Impact of self-assessment on dental student's performance in pre-clinical conservative dentistry course.

BACKGROUND: Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course. METHODS: Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3. RESULTS: The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001). CONCLUSION: SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry.

Accumulation of Biological and Behavioral Data of Female Sex Workers Using Respondent-Driven Sampling: Protocol for a Systematic Review.

BACKGROUND: Respondent-driven sampling (RDS) is a nonprobability sampling technique that allows the extrapolation of its outcome to the target population. This approach is typically used to overcome the difficulties in studying hidden or difficult-to-reach groups. OBJECTIVE: The purpose of this protocol is to generate a systematic review on the accumulation of biological and behavioral data of female sex workers (FSWs) through different surveys that use the RDS method from around the world in the near future. The future systematic review will discuss the initiation, actualization, and problems of RDS during the accumulation of biological and behavioral data of FSWs through surveys from around the world. METHODS: The behavior and biological data of FSWs will be extracted from peer-reviewed studies published between 2010 and 2022 and that are acquired through RDS. Using PubMed, Google Scholar, the Cochrane database, Scopus, Science Direct, and the Global Health network, all papers that are available will be obtained using the search phrases "respondent-driven" and "Female Sex Workers" OR "FSW" OR "sex workers" OR "SW." According to STROBE-RDS (Strengthening the Reporting of Observational Studies in Epidemiology for Respondent-Driven Sampling) criteria, the data will be retrieved through a data extraction form and will be organized using World Health Organization classifications of areas. The Newcastle-Ottawa Quality Assessment Scale will be used to measure bias risk and overall study quality. RESULTS: The future systematic review that will be generated from this protocol will offer evidence for or against the claim that using the RDS technique to recruit participants from "hidden" or "hard-to-reach" populations is the best strategy. The results will be disseminated through a peer-reviewed publication. Data collection started on April 1, 2023, and the systematic review is expected to be published by December 15, 2023. CONCLUSIONS: A minimum set of parameters for specific methodological, analytical, and testing procedures, including RDS methods to evaluate the overall quality of any RDS survey, will be provided by the future systematic review, in accordance with this protocol, to assist researchers, policy makers, and service providers in improving RDS methods for the surveillance of any key population. TRIAL REGISTRATION: PROSPERO CRD42022346470; https://tinyurl.com/54xe2s3k. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43722.

Association of vitamin D with the severity of disease and mortality in COVID-19: Prospective study in central India.

Background: Many factors have been proposed to be associated with the severity of disease and mortality in COVID-19. Vitamin D had recently been reviewed as one of these factors. Aim and Objectives: To evaluate the association between Vitamin D and the disease severity and mortality in COVID-19. Materials and Methods: After approval from Institutional Ethics Committee, this prospective cohort study was carried out in selected tertiary care teaching medical institutes of Central India. Participants were COVID-19 patients of the age group of 18 years and above admitted during the study period. They were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. Serum level of Vitamin 25(OH) D was measured using chemiluminescent immunoassay. The outcome of the disease was classified as recovery and death during hospitalization. The association of sociodemographic and medical characteristics with treatment outcome was studied using an appropriate statistical test. A full logistic regression model was built for the assessment of the relationship between treatment outcomes with Vitamin D level. Further, one receiver operating characteristic curve was developed to examine the prognostic significance of Vitamin D levels in COVID-19 patients. Results: Out of 748 enrolled patients, 44 (5.88%), had severe disease (Group D). A total of 721 cases (96.39%) recovered and were discharged, whereas 27 (3.61%) died during hospitalization. Mean Vitamin D level was found to be significantly different in discharged patients compared to those who were deceased. Increasing age-adjusted odds ratio (AOR) (95% confidence interval [CI]=1.07 [1.02-1.12]), known hypertension AOR (95%CI) = 3.38 (1.13-10.08), and diabetes mellitus AOR (95%CI) =28.5 (6.04-134.13) were found to be significant predictors of death among COVID-19 patients. Increasing Vitamin D level was found to be protective against COVID-19-related death (AOR (95% CI = 0.87 [0.80-0.94]). Conclusion: Vitamin D was significantly associated with the disease severity and mortality in COVID-19.

Résumé Contexte: Il a été proposé que de nombreux facteurs soient associés à la gravité de la maladie et de la mortalité dans le Covid - 19. La vitamine D avait récemment été examinée comme l'un de ces facteurs. Objectif et objectifs: évaluer l'association entre la vitamine D et la gravité de la maladie et la mortalité dans le Covid-19. Matériel et méthodes: Après l'approbation du comité d'éthique institutionnel, cette étude de cohorte prospective a été réalisée dans des instituts médicaux d'enseignement des soins tertiaires de l'Inde centrale. Les participants étaient des patients Covid-19 du groupe d'âge de 18 ans et plus admis au cours de la période d'étude. Ils ont été classés en quatre groupes comme asymptomatiques (groupe A), légers (groupe B), modérés (groupe C) et sévères (groupe D) sur la base des symptômes cliniques, de la fréquence respiratoire, de la saturation en oxygène et de l'imagerie thoracique. Niveau sérique de la vitamine 25 (OH) DWAS mesuré en utilisant l'immunodosage chimioluminescent. L'issue de la maladie a été classée comme récupération et décès pendant l'hospitalisation. L'association des caractéristiques sociodémographiques et médicales avec les résultats du traitement a été étudiée à l'aide d'un test statistique approprié. Un modèle de régression logistique complet a été construit pour l'évaluation de la relation entre les résultats du traitement au niveau de la vitamine D. De plus, une courbe caractéristique de fonctionnement du récepteur a été développée pour examiner la signification pronostique des niveaux de vitamine D chez les patients COVID-19. Résultats: Sur 748 patients inscrits, 44 (5,88%), avaient une maladie grave (groupe D). Un total de 721 cas (96,39%) ont récupéré et ont été libérés, tandis que 27 (3,61%) sont décédés pendant l'hospitalisation. Le niveau moyen de la vitamine D s'est révélé significativement différent chez les patients libérés par rapport à ceux qui ont été décédés. Augmentation du rapport de cotes ajusté à l'âge (AOR) (intervalle de confiance à 95% [IC] = 1,07 [1,02­1,12]), hypertension connue AOR (IC à 95%) = 3,38 (1,13­10,08) et diabète mellite aor (IC 95% ) = 28,5 (6,04­134.13) se sont révélés être des prédicteurs significatifs de la mort chez les patients COVID-19. L'augmentation du niveau de vitamine D s'est avérée protectrice contre la mort liée au Covid - 19 (AOR (IC à 95% = 0,87 [0,80­0,94]). Conclusion: La vitamine D était significativement associée à la gravité de la maladie et à la mortalité dans le Covid - 19. Mots clés: Covid - 19, tempête de cytokines, mortalité, gravité, vitamine D.

Vertical Transmission Rate of Human Immunodeficiency Virus Exposed Twin Pregnancies and Associated Factors in West Bengal, India: a Retrospective Cohort Study.

Twin pregnancies are often associated with adverse obstetric outcomes. The mother-to-child transmission of the human immunodeficiency virus (HIV) in twin pregnancies has been less explored. Therefore, the present study aimed to determine the risk of vertical transmission of HIV in HIV-exposed twin pregnancies compared with that of singleton pregnancies and to explore the associated factors. We conducted a retrospective cohort study involving 348 HIV-exposed babies (58 twins and 290 singletons) through a systematic sampling from the program database of West Bengal, India, from April 2016 to March 2021. HIV vertical transmission rates were compared between single and twin live births. The effects of factors such as maternal age, timing of maternal HIV diagnosis, duration of antiretroviral treatment, mode of delivery, birth weight, and the sex of the baby were determined. The HIV transmission rate for twin pregnancies (15.5%) was significantly higher than that for single live births (5.5%) (adjusted odds ratio [OR] = 3.38 [1.17-9.69]). Among twin deliveries, maternal HIV diagnosis during the intrapartum and postpartum period was associated with HIV transmission (crude OR = 11.0, [2.2-54.9]). Perinatal HIV transmission is more common in twin pregnancies and is associated with the time of detection of maternal HIV. Therefore, early HIV detection and additional antiretroviral regimens should be considered for twin pregnancies.

Expanding Roles of Accredited Social Health Activists (ASHAs) in the 2019 Hepatitis E Outbreak in a Peri-urban Slum, Nagpur, India.

OBJECTIVE: Due to constraints in the dedicated health work force, outbreaks in peri-urban slums are often reported late. This study explores the feasibility of deploying Accredited Social Health Activists (ASHAs) in outbreak investigation and understand the extent to which this activity gives a balanced platform to fulfil their roles during public health emergencies to reduce its impact and improve mitigation measures. METHODS: Activities of ASHAs involved in the hepatitis E outbreak were reviewed from various registers maintained at the subcenter. Also, various challenges perceived by ASHAs were explored through focus group discussion (FGD). During March to May 2019, 13 ASHAs involved in the hepatitis outbreak investigation and control efforts in a peri-urban slum of Nagpur with population of around 9000. In total, 192 suspected hepatitis E cases reported. RESULTS: During the outbreak, ASHAs performed multiple roles comprising house-to-house search of suspected cases, escorting suspects to confirm diagnosis and referral, community mobilization for out-reach investigation camps, risk communication to vulnerable, etc. During the activity, ASHAs faced challenges such as constraints in the logistics, compromise in other health-related activities, and challenges in sustaining behavior of the community. CONCLUSIONS: It is feasible to implement the investigation of outbreaks through ASHAs. Despite challenges, they are willing to participate in these activities as it gave them an opportunity to fulfil the role as an activist, link worker, as well as a community interface.

Role of dietary habits and personal hygiene on nutritional status of school-going adolescents: A cross-sectional study in selected schools located in slum areas of Nagpur City, Maharashtra.

Purpose: Adolescence is a nutritionally vulnerable time when rapid physical growth increases nutrient demand. Addressing the nutrition needs of adolescents could be an important step toward breaking the vicious cycle of intergenerational malnutrition. Under the healthy school initiative, a baseline assessment was carried out to assess the nutritional status, dietary habits, and personal hygiene of school-going adolescents to plan the future interventions at school level. Materials and Methods: A cross-sectional study was conducted in two government-aided schools for 6 months among 814 students of Class VI-IX to assess their dietary habits and personal hygiene by using the GSHS( Global School based student Health Survey) -2007(Indian version) tool. Anthropometric measurement was taken by standard technique. Results: The study found the proportion of thinness, stunting, and overweight/obesity as 40%, 20%, and 4.2%, respectively. Male students were found more thin (61.1% vs. 38.8%) and stunted (55.6% vs. 44.4%) as compared to female students. Less than one-fourth (13.7%) of the students reported <5 servings of fruits and vegetables. In multivariable analysis, male students, children of homemaker mother, skipping breakfast on all days of week, consumption of fast food ≥3 times/week, consumption of high sugary ready to use food, and infrequent handwashing after toilet were found to be predictors of thinness. Conclusion: Dietary habits and personnel hygiene were found to be important factors of undernutrition; promoting health behavior through school health policy with involvement of teachers, students, and parents is highly recommended to reduce the problem of undernutrition among adolescents.

Résumé Objectif: L'adolescence est une période de vulnérabilité nutritionnelle pendant laquelle une croissance physique rapide augmente la demande en nutriments. Répondre aux besoins nutritionnels des adolescents pourrait constituer une étape importante vers la rupture du cercle vicieux de la malnutrition intergénérationnelle. Dans le cadre de l'initiative pour une école saine, une évaluation de base a été réalisée pour évaluer l'état nutritionnel, les habitudes alimentaires et l'hygiène personnelle des adolescents scolarisés afin de planifier les futures interventions au niveau de l'école. Matériels et Méthodes: Une étude transversale a été menée dans deux écoles subventionnées par le gouvernement pendant 6 mois auprès de 814 élèves des classes VI à IX pour évaluer leurs habitudes alimentaires et leur hygiène personnelle à l'aide du GSHS (Enquête mondiale sur la santé des élèves en milieu scolaire) -2007 (version indienne) outil. La mesure anthropométrique a été prise par la technique standard. Résultats: L'étude a révélé que la proportion de maigreur, de retard de croissance et de surpoids/obésité était de 40 %, 20 % et 4,2 %, respectivement. Les étudiants de sexe masculin se sont révélés plus minces (61,1 % contre 38,8 %) et rabougris (55,6 % contre 44,4 %) que les étudiantes. Moins d'un quart (13,7 %) des élèves ont déclaré <5 portions de fruits et légumes. Dans une analyse multivariée, les étudiants de sexe masculin, les enfants d'une mère au foyer, le fait de sauter le petit-déjeuner tous les jours de la semaine, la consommation de restauration rapide ≥ 3 fois/semaine, la consommation d'aliments prêts à l'emploi riches en sucre et le lavage peu fréquent des mains après la toilette se sont révélés être des prédicteurs de minceur. Conclusion : Les habitudes alimentaires et l'hygiène du personnel se sont révélées être des facteurs importants de dénutrition ; la promotion de comportements sains par le biais d'une politique de santé scolaire avec la participation des enseignants, des élèves et des parents est fortement recommandée pour réduire le problème de la dénutrition chez les adolescents Mots-clés: Adolescent, habitudes alimentaires, hygiène personnelle, dénutrition.

Are women with more of 'social capital' more empowered? A cross-sectional analysis from rural Wardha, Central India.

Background: Despite international commitment and government policies and programmes, a vast majority of women of rural India are socially and economically deprived in the patriarchal sociocultural framework. Strategies to improve women empowerment need context-specific field-based evidence. Objectives: This study was undertaken to address the research question: "Are women with a higher level of social capital more empowered than their counterparts?" Methods: A community-based cross-sectional analytical study was carried out in the Wardha district of Maharashtra, where a two-stage cluster random sampling technique was used to select the 300 study subjects. The outcome variable, women empowerment was assessed using four domains: mobility, inter-spouse communication, household decision-making and asset ownership. The independent variables included social capital along with potential sociodemographic confounders. Multivariate linear regression was applied using the backward stepwise method. Results: The participants had better women empowerment percentage score in the "Household decision-making" domain compared to the other domains. The women empowerment score was found to be significantly higher in the participants with increasing age, higher education, those involved in business/service, above poverty line (ABL), nuclear family, married, and those having at least one living child. In the adjusted analysis, the social capital was found to be a significant determinant of women empowerment, along with age, education, religion, marital status and family type. Conclusion: The improvement of social capital in the form of community-based development projects through Self-Help Groups (SHG) and microfinance programmes need to be encouraged by the Government and NGOs, as this strategy has the potential to improve women empowerment through community-driven development.

Magnitude and determinants of "Social Capital" among women in reproductive age group - A cross-sectional study from rural Wardha, Central India.

CONTEXT: Social capital reflects the trust, norms, values and social processes that governs interaction among people. AIM: This study was conducted to estimate the magnitude and determinants of social capital among women of reproductive age group in selected village of rural Wardha, Central India. MATERIALS AND METHODS: It was a community based cross-sectional study where two stage cluster sampling technique was used to select 300 participants from 22 villages. Data were collected using a pre-designed interviewer administered questionnaire by house-to-house survey. Social capital was measured using the core set of Integrated Questionnaire for the Measurement of Social Capital developed by World Bank. STATISTICAL ANALYSIS: Multivariate linear regression was applied to find out determinants of social capital. RESULTS: Most of the participants had poor social capital score (women having lowest and middle tertile scores were 36.0% and 45%, respectively). social capital poorer in younger women, women with lower educational qualification, not involved in gainful occupation, belonging to below poverty line and unmarried compared to their counterparts. Having at least one son was positively associated with higher social capital. In adjusted analysis, age, education, occupation, marital status, and whether the woman has son were revealed as significant determinants of social capital. CONCLUSION: The study findings reflect the need of improving education and job opportunity among rural women to improve their social capital. Increase of social capital among women having male child reflects the need to percolate the message of gender equity and gender sensitive education.

Urban health and nutrition day or only immunisation day? barriers and bottlenecks in implementing Urban health and nutrition day in an Urban primary health centre of Nagpur, Central India.

BACKGROUND: This study was carried out to evaluate the implementation status of Urban Health and Nutrition Day (UHND) and to explore barriers and bottlenecks as perceived by community-level service providers in the selected city of Nagpur, Maharashtra. MATERIAL AND METHODS: This mixed-method study was conducted using a triangulation design. An initial gap assessment was carried out quantitatively using an observation checklist. Focus group discussion among ASHAs and interviews among frontline health workers involved in community mobilisation were carried out to understand the bottlenecks and barriers. RESULTS: Supplies of drugs and logistics, like paediatric iron and folic acid tablets, calcium tablets, and weighing machines, were inadequate. Services like distribution of conventional contraceptives, testing for malaria, urine albumin/sugar, haemoglobin estimation, screening for diabetes and hypertension, sputum collection, and qualitative iodine test kits are not available in any of the UHND sessions. Major challenges in the implementation of UHND were found to be as follows: unserved areas and left-out urban slum pockets; the distribution paradox of UHND location with an ill-defined geographic boundary; restriction of range of services to antenatal registration and immunisation with gross neglect of other components; suboptimal training of staff; insufficient availability of space, logistics, and health manpower; non-involvement of community members and Urban Local Bodies; and poor monitoring and supervision. CONCLUSION: The conduct, use, and list of services offered in UHND are far from the desired goal. For optimal use, reallocation of the UHND sessions, preferably in unserved and underserved slums, need to be carried out after suitable vulnerability assessment. Integration of the Health, Women, and Child Department and Urban Local Bodies is required for convergent planning, monitoring, and supervision.

Lumbar spine instrumented fusion surgery under spinal anaesthesia versus general anaesthesia-A retrospective study of 239 cases.

OBJECTIVE: Conventionally spinal surgeries are done under general anaesthesia (GA). Plenty of literature is available on lumbar spine non-instrumented surgeries under spinal anaesthesia (SA) but handful of literature is there on lumbar spinal instrumented fusion surgeries under SA. We retrospectively analysed the data of 131 patients operated under SA and 108 patients under GA. Aim of the study was to evaluate the safety, advantages and disadvantages of doing lumbar spine instrumented fusion surgeries under SA.In time of COVID-19 pandemic, aerosol generating procedure like intubation, can be avoided if lumbar spine instrumented fusion surgeries are performed under SA. METHODS: 239 patients aged between 20 and 79 years operated from January 2014 to December 2019 were included in this study. Indications for surgery were lumbar canal stenosis, degenerative or lytic spondylolisthesis. They underwent L4-L5 or L5-S1 fusion surgeries either TLIF or pedicle screw fixation postero lateral fusion (PLF) and decompression. Out of 239 patients,131 were operated under SA and 108 patients under GA. Heart rate, mean arterial pressure (MAP), blood loss, operating room time, post-op pain relief and need of analgesics, cost of surgery and anaesthesia related complications were analysed. RESULTS: The study found significantly less blood loss (p<.05), less OR time, better post-op analgesia and lesser incidence of nausea and vomiting in SA (8.4%) than GA (29.6%). We observed average 10% cost reduction in SA. This study did not find any prone position related complication in regional anaesthesia but one transient brachial plexus palsy and one post-op shoulder pain in GA group. CONCLUSION: SA is a safe alternative to GA for lumbar spine instrumented fusion surgery with significant less blood loss, OR time, better post-op analgesia, average 10% overall cost reduction and no reported prone-position related complications.

Care-seeking behaviour of suspected snakebite cases admitted in a medical college of West Bengal: A pathway analysis.

BACKGROUND: Snakebite is a time decisive medical emergency requiring contact with health facility at the earliest. Many snakebite victims yet seek care from traditional healers (THs) or village quacks (VQs) before reaching an appropriate facility, which leads to adverse consequences. This study was conducted to assess care-seeking behaviour and pathways followed in reaching appropriate facilities among suspected snakebite cases and to identify associated factors. METHODS: A hospital-based cross-sectional study was conducted at a medical college in West Bengal. All suspected snakebite cases admitted during a reference period of two months were studied. Study subjects and/or accompanying persons were interviewed for care-seeking behaviours and pathways followed. RESULTS: Among the 393 study participants, most were ≤30 years of age, men, agricultural workers, of lower middle and lower socioeconomic class and only 69.5% had formal schooling. The commonest place of occurrence was the agricultural field (40.7%), and the commonest biting site was the lower extremity (77.6%). Only half of participants (55.2%) used immediate correct measures at the biting site. Incorrect practices included tourniquet application (29.5%), use of herbal preparation (7.1%), blade shaving at site (2.8%) etc. As first care-seeking points, 15% and 24.9% of cases visited THs and VQs, respectively. Pathway analysis revealed that unfavourable pathway was followed by 39.9% participants. Two unfavourable points were consulted by 3.8% of participants. The care-seeking pathway was significantly associated with religion, caste, education and socioeconomic class. CONCLUSIONS: Findings of this study highlight the urgent need for behaviour change interventions addressing the myths and misconceptions of people regarding snakebite.

Assessment of knowledge, attitude, and practice about biomedical waste management among healthcare workers during COVID-19 pandemic in a health district of West Bengal.

BACKGROUND: Efforts to combat Coronavirus disease (COVID-19) pandemic have significantly increased the quantity of bio-medical waste (BMW) generation. OBJECTIVES: A cross-sectional study was performed to assess the knowledge, practice, and attitude and factors affecting knowledge on BMW management among Health Care Workers (HCWs) when taking care of patients with COVID-19. METHODS: This cross-sectional study was conducted among 384 HCWs, actively involved in caring of COVID-19 patients in Healthcare settings of North 24 Parganas Health District, West Bengal. Data were collected using a structured self-administered questionnaire (through Google Forms) and an observational checklist after selection criteria and having consent. The Questionnaire included four sections like the sociodemographic information, knowledge related to BMW management, observational questionnaire assessing the practice of HCWs on BMW management and rating scale related to attitudes towards BMW management. RESULTS: 166 HCWs (43.2%) had an excellent knowledge with overall mean score 13.5 ± 3.6. A high mean score (14.4 ± 3.2) was obtained by doctors followed by nurses (13.6 ± 3.8). Regarding practice, the majority of HCWs (52.8%) followed the color-coding of BMW and 49.5% followed policies in separating the wastes according to hazard. Doctors (91%) and nurses (81%) had more favorable attitude than others. There was a statistically significant association found among knowledge level and educational qualification (P = 0.0001), gender (P = 0.001), and work experience (P = 0.05) and work area (P = 0.05). CONCLUSION: Emphasis should be given to aware and train all HCWs regarding proper BMW management during this pandemic to prevent infection transmission.

Prevalence and Predictors of Hardcore Smoking in India-: Findings from the Global Adult Tobacco Survey (2016-2017).

BACKGROUND: Hardcore smokers are of significant public health concern having a greater risk of developing tobacco-related diseases. OBJECTIVE: This study aimed to identify burden of hardcore smokers, its distribution, and determinants in India. SUBJECTS AND METHODS: Analysis of Global Adult Tobacco Survey India 2016-2017 data was carried out. Hardcore smoking was defined when the following criteria were fulfilled - current daily cigarette smoking for at least 5 years, no quit attempt in past 12 months, no intention to quit in next 12 months, and time to first smoke within 30 min of waking up. Independent variables included sociodemographic, knowledge of side effects, indoor smoking policy, and age of smoking initiation. Multivariable logistic regression was carried out, with adjustment for clustering, stratification, and sampling weight. RESULTS: Proportion of hardcore smoking among the general population and current daily smokers were 3.43% and 32.3%, respectively. In the adjusted model, it was found to be significantly associated with increasing age, earlier initiation of daily smoking, tribal caste, and unfavorable indoor smoking policy. CONCLUSION: Tobacco control strategies should be modified to tackle these issues, especially early age of initiation of daily smoking and indoor smoking policy.

Perceived Discrimination among Tuberculosis Patients in an Urban Area of Kolkata City, India.

CONTEXT AND AIMS: Tuberculosis (TB) in India is a leading public health problem plagued by social determinants such as stigma and discrimination, which may affect treatment seeking, adherence, and possibly treatment outcome. This study was conducted to elicit the perceived discrimination, its determinants, as well as to determine whether perceived discrimination is predicting treatment outcome among TB patients registered in an Urban Health District, Kolkata City, India. SETTINGS AND DESIGN: An institutionbased follow-up study was conducted where all the TB patients registered within the 1st 4 months of data collection were followed up for their current course of treatment. SUBJECTS AND METHODS: Perceived discrimination was assessed at treatment initiation, after intensive period and after continuation phase using a predesigned and pretested questionnaire. STATISTICAL ANALYSIS USED: Multivariable logistic regression analyses were performed to identify the determinants of perceived discrimination as well as the treatment outcome. RESULTS: Perceived discrimination by family members, neighbors, and colleagues was reported by 9.4%, 36.5%, and 34.2% participants, respectively, overall discrimination being 37.9%. Multivariable analysis revealed that discrimination was significantly more among patients with older age group, females, and from joint families. Perceived discriminated was found to be significantly predicting unfavorable treatment outcome even after adjustment with background and treatment-related variables. CONCLUSIONS: Sensitization programs should incorporate measures to address stigma and discrimination and more emphasis needs to be placed on women and elderly patients.

Determinants of out-of-pocket and catastrophic health expenditure in rural population: A community-based study in a block of Purba Barddhaman, West Bengal.

BACKGROUND: In India, health expenditure accounts for <5% of the Gross domestic product and the level of out-of-pocket (OOP) spending is 69.5% of total health expenditures. OOP expenditure (OOPE) has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. OBJECTIVES: The study aimed to estimate the OOPE on health and catastrophic health expenditure (CHE) and their sociodemographic determinants in a rural area of Purba Barddhaman. METHODS: A community-based cross-sectional study was conducted between July 2018 and February 2019 in Bhatar Block of Purba Bardhaman district, West Bengal. Required sample of 235 households, selected randomly were primary study units. One respondent from each household was interviewed with a predesigned, pretested schedule for sociodemographic and health-care expenditure-related variables. Mann-Whitney U test/Kruskal Wallis H test and multivariable logistic regression was applied. RESULTS: The median OOP health expenditure was Rs. 3870 (inter quartile range: 2156-4952). Of 235 families, 38 (16.2%) had CHE over a period of 1 year. The significant correlates for CHE were type of village according to the presence of public health-care facility (adjusted odds ratio [AOR] = 4.748; 95% confidence interval [CI]: 1.886-11.956), presence of health insurance (AOR = 11.124; 95% CI: 3.690-33.535) and gender of the head of the family (AOR = 18.176; 95% CI: 3.353-98.534). Concentration curve suggested a higher concentration of CHE among poor households. CONCLUSION: CHE is substantially high in the area. The efforts are required to make the services available as close to the households as possible and to increase awareness about health facilities.

Coverage of mass drug administration for elimination of lymphatic filariasis in urban Nagpur, Central India: A mixed method study.

BACKGROUND AND AIMS: Mass Drug Administration (MDA) coverage remains an important indicator in elimination of Lymphatic Filariasis (LF), especially in context of recent changes in programme strategies in India, such as incorporation of Ivermectin and involvement of urban Accredited Social Health Activists (ASHAs). This study aimed at assessing the coverage and compliance with MDA of Filariasis as well as exploring perspective of beneficiaries for non-consumption in selected slum area of Nagpur city. METHODS: Mixed-method study design comprising of quantitative assessment of MDA coverage, followed by qualitative method to explore the reasons of non-compliance was used in selected slum areas of Nagpur city. Using cluster sampling, 240 households were selected and house-to-house visits were made to interview the eligible participants. In-depth interviews were conducted among selected non-compliant participants. STATISTICAL ANALYSIS: Multivariable logistic regression analysis to identify the factors associated with non-consumption. Thematic analysis was done to obtain the reasons of non-consumption as perceived by the beneficiaries. RESULTS: Among the 1096 individuals studied, distribution and consumption coverage were 55.2% and 48.5%, respectively. Effective supervised consumption was further low (28.9%). Coverage compliance gap (CCG) was 12.1%. Male sex and younger age (2-5 years) were significant socio-demographic determinants of non-consumption. No repeat visit to houses left in first round, fear of side effects, pill burden, poor understanding about the need were important reasons as revealed by qualitative inquiry. CONCLUSION: Effective pre-campaign awareness, incorporation of context specific drug delivery strategies and strengthening monitoring system are essential for successful MDA implementation.

Effect of DOTS on quality of life among tuberculosis patients: A follow-up study in a health district of Kolkata.

CONTEXT AND AIMS: This study was carried out to assess quality of life (QoL) of tuberculosis patients receiving treatment from DOTS centres, to find out its change with treatment, and to ascertain its determinants. MATERIALS AND METHODS: An institution based follow-up study was conducted in Bagbazar Urban Health District (UHD), Kolkata where all the tuberculosis patients registered within 1st 4 months of data collection were followed up for their current course of treatment. Quality of Life (QoL) was assessed using SF36v2 questionnaire at the start of treatment and after continuation phase (CP) (within 14 days). STATISTICAL ANALYSIS USED: General Linear Model was used to assess the predictors of change of QoL with treatment. RESULTS: 61.4% and 16.4% patients were at the risk of depression at the start and end of their TB treatment respectively. Patient's per-capita monthly Income (PCI) and current smoking status interacted with time to predict trends in the Physical component scores. Similarly, PCI and educational status interacted with time to predict trends in the mental component scores. PCI and unemployment were found to be predictor of differences of Physical and mental component scores (between subject effects) respectively. CONCLUSIONS: QoL assessment in different stages of treatment should be incorporated in the ongoing RNTCP to make the programme more client-oriented and comprehensive, and to provide social support to those who need it most. Directly observed treatment should be supplemented with economic support, de-addiction campaign and Inter-personal counselling by the DOTS providers.

Predictors of Inconsistent Condom Use among Female Sex Workers: A Community-Based Study in a Red-Light Area of Kolkata, India.

BACKGROUND: Condom is an integral part of all interventions for female sex workers (FSWs). However, certain situations hinder them from practicing consistent condom use. This paper aims at identifying the situations that predict inconsistent condom use by FSWs of Sonagachi red-light area, Kolkata. SUBJECTS AND METHODS: The cross-sectional community-based observational study was conducted among 296 brothel-based FSWs of Sonagachi. Outcome variable, that is, inconsistent condom use was said to be present if any sex act with any type of partner was not protected by condom. Association with sociodemographic, occupational, and behavioral characteristics of FSWs was examined. RESULTS: Inconsistent condom use was present among 37.5% of the study participants, and this was predicted by the presence of a nonpaying partner (NPP) (adjusted odds ratio [AOR] [95% confidence interval (CI)]: 15.04 [7.52-30.08]), violence (AOR [95% CI]: 2.08 [1.07-4.03]) and sexual intercourse under the influence of alcohol (AOR [95% CI]: 1.86 [1.02-3.39]). The major cause behind nonuse of condom as reported by the participants was trust on partner. CONCLUSION: NPPs need to be given emphasis in program strategies for FSWs. The FSWs should constantly be motivated for safe sex emphasizing the fact that trust on partner may be detrimental for their health.