicators in one rural and one urban tuberculosis unit in Burdwan, West Bengal, and find out any influencing factor. MATERIALS AND METHODS: A comparative record analysis for the year 2007 was undertaken RESULTS: The study revealed significantly more urban adolescents (P<0.001) were treated. In both areas, the proportion of NSN cases and smear positive retreatment cases among total smear positives were less than expected, while more NSP cases were registered. Significantly lesser retreatment cases (13.33%) were registered in the rural area. Smear negative and EP cases of all the patients in Cat I were significantly less in the rural area. Outcomes like cured, treatment completed, default, and death were similar approaching the RNTCP norm. But sputum conversion (78.02%) and failure rate (4.93%) were worse than the RNTCP norm in the urban area and varied significantly between two areas. The outcomes like cured, treatment completed, and default differed significantly with age in the areas. The outcome of TAD cases was different, but the outcomes of NSN, EP, and other retreatment cases were similar in two areas. Age at treatment onset was found to be the only factor associated with default. CONCLUSION: Managerial indicators may reveal something different despite common indicators showing acceptable results.

Enduring starvation in silent population: a study on prevalence and factors contributing to household food security in the tribal population in Bankura, West Bengal.

BACKGROUND: Strengthening food security enhancement intervention should be based on the assessment of household food security and its correlates. OBJECTIVES: The objective was to find out the prevalence and factors contributing to household food security in a tribal population in Bankura. METHODS: A cross-sectional study was conducted among 267 tribal households in Bankura-I CD Block selected through cluster random sampling. Household food security was assessed using a validated Bengali version of Household Food Security Scale-Short Form along with the collection of information regarding the monthly per capita expenditure (MPCE), total to earning member ratio, BPL card holding, utilization of the public distribution system (PDS) and receipt of any social assistance through a house-to-house survey. RESULT AND CONCLUSION: Overall, 47.2% of study households were food secure whereas 29.6% and 23.2% were low and very low food secure, respectively. MPCE ≥ Rs. 356, total to earning member ratio ≤ 4:1, regular utilization of PDS, and nonholding of the BPL card were significantly related with household food security.

Limited access to iodized salt among the poor and disadvantaged in North 24 Parganas district of West Bengal, India.

Iodine deficiency is endemic in West Bengal as evident from earlier studies. This community-based, cross-sectional descriptive study was conducted in North 24 Parganas district during August-November 2005 to assess the consumption of adequately-iodized salt and to ascertain the various factors that influence access to iodized salt. In total, 506 households selected using the multi-stage cluster-sampling technique and all 79 retail shops from where the study households buy salt were surveyed. The iodine content of salt was tested by spot iodine-testing kits. Seventy-three percent of the households consumed salt with adequate iodine content (> or = 15 ppm). Consumption of adequately-iodized salt was lower among rural residents [prevalence ratio (PR): 0.8, 95% confidence interval (CI) 0.7-0.9], Muslims (PR: 0.8, 95% CI 0.7-0.9), and households with monthly per-capita income of < or = US$ 10 (PR: 0.7, 95% CI 0.6-0.8). Those who heard and were aware of the risk of iodine-deficiency disorders and of the benefit of iodized salt were more likely to use appropriate salt (PR: 1.2, 95% CI 1.1-1.3). Those who were aware of the ban on non-iodized salt were more likely to consume adequately-iodized salt (PR: 1.1, 95% CI 1.01-1.3). The iodine content was higher in salt sold in sealed packets (PR: 2.9, 95% CI 1.8-4.8) and stored on shelves (PR: 1.6, 95% CI 1.3-2.0). Seventy-two percent of the salt samples from the retail shops had the iodine content of > or = 15 ppm. The findings indicate that elimination of iodine deficiency will require targeting the vulnerable and poor population.

A study on factors influencing treatment outcome of failure patients receiving DOTS in a district of West Bengal.

Failure to primary treatment under RNTCP can be an enormous setback for the society. A record based retrospective cohort analysis of 212 patients failing primary treatment under Cat I or Cat III was done in Burdwan district of West Bengal to find the treatment outcome after re-registration under Cat II and its possible influencing factors. Retreatment of failed patients resulted in 24.06% chronicity. Important factors influencing the outcome of being failure were found to be Adolescence (AOR = 2.350; C.I. 0.660-8.281), Urban residence (AOR = 1.878; C.I. 0.705-5.002), primary categorization in Cat I versus Cat III (AOR = 5.036; C.I. 0.897-28.281), higher bacillary load at the beginning of retreatment regimen (AOR = 5.437; C.I. 0.787-37.562) and more than three weeks delay in instituting Cat II treatment (AOR = 3.550; C.I. 0.941- 13.393). 17.35% of such failed patients were still defaulters. Hence such factors may be looked into for more efficient control of Tuberculosis in our country.

Cross-sectional study of consumption, compliance and awareness about antibiotic utilisation amongst the urban community in Kolkata.

A cross-sectional survey was conducted upon 500 respondents, comprising of 250 adults and 250 children who did consume antibiotics in the previous three months. Data were analysed to determine the patterns of utilisation, compliance and awareness regarding antibiotic medication amongst a selected urban population at Kolkata. Antibiotic consumption without prescription was evident amongst 41.2% of adults in comparison to that of 8.4% in children (P < 0.01). Compliance to daily dosage was observed in 40.8% of adults in comparison to 82.8% in children (P < 0.01). Awareness pattern regarding antibiotics were reported to have been more in the children group (16.4%) while compared to the adults (8%). The knowledge regarding antibiotic resistance remained more or less similar in both the groups. The study concludes that high over the counter (OTC) sale and inadequate compliance to antibitotic medication needs further intervention approach towards information, education and communication (IEC) to all concerned.