Unmet Need of Antenatal Screening for Asymptomatic Bacteriuria: A Risk Factor for Adverse Outcomes of Pregnancy.

Recommended urine culture is unsuitable for screening pregnant women for asymptomatic bacteriuria due to long turn-around time, unaffordability, and user-unfriendliness. The objective of this review was to evaluate the suitability of various tests for this purpose. A PubMed-based systematic review of published articles irrespective of year and language was done. Search terms included asymptomatic bacteriuria, screening test, urinary tract infection, and diagnostic test. Diagnostic accuracy studies conducted on human populations comparing tests with urine culture were included. One author extracted predefined data fields, including quality indicators, another validated it. Of 78 records, 25 studies describing 15 tests were included. All tests were rapid, seven were valid and two of them were affordable and easy-to-use. No test provided comprehensive identification with antibiotic susceptibility. Despite publication bias, no test was found suitable for screening asymptomatic bacteriuria antenatally and providing evidence-based prescription. Further research is needed to develop tests which suit this purpose.

Blending virtual with conventional learning to improve student midwifery skills in India.

India's state of Bihar has suboptimal quality of pre-service training for auxiliary nurse midwives. To address this, state government of Bihar implemented a blended training model to supplement conventional classroom teaching with virtual training. A 72-hour virtual training package with updated content on key maternal and newborn health practices was developed for final year students and broadcasted from one instructor location simultaneously to two auxiliary nurse midwives training centres. This pre-post intervention study compared skills of two auxiliary nurse midwife student cohorts. Eighty-five students from pre-intervention cohort of academic year 2012-13, received only conventional teaching during the final year. The 51 students in the post-intervention cohort from successive academic year 2013-14, received a combination of the both conventional and virtual training. The two cohorts were objectively assessed on identified midwifery skills. A passing score was set at achieving 75% or higher. The students exposed to blended learning scored 32.57 points (p = <0.001) more than their counterparts, who received only conventional teaching. In the post-intervention cohort, 55% students (N = 28) passed as compared to none in the pre-intervention cohort. We found blended learning approach effectively improved access to quality training, and identified key midwifery skills of auxiliary nurse midwife students from remote locations.

Effectiveness of virtual classroom training in improving the knowledge and key maternal neonatal health skills of general nurse midwifery students in Bihar, India: A pre- and post-intervention study.

BACKGROUND: In 2008-09, the National Health Systems Resource Center of India reported overall quality of nurse-midwifery education in Bihar as grossly sub-optimal. To address this, we implemented a competency-based training using virtual classrooms in two general nurse midwives (GNM) schools of Bihar. The students from remotely located nursing institutions were now able to see live demonstrations of maternal and newborn health (MNH) practices performed by a trained faculty on simulation models at instructor location. OBJECTIVE: To evaluate the effectiveness of virtual classroom training in improving the MNH-related skills of the nursing-midwifery students in Bihar, India. DESIGN: This study used a pre- and post-intervention design without a control group. SETTINGS: Students from two public GNM schools of Bihar. PARTICIPANTS: Final-year students from both the GNM schools who have completed their coursework in MNH. METHOD: A total of 83 students from selected GNM schools were assessed for their competencies in six key MNH practices using objective structured clinical examination method prior to intervention. A 72hour standardized training package was then implemented in these schools through virtual classroom approach. Post-intervention, 92 students from the next batch who attended virtual training were assessed for the same competencies. RESULTS: The mean student score assessed before the intervention was 21.3 (95% CI, 19.9-22.6), which increased to 62.0 (95% CI, 60.3-63.7) post-intervention. This difference was statistically significant. When adjusted for clustering using linear regression analysis, the students in post-intervention scored 52.3 (95% CI, 49.4%-55.3%) percentage points higher than pre-intervention, and this was statistically significant. CONCLUSION: Virtual classroom training was found to be effective in improving knowledge and key MNH skills of GNM students in Bihar, India.

Refractive error and vision-related quality of life in South Indian children.

PURPOSE: To understand the vision-related quality of life (QoL) of schoolchildren with uncorrected refractive error (URE). METHODS: A snapshot qualitative research design and homogeneous sampling strategy was adopted. Thirty-one, 27, and 22 eye care practitioners, children, and teachers participated in four, three, and two focus group discussions, respectively. The participants were recruited from various parts of Chennai, India. The discussions were audio recorded, transcribed, coded, and analyzed. RESULTS: Eight themes emerged: complaints and symptoms of children with URE, vision-related activity limitation, coping strategies, psychological impact, social impact, the perceived difference after first time refractive correction, reasons for refractive error remaining uncorrected, and the significant amount of refractive error. CONCLUSIONS: The study gives a holistic view of the vision-related QoL of children with URE by demonstrating the difficulties and problems that they face in their day-to-day life and also by describing the perceived difference in QoL after wearing refractive correction.

Parents' awareness and perception of children's eye diseases in Chennai, India.

PURPOSE: To report parents' awareness and perception of eye diseases in their children. METHODS: Thirty-five parents and 16 eye care practitioners either participated in in-depth interviews or focus group discussions. Data on parents' awareness and perception were collected using interview guides with unstructured questions. Data were transcribed, familiarized, and coded, and themes were generated. Redundancy was considered as the end point of data collection. RESULTS: The study results conveyed that parents were aware of common eye problems like refractive error, squint, and cataract, except for amblyopia, in their children. The causative factors for ocular diseases were not well understood by parents. The parents' perception was that eye problems can be treated with food, such as eggs or carrots, and exercises. Most of the parents perceived squint as a sign of good luck and spectacle correction as a social stigma. CONCLUSIONS: One of the prerequisites of health-seeking behavior is knowledge of disease and their symptoms, which seems to be lacking in parents of children. The findings of this study suggest that programs to increase awareness of the causative factors, spectacle wearing, and on the harmful effects of squint should be conducted.

Improving health of children in urban slums through an integrated model based approach-a case study from Chennai.

An integrated model based approach was used to improve health status of children in an urban slum. An urban slum was selected based on fixed criteria and health needs were assessed. The environmental conditions were improved. Health care needs were taken care of and self-help groups were started to make them financially independent. This model was evaluated in 204 families with 350 under-five children. Survey revealed that 88% of them used safe garbage disposal and 95% of them had household latrines. Only 24% of under-five children had water borne morbidity in past one year and there were no vector borne diseases. 71% of the eligible couples followed some contraception. Mean duration of exclusive breast feeding was 7 months and average total duration of breast feeding was 15 months. Integrated model based approach based on principles of primary health care works in urban slum with effective community participation.

Experiences from tsunami relief activity: implications for medical education.

A tsunami struck the coast of Tamilnadu and Pondicherry on 26 December 2004. Jawaharlal Institute of Postgraduate Medical Education & Research, (JIPMER) in Pondicherry played a vital role in providing medical relief. The experiences from the relief activities revealed areas of deficiency in medical education in regards to disaster preparedness. A qualitative study using focus group discussion was employed to find the lacunae in skills in managing medical relief measures. Many skills were identified; the most important of which was addressing the psychological impact of the tsunami on the victims. Limited coordination and leadership skills were also identified. It is recommended that activity-based learning can be included in the curriculum to improve these skills.