Effectiveness of multi-component modular intervention on screen-based and non-screen-based sedentary time among adolescents in an urban area of Mangalore: a school-based cluster randomised controlled trial-protocol.

Background: Behavioural risk factors may often present during adolescence and account for 70% of premature deaths during adulthood. Excessive sedentary behaviour and screen time have become significant concerns, especially among adolescents, due to their potential negative impact on physical and mental health. Adolescents with a high screen-based sedentary time are more likely to be physically inactive, have unhealthy body structure and poor academic performance. The objective of our study is to assess the effect of multi-component modular educational intervention on screen-based sedentary time (SST) and non-screen-based Sedentary time (NSST) among adolescents. Methods: Ethical approval for the study has been obtained from the institutional Ethics Committee of Kasturba Medical College in Mangalore, India. This cluster randomized control trial will be carried out in schools located in the urban area of Mangalore. Using simple randomization, the eligible schools will be randomized into intervention and control arms, each consisting of 10 clusters. A multi-component modular educational intervention will be administered to participants in the intervention group at baseline, second and fourth month. The control group will receive the standard curriculum. Both the groups will be assessed at baseline and at second month, fourth month and sixth month of follow up for SST, NSST and level of physical activity. Anthropometric measurements like height, weight, waist circumference and hip circumference will be taken at baseline and sixth month of follow up. Results: A comprehensive school-based modular educational intervention can have cumulative advantages by reducing screen- and non-screen-based sedentary time, and encouraging physical activity. Similar modular teaching can be incorporated into the curriculum, which will promote healthy life-style among the adolescents.

Paternal perspectives towards infant and young child feeding (IYCF): a qualitative analysis from Coastal South India.

BACKGROUND: The infant and young child feeding practices (IYCF) decide child growth and well-being. Paternal perspectives and involvement in IYCF are of paramount importance and are grossly under-studied. AIMS: To study the experiences and opinions of fathers of infants and young children towards feeding practices. SETTINGS AND DESIGN: Two focus group discussions (FGD) were carried out in the community settings in Dakshina Kannada District, Karnataka State. METHODS AND MATERIAL: FGDs were carried out in the areas of two selected primary health centres. FGD guide was used and the discussions were audio recorded. Themes were derived from the transcript. RESULTS: Four main themes were generated from the transcripts of two FGDs. Lack of time to involve in child feeding, lack of felt need for increased involvement, sense of being complete in providing paternal care and readiness to learn were the generated themes. All participating fathers had favourable attitudes towards learning more about IYCF. CONCLUSIONS: Lack of time felt need for higher paternal involvement in IYCF and sense of being complete in providing paternal care were the themes extracted, along with favourable attitude towards increasing their involvement in IYCF.

Module intervention to improve involvement and practices of fathers towards infant and young child feeding (IYCF) in Coastal South India - a randomized controlled trial.

Background: Overall child health depends on nutrition and its related practices. At the family level, responsibility of child feeding lies with both parents. There is no uniform and systematic way to determine and assess the practices of fathers in infant and young child feeding (IYCF). Also, there is a paucity of evidence related to interventions for fathers in improving their practices and involvement in the feeding of their infant or young child (aged less than two years). Methods: This was a community-based randomized control trial, conducted among 120 fathers with infants and/or young children in Dakshina Kannada District of Karnataka. Fathers with poor level of involvement and practices towards IYCF, during the initial assessment, were included as the study participants. For the intervention, a module in the flipchart format was developed. Simple randomization technique was used to allot the participants into two groups - intervention and control. Participants in the intervention group received module intervention, in addition to the care which they received routinely, and the control group received only routine care. The participants in the intervention group were paid a monthly visit to implement the module, for six months. The post-intervention assessment was done at the end of 6 months. Results: A total of 117 participants provided post-intervention data. The mean age was 34.7 (+/- 5.48) years in the intervention group and 34.36 years (+/- 5.26) in the control group. The intervention group had a significant improvement in knowledge, attitude, and practice components at 6 months. We noted higher change scores for the intervention group (p<0.05). Conclusions: The extent of increase in practice and involvement in child feeding was clearly higher among the intervention group. The module developed was successful in improving the practices of fathers in feeding their infants and young children. Clinical Trials Registry India: CTRI/2017/06/008936 (29/06/2017).

Incentives for pregnant mothers during antenatal care for better maternal and neonatal health outcomes in low and middle income countries: A systematic review protocol.

Background: Universal access to maternal new-born and child healthcare services (MNCH) is detrimental for attainment of Sustainable Development Goal (SDG) three pertaining to promotion of health at all ages. Incentivization in the form of cash, vouchers, and goods have been used as part of strategies to improve maternal and neonatal health outcomes around the world. However, there exists uncertainties regarding the effectiveness of various incentive-based programmes targeted for pregnant mothers in low- and middle-income countries during their antenatal period. Methods: We will search six electronic databases, namely the Medical Literature Analysis and Retrieval System Online (Medline), Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, and Embase in addition to Google Scholar. Manual searching of the reference lists of included studies will also be done. The reporting of this protocol will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 statement [29]. Only interventional studies that follow randomized, quasi randomized, and cluster randomized controlled study designs will be included. A three-stage screening process will be adopted to select articles. Risk of bias for the included studies will be assessed using the tools and criteria specified in the Cochrane handbook. In addition, the GRADE approach will be used to assess the quality of evidence for the maternal and neonatal health outcomes. Conclusion: This review of trials is essential to inform the effectiveness of incentive-based programmes targeted for pregnant women in low- and middle-income countries. It will help the policy makers to utilise the resources more effectively and to integrate the evidence based public health initiatives into the health system. This can also help build the continuum of care financial packages for all pregnant women.

The COVID-19 pandemic and mental health outcomes - A cross-sectional study among health care workers in Coastal South India.

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care. Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1 st March -30 th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported. Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05) Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.

Paternal Involvement in and Sociodemographic Correlates of Infant and Young Child Feeding in a District in Coastal South India: A Cross-Sectional Study.

Context: The feeding practices during first 2 years of life determine the overall health and survival during childhood and beyond. Child nutrition is responsibility of both parents and so far emphasis has been laid mostly on mothers. Fathers' involvement toward Infant and Young child feeding (IYCF) has been proved to be of paramount importance and yet it is given limited importance. Objectives: This study aims to study the level of paternal involvement toward IYCF and its associated factors and to assess the knowledge, attitude, and practices toward IYCF in Dakshina Kannada District in South Indian State of Karnataka. Settings and Design: This community-based cross-sectional study was conducted in the coastal District of Dakshina Kannada; Karnataka State in India. Methods: The study included 450 fathers of infant and young children (aged <2 years) in five taluks of Dakshina Kannada district. They were assessed for knowledge, attitude, and practices related to IYCF. Median score for the practice component was considered cut off to classify involvement in IYCF. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Chi-square-test and Binary Logistic Regression with Hosmer-Lemeshow goodness-of-fit model were used. Unadjusted and adjusted odds ratios were generated. A p-value of <0.05 was considered statistically significant. Results: Mean age of the study population was 34.6 years (SD, 5.4). The practice scores median (IQR) was 34.0 (IQR, 31.0-39.0), and 40.9% of the participants had poor involvement in IYCF. This was significantly higher among fathers from predominantly urban area. Those who had education above graduation and younger fathers had better involvement in IYCF. Conclusions: Less than half of fathers had poor involvement in IYCF, and it was lower among fathers from urban areas, higher age, and lower educational levels.

Awareness and attitude regarding breastfeeding and immunization practices among primigravida attending a tertiary care hospital in southern India.

INTRODUCTION: Infant mortality rate (IMR) is considered as one of the most sensitive indicators of health status of a community. Infant mortality figures in India are very high and the two important causes which contributes maximum to the IMR is inadequate breastfeeding and immunization. The major cause of death among under five children in India is neonatal sepsis, diarrhea and pneumonia and breast milk is protective against all the three diseases. Immunization along with breastfeeding reduces a significant number of infant and maternal mortality. Disease like neonatal tetanus is rampant in our country and it can be prevented by vaccination of the women during pregnancy. This study tries to find out the awareness and attitude among the primigravida females regarding breastfeeding and immunization. MATERIALS AND METHODS: This facility based cross-sectional study was conducted among 186 primigravida who came to the hospital for delivery and antenatal check-up during March 2014 in three associated teaching hospitals of Kasturba Medical College, Mangalore, which is situated in coastal South India. Approval was obtained from the Institutional Ethics Committee (IEC) of KMC (Manipal University), Mangalore, India. A pre tested, semi structured questionnaire was used as the data collecting tool. RESULTS: Majority (n=163, 87.6%) were Hindus followed by Muslims (n=16, 3.2%). Nearly half of the participants (n=92, 49.5%) were in the 21-25 y age group, 54.8% participants were not aware of correct position of baby during feeding and 10.8% (n=20) believed that immunization should be stopped if it showed side effects. CONCLUSION: Breastfeeding and Immunization is an effective way of reducing child and maternal mortality. The results from our study showed that many participants had lacunae in knowledge and attitude and adequate health education should be given to the pregnant women.

Married Men's Involvement in Family Planning - A Study from Coastal Southern India.

BACKGROUND: Over the years, India has emerged as one of the most populous countries in the world, next only to China. Unregulated fertility can compromise the economic development and political stability of a country. Family planning was always thought to be a woman's prerogative, especially in a male dominant society like India. Consequently, most of the studies on family planning focused on women as the subject of interest. PURPOSE: To assess the knowledge, attitude and practices of family planning amongst men who have been married for at least five years. MATERIALS AND METHODS: A cross-sectional study was carried out in the teaching hospitals of Kasturba Medical College (Manipal University), Mangalore; India among 156 men who had been married for at least five years. They were selected using non-random sampling method and were interviewed using a pretested semi structured validated questionnaire. Chi-square test was used for statistical analyses. RESULTS: Overall, 75.6% were aged between 26 and 34 years, 41.7% had one child, 92.3% subjects from upper and 86.9% from lower socio-economic status were aware about the male family planning services available in the market. Most husbands preferred that their spouse should be sterilized (53.8%). Family planning methods were actively practiced by 71.2 %. CONCLUSION: Most of the studies on family planning have focused mainly on females. This study throws light on the male perspective of family planning. Our study subjects were well aware about various family planning services and their attitude towards family planning was favorable, but the number of men practicing family planning was not high.

Immunization practices of pediatricians for children younger than five years in coastal South India.

CONTEXT: Immunization helps in controlling infectious diseases. Child immunization is an important component of child survival programs in India, which mainly follows the National Immunization Schedule. Also, many of the injection practices followed are not safe. AIMS: To study the practices of pediatricians toward the immunization of children younger than 5 years and injection-related waste management. SETTINGS AND DESIGN: Cross-sectional study carried out in the city of Mangalore, a rapidly developing city in southern India. METHODS AND MATERIAL: All the practicing pediatricians were included in the study and an interview was done on prior appointment using pretested interview schedule in March 2012, after obtaining clearance from the institutional ethics committee. Data were analyzed using the Statistical Package for Social Sciences version 11.5. RESULTS: Among the 54 practicing pediatricians in Mangalore, 42 were included in this study after exclusion criteria were applied. Among them, 71.4% were following the National Immunization Schedule, 5% did not prefer to give combination vaccines, 17% reported vaccine failure at least once in their practice, and 85.7% motivated the parents for future doses. Distance to the clinic and affordability were the major reasons for loss of follow-up. Only 38.1% used auto-disabled syringes, 11.9% did not observe the children following the immunization, and 45.2% did not use color coding for disposal of injection-related wastes. Mechanical hub cutters were preferred by 41% of the respondents. CONCLUSION: The study showed the diversity in immunization practices. The National Immunization Schedule is the most commonly followed schedule. However, the safety of the injection practices was limited.

Awareness and Attitude of the General Public Toward HIV/AIDS in Coastal Karnataka.

OBJECTIVE: To assess the awareness and attitude of the general public toward people living with HIV/AIDS (PLWHA) in Mangalore, a city in Coastal Karnataka. DESIGN: Community-based cross-sectional study. MATERIALS AND METHODS: The study population included 630 individuals aged 18 years and above. The information was collected using a semi structured pre-tested questionnaire. The questionnaire consisted of 24 questions regarding awareness of the modes of transmission of HIV/AIDS (nine questions) and questions to assess the attitude toward People Living With HIV/AIDS (PLWHA) (15 questions). Statistical package SPSS version 11.5 was used, Chi-square test was conducted and P < 0.05 was considered as statistically significant. RESULTS: About one-third of the study population thought that one could get infected by merely touching an HIV positive individual. Approximately 45% stated that they would dismiss their maid on finding out her HIV positive status. About 54% were willing to undergo the HIV test. The respondents with less than secondary school education had a discriminatory attitude toward HIV positive people, with regard to them deserving to suffer, dismissing a HIV positive maid, hesitating to sit next to a HIV positive person in the bus, divorcing the infected spouse, and willingness to get tested for HIV, which was found to be statistically significant. CONCLUSION: Stigma among the general public was mostly due to fear of contracting the illness. Stigma does exist to significant degrees among the educated people, which was suggested by about 45% of the participants being willing to undergo the HIV test. There is a need for greater attempts toward making information regarding HIV/AIDS available to every individual of the society.