Gender-based Violence and its Predictors: A Cross-sectional Study Among the Adolescents of Madhya Pradesh, Central India.

Background: Gender-based violence (GBV) is a global public health concern. India's socio-cultural and regional diversity poses challenges for obtaining accurate and comprehensive indicators of gender-based violence. This study aimed to explore the prevalence and predictors of GBV among adolescents. This was a community-based cross-sectional study conducted among adolescents aged 10 to 19 years in six districts of Madhya Pradesh, the central part of India, from December 2017 to 2019. Methods and Material: GBV was assessed using a validated questionnaire adapted from a nationwide survey. Data were analyzed using SPSS (version 16.0). Logistic regression analysis was performed to identify factors associated with GBV. Results: The study revealed that 10.4% of adolescents were victims of GBV. The multi-variable logistic regression showed that girls were at higher risk (odds ratio = 5.7) of facing GBV. Other significant factors associated with GBV included older adolescents (15-19 years old), those belonging to scheduled caste/tribal areas, those whose mothers were literate, those who had a boyfriend/girlfriend, and those who justified wife beating. Conclusion: GBV is a serious public health problem among adolescents, with one in every 10 adolescents experiencing GBV. It is essential to instil awareness of gender-equal norms from early childhood and within households. Implementing violence prevention policies and strategies in educational and work institutions, as well as at the community level, is crucial.

Feasibility of Self-Management of Hypertension and Diabetes Using Patient-Generated Health Data Through M-health in Central India.

INTRODUCTION: Digital health innovations are modern solutions for the management and treatment of diseases, particularly non-communicable diseases. This study was conducted to assess the feasibility of the management of diabetes and hypertension through patient-generated health data (PGHD). METHODS: A mobile application (One Health) was used for the entry of data on blood pressure, blood glucose, physical activity, and dietary intake for six months by the patients. Frequency of application download, monthly data entry, and change in control of blood pressure and glycemic markers during six months of application use were used to assess the feasibility and impact of the application for the management of hypertension and type 2 diabetes mellitus (T2DM). RESULTS: A higher proportion of patients entered data generated non-invasively (blood pressure) as compared to data generated via invasive techniques (glycemic control measures). The frequency of monthly data entry remained unchanged during One Health use. At the end of six months, control of hypertension and glycemic control was achieved in 53.3% and 33.9% of patients, respectively. Furthermore, there was a significant reduction of mean diastolic blood pressure (0.60 (±2.31); p=0.03) and glycosylated hemoglobin (0.657 (±1.808); p=0.04). DISCUSSION: The acceptability of One Health appears to be associated with the frequency of data entry. The entry of health data by patients was sufficient to effect positive change in health indicators. Although mobile applications enable the monitoring and management of chronic health conditions, additional research shall help in optimizing interventions to be adopted as acceptable tools of patient management.

Trends in willingness to receive COVID-19 vaccines among healthcare workers in India: Findings from repeated cross-sectional national surveys.

Background: COVID-19 vaccination of the healthcare workers (HCWs) is a key priority in the fight against the SARS-CoV-2 pandemic. India launched its COVID-19 vaccination program in January 2021. We aimed to understand the trends in willingness to receive COVID-19 vaccines and its associated factors among HCWs in India. Methods: Using a repeated cross-sectional survey design, we collected information from HCWs in three critical time points: before (n = 937, October 2020), during (n = 1346, January 2021); and after (n = 812, May 2021) the introduction of COVID-19 vaccines in India. The third survey coincided with the peak of the second wave of COVID-19 pandemic in India. Findings: Of the study participants, 43.7, 60.2, and 73.2% were willing to receive COVID-19 vaccines during the first, second and third rounds of surveys, respectively. In multivariable logistic regression analysis, participants who trusted the health care system were more likely to report willingness to receive a COVID-19 vaccine; medical trust emerged as a significant factor in all the three rounds of surveys (First survey-aOR: 2.24, 95% CI: 1.67-2.99; Second survey-aOR: 3.38, 95% CI: 2.64-4.33; Third survey-aOR: 2.54, 95% CI: 1.65-3.91). Having confidence in domestic vaccines (Second survey-aOR: 2.21, 95% CI: 1.61-3.02; Third survey-aOR: 2.05, 95% CI: 1.24-3.37); and high perceived risk of contracting COVID-19 (Second survey-aOR: 1.48, 95% CI: 1.13-1.93; Third survey-aOR: 2.02, 95% CI: 1.31-3.13) were found to be associated with willingness to receive vaccines. Among socio-demographic characteristics, being married (aOR: 1.71, 95% CI: 1.08-2.71) and having high socio-economic status (aOR: 3.01, 95% CI: 1.65-5.51) emerged as significant factors associated with willingness to receive COVID-19 vaccines in the third round of the surveys. Interpretation: Willingness to receive COVID-19 vaccine increased with time, as the severity of the pandemic increased. To increase COVID-19 acceptance and coverage among HCWs, it is important to instill confidence in domestic vaccines and assist in accurate assessment of risk toward contracting COVID-19 infection.

Community health workers willingness to participate in COVID-19 vaccine trials and intention to vaccinate: A cross-sectional survey in India.

Background: Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers' willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India. Methods: A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine. Results: Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18-7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51-8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24-4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17-4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12-0.88), p = 0.027]. Conclusions: Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.

Is ignorance of the weekly iron and folic acid scheme among adolescents the deciding factor for its suboptimal utilization and ineffectiveness? A cross-sectional study.

INTRODUCTION: Targeting the huge burden of adolescent anemia, the Weekly Iron and Folic acid Supplementation (WIFS) was launched by the Government of India. Few studies have been done to assess the effective functioning of the program since its inception. The present study was done to assess the knowledge WIFS among adolescents of Madhya Pradesh and the associated factors. MATERIALS AND METHODS: A cross-sectional study was done in a total of six districts (3 districts where the national adolescent program was implemented and 3 districts where it was not) of Madhya Pradesh. Multistage stratified random sampling technique was used for the enrollment of 3213 adolescent boys and girls, and a prestructured and validated tool was used to collect paperless data. Ethical approval and consent from the participants were obtained. Statistical analysis was performed using SPSS v21. RESULTS: It was observed that the knowledge of WIFS was more among adolescent girls (29.3%) as compared to adolescent boys (14.1%). More of the adolescent girls received Iron and folic acid tablets as compared to adolescent boys (60.8% girls vs. 24.1% boys). Mostly, the adolescents got Iron tablets from school followed by Anganwadi and PHC/CHC. Girls, rural location, literacy, below poverty line status, knowledge of anemia, adolescents who got iron and albendazole tablets, and adequate consumption of iron tablets (>4) were associated with higher knowledge of WIFS. CONCLUSION: The knowledge of WIFS was found to be less in adolescent boys. There is a hint of the fact that effective execution of the program among its beneficiaries leads to an automatic increased knowledge of the program, at least among the beneficiaries. Thus, an indirect but significant indirect finding is that the nationwide WIFS program needs to be put to greater focus among the adolescent boys, apart from its major focus on the female gender among most age groups.

Sociodemographic Determinants of Willingness and Extent to Pay for COVID-19 Vaccine in India.

Background: Responding to the fast transmission rates and increasing fatality rates, countries across the world expedited the development and deployment of the vaccine for coronavirus disease 2019 (COVID-19). Evaluation of individuals' willingness to pay (WTP) would provide pertinent information regarding future demand and financing preferences, which shall help to devise the effective payment strategy for COVID-19 vaccination. Methods: A nationwide, cross-sectional, and self-administered online survey using a structured questionnaire was conducted to identify the sociodemographic determinants of willingness and extent to pay for COVID-19 vaccine in India. A non-probability convenience sampling followed by snowball sampling was employed to recruit participants (n = 3,341). The likelihood of sociodemographic determinants to predict willingness and extent to pay was modeled using the multivariate binary logistic regression analysis. Results: Out of 3,341 participants, 68% (n = 2,271) were willingness to pay for COVID-19 vaccine. Results showed significantly higher odds for willingness to pay among participants who were single [adjusted odds ratio (aOR) = 1.394, p < 0.01] and having a family size of 4 members (aOR = 1.346, p < 0.01). The adjusted odds ratio sizably increased from 1.396 for participants whose monthly income was between INR 10,000 and 20,000/month to 2.240 for participants whose monthly income was above INR 50,000/month. Further, out of 2,271 of those participants who were willingness to pay for COVID-19 vaccine, majority (n = 1,246, 54.9%) of participants were willingness to pay below 50% of COVID-19 vaccine cost. This study found that those who are single (aOR = 0.688, p < 0.01), having an income between INR 20,000 and 50,000/month (aOR = 0.686, p < 0.05), and those who belonged to socially disadvantaged category (aOR = 0.450, p < 0.01) were estimated to have significantly lower odds of willingness to pay more than 50% of COVID-19 vaccine cost. Conclusion: This study observed that majority of those participants who willingness to pay for COVID-19 vaccine were willingness to pay only up to 50% of COVID-19 vaccine and income was observed as a precursor predictor of the willingness and extent to pay for COVID-19 vaccine. The understanding on the willingness and extent to pay for COVID-19 vaccine and its sociodemographic determinants will be helpful for making the strategic decisions related to the financing of COVID vaccine in India.

Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India.

Background: Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India. Methods: A cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents. Results: Seven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects. Conclusion: Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

How to make services adolescent friendly? A cross-sectional study on awareness of adolescent friendly health clinics in Central India.

Background: India's flagship program on adolescent health - Rashtriya Kishor Swasthya Karyakram (RKSK) emphasises the importance of strengthening Adolescent Friendly Health Clinics (AFHCs) under its facility-based approach for improving the health of adolescents. AFHCs are intended to provide targeted intervention in six domains - nutrition, injuries & violence (including gender-based violence), mental health, sexual & reproductive health, substance abuse and noncommunicable diseases. Objective: The current study was conducted to assess the determinants of awareness and utilisation of AFHC services in districts with RKSK services in Madhya Pradesh. Subjects: In total, 1605 adolescents (both males and females) within the age group of 10-19 years were included in the study. Methods: Multistage stratified random sampling was employed to enrol participants from three districts of Madhya Pradesh, where AFHC services have been launched. Results: The mean age of the participants was 15.07 ± 2.32 years. Only 153 (9.5%) adolescents were aware of AFHC services. On multivariate logistic regression, awareness of AFHC was seen to be associated with being aware of RKSK, being a part of the peer educator-led peer group, having had adolescent health days organised in the village and belonging from one of the financially better off districts. Utilisation rate of AFHC services was lower still - at 2.74%. Conclusion: Both awareness and utilisation of AFHC services remain very low among adolescents. There is a pressing need to focus on awareness generation campaigns - via mass media, but more importantly, through community health workers and peer educators - in order to sensitise target beneficiaries about the available services.

Is There Any Relationship between Poor Menstrual Hygiene Management and Anemia? - A Quantitative Study Among Adolescent Girls of the Urban Slum of Madhya Pradesh.

BACKGROUND: Anemia and poor menstrual hygiene practices have a considerable impact on all aspects of an adolescent girl's life. There is a dire need for evidence on the burden and its association to provide actionable preventive measures. OBJECTIVE: The objective of this study is to explore the magnitude and association between poor Menstrual Hygiene Management (MHM) practices and anemia. MATERIALS AND METHODS: A cross-sectional study conducted among 393 adolescent girls of the urban slum of Bhopal (June 2017-July 2018). Hemoglobin (Hb) was determined by a portable Hb meter (HemoCue). Logistic regression analysis was done to find out if there is any association between poor MHM practices and anemia. RESULTS: The present study found the prevalence of anemia as 38.7% among which 65.1%, 31.5%, and 3.2% were suffering from mild, moderate, and severe forms of anemia, respectively, and 87.3% were practicing poor MHM. Logistic regression found that the MHM, bleeding during menstruation, religion, educational status, and nutritional status of adolescents were significant factors associated with anemia. CONCLUSION: The study concluded that there is a significant association between poor MHM and anemia. Concerted convergent actions focusing on the provision of awareness regarding MHM and sanitary facilities to maintain proper menstrual hygiene are needed to reduce the burden of anemia.

Handling the pandemic our way: A qualitative content analysis of the guidelines issued by Apex Institutes of National Importance (INIs) of India to combat COVID-19 crisis.

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) pandemic created havoc within a few weeks of its outbreak affecting over 100 countries. The rapid increase in the established cases urged for the prevention and control of COVID-19 belligerently on both national and worldwide fronts to prevent the healthcare systems from collapsing. For the sake of successfully preventing and restricting a fatal pandemic outbreak such as COVID-19, it requires the apex health institutions to have a uniform, urgent, flexible and effective policy response framework ensuring strict adherence too. In this regard, the Apex Institutes of National Importance in India (INIs) have released a series of documents on COVID-19 prevention and management. METHODS: Documents regarding COVID-19 preparedness and management were retrieved from the official websites of the INIs in India. The general population and healthcare workers' guidelines, standard operating procedures (SOPs) on COVID-19 prevention and management, action and response plans were included in the study. The full text of each document was analysed in detail and themes and subthemes were derived through content analysis. RESULTS: A total of 68 documents was included in the study. Five major themes and 12 subthemes were formulated after content analysis. A major similarity was found across all INIs on screening and testing and infection prevention control measures. The INIs formulated guidelines adhering to the World Health Organization, Indian Council of Medical Research and Ministry of Health and Family Welfare Recommendations. CONCLUSION: Common measures like quarantine, social distancing, travel bans and mass gathering restrictions were adopted to prevent the spread of COVID-19 during the initial period. The INIs have developed policies and standard operating protocols on COVID-19 management based on the Government of India guidelines. Better understanding of these guidelines will help in effective implementation of the nationwide pandemic management.

Factors Influencing COVID-19 Vaccination Intentions Among College Students: A Cross-Sectional Study in India.

Background: Students act as messengers in delivering effective messages for better uptake of health-promoting behavior. Understanding their knowledge about coronavirus disease 2019 (COVID-19), intentions to use the COVID-19 vaccine, and its associated factors will help develop promising strategies in vaccine promotion concerning the current COVID-19 pandemic. Methods: A cross-sectional online survey was carried out among students in the healthcare and non-healthcare sectors to assess their intentions to get vaccinated against the COVID-19. A non-probability snowball sampling technique was used to recruit study participants (N = 655) through social media platforms and emails. Study participants were recruited across the country, including six major geographical regions (Eastern, Western, Northern, Southern, North-east, and Central) in India between November 2020 and January 2021 before the introduction of the COVID-19 vaccine. Descriptive statistics were used to present the sociodemographic, and vaccine-related behaviors of the study participants. Key determinants that likely predict vaccine acceptance among students were modeled using logistic regression analysis. For each analysis, p < 0.05 was considered significant. Results: A total of 655 students were recruited, 323 from healthcare and 332 from non-healthcare sectors, to assess their intentions to receive the COVID-19 vaccine. Of the 655 students, 63.8% expressed intentions to receive the COVID-19 vaccine. The acceptance was higher among non-healthcare students (54.07 vs. 45.93%). At the time of the study, 27.8% of the students indicated that they had been exposed to a confirmed COVID-19 patient. A vast majority (93.4%) of the students knew about the COVID-19 virus, and most (89.3%) of them were aware of the development of a COVID-19 vaccine. The history of vaccine hesitancy was found to be low (17.1%). Only one-third (33.4%) of the students showed concern about contracting COVID-19. Trust in the healthcare system [adjusted odds ratio (aOR): 4.13; (95% CI: 2.83-6.04), p < 0.00] and trust in domestic vaccines [aOR: 1.46; (95% CI: 1.02-2.08), p < 0.05] emerged as the significant predictors of student's intention to get vaccinated. Higher acceptance for vaccine was observed among students in the non-healthcare [aOR: 1.982; 95% CI: 1.334-2.946, p < 0.00]. Conclusion: This study shows that the Indian college students had relatively high levels of positive intentions to receive COVID-19 vaccines, although about one-third were not sure or unwilling to receive the vaccine, highlighting possible vaccine hesitancy. Informational campaigns and other strategies to address vaccine hesitancy are needed to promote uptake of COVID-19 vaccines.

A study of quality of care of sterilization services in Madhya Pradesh.

BACKGROUND: In a country with a high demand for contraception such as India, one of the most common methods is surgical sterilization, which is delivered by two approaches namely the camp approach and the fixed day static approach. The quality of services for sterilization in India for both the approaches has remained questionable. OBJECTIVES: This paper seeks to determine the quality of sterilization services at fixed day static centers of Madhya Pradesh. METHODS: It was a descriptive observational study done between September 2017-December 2017 in 10 districts of Madhya Pradesh. One District Hospital and 2 Community Health Centers were randomly chosen from each district. The study was carried out using a prestructured, pretested, and prevalidated tool which used the Ona Platform. RESULTS: Two of the facilities conducted more than 30 operations on the day of the visit. In only 18.3% of the cases was the patient informed about all contraception options. The duration between the start of surgery and the signing of consent was less than 2 h in 42% of the patients. The surgical protocol for proper surgical wear was not followed in most cases. CONCLUSION: The quality of care of sterilization services was found to be substandard in the fixed day static centers. The guidelines for the sterilization services were not being followed, and follow up of the patients was also neglected. Better training of the staff with strict and timely supervision is required for the better quality provision at the fixed day static centers.

A study of the status of provision of sterilisation services in India.

CONTEXT: India has the second-largest population in the world with a significant growth rate that adversely affects the quality of life (QoL). Sterilisation is one of the main methods of female contraception in the country. Meeting the sterilisation services' numerical demand and quality requirements have remained a challenge. AIMS: This study was done to assess the infrastructural component of the sterilisation services provided by the static centres. SETTINGS AND DESIGN: This was a descriptive cross-sectional facility-based study conducted from September to December 2017. It involved 30 facilities (10 district hospitals and 20 community health centres [CHCs]) from 10 divisions of the state of Madhya Pradesh. METHODS AND MATERIALS: The data were collected using a pre-tested and pre-structured questionnaire, which was uploaded on the Ona platform. STATISTICAL ANALYSIS USED: Data analysis was performed using SPSS version 21. RESULTS: Only 11 of the 30 facilities had proper waiting areas for the patients. Approximately, only 63% of the facilities had proper toilets, 50% had display of the contraceptives, and 43% had a complaint/suggestion box. In terms of the availability of equipment, only 43% of the facilities had a table with the Trendelenburg facility. CONCLUSIONS: The main limitations in the infrastructure of the facilities were general cleanliness; availability of proper waiting and post-operative areas; and the lack of equipment, record keeping, and supervision. To accomplish the provision of quality sterilisation services, policy-makers and programme managers need to pay attention to and address these limitations.

Iodine nutritional status and prevalence of goitre among school going children: a cross-sectional study to assess progress towards universal salt iodization in Tikamgarh district of Madhya Pradesh.

BACKGROUND AND OBJECTIVES: Iodine deficiency disorders (IDD) has been a major public health challenge for the Indian subcontinent over many years. Our study was conducted in Tikamgarh district of Madhya Pradesh, an iodine deficiency disorders-endemic district, with the objective to estimate total goitre rate and iodine nutrition status. METHODS AND STUDY DESIGN: A cross-sectional study with 30 cluster sampling was conducted between June to July 2016 among school-going children in the age group of 6-12 years. Ninety children from each school (30x90=2700) were selected for the assessment of Goitre. Total 540 salt samples and 270 urine samples were collected to estimate salt iodine content from their house-hold and urine iodine excretion (UIE) respectively. A total of 150 households and 30 shopkeepers were interviewed to understand the awareness level for salt iodization. RESULTS: Goitre rate in Tikamgarh district was 1.9% with prevalence of grade I & II was 1.7% and 0.2% respectively. The median UIE level was 200 mcg/L. The 20% the population had iodine deficiency, 28.9% population had adequate iodine nutrition and 51.1% population had either more than adequate level of iodine. The 72.4% of the population consume adequately iodized salt (>=15 ppm). CONCLUSIONS: Our study concludes that Tikamgarh district is non-endemic for IDDs against the earlier classification as an IDD-endemic district. About 20% population has 'iodine deficiency' and approximately 51.1% population has 'more than adequate iodine intake'. We recommend stringent programme monitoring, undertake periodic assessment of IDD and explore manifestations of excess iodine intake (>=300 mcg/L) such as Iodine-induced hyperthyroidism in future.

Goitre Is No Longer Prevalent and Urinary Iodine Excretion Is above Normal among School Going Children in Jabalpur, India: Is This Major Health Problem Already Solved?

Iodine deficiency disorder (IDD) is a major public health problem in India. We conducted this study to assess goitre prevalence, urinary iodine excretion (UIE) among school children and to determine iodine concentration in salt samples at consumer level, in Jabalpur district. We adopted "30 cluster" sampling, recommended by joint WHO/UNICEF/ICCIDD Consultation. A total of 2700 children were examined and 540 salt samples and 267 urine samples were collected. Also 150 households and 30 shopkeepers were interviewed for awareness about salt iodization. Total goitre prevalence rate was 2.2% with median UIE level as 218 µg/l and 19.1% of population had adequate iodine intake. About 90.6% of studied population consumed adequately iodized salt. Jabalpur is now no more an endemic area for goitre. The district has achieved the target of universal salt iodization (USI) but now proceeding towards toxicity. Hence the concern is the need of sustainability of the policy of USI.

Iodine Deficiency and Toxicity Among School Children in Damoh District, Madhya Pradesh, India.

OBJECTIVE: To estimate the prevalence of Iodine Deficiency Disorders, and household consumption of adequately iodized salt in Damoh district, Madhya Pradesh in 2016. METHODS: Cross-sectional study with cluster sampling method was used among school-going children. 30 clusters, each with 90 children were selected to access Total Goiter rate (TGR). 540 salt samples were collected to estimate salt iodine content from their household and 270 on the spot urine samples were collected to estimate Urine Iodine Excretion level. RESULTS: TGR was 2.08%. The prevalence of iodine deficiency, adequate iodine nutrition, and either more than adequate or toxic level of Iodine was 26%, 28% and 46 %, respectively. 72.4% people were consuming adequately iodized salt. CONCLUSION: Damoh district is no more an endemic area for iodine deficiency. We recommend continuous monitoring to assess IDDs as well Iodine-induced toxicity in future.

Evaluation of competency and skills of skilled birth attendants in Madhya Pradesh, central India.

The National Health Mission tracks the proportion of women delivered by skilled birth attendants (SBAs). We assessed SBAs competence in Madhya Pradesh, India, using structured evaluation tools. It is a cross-sectional study conducted from 2014 to 2015. We evaluated 335 trained SBAs using multistage stratified random sampling. Of total, 335 skilled births attendant selected 41.8% were auxiliary nurse midwife, 47.8% were staff nurse, and 10.4% were lady health visitors. Grouping all provider and knowledge test versions, SBAs were correct on 75.4% of the questions. By topic, results ranged from 77.9% correct for the management of normal pregnancy and childbirth to 70.2% correct for intranatal care. The skill evaluation score was 88.1% of infection prevention practices to 74.3% for postnatal care. The present study found significant variations in knowledge and skill competency scores of the SBAs. There is a critical need to improve the training quality of skill birth attendants.

How Non Consumers Differ from Consumers: A Qualitative Approach to Synthesize the Attributes of Iron Folic Acid End Users.

INTRODUCTION: Anaemia continues to be a major hurdle to achieve optimum health in Indian population context. Although government continues to promote Iron Folic Acid (IFA) supplementation as one of the key strategies to combat with burden of anaemia, the expected level of IFA consumption and subsequent anaemia reduction could not be achieved. This study tries to investigate those influences, concerns, experiences and behaviour from an end user perspective through a qualitative methodology which may affect the IFA consumption ambi-directionally. AIM: To explore and understand the several aspects related with anaemia and IFA supplementation with special emphasis to reveal the contributory factors behind low level of IFA consumption at consumer end. MATERIALS AND METHODS: A community based qualitative study was conducted in clusters identified through multileveled stratification from a state of central India. A conceptual construct was made in priory for this study. As the research question was related with policy, this study adapted a framework technique for making interview topic guides. Two consumers and two non consumers from each identified cluster were interviewed in depth. The data obtained through 160 in depth interviews (from 80 consumers and 80 non consumers) was utilized for thematic framework, linkage association and to typify the phenomenon. RESULTS: Ignorance, difficult intake, meaninglessness, misconceptions and discontentment with the system were the major dimensions (sub themes) associated with discontinuation. All these sub themes were further converged into major theme of informational discontinuity. Investigators further typified the users/non users into persistent user, potential defaulters, impending defaulters and absolute non users. CONCLUSION: Informational gap seems to be the fundamental factor behind sub optimum IFA consumption. On a policy perspective, all the attempts should be done to instigate arise felt need' among target groups for IFA consumption.

Isoniazid Preventive Therapy among Children Living with Tuberculosis Patients: Is It Working? A Mixed-Method Study from Bhopal, India.

Objective: We assessed uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive tuberculosis (TB) patients and its implementation challenges from healthcare providers' and parents' perspectives in Bhopal, India. Methods: A mixed-method study design: quantitative phase (review of programme records and house-to-house survey of smear-positive TB patients) followed by qualitative phase (interviews of healthcare providers and parents). Results: Of 59 child contacts (<6 years) of 129 index patients, 51 were contacted. Among them, 19 of 51 (37%) were screened for TB and one had TB. Only 11 of 50 (22%) children were started and 10 of 50 (20%) completed IPT. Content analysis of interviews revealed lack of awareness, risk perception among parents, cumbersome screening process, isoniazid stock-outs, inadequate knowledge among healthcare providers and poor programmatic monitoring as main barriers to IPT implementation. Conclusion: National TB programme should counsel parents, train healthcare providers, simplify screening procedures, ensure regular drug supply and introduce an indicator to strengthen monitoring and uptake of IPT.

Socio-cultural and Knowledge-Based Barriers to Tuberculosis Diagnosis for Women in Bhopal, India.

BACKGROUND: In India, only one woman is diagnosed with tuberculosis (TB) for every 2.4 men. Previous studies have indicated gender disparities in care-seeking behavior and TB diagnosis; however, little is known about the specific barriers women face. OBJECTIVES: This study aimed to characterize socio-cultural and knowledge-based barriers that affected TB diagnosis for women in Bhopal, India. MATERIALS AND METHODS: In-depth interviews were conducted with 13 affected women and 6 health-care workers. The Bhopal Diagnostic Microscopy Laboratory Register (n = 121) and the Bhopal district report (n = 261) were examined for diagnostic and care-seeking trends. RESULTS: Women, especially younger women, faced socio-cultural barriers and stigma, causing many to hide their symptoms. Older women had little awareness about TB. Women often sought treatment from private practitioners, resulting in delayed diagnosis. CONCLUSIONS: Understanding these diagnostic and help-seeking behaviors barriers for women is critical for development of a gender-sensitive TB control program.