Barriers, Facilitators of Iron and Folic Acid Supplementation, and Deworming Program among School-Going Adolescents of Deoghar, Jharkhand, India: A Mixed-Methods Study.

Background: This study aimed to identify barriers and facilitators of iron and folic acid supplementation and deworming programs among school-going adolescents. Methods: A mixed-method observational study was conducted among adolescents in the 8th to 10th standards and their teachers across four schools in Deoghar, Jharkhand, India, using simple random sampling. The study included a questionnaire on socio-demographics, knowledge (34 items) (α=0.894), attitudes (2 items) (α=0.711) toward iron deficiency anemia, awareness of the Weekly Iron and Folic Acid Supplementation (WIFS) program and deworming (20 items) (α=0.783), and practices related to iron folic acid supplementation (IFS) and deworming, along with qualitative components. Data were analyzed using jamovi. Results: Compliance rates for IFS and deworming were 27.5% and 67.9%, respectively. The multivariable logistic regression analysis showed that sex, religion, caste, father's educational status, per capita monthly family income (PCMI), diet type, adequate knowledge, and positive attitude toward anemia influenced IFS compliance. Religion, PCMI, and prior information on the importance of deworming facilitate compliance. Implementation barriers included irregular medication supply and a lack of student awareness. Conclusion: Periodic evaluation, regular sensitization, and a consistent drug supply are necessary to effectively implement WIFS and deworming programs in the study area.

Effect of educational intervention on risk factors of cardiovascular diseases among school teachers: a quasi-experimental study in a suburb of Kolkata, West Bengal, India.

OBJECTIVE: This prospective study aimed to evaluate the effects of a health education intervention on cardiovascular disease (CVD) risk factors among school teachers. METHODS: The study, conducted from August 2016 to May 2017, involved teachers from four schools in Baruipur, West Bengal, India. It was a multicentric, quasi-experimental study with an intervention group receiving tailored health education promoting lifestyle modifications, while the control group received no intervention. Baseline and endline assessments included behavioural and biological characteristics related to cardiovascular health and risk assessment. Data were analysed using JAMOVI. RESULTS: The intervention group showed significant improvements in physical activity levels [Cohen's d (Cd): 0.43, p = 0.006] and the consumption of fruits and vegetables (Cd: 1.00, p = < 0.001). Notably, there was a considerable reduction in the consumption of salt (Cd: -0.93, p = 0.039), oil (Cd: -0.98, p = < 0.001), fast food (Cd: -0.99, p = < 0.001), junk food (Cd: -0.99, p = < 0.001), and red meat (Cd: -1.00, p = < 0.001) among participants. However, there were no significant improvements in biological characteristics within the intervention group. In contrast, the control group exhibited no significant changes in behavioural and biological characteristics compared to baseline. The intervention group showed a minor non-significant reduction (3.0%) in their 10-year cardiovascular risk compared to baseline (Cd: -1.00, p = 0.50), while the control group had a negligible non-significant increase (0.7%) in their cardiovascular risk (Cd: 1.00, p = 1.00). CONCLUSION: Health education intervention positively influenced behavioural characteristics, such as physical activity and dietary habits, among school teachers. However, no significant improvements were observed in biological characteristics or cardiovascular risk factors.

An Epidemiological Study of the Quality of Life of Children With Beta-Thalassemia Major (ß-TM) and Its Correlates in Kolkata, West Bengal, India.

Background and objectives In contrast to their peers who are healthy, children with thalassemia disease are likely to have a lower quality of life (QoL). Knowledge of attributes affecting the QoL of thalassemic children may help identify key areas of intervention to improve it. Thus, the current study was envisioned to find out the quality of life (QoL) of children with beta-thalassemia major (ß-TM) and its various correlates. Methods Between May 2016 and April 2017, an institution-based cross-sectional observational study was conducted in the thalassemia unit of Calcutta National Medical College and Hospital (CNMC&H), Kolkata, West Bengal, India. During the study period, 328 ß-TM children and their carers were interviewed using a structured schedule. Results In the final multivariable logistic regression model, thalassemic children who were residing in an urban area (adjusted odds ratio (AOR) (95% confidence interval (CI)): 2.1 (1.1-4.0)), had mothers with a higher educational level (middle and above) (AOR (95%CI): 2.1 (1.1-4.0)), had working parents (AOR (95%CI): 2.7 (1.2-6.3)), had no family history of thalassemia (AOR (95%CI): 3.5 (1.6-8.0)), received less number of blood transfusion in the previous year (<12) (AOR (95%CI): 2.1(1.1-4.2)), had higher pre-transfusional hemoglobin (Hb) level (AOR (95%CI): 1.7(1.1-2.6)), had no transfusion-transmitted infections (TTIs) (AOR (95%CI): 2.8 (1.5-5.2)), had higher body mass index (BMI) Z score (AOR (95%CI): 1.6 (1.1-2.2)), and had higher Carer Quality of Life (CarerQoL) score (>5) (AOR (95%CI): 3.2 (1.6-6.2)) were more likely to have favorable QoL (Pediatric Quality of Life Inventory (PedsQL) score > 54.3). Interpretation and conclusions The QoL of the study participants was significantly correlated with their carers' CarerQoL, mother's educational level, parent's working status, place of residence, family history of the disease, blood transfusion frequency, pre-transfusional Hb level, and nutritional and comorbidity status.

Pattern and predictors of mortality among inborn and out born neonates on ventilatory support: an unmatched case-control study.

BACKGROUND: Limited literature was available on the pattern and determinants of mortality among inborn neonates in comparison to the out born ones. The study's goal was to investigate the patterns and risk factors for mortality among hospitalised, on-ventilator inborn and out born neonates. MATERIALS AND METHODS: It was an unmatched, case-control, pilot study conducted between January and December 2020 using information retrieved from the medical records of patients attending the neonatal intensive care unit (NICU) of a tertiary healthcare facility, namely Narayan Medical College & Hospital, situated in eastern India. RESULTS: Congenital pneumonia was the leading cause of death in inborn neonates, with an overall mortality rate of 33.4%. Meanwhile, the overall fatality rate for out born neonates was found to be 43.3%, with birth hypoxia being the most common cause. The only significant attribute affecting mortality in inborn neonates was low arterial blood gas (ABG) pH, whereas in out born neonates they were prematurity, thrombocytopenia, low ABG pO2, and high pCO2. Overall, new-borns with thrombocytopenia, low ABG pO2, and high pCO2 were observed to be at higher risk for mortality compared to others. CONCLUSION: The mortality rate of out born neonates was higher than inborn ones. The attributes affecting mortality were observed to be prematurity, thrombocytopenia, low ABG pH, pO2, and high pCO2.

Capacity building among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs): Findings of an implementation study from Bihar, India.

Background: Community-based screening is one of the key preventive strategies to tackle the ever-rising burden of non-communicable diseases (NCDs) under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Objective: The current study was aimed to build capacity among frontline health workers (FHWs) in screening for cardiovascular diseases (CVDs) under NPCDCS in the selected districts of Bihar state. Methodology: This was an implementation study with follow-up components, conducted among 75 FHWs [14 auxiliary nurse midwives (ANMs) and 61 accredited social health activists (ASHAs)] from 15 primary healthcare facilities across four districts of Bihar state from October 2019 to September 2021. The selected FHWs were initially trained on NPCDCS for a day, including pre- and post-training knowledge assessment. Then, supportive supervision (SS) visits using a predesigned questionnaire were done. Results: The pre- and post-training mean knowledge scores of the FHWs were 12.9 and 22.1, respectively, with an overall effect size of 2.5. During SS visits, only 20.0% of the visited primary healthcare facilities had all the required logistics to conduct weekly NCD screening clinics for CVDs. Considering different measurements and operative skill proficiencies of FHWs, waist circumference skills (41.7% for ANMs and 50.8% for ASHAs), followed by blood pressure (BP) (41.7%) and random blood sugar (RBS) measurement (25.0%), were found to be the most deficient skills (among ANMs). Moreover, the quality of initial and follow-up home visits was found to be satisfactory for only 54.1% of the ASHAs. The reported barriers of NCD screening were reported to be non-cooperation, unawareness among community dwellers, lack of knowledge and skill of FHWs, logistic constraints and delayed honorarium credit. Conclusion: One-day training on NCDs for FHWs was quite effective. However, for translating all the desired skills for CVD screening into action, periodic training needs assessment, and SS of FHWs might be fruitful.

Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study.

Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December-March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46-59 years, 3.4 [95% CI: 1.5-7.7]; 60-74 years, 4.1 [95% CI: 1.7-9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0-30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2-2.9]); malignancy (aOR: 3.1 [95% CI: 1.3-7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2-8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4-3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7-11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6-3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.

Transfusion-transmitted infections, its risk factors and impact on quality of life: An epidemiological study among ß-thalassemia major children.

BACKGROUND: Multi-transfused thalassemic children are at higher risk of acquiring transfusion-transmitted infections (TTIs). There are limited data available on TTIs among thalassemic children, especially on its impact on their quality of life (QoL). AIM: The aim of this study is to find out the proportion of multi-transfused ß-thalassemia major (ß-TM) children suffering from TTIs, its risk factors and impact on QoL. METHODS: This was a hospital-based, analytical observational study, cross-sectional in design, conducted among 328 ß-TM children and their caregivers attending thalassemia day care unit of a medical college during May 2015-April 2016, with a structured schedule. Data were analyzed with appropriate statistical methods using the Statistical Package for the Social Sciences. RESULTS: Two-fifth (39.9%) of them were found to have TTIs with hepatitis C being the most common (34.5%), followed by hepatitis B (4.5%) and human immunodeficiency virus (1.8%). In the multivariable model, place of residence (adjusted odds ratio [AOR] - 2.23 [1.19-4.17]), per capita monthly family income (AOR - 1.84 [1.10-3.07]), and blood transfusion frequency (AOR - 1.19 [1.10-1.29]) were significant predictors of TTIs adjusted with their age, age at diagnosis, last pretransfusional hemoglobin level, size of spleen, and caregivers knowledge regarding the disease. The study participants with TTIs had a lower QoL compared to others as there were significant differences in between the total QoL scores ([49.9 ± 15.6 vs. 57.4 ± 15.5], P ≤ 0.001) and its various domains. CONCLUSION: There was high burden of TTIs among multi-transfused ß-TM children and it has significant negative impact on their quality of lives.

Financial literacy and its correlates among healthcare professionals of India: An ignored educational need.

BACKGROUND: Financial literacy is a person's capability to manage their own monetary matters. There was no information available on financial literacy status of healthcare professionals (HCPs) of India. So, the current research was formulated to assess the financial literacy status and its correlates among HCPs of India. MATERIALS AND METHODS: It was an observational study, cross-sectionally designed, conducted among 524 HCPs of India using a structured Google form during July 2020. For data analysis, SPSS (version 22) was used. RESULTS: Among the study participants, 68.3% were found to be financially literate. Among the various subdomains of the total financial literacy, knowledge regarding general domain was observed to be the best (69.3%) followed by savings (63.7%) and investment (58.0%) domains, respectively. The total financial literacy score was found to be positively correlated with higher age [spearman rho correlation co-efficient (ρ) = 0.25; P =< 0.01], qualification [(medical postgraduate) (ρ= 0.16; P =< 0.01); (medical super speciality) (ρ = 0.14; P =< 0.01)], and annual family income (ρ= 0.29; P =< 0.01). Moreover, males (ρ= 0.23; P =< 0.01)], currently married (ρ= 0.19; P =< 0.01), and surgeons (ρ= 0.12; P =< 0.01) were found to be more financially literate compared with others. Positive financial attitude (ρ= 0.26; P =< 0.01) and regular maintenance of financial record (ρ= 0.21; P =< 0.01) were the other enabling factors of financial literacy observed in the study. CONCLUSIONS: Financial literacy was found to be quite low in the surveyed HCPs as every third study participant were found to be deficient in knowledge regarding one or more financial attributes. Incorporation of finance management in curriculum of the healthcare allied courses and repeated sensitization of the graduated HCPs are warranted to enable them to take effective financial decisions to meet their personal and organizational financial goals.

Resilience level, its determinants and its effect on psychological well-being: A cross-sectional evaluation among school-going adolescents of Patna, Bihar, India.

BACKGROUND: Adolescents with higher resilience levels are reported to be less vulnerable to psychological illnesses. The study examined resilience level, its determinants and its effect on psychological well-being among school-going adolescents of Patna, Bihar, India. METHODS: Adopting cross-sectional design we examined resilience levels among the study participants reading in the sixth, seventh and eighth standards of selected schools of Patna district using the Child Youth Resilience Measure-Revised questionnaire during March 2021. Psychological well-being was assessed using Patient Health Questionnaire-4. Data of in total 468 enrolled participants were analysed using SPSS 22.0. RESULTS: The mean resilience score was observed to be 62.4 ± 8.8. In multiple linear regression analysis using backward method; increasing age (unstandardised beta [ß]: 0.564, standard error [SE]: 0.271, P: 0.038), male gender (ß: 2.753, SE: 0.775, P < 0.001), high per capita monthly family income (≥18 USD [median]) (ß: 1.829, SE: 0.743, P: 0.014), academic satisfaction (ß: 2.003, SE: 0.962, P: 0.038), no history of abuse (physical or mental) in the past 30 days (ß: 2.752, SE: 1.220, P: 0.025) and increasing self-esteem score (measured by Rosenberg Self-Esteem Scale) (ß: 0.808, SE: 0.098, P: < 0.001) were found to be positive determinants of the total resilience level. Resilience was found to be positively correlated with psychological well-being (spearman rho correlation co-efficient [ρ]: 0.363, P < 0.001). CONCLUSIONS: Abuse, academic satisfaction and self-esteem were the modifiable determinates of resilience that could be elucidated in this investigation. Resilience level positively influenced psychological well-being.

Effectiveness of COVID-19 vaccine in preventing infection and disease severity: a case-control study from an Eastern State of India.

Effectiveness of corona virus disease-19 (COVID-19) vaccines used in India is unexplored and need to be substantiated. The present case-control study was planned to elicit the effectiveness of COVID-19 vaccines in preventing infection and disease severity in the general population of Bihar, India. This case-control study was conducted among people aged ≥45 years during April to June 2021. The cases were the COVID-19 patients admitted or visited All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India, and were contacted directly. The controls were the individuals tested negative for severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) at the Virology laboratory, AIIMS-Patna and contacted telephonically for collection of relevant information. The vaccine effectiveness (VE) was calculated by using the formula (VE = 1 - odds ratio). The adjusted VE for partial and full vaccination were estimated to be 52.0% (95% confidence interval (CI) 39.0-63.0%) and 83.0% (95% CI 73.0-89.0%) respectively for preventing SARS CoV-2 infection. The sub-group analyses of the cases have shown that the length of hospital stays (LOS) (partially vaccinated: 9 days vs. unvaccinated: 12 days; P = 0.028) and the severity of the disease (fully vaccinated: 30.3% vs. partially vaccinated: 51.3% and unvaccinated: 54.1%; P = 0.035) were significantly low among vaccinated compared to unvaccinated individuals. To conclude, four out of every five fully vaccinated individuals are estimated to be protected from contracting SARS CoV-2 infection. Vaccination lowered LOS and chances of development of severe disease.

Tobacco use pattern and quitting behaviour among healthcare professionals during the COVID-19 pandemic: Insights from a pan India online survey.

BACKGROUND: Healthcare professionals (HCPs) have a definite role in tobacco control and can help immensely by setting examples. The current study aimed to study the tobacco use pattern and quitting behaviour among HCPs of India during the COVID-19 pandemic. METHODS: We addressed the research objective using a cross-sectional, anonymous online survey using 'google form" among 687 HCPs of India during December 2020. Descriptive and inferential statistics were performed using SPSS. RESULTS: Overall, 32.6% of the HCPs were ever tobacco user while 23.4% and 16.9% were current and daily tobacco user. During the COVID-19 pandemic, 51.7% and 43.1% of HCPs cut down the frequency and amount of tobacco use respectively while for 24.1% COVID-19 pandemic exerted no effect on their tobacco use. Presence of vulnerable population at home [ adjusted odds ratio (AOR): 17.5 (95% confidence interval (CI): 3.3-92.2)], ever tobacco quit attempt [AOR: 13.5 (95% CI:2.7-67.7)] and history of COVID-19 disease [AOR: 5.1 (95% CI:1.3-20.7)] significantly determined reduced tobacco use (60.3%) during the pandemic. Similarly, reduced tobacco use during the pandemic [AOR: 4.8 (95% CI:1.7-13.5)] and perception of both smoking and smokeless tobacco form to be harmful for COVID-19 [AOR: 4.8 (95% CI:1.7-13.5)] were the independent correlates of tobacco quit attempt (50.0%) during the pandemic. CONCLUSION: Tobacco use was quite rampant among the HCPs with every fourth and sixth being a current and daily tobacco user respectively. During the COVID-19 pandemic three in every five HCPs surveyed reduced tobacco use while every second HCP made a quit attempt.

Early Determinants of Length of Hospital Stay: A Case Control Survival Analysis among COVID-19 Patients admitted in a Tertiary Healthcare Facility of East India.

BACKGROUND: Length of hospital stay (LOS) for a disease is a vital estimate for healthcare logistics planning. The study aimed to illustrate the effect of factors elicited on arrival on LOS of the COVID-19 patients. MATERIALS AND METHODS: It was a retrospective, record based, unmatched, case control study using hospital records of 334 COVID-19 patients admitted in an East Indian tertiary healthcare facility during May to October 2020. Discharge from the hospital (cases/survivors) was considered as an event while death (control/non-survivors) as right censoring in the case-control survival analysis using cox proportional hazard model. RESULTS: Overall, we found the median LOS for the survivors to be 8 days [interquartile range (IQR): 7-10 days] while the same for the non-survivors was 6 days [IQR: 2-11 days]. In the multivariable cox-proportional hazard model; travel distance (>16 km) [adjusted hazard ratio (aHR): 0.69, 95% CI: (0.50-0.95)], mode of transport to the hospital (ambulance) [aHR: 0.62, 95% CI: (0.45-0.85)], breathlessness (yes) [aHR: 0.56, 95% CI: (0.40-0.77)], number of co-morbidities (1-2) [aHR: 0.66, 95% CI: (0.47-0.93)] (≥3) [aHR: 0.16, 95% CI: (0.04-0.65)], COPD/asthma (yes) [ [aHR: 0.11, 95% CI: (0.01-0.79)], DBP (<60/≥90) [aHR: 0.55, 95% CI: (0.35-0.86)] and qSOFA score (≥2) [aHR: 0.33, 95% CI: (0.12-0.92)] were the significant attributes affecting LOS of the COVID-19 patients. CONCLUSION: Factors elicited on arrival were found to be significantly associated with LOS. A scoring system inculcating these factors may be developed to predict LOS of the COVID-19 patients.

Evaluation of Ivermectin as a Potential Treatment for Mild to Moderate COVID-19: A Double-Blind Randomized Placebo Controlled Trial in Eastern India.

BACKGROUND: There has been a growing interest in ivermectin ever since it was reported to have an in-vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This trial was conducted to test the efficacy of ivermectin in mild and moderate coronavirus disease 19 (COVID-19). METHODS: A double blind, parallel, randomised, placebo-controlled trial conducted among adult COVID-19 patients with mild to moderate disease severity on admission in a COVID dedicated tertiary healthcare of eastern India. Enrolment was done between 1st August and 31st October 2020.  On day 1 and 2 post enrolment, patients in the intervention arm received ivermectin 12 mg while the patients in the non-interventional arm received placebo tablets. RESULTS: About one-fourth (23.6%) of the patients in the intervention arm and one-third (31.6%) in the placebo arm were tested reverse transcriptase polymerase chain reaction (RTPCR) negative for SARS-CoV-2 on 6th day. Although this difference was found to be statistically insignificant [rate ratio (RR): 0.8; 95% confidence interval (CI): 0.4-1.4; p=0.348]. All patients in the ivermectin group were successfully discharged. In comparison the same for the placebo group was observed to be 93%. This difference was found to be statistically significant (RR: 1.1; 95% CI; 1.0-1.2; p=0.045). CONCLUSIONS: Inclusion of ivermectin in treatment regimen of mild to moderate COVID-19 patients could not be said with certainty based on our study results as it had shown only marginal benefit in successful discharge from the hospital with no other observed benefits.

Seroprevalence of IgG against SARS-CoV-2 and its determinants among healthcare workers of a COVID-19 dedicated hospital of India.

Healthcare workers (HCWs) due to their job profile are at utmost risk of contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Serological survey is an useful tool for vulnerability mapping in an infectious disease pandemic. The aim of the current study was to assess seroprevalence of IgG against SARS-CoV-2 and its determinants among HCWs of a tertiary healthcare facility of India. It was an observational study, cross-sectional in design conducted among 919 HCWs of All India Institute of Medical Sciences, Patna, Bihar, India during September, 2020. In results, IgG seroprevalence for SARS-CoV-2 among the study subjects was 13.3% [95% confidence interval (CI): 11.2-15.6%]. In univariate logistic regression analysis; gender, occupation, place of posting, use of full personal protective equipment (PPE), prior corona virus disease (COVID)-19 infection, influenza like illness (ILI), use of steam inhalation, consumption of azithromycin, zinc and vitamin C were the significant attributes which affected the IgG seropositivity for SARS-CoV-2. In the multivariable logistic regression model; occupation, place of posting, prior COVID-19 infection and ILI were significant determinants of IgG seropositivity for SARS-CoV-2. To conclude, majority of the HCWs were found to be IgG seronegative for SARS-CoV-2. Till availability of effective vaccine all of the HCWs should abide by infection prevention and control (IPC) measures to keep themselves and their contacts protected from SARS-CoV-2.

Attributes of screening and vaccination for cervical cancer: insights of an online survey among female school teachers of Kota, Rajasthan, India.

Background: Cervical cancer is largely preventable. The study was aimed to find out the attributes of screening and vaccination for cervical cancer among female school teachers of Kota, Rajasthan, India. Methods: It was an observational study, cross-sectional in design conducted among female school teachers of Kota, Rajasthan, India using a predesigned structured questionnaire administered by Google Form during the months of March to May, 2020. In total, 397 schoolteachers from 18 different schools of Kota participated in our survey. Results: Among the study subjects, 33 (8.3%) had ever undergone screening for cervical cancer, whereas only 12 (3.0%) had taken vaccine against it. In multivariable logistic regression analysis; age (>40 years) [adjusted odds ratio (AOR): 5.7 (2.0-15.8)], correct knowledge regarding frequency of screening (yes) [AOR: 6.0 (2.4-15.5)], positive attitude for the disease (yes) [AOR:3.0 (1.1-8.0)] and gynaecologist consultation behaviour (periodic) [AOR: 1.4 (1.1-8.6)] were significant attributes of ever undergoing screening for cervical cancer. On the other hand, themultivariable significant attributes of vaccination were age (≤40 years) [AOR: 7.6 (1.5-38.9)]and positive attitude for the disease (yes) [AOR: 6.4 (1.1-38.2)]. Conclusion: Acceptance of screening and vaccination for cervical cancer among the study subjects was found to be quite low. Policymakers should more actively involve school teachers in generating awareness and in raising the demand for cervical cancer screening and vaccination in their native communities to curb the disease in the country.

Malnutrition, Its Attributes, and Impact on Quality of Life: An Epidemiological Study among ß-Thalassemia Major Children.

BACKGROUND: India is home to a large number of thalassemic children. Despite malnutrition being an essential determinant of their therapeutic goals and quality of life (QoL), it was hardly ever explored. With this background, this study aimed to estimate the proportion of ß-thalassemia major (ß-TM) children experiencing malnutrition, its attributes, and impact on their QoL. METHODS: This cross-sectional, hospital-based, analytical observational study was conducted among 328 ß-TM children attending the thalassemia day care unit of a medical college from May 2016 to April 2017, with a structured schedule. Data were analyzed following appropriate statistical methods using SPSS statistical package ver. 16.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Among the study participants, 48.2% were malnourished with a mean body mass index of 13.9 kg/m2 . In the multivariable logistic regression model, participants' age (adjusted odds ratio [AOR], 1.15; 95% confidence interval [CI], 1.02-1.29), caste (AOR, 2.11; 95% CI, 1.23-3.60), mothers' educational level (AOR, 2.05; 95% CI, 1.22- 3.44), blood transfusion frequency (AOR, 1.25; 95% CI, 1.16-1.31), and palpable spleen size (AOR, 1.22; 95% CI, 1.08-1.37) were significant predictors of malnutrition after adjusting for pre-transfusion hemoglobin level and hemolytic facies status. In multiple linear regression analysis, malnutrition negatively impacted total QoL (unstandardized beta [standard error], -4.4 [1.7]; P=0.009) and various domains of the study participants except the social and school domains adjusted for age, sex, caste, place of residence, parents' educational level, and socioeconomic status. CONCLUSION: Almost half of the study participants had malnutrition. Malnutrition had a negative impact on their QoL.

Epidemiological determinants of COVID-19 infection and mortality: A study among patients presenting with severe acute respiratory illness during the pandemic in Bihar, India.

OBJECTIVES: The study was designed to explore epidemiological characteristics, determinants of COVID-19 infection development and mortality of patients presenting with severe acute respiratory illness (SARI) to a tertiary care health facility of Bihar. METHODS: This was an observational record-based study, longitudinal in design. Data of 281 SARI patients who have attended All India Institute of Medical Sciences, Patna, Bihar, India during 25th April 2020, till 12th July 2020 (16 weeks) were used for the study. RESULTS: Out of 281 study participants, 95 (33.8%) were detected to have COVID-19 and 42 (14.9%) died. Among COVID-positive study subject's death rate was 28.4%. In the multivariable logistic regression analysis; increasing age (adjusted odds ratio [AOR] = 1.02 [1.00-1.03]), gender (males) (AOR = 2.51 [1.27-4.96]), presenting symptom (cough) (AOR = 2.88 [1.46-5.70]), co-morbidity (hypothyroidism) (AOR = 4.59 [1.45-14.56]) and delay between symptom onset and admission (>2 days) (AOR = 2.46 [1.19-5.07]) were significant predictors of COVID-19 infection among study participants adjusted with other co-morbidities (diabetes and hypertension). Similarly, place of residence (outside Patna district) (AOR = 2.38 [1.03-5.50]), co-morbidity (diabetes) (AOR = 3.08 [1.12-8.50]), intensive care unit (ICU) requirement at admission (yes) (AOR = 9.47 [3.98-22.52]) and COVID status (positive) (AOR = 6.33 [2.68-14.96]) were significant predictors of death among the study participants whereas place of residence (outside Patna district) (AOR = 4.04 [1.33-12.28]) and ICU requirement at admission (yes) (AOR = 7.22 [2.54-20.52]) were attributes affecting death of COVID-positive study participants. CONCLUSION: Risk of COVID-19 infection among the study participants was high. Age, gender and co-morbidities increased the risk of infection. COVID-19 infection negatively impacted the treatment outcome of the study participants. Age, co-morbidity and ICU requirement were the other attributes affecting mortality.

Health seeking behavior of ß-thalassemia major children and its attributes: An epidemiological study in Eastern India.

BACKGROUND: Health seeking behaviour (HSB) of thalassemic children is one of the rarely explored entity. AIM: To explore HSB of ß-Thalassemia Major (ß-TM) children and its attributes. MATERIALS AND METHODS: It was a cross-sectional design, observational study, conducted among 328 ß-TM children and their caregivers attending a tertiary care health facility of Kolkata; West Bengal situated in Eastern India in between May 2016 and April 2017 with a structured schedule. The data were analyzed using SPSS 16.0 version. RESULTS: At the disease onset, 79.6% of them consulted an allopathic doctor. In multivariable logistic regression model, those who were residing in urban area [adjusted odds ratio, AOR: 3.2 (1.2-8.7)], Hindu by religion[AOR: 3.0 (1.2-7.4)], had educated parents [AOR: 3.2 (1.1-9.2)], no family history of the disease [AOR: 3.6 (1.5-8.5)], belonged to higher socio-economic status (Class II, III and IV) [AOR: 2.9 (1.2-6.8)] and had caregiver with satisfactory knowledge related to the disease (≥4)[AOR: 12.2 (5.1-29.6)] were significantly more likely to seek healthcare from an allopathic doctor at onset of the disease. When we consider their HSB till date, 61.0% continued to consult allopathic doctors only. The multivariable determinants of satisfactory HSB till date were place of residence [AOR: 2.7 (1.4-5.2)], caste [AOR: 3.3 (1.6-6.7)], religion [AOR: 3.4 (1.7-6.9)], family history of the disease [AOR: 2.3 (1.2-4.6)] and caregiver's knowledge related to the disease [AOR: 5.3 (3.1-9.2)]. CONCLUSIONS: HSB of the study participants were significantly associated with their caregiver's knowledge regarding the disease, parents' educational level, socio-economic status, caste, religion and family history of the disease.

Care-Related Quality of Life of Caregivers of Beta-Thalassemia Major Children: An Epidemiological Study in Eastern India.

Caregivers are the persons who provide care at the time of distress or illness. They face many stress and strain to provide the best possible medical care for their children. There are very few studies that explored the care-related quality of life (CarerQoL) of the caregivers of thalassemic children and its correlates. With this background, the current study was designed to explore the CarerQoL of the caregivers of ß-Thalassemia Major (ß-TM) children and its various correlates. It was a cross-sectional observational study conducted among caregivers of ß-TM children attending a tertiary care health facility of Eastern India in between May 2016 and April 2017 with a structured schedule. The median CarerQoL score was found to be 5 with an interquartile range of 4-7 (range: 11). In the final multivariable logistic regression model, care receivers' (thalassemic children) age [adjusted odds ratio (AOR): 2.2 (1.2-4.2)], spleen status [AOR: 4.1 (2.0-8.7)], blood transfusion frequency [AOR: 2.1 (1.1-3.9)], and quality of life (QoL) [AOR: 3.0 (1.6-5.5)] and caregivers' educational level [AOR: 2.3 (1.2-4.1)], perceived social discrimination [AOR: 2.3 (1.3-4.1)], debt [AOR: 2.3 (1.2-4.3)], nongovernmental organization assistance [AOR: 2.0 (1.0-4.0)], and wage loss due to seeking treatment [AOR: 1.9 (1.1-3.4)] were significant predictors of CarerQoL of the study participants adjusted with their age, sex, working status, per-capita monthly income, knowledge level related to the disease, and care receivers' comorbidity status. To conclude, CarerQoL of the study participants were significantly associated with QoL of their wards. Other significant associates of CarerQoL were caregivers' education level, financial profile, patients' age, and their clinico-therapeutic profile.

Doctor Consultation through Mobile Applications in India: An Overview, Challenges and the Way Forward.

OBJECTIVES: To layout mHealth (mobile health) applications operating in India with the facility of either online doctor consultation or offline doctor appointment booking. METHODS: A cross-sectional, observational and web-based study was conducted. We searched the Google Play Store with the search strategy "health apps in India". In the results, 250 applications (apps) appeared. Out of 250 apps, finally, 22 apps were found to be providing online doctor consultation and/or doctor appointment booking-related services. RESULTS: Among the selected mHealth apps operating in India and providing doctor consultation-related services online/offline, Practo, mfine, DocsApp, 1mg, Netmeds, Lybrate, MediBuddy, and Medlife were found to be the eight most popular ones with over a million downloads and on average four-plus user rating out of five. Practo, mfine, and Lybrate offer doctor consultation through chat, audio, and video calling. Netmeds and DocsApp offer doctor consultation through both chat and audio call. 1mg offers free chat consultation, while MediBuddy and Medlife offer audio call consultation only. Considering booking doctor appointments for offline consultation, Practo, mfine, 1mg, and Lybrate only offer this facility among the eight most popular selected mHealth apps. CONCLUSIONS: mHealth apps providing doctor consultation are gaining popularity in India, and they have enormous potential in the country. The government should make enabling policies to facilitate and popularise mHealth apps.