A mixed method study to assess notification of tuberculosis patients by private practitioners in New Delhi, India.

Background: A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low. Objectives: The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private-sector treatment providers. Methods: This cross-sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done. Results: Out of 375 private practitioners, over two-third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was "don't know how to" and major barrier considered was "lack of training." Conclusion: Strategies such as training and retraining, and one-to-one sensitization of private practitioners to address barriers may enhance TB notification.

Household transmission dynamics of COVID-19 among residents of Delhi, India: a prospective case-ascertained study.

Objective: The aim of this study was to observe the secondary infection rate and transmission dynamics of COVID-19 among household contacts, and their associations with various factors across four dimensions of interaction. Methods: This was a case-ascertained study among unvaccinated household contacts of a laboratory-confirmed COVID-19 case in New Delhi between December 2020 and July 2021. For this study, 99 index cases and their 316 household contacts were interviewed and sampled (blood and oro-nasal swab) on days 1, 7, 14, and 28. Results: The secondary infection rate among unvaccinated household contacts was 44.6% (95% confidence interval (CI) 39.1-50.1). The predictors of secondary infection among individual contact levels were: being female (odds ratio (OR) 2.13), increasing age (OR 1.01), symptoms at baseline (OR 3.39), and symptoms during follow-up (OR 3.18). Among index cases, age of the primary case (OR 1.03) and symptoms during follow-up (OR 6.29) were significantly associated with secondary infection. Among household-level and contact patterns, having more rooms (OR 4.44) and taking care of the index case (OR 2.02) were significantly associated with secondary infection. Conclusion: A high secondary infection rate highlights the need to adopt strict measures and advocate COVID-19-appropriate behaviors. A targeted approach for higher-risk household contacts would efficiently limit infections among susceptible contacts.

Burden of iodine deficiency disorders and its association with various sociodemographic variables in a district of North East India.

Introduction: Iodine is one such micronutrient, the deficiency of which can impair the mental growth and development of young children and is the leading cause of preventable mental impairment. The present study has been conducted to study the prevalence of iodine deficiency disorders (IDDs) and its association with various sociodemographic variables among children (6-12 years) residing in the East Khasi Hills district of Meghalaya. Methods: The sample size was 2700 with a multistage 30 cluster sampling method. A questionnaire was used to collect data on the various sociodemographic variables. The weight and height of each child were recorded as per the standard procedure. In order to assess goitre, children were examined as per standard procedures prescribed by the National Iodine Deficiency Disorder Control Programme (NIDDCP). Results: A total of 2700 children were interviewed in total. Out of these, 1365 (50.5%) were males. The total goitre rate was found to be 195 (7.22%), indicating that IDDs are a mild public health problem in the study area. The median (interquartile range) urinary iodine excretion levels were 150 (108.05-189.37) mg/L. With respect to weight-for-age, it was observed that 93 (3.9%) children were severely underweight and 389 (16.8%) had severe stunting. A significant association was observed between goitre with the age group of children (p <.00001), maternal education (p <.00001), prevalence of stunting (p <.00001), and underweight (p <.05).

Assessment of frontline health workers in providing services for malaria elimination in the tribal district of Mandla, Madhya Pradesh.

Background: The Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) are the frontline health staff that provide essential health care services, including diagnosis and treatment of malaria. To support India's malaria-free goal by 2030, a project known as the Malaria Elimination Demonstration Project (MEDP) in the tribal district of Mandla was initiated. This study assessed the capabilities of ASHAs and ANMs of Mandla district to diagnose and treat malaria. Methods: A cross-sectional study was conducted in the 71 sub-centers and their villages where at least one positive malaria case was diagnosed in 2019. Pre-designed and validated tools were used to assess the knowledge, attitude, and practices of ASHAs and ANMs. Analysis was performed using descriptive statistics and multivariate logistic regressions. Results: Malaria is the fifth priority of the ASHAs and ANMs of Mandla district. Good level of knowledge regarding malaria etiology, diagnosis, and prevention was found, but the ability to treat a malaria case as per the national drug policy was below expectations. Frequent and prolonged stockouts of drugs and diagnostics were found. Logistic regressions revealed better capacity of ANMs to dispense correct treatment as compared to the ASHAs. Improvement was seen in the ASHAs ability to interpret rapid diagnostic test (RDT) results following trainings by MEDP Mandla. Conclusion: There is a need to increase the capabilities of the frontline health staff of Mandla for malaria diagnosis and treatment. Continuous trainings and a robust supply chain management system is required to equip the ASHAs and ANMs to effectively deliver malaria diagnosis and treatment services.

Assessment of the knowledge, preferences and concern regarding the prospective COVID-19 vaccine among adults residing in New Delhi, India - A cross-sectional study.

BACKGROUND: Understanding the perception and concerns of people about COVID-19 vaccine in developing and populous country like India will help in understanding demand for the vaccine and further tailoring out public health information and education activities. The study was carried out to assess the present state of knowledge people have about the probable vaccine for COVID-19, to know the preferences of respondents about this vaccine and to learn the expectations and apprehensions of people about features of this prospective COVID-19 vaccine residing in the capital city of India. METHODS: This cross-sectional study was conducted amongst the residents of Delhi, India from July to October 2020. Both offline and online interview method was used to collect date from 513 participants representing various occupational strata. Data were collected on sociodemographic variable, vaccine acceptance and concerns regarding COVID-19 vaccine. RESULTS: Among the study population, 79.5% said they will take the vaccine while 8.8% said they were not going to take the vaccine and remaining 11.7% had not yet decided about it. More than 50% were willing to pay for the vaccine and 72% felt vaccine should first be given to health workers and high-risk group. CONCLUSION: The following study has helped to understand the percentage of people who are hesitant to take the vaccine and also the concerns regarding the vaccine. Also since half of the population is willing to pay for the vaccine, a strategic approach considering the various economical classes of people could be applied in a developing country like India.

A Community-based Intervention Study to Assess the Effectiveness of Awareness Imparted on Earthquake Preparedness among the Residents of South Delhi, India.

BACKGROUND: New Delhi is located in seismic zone IV, and the occurrence of earthquake is fairly common. Previous disasters have shown that only sustained and timely action to reduce risk can prevent or mitigate the impact of a disaster. OBJECTIVES: The objective was to assess the knowledge and preparedness regarding earthquake among the residents of South Delhi and to impart the awareness and assess the effectiveness of the awareness imparted. METHODOLOGY: One group pretest-posttest quasi-experimental research was done among 300 respondents on earthquake preparedness. RESULTS: As per the study, 89% of participants felt that earthquake is a concern for Delhi. It was observed that majority of the population are not prepared to handle large scale disaster. Significant association was found between pretest and posttest knowledge assessment scores of the study population. CONCLUSION: Disasters due to their unpredictable occurrence are difficult to tackle, but awareness and preparedness to face the calamity will help to reduce the burden of disaster.

Interplay of multimorbidity and polypharmacy on a community dwelling frail elderly cohort in the peri-urban slums of Delhi, India.

The United Nations Population Fund suggests that the number of elderly persons is expected to grow to 173 million by 2026. The aging phase is further made adverse by conditions such as failty, multimorbidity and polypharmacy. AIM: To assess the status and associates of frailty among elderly (>60 years) residing in a peri-urban slum area in Delhi by using the EDMONSTON Frail scale and evaluate the interplay of multimorbidity (MM) and polypharmacy (PP) on the frail pre-frail spectrum of the community-dwelling elderly cohort. METHOD: A community study from Dec 2018 till July 2019 with a sample size of 300 participants who were willing and consented to the study. Frailty was assessed and the STOP criteria was used for PP assessment. RESULT: There were 76 frail, 51 pre-frail, and 173 non-frail elderly. A higher prevalence (51%) of multimorbidity among the pre-frails and a higher probability (74%) of polypharmacy among the frails were found. Of the total in the frail-prefrail spectrum (127), 29.1% had multimorbidity (MM) and 39.4% had polypharmacy (PP). MM and PP were significantly higher among the old. Factors such as sex, marriage, loneliness, social circle, and education also had a positive bearing on the frailty-prefrailty spectrum. The working group had an increased (86%) probability of PP with statistical significance. Regression analysis depicted significant increased odds of MM and PP among female, illiterate, very old, lone, and single subjects. DISCUSSION AND CONCLUSION: Thus, we recommend earlier and timely intervention for the frail-prefrail which can revert their adversities.

A sneak peek into the curriculum on disaster management medicine in India for health professionals: A mixed-methods approach.

INTRODUCTION: India being a disaster-prone country necessitates us to be able to act proactively for any sort of preparedness and prevention. This necessitates a curriculum which can bring all the aspects related to disaster under one umbrella and thus impart training. AIM: The aim of the study was to assess the responses of students about the importance of disaster management (DM) in their MBBS course, take up suggestions about the important inclusions to be made in their curriculum, and get an insight of the higher education and research of DM domain in the Indian context. METHODOLOGY: A cross-sectional study with a batch of 100 MBBS students purposively sampled were part of the questionnaire. Besides, a thorough Internet search for institutes providing training on DM was done, and relevant details were noted down. Later on, the students were given guest lectures and demonstrations by certified trainers and experts along with a know-how of where to go for getting a hands-on training and whom to respond to. RESULTS: Seventy-two percent of the students felt the portion of DM being taught to them to be insufficient, and 95% never got any training or demonstration for DM although 22% felt that it is not so important for them as a doctor. Only 23% of them knew about any sort of DM courses or certifications in India, and almost 16% of the students were confident enough to tackle any incidence of public health emergency. CONCLUSION: Making an earlier start will impart seriousness and accountability in the mindset of budding physicians.

School absenteeism during menstruation amongst adolescent girls in Delhi, India.

BACKGROUND: Girls' health and education form the cornerstone of development and the gateway to full participation as women in political, economic, and cultural life of a country. Poor menstrual hygiene management has been shown to result in a sense of shame, anxiety, and embarrassment that contributes to absenteeism and poor performance at school. The objectives of this study were to determine the percentage of girls absent from school during menstruation, to evaluate the various factors associated with school absenteeism during menstruation, and to assess the practices regarding menstrual hygiene. MATERIALS AND METHODS: A mixed method research of combined cross-sectional study and qualitative research was conducted in six government schools of Delhi by means of a questionnaire survey and focus group discussions. The sample size was 600 adolescent girls. RESULTS: Out of 600, 245 (40%) girls remained absent from school during their menstruation. School absenteeism was significantly associated with the type of absorbent used, lack of privacy at school, restrictions imposed on girls during menstruation, mother's education, and source of information on menstruation. Nearly 65% reported that it affected their daily activities at school and that they had to miss their class tests and classes as a result of pain, anxiety, shame, anxiety about leakage, and staining of their uniform. CONCLUSION: Since mothers are the primary source of information, they should be counseled to dispose of their taboos about discussing issues related to menstruation. They should be taught about the ill effects of adhering to taboos related to menstruation. The curriculum on general biology should have more detail on menstruation.

Postpartum Depression in Women: A Risk Factor Analysis.

INTRODUCTION: Postpartum Depression (PPD) is a known entity affecting not only the women but the whole family. It affects women more harshly and chronically due to their increased stress sensitivity, maladaptive coping strategies and multiple social roles in the community. AIM: To estimate the commonly associated risk factors of PPD among the women coming to a tertiary hospital in New Delhi, India. MATERIALS AND METHODS: It was a longitudinal study conducted at the antenatal clinic for a period of one year. Total 260 women were screened at > 36 weeks of gestation, of which 149 postnatal women completed the questionnaire for PPD at six weeks of their delivery. The inform consent, demographical data and obstetrical details from each participant was taken before commencing the screening. Various risk factors and their association were determined by odds-ratio and significant association was accepted at < 5% level of error. In order to identify the most important confounding variables, logistic regression analysis was used. RESULTS: PPD is a common mental health problem seen among the postnatal women as it was found in 12.75% (19 out of 149) of subjects at six weeks of their delivery. Moreover, it has significant association with the young maternal age (p-value=0.040), birth of the female child (p-value=0.015), previous stressful life events (p-value= 0.003), low self-esteem and feeling of loneliness (p-value=0.007). CONCLUSION: This study provides important information regarding the risk factors associated with development of PPD in this region of India. Female sex of the new born and the younger age play an important role in the development of PPD.

Predictors of intention to quit tobacco among construction site workers in Delhi, India.

BACKGROUND: Information on predictors of quitting behavior among construction site tobacco users is scarce in India. Hence, this study was conducted to assess the intention of tobacco users toward quitting and its predictors with reference to sociodemographic profile. METHODOLOGY: A community-based, observational study was conducted on adult 172 construction site workers in a university campus of Delhi. Data were collected by an interview using the WHO-adopted, pretested, semi-structured questionnaire. Chi-square test was used for univariate analysis. Pearson's correlation coefficient and multivariate logistic regression model were used to identify the predictors. RESULTS: Of the 172 users, 73% had intention to quit. More than half of smokers (56.5%) and 81% of smokeless tobacco users intended to quit. Majority of the tobacco users who intended to quit were literate (75.0%), started tobacco use >15 years of age (75.4%), occasional tobacco users (78.9%), and less dependent on nicotine (74.4%). CONCLUSIONS: Suitable plan for quitting keeping in mind this vulnerable group of workers should be developed depending on the literacy, type of tobacco used, and nicotine dependency.

Effectiveness of Awareness Package on Occupational Health Hazards among Ragpickers of New Delhi, India.

BACKGROUND: Ragpickers are informal workers who collect recyclable materials to earn a small wage on daily basis. They work in vulnerable conditions and awareness regarding occupational and environmental hazard is essential for them. OBJECTIVE: To study the effectiveness of awareness program on various occupational health hazards among the ragpickers. MATERIALS AND METHODS: This interventional study was conducted from May through October 2016 among the ragpickers living near field practice area of Department of Community Medicine and those living in slum areas around HAHC Hospital, New Delhi, India. The awareness regarding occupational and environmental health hazards was assessed using a pretested and predesigned pro forma. Snowball sampling technique was used to select the ragpickers from the various areas. Health awareness and education package was designed for the ragpickers. The package was delivered by medical officers and health workers. A posttest assessment was done 2 weeks after the awareness activity. RESULT: Among 150 ragpickers, there was significant improvement in knowledge immediate post training on knowledge of occupational hazard and hygiene. CONCLUSION: Efforts should be put to develop training materials on occupation and environmental health and injury issue relating to waste management.

The intergenerational transmission of tobacco habit: Role of parents and the family.

INTRODUCTION: Tobacco pandemic has become one of the greatest public health challenges of all time. The socio-environmental factors prevailing at home have been identified as one of the most important causes of adopting smoking and other types of smokeless tobacco. OBJECTIVES: The present study was conducted to find out the prevalence and pattern of tobacco use in the patients registered in the clinic and to study the role of parental and family influence on tobacco use. MATERIALS AND METHODOLOGY: This cross-sectional study was performed in a Tertiary Care Hospital in Delhi. The study included all 307 patients who were registered in a cardiac clinic between January and December 2014. The history of tobacco use in siblings, offspring, and parents was taken from these patients. Pedigree profiles provided detailed information about tobacco use in the family. The association between the use of tobacco among parents and tobacco habits was assessed by odds ratio and Chi-square test. RESULTS: Among the patients, 48% were tobacco users and family history of tobacco use was present in 81% of users. Odds ratio of tobacco use in parents, offspring, siblings, and three generations was 3.477, 1.987, 2.626, and 7.626 than that of nontobacco users. CONCLUSION: Previous anti-smoking campaigns have concentrated much of their effort on discouraging individuals from smoking with the aim of creating a nonsmoking generation. This approach does not take sufficient account of the fact, reconfirmed by our findings that children are influenced by the behavior and attitudes of adults, especially their parents.

Prevalence and correlates of nicotine dependence among construction site workers: A cross-sectional study in Delhi.

INTRODUCTION: Workers represent half the world's population and are major contributors to economic and social development. Tobacco consumption in construction site workers has been considered a big challenge. OBJECTIVES: (1) To assess the prevalence of nicotine dependence among tobacco users. (2) To study the correlates of nicotine dependence among the construction site workers. METHODOLOGY: A cross sectional study was conducted using a predesigned and pretested structured proforma. The study was conducted among all construction site workers aged 18yrs and above in campus of Hamdard Institute of Medical Sciences and Research and associated HAH centenary hospital, New Delhi. Karl Fagerstrom Nicotine Dependence Questionnaire was used to assess dependence on nicotine. RESULTS: The mean age of construction site workers was 32.04±11.6 years. Among the workers, majority (91%) were tobacco user. Among the users, 60% found it difficult to refrain from smoking/chewing in places where use of tobacco is not allowed (e.g. hospitals, government offices, cinemas, Libraries etc). 55% of the users smoked or chewed tobacco during the first hours after waking than during the rest of the day. On multivariate analysis, the factors which were found to be significantly associated with nicotine dependence were lower income group (OR 2.57, CI:1.66-3.99), smokeless tobacco use (OR 2.36, CI:1.30-4.27) and lower education (OR = 2.86 (95% CI 1.97-4.16) for illiterate). DISCUSSION: The prevalence of tobacco use (91%) among construction workers is very high compared to that in the general population. Recognition of construction sites as work places and proper implementation of law is needed.

A community-based case-control study to investigate the role of iron deficiency in the persistence of goiter.

OBJECTIVES: To find out the magnitude of iron deficiency anemia in the age group of 6-12 years and investigate the role of iron deficiency as a possible contributor to endemic goiter in school children in Ambala. MATERIALS AND METHODS: The present study was conducted as a subset of a cross-sectional study among 2700 children from 6 to 12 years of age to find out the prevalence of goiter. All the subjects who were found to be suffering from goiter in the cross-sectional study were enrolled in the case-control study as cases and were compared with age- and sex-matched controls (children without goiter) from the same cohort. The study was conducted from February 2011 to January 2012. RESULTS: Out of total, goiter was observed in 12.6% of the subjects. Urinary iodine excretion was found to be <100 µg/L in 57 (10.5%) children. Mean hemoglobin (Hb) level of the study population was 11.9 g/dL. It was noted that 71% of the goitrous children had anemia (Hb <12 g/dL) as compared to 63.7% of the control group. Serum ferritin (SF) was <15 ng/mL in 70% of the children. The mean ± standard deviation of SF in the goitrous and nongoitrous children was 19.65 ± 32.51 µg/L and 27.55 ± 21.07 µg/L, respectively (P = 0.012). CONCLUSION: The findings in the study suggest that iron deficiency anemia in children is contributing toward the persistence of goiter in the postiodization phase.

Assessment of the nutritional status of the elderly and its correlates.

BACKGROUND: The percentage of elderly is growing rapidly and malnutrition is not uncommon in the elderly. OBJECTIVES: The present study was carried out to assess the nutritional status of the elderly using the Mini Nutritional Assessment (MNA) tool, and to study the various epidemiological factors influencing their nutritional status. MATERIALS AND METHODS: This cross-sectional study was done from July 2012 to August 2013 in Boko-Bongaon Block, Kamrup District, Assam, India. The elderly, those over 60 years of age, who met the inclusion criteria participated in the study. A total of 30 clusters were selected and 12 elderly from each cluster were taken to achieve the desired sample size of 360. Nutritional status was assessed by the MNA tool and a 24-h dietary recall method. RESULTS: Out of the total of 360 elderly persons, 15% were found to be malnourished and 55% were at risk of malnutrition. The association between nutritional status and older age group, female gender, dependent functional status, dependent financial status and inadequate calorie intake was found to be significant. CONCLUSION: The present findings reveal that malnutrition is not an uncommon problem in the elderly, and further studies are needed in this regard.