Occupational Ventilatory Defects Among Workers Employed in Tea Gardens, A Cross-Sectional Study in Siliguri Subdivision of Darjeeling District, West Bengal.

Introduction: During the refining and packing of tea, a very fine dust is formed which is called the tea fluff. Exposure to this fluff has been reported to cause ventilatory defects on chronic exposure. Objective: To determine the association between air quality of the different work sections of tea gardens and the ventilatory functions of the workers. Methodology: An observational analytical study with cross sectional design was conducted on 400 apparently healthy individuals working in different sections of 4 tea gardens. Data on sociodemographic characters of the population, particulate matter (PM) and air quality (AQI) was recorded. All participants underwent spirometric evaluation. Results: The mean (SD) age of the study population was 37.8 (8) years. Most (67%) of the study participants were females. The participants were engaged in the job for a mean (SD) of 4.7 (2.7) years. The median distribution of PM2.5, PM 10 and AQI are progressively higher from the garden section to the dry section. A significant correlation between FVC and PM2.5 and PM10 is seen. FEV1 and FEV1/FVC shows a significant correlation with all air quality parameters while FEF25-75 is correlated to none of them. Comparison of the three models to predict the spirometric variables show that even after adjustments, the FEV1 is significantly associated with air quality parameters, FEV1/FVC is significantly associated with the air quality parameters and age while the FEF25-75% is dependent on the age of the participant. Conclusion: There is a strong correlation between the ventilatory parameters and the cumulative exposure of PM2.5, PM10 and AQI, which persists even after adjustment for confounders.

Assessing prevalence and predictors of depression in Type 2 Diabetes Mellitus (DM) patients - The DEPDIAB study.

OBJECTIVES: Depression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled "DEPression in DIABetes" (DEPDIAB). MATERIAL AND METHODS: A cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ - 9 and Beck depression scales. Socioeconomic status was assessed by the "Revised Kuppuswamy and B G Prasad socio-economic scales for 2016", a validated scoring system for assessing the socioeconomic status of Indian patients. RESULTS: In our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18-40 years vs. >60 years) [OR-2.09; 95% CI 1.11-3.96], female sex [OR-1.31; 95% CI 1.11-2.01], low socioeconomic status [OR-2.69; 95% CI 1.34-3.79], poor compliance [OR- 5.05; 95% CI 2.79-8.13], hypoglycemia [OR 1.466; 95% CI 1.076-1.999] and difficulty in managing day-to-day activities [OR- 4.648; 95% CI 3.450-6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (>1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate withbody mass index (BMI), fasting plasma glucose (FPG) or insulin usage. CONCLUSIONS: We found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.

Risk factors for pneumonia mortality in under-five children in a tertiary care hospital of Darjeeling district of West Bengal: A prospective case-control study.

BACKGROUND: Among children admitted with pneumonia, several modifiable predictors have been identified for deaths in children in hospitals. Despite the presence of a several national programs designed to address most of the risk factors directly or indirectly it is surprising that they continue to be common in children with pneumonia. OBJECTIVES: The objective is to determine the risk factors for pneumonia mortality in under-five children in a tertiary care hospital of Darjeeling district of West Bengal. METHODS: An analytical study with case-control design was conducted between May 2016 and October 2017. Children aged 2-59 months admitted with the diagnosis of pneumonia were followed up after admission and who died were recruited as cases and two consecutive age- and sex-matched controls were recruited among children who were declared cured and discharged. A total of 95 cases and 190 controls were studied and the risk factors were compared in the pair matched groups by the conditional logistic regression. RESULTS: Factors influencing childhood pneumonia mortality were severely underweight (adjusted odds ratio [AOR]: 3.66 [1.28,10.46]) unimmunized child (AOR 4.18 [1.53, 11.41]), lack of exclusive breast feeding (AOR: 3.12 [1.23, 7.91]), past history of diarrhea or acute respiratory infection in the last 3 months (AOR: 7.27 [3.68, 14.36]), hypoxemia on admission (AOR: 2.53 [1.14, 5.61]), sub-center as the first contact health facility (AOR: 6.49 [2.15, 19.67]), and antibiotic not received at first contact (AOR: 3.18 [1.36, 7.43]). CONCLUSIONS: Most of the risk factors for death in children between 6 and 59 months of age are directly or indirectly related to health service delivery and can be ameliorated through proper structural and administrative measures.

Prevalence of soil-transmitted helminth infestations among children attending Integrated Child Development Service centers in a tea garden area in Darjeeling.

INTRODUCTION: Helminths infestations are common in children in the tea garden areas of Darjeeling, which present unique social, cultural, and environmental conditions. The present study was conducted to determine the proportion of soil-transmitted helminth (STH) infestations and association of STH to sociodemographic variables among children attending Integrated Child Development Services centers of a tea garden area in Darjeeling. METHODOLOGY: A cross-sectional descriptive study was conducted at Kiran Chandra Tea Estate, a tea garden in Naxalbari, Darjeeling, between August and September 2016. Stool samples were collected from children attending ICDS centers in the area and examined using the direct and concentration methods. A pretested and predesigned questionnaire was used to collect data on the sociodemographic profile of the children's families. RESULTS: Stool samples could be collected from 52 (45%) of the 115 eligible children. The children were predominantly male (61.5%), from families with an income between Rs. 2000 and 4000 per month, had mothers with no formal education (75.0%) and came from households with no sanitary toilets (33.5). The proportion of children with STHs was 9.6%; with Ascaris found in 7.7% and Trichuris in 1.9%. No statistically significant differences were found in selected variables between the worm-positive and worm-negative children. CONCLUSIONS: The proportion of STH infestation is low among children <6 years of age attending ICDS in the study area probably because of the mass de-worming strategy of the government of India. Some differences in infestations among groups might suggest a clustering effect.

Determinants of infant mortality in rural India: An ecological study.

BACKGROUND: Long-term reductions in infant mortality (IM) are possible only by addressing the distal determinants. OBJECTIVES: The objective of the present study was to determine the relationship between IM and its major distal determinants in rural India. METHODS: The dependent variable used in the study was state wise IM rate (IMR), the values of which were obtained from the Sample Registration System, 2015. State level literacy rate in females, unemployment rates of females, GINI index, and round-the-clock neonatal services in primary health centers in the rural areas and the per capita gross state domestic product at purchasing power parity (GSDP at PPP) of the states, were used as the predictor variables for IM. Relationship between the variables was obtained by the Pearson's correlation coefficient. Bivariate and multivariable linear regressions were used to identify the magnitude and direction of the predictors on IM. RESULTS: Correlation statistics showed none or weak positive correlation between the Gini coefficient and 24 × 7 primary health-care services and IMR. There was a strong negative correlation between female literacy rate and IMR, while the unemployment rates and per capita gross state domestic product (GSDP) were moderately negatively correlated to IMR. Bivariate analysis revealed that, for unit increase in unemployment rates in females, proportion of literate women, and 1000$ increase in the GSDP at current prices, IMR decreased by 0.07, 0.763, and 1.702, respectively. However, after adjustment, only the female literacy rates showed significant association with IMR. CONCLUSIONS: Of the major determinants included in the study, rural female literacy is the most important distal determinant of IM in rural areas of India.

Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India.

BACKGROUND: Despite evidence regarding the beneficial effects of vaccines, vaccination uptake has not been up to the mark across the globe in various sociocultural and sociodemographic groups. Logistics and workforce have been issues of concern to public health managers, but the latent issue of vaccine hesitancy leading to vaccine delays and refusals has not been widely addressed particularly in the Indian context. OBJECTIVES: The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for childhood vaccinations in slums of Siliguri, India. METHODS: A cross-sectional study was carried out among 194, 0-59 months' children residing in slums of Siliguri in 2016. Data were collected at the household with interviews of mothers/primary caregivers using a predesigned pretested interview schedule developed based on the validated version of vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts working group on vaccine hesitancy. Associations were analyzed using logistic regression. RESULTS: Majority 161 (83%) of the families were vaccine-hesitant and only 33 (17%) were not hesitant. Nuclear families and mothers of lower educational status had significantly higher odds of vaccine hesitancy. Reluctance to vaccinate (26.1%) and to be unaware/having no reliable information (20.5%) were the major reasons cited for vaccine hesitancy. CONCLUSION: Most of the families of the children were vaccine-hesitant in the area. Uniformity in schedules in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mothers' education can address the issue of vaccine hesitancy.

An Epidemiological Study of Blood Pressure and Its Relation with Anthropometric Measurements among Schoolboys of Burdwan Municipal Area, West Bengal.

BACKGROUND: High blood pressure (BP) is often an underdiagnosed problem, because of the asymptomatic nature in early phases of onset during adolescence. This increases the chances of developing complications later during adult life. OBJECTIVE: The objective of this study was to find the relationship of BP with anthropometric measurements among school-going adolescent boys. MATERIALS AND METHODS: It was a cross-sectional study conducted among 894 adolescent schoolboys aged 13 to 18 years from July 2013 to October 2014 in schools of Burdwan Municipal area, West Bengal. The required number of students from each school was determined by proportional probability sampling. Then, the required number of students from each school was selected by systematic random sampling technique. BP and anthropometric measurements such as weight, height, and waist circumference were done using standard guidelines. RESULTS: The mean systolic and mean diastolic BP in the study participants was significantly higher with an increase in weight, height, waist circumference, and body mass index (BMI) (P < 0.05). BP was found to be positively correlated with different anthropometric measurements such as weight, height, waist circumference, and BMI, which were statistically significant. CONCLUSION: Early detection of high BP and application of lifestyle modification among adolescents will be helpful in reducing the burden of high BP in adult life.

Utilization of safe drinking water and sanitary facilities in slum households of Siliguri, West Bengal.

BACKGROUND: With the rapid expansion of urban population, provision of safe water and basic sanitation is becoming a challenge; especially in slums. This is adversely affecting the health of the people living in such areas. OBJECTIVES: The study was conducted to measure the proportion of households using improved drinking water and sanitation facilities and to determine the association between diarrhea in under-five children with water and sanitation facilities. METHODS: A community-based, cross-sectional study was conducted among 796 slum households in Siliguri from January to March 2016 by interviewing one member from each household using a predesigned and pretested questionnaire based on the WHO/UNICEF Joint Monitoring Program Core questions on drinking water and sanitation for household surveys. RESULTS: A majority 733 (92.1%) of slum households used an improved drinking water source; 565 (71%) used public tap. About two-thirds (65.7%) household used improved sanitation facilities. About 15.8% households had reported diarrheal events in children in the previous month. Unimproved drinking water sources (AOR = 4.13; 1.91, 8.96), houses without piped water supply (AOR = 4.43; 1.31, 15.00), and latrines located outside houses (AOR = 3.61; 1.44, 9.07) were significantly associated with the diarrheal events in children. CONCLUSION: The utilization of improved drinking water source was high but piped water connection and improved sanitary toilet used was low. Association between diarrheal events and type of drinking water sources and place of sanitation might suggest fecal contamination of water sources. Awareness generation through family-centered educational programs could improve the situation.

Nomophobic behaviors among smartphone using medical and engineering students in two colleges of West Bengal.

BACKGROUND: Growing smartphone usage among global and Indian college students has resulted in considerable issues of "nomophobia" (NMP) or feelings of discomfort or anxiety experienced by individuals whenever unable to use their smartphones. This significantly impacts their health, work, and study. OBJECTIVE: The objective of this study is to find out the prevalence of NMP among smartphone using medical and engineering undergraduates of West Bengal and to compare the nomophobic behaviors, its predictors, and smartphone usage among them. METHODS: A cross-sectional study was conducted among 303 medical and 305 engineering undergraduates in West Bengal using a validated NMP questionnaire consisting of four factors. Comparison of means of individual questions and factor scores was done. Nomophobic clusters among the two groups were identified using two-stage cluster analysis. Binary logistic regression was used for comparison of predictors of NMP. RESULTS: Engineering students showed a higher proportion of nomophobics (44.6%) than medical students (42.6%). Significant higher means was observed among engineering students for the factor "giving upconvenience" and individual variables like "scared due to running out of battery," "nervous due to disconnection from online identity," "uncomfortable when unable stay up-to-date with social media" and "anxious when unable to check E-mails." A Higher proportion of nomophobics among both groups were females, those owning smartphone beyond 2 years, having monthly mobile bill above Rs. 200 and spending over 4 h daily on smartphone. CONCLUSION: NMP has emerged as a significant cause of concern among both the groups. Standardized measures for identification and appropriate psychobehavioral therapy for those seeking help might alleviate the problem.

Suspected anthrax outbreak: Investigation in a rural block of west Bengal and public health response.

Anthrax is one of the top 10 diseases reported in India and also one of the major causes of death in livestock. This study was conducted to confirm the outbreak of suspected anthrax, determine the transmission mechanism, and implement control measures in Bhatar block of Burdwan district, West Bengal, India. A cross-sectional descriptive study was conducted through house-to-house visits in Oregram and Kathaldanga villages during the period from May 30, 2013 to June 8, 2013. Out of the 93 persons exposed to anthrax, 11 persons had history of slaughtering, while 82 consumed the meat. All of the 7 cases of suspected anthrax were male (mean age 41.14 ± 10.04 years) and involved in slaughtering the animal. Most cases presented with papule and vesicle over the upper extremity and the trunk. One patient among the suspected cases died. The outbreak was labeled as a suspected anthrax outbreak. A health awareness camp was organized to improve awareness of anthrax among villagers.

Risk factors associated with default among tuberculosis patients in Darjeeling district of West Bengal, India.

BACKGROUND: The treatment outcome "default" under Revised National Tuberculosis Control Program (RNTCP) is a patient who after treatment initiation has interrupted treatment consecutively for more than 2 months. AIMS: To assess the timing, characteristics and distribution of the reasons for default with relation to some sociodemographic variables among new sputum-positive (NSP) tuberculosis (TB) patients in Darjeeling District, West Bengal. SETTINGS AND DESIGN: A case-control study was conducted in three tuberculosis units (TUs) of Darjeeling from August'2011 to December'2011 among NSP TB patients enrolled for treatment in the TB register from 1(st) Qtr'09 to 2(nd) Qtr'10. Patients defaulted from treatment were considered as "cases" and those completed treatment as "controls" (79 cases and 79 controls). MATERIALS AND METHODS: The enrolled cases and controls were interviewed by the health workers using a predesigned structured pro-forma. STATISTICAL ANALYSIS USED: Logistic regression analysis, odds ratios (OR), adjusted odds ratios (AOR). RESULTS: 75% of the default occurred in the intensive phase (IP); 54.24% retrieval action was done within 1 day during IP and 75% within 1 week during continuation phase (CP); cent percent of the documented retrieval actions were undertaken by the contractual TB program staffs. Most commonly cited reasons for default were alcohol consumption (29.11%), adverse effects of drugs (25.32%), and long distance of DOT center (21.52%). In the logistic regression analysis, the factors independently associated were consumption of alcohol, inadequate knowledge about TB, inadequate patient provider interaction, instances of missed doses, adverse reactions of anti-TB drugs, Government Directly Observed Treatment (DOT) provider and smoking. CONCLUSIONS: Most defaults occurred in the intensive phase; pre-treatment counseling and initial home visit play very important role in this regard. Proper counseling by health care workers in patient provider meeting is needed.

Nursing personnel planning for rural hospitals in Burdwan District, West Bengal, India, using workload indicators of staffing needs.

Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO-Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel.

Gender preference and awareness regarding sex determination among antenatal mothers attending a medical college of eastern India.

AIM: There are many women "missing" due to an unfavourable sex ratio in India, which has strong patriarchal norms and a preference for sons. Female gender discrimination has been reported in health care, nutrition, education, and resource allocation due to man-made norms, religious beliefs, and recently by ultrasonography resulting in lowered sex ratio. METHODS: The present study attempts to find out the level of awareness regarding sex determination and to explore preference of gender and factors associated among antenatal mothers attending a medical college in eastern India. Interviews were done by predesigned pretested proforma over 6 months. The data were analysed by SPSS 16.0 software for proportions with chi-squared tests and binary logistic regression analysis. RESULTS: Most women who were multigravida did not know about contraceptives; 1.8% of mothers knew the sex of the fetus in present pregnancy while another 34.7% expressed willingness; 13.6% knew of a place which could tell sex of the fetus beforehand; 55.6% expressed their preference of sex of the baby for present pregnancy while 50.6% of their husbands had gender preference. Gender preference was significantly high in subjects with: lower socioeconomic status (p=0.011); lower level of education of mother (p=0.047) and husband (p=0.0001); multigravida (p=0.002); presence of living children (p=0.0001); and husband having preference of sex of baby (p=0.0001). CONCLUSIONS: Parental education, socioeconomic background, and number of living issues were the main predictors for gender preference. Awareness regarding gender preference and related law and parental counselling to avoid gender preference with adoption of small family norm is recommended.

Assessment of Validity and Reliability of IMNCI Algorithm in Comparison to Provisional Diagnosis of Senior Pediatricians in a Tertiary Hospital of Kolkata.

BACKGROUND: Integrated management of childhood illness (IMNCI) is already operational in many states of India, but there are only limited studies in Indian scenario comparing its validity and reliability with the decisions of pediatricians. Aims and. OBJECTIVES: To assess the validity and reliability of the IMNCI algorithm with provisional diagnosis of senior pediatricians for each IMNCI classifications. MATERIALS AND METHODS: The present study is done with all the young infants between 0-2 months presented during the study period with a fresh episode of illness to test the validity and reliability of the algorithm in comparison to provisional diagnoses of senior pediatricians. The study was done in a tertiary care hospital. Validity characteristics such as sensitivity, specificity, positive predictive value, negative predictive value, and reliability characteristics such as percent agreement and Kappa were assessed for individual IMNCI classifications. RESULTS: The sensitivity of possible serious bacterial infection, local bacterial infection, jaundice, no dehydration and possible serious bacterial infection, not able to feed were 88.89, 14.29, 66.67, 25 and 44.44% respectively. The specificities for the same conditions were 71.72, 99.09, 99.07, 94.50 and 86.87%. Percent agreements for similar conditions were 74, 94, 97, 90 and 80% respectively and the Kappa ratios were 0.38, 0.20, 0.73, 0.19 and 0.29 respectively. CONCLUSION: It could be concluded that IMNCI is quite a sensitive strategy and could identify severe illnesses of young infants requiring referral to higher facility. Further studies, particularly in primary health care setting, are required.

A Comparative Study of the Management Decisions by IMNCI Algorithm and by Pediatricians of a Teaching Hospital for the Children Between 2 Months to 5 Years.

BACKGROUND: Integrated management of neonatal and childhood illness (IMNCI) is already operational in many states of India, but there are very few studies in Indian scenario comparing its validity and reliability with the pediatricians' decisions. OBJECTIVES: 1) To compare the IMNCI decision with the decision of pediatricians; 2) to assess the significance of multiple presenting symptoms in the IMNCI algorithm. MATERIALS AND METHODS: The study was conducted among the sick children between 2 months to 5 years presented in pediatric department from January to March 2009. The IMNCI decision was compared with pediatrician's decisions by percent agreement, Kappa and weighted Kappa with the aids of SPSS version 10. RESULTS: The overall diagnostic agreement between IMNCI algorithm and pediatrician's decisions was 36.64%, (Kappa 0.16 and weighted Kappa 0.29) with 51.15% over diagnosis and 12.21% under diagnosis. The importance given by IMNCI algorithm in cases of multiple presenting symptoms was also reflected as it was evident that 37.50% children presented with three symptoms were categorized as red, whereas it was 28.57% and 11.67% for those presented with two and one symptom, respectively, (P < 0.0001). Pediatricians also gave importance for presence of multiple symptoms by considering 50% as admissible in the group presented with three symptoms, 30.16% in the group presented with two symptoms, and 16.67% in the group presented with only one symptom. The association was also statistically significant (P = 0.018). CONCLUSION: Diagnostic discordance is seen mainly due to over diagnosis of all fever cases as malaria. Importance of presence of comorbidities was also reflected.

Domestic violence among ever married women of reproductive age group in a slum area of Kolkata.

BACKGROUND: Domestic violence has serious impact on women's health and well-being. A nationwide survey conducted in India observed that 37.2% of women experienced violence after marriage. OBJECTIVES: To assess the prevalence of domestic violence among the ever married women in reproductive age group and to find out the types of domestic violence and factors associated with it. MATERIALS AND METHODS: The study was a community based cross-sectional study, conducted in a slum area of Kolkata. RESULTS AND CONCLUSION: Overall prevalence of domestic violence was 54%, of which 41.9% suffered from both current and lifetime physical and psychological violence. Presence of property, higher per capita income and social support were protective factors against domestic violence, whereas alcohol addiction and multiple sex partners were the important contributory factors for it. The study recommended more social support, awareness and income generation for women in the slum areas.