Multipronged effects of increased screen time on the nutritional imbalance: A cross-sectional study of students of Amritsar aged 6-16 years.

Background: Intense marketing of fast-food items impacts the eating habits among children and adolescents. Various studies suggest that increased screen time leads to increased fast-food consumption and decreased sleep duration, both of which are linked to obesity in growing age. Objectives: To assess screen time and dietary habits among the study group and to estimate their effect on sleep deprivation and obesity. Methods: This cross-sectional study was conducted from January 2019 to December 2019 in three schools in Amritsar selected by lottery method of simple random sampling. Out of 4,226 students, 355 overweight and obese students were interviewed regarding their dietary habits. An informed written assent was taken from the mothers. The information was collected on a semi-structured, pre-designed questionnaire by interviewing the mothers of students between 6 and 11 years of age and the students of 12-16 years. Results: 94.4% of students preferred fast foods to regular meals and 58.3% were in the habit of skipping breakfast. 59.4% had a history of daily intake of fast foods while 76.1% had a habit of consuming fast foods while watching television. Only 31.7% had an adequate sleeping pattern of 9-11 hours and 79.7% of the students had a screen time of over 3 hours. Conclusions: More the screen time, the more the chances of missing meals. Being awake for a long odd time leads to increased consumption of foods/snacks furthermore. Regarding the harmful effects of fast foods, the source of information was from schools, but only 41.4% were aware about these effects.

Assessing the Utilization of Postnatal Services Among Mothers: A Cross-Sectional Study.

BACKGROUND: Women in the postnatal period are a special group with a high risk to health. Providing good quality postnatal care can help reduce maternal morbidity and mortality and improve the quality of life. The objective of the study was to assess the utilization of the postnatal services provided to mothers and to find the factors affecting the utilization of these services. MATERIALS AND METHODS: A cross-sectional study where 154 mothers from Patiala were interviewed regarding postnatal services using a pretested semi-structured questionnaire. RESULTS: A total of 92.9% of mothers (95%CI=88.76-97.04) availed postnatal care with a multi-purpose health worker-female (MPHW-F) and an accredited social health activist (ASHA (U)) as the main providers. Only 47.4% of mothers (95%CI=39.35-55.45) had visited a doctor for a postnatal check-up. Mother's education, type of family, place, and type of delivery were significantly associated with the number of visits to the doctor during the postnatal period. Thirty-nine (25.3%) mothers (95%CI=18.3-32.3) reported a health problem in the period, out of which only 32 mothers had taken treatment for their health problems. Mothers who were visited by MPHW-F in the postnatal period had fewer morbidities as compared to those who were not visited by MPHW-F (χ2=7.697; df=2; p value=0.02). CONCLUSIONS: Working women with cesarean section delivery in the private sector reported more utilization of postnatal services. These women had higher education levels and belonged to joint families. More visits by MPHW-F were associated with fewer health problems. A multi-pronged approach, targeting individuals, families, and communities, may be necessary to improve postnatal care service utilization rates.

Positive influencers for early initiation of breastfeeding.

Background: The practice of newborns being put to the breasts soon after birth results in a reduction in neonatal mortality. Factors such as antenatal care attendance, delivery at the Baby Friendly Hospital Initiative (BFHI) facility, mode of delivery, number of children, and various socio-cultural practices are found to have a positive impact on the early initiation of breastfeeding. The present study was performed to determine the socio-demographic, maternal, and neonatal factors affecting the early initiation of breastfeeding. Methodology: A hospital-based cross-sectional study was performed at the Immunization Clinic and Nursery situated in a government tertiary care hospital for assessing the pattern of breastfeeding initiation. Children born at the hospital and also those reporting to the clinic from outside were included in the study. Results: Breastfeeding initiation within 1 hour after delivery was only 30%, and 9% did not initiate breastfeeding at all. About half of the reasons for not initiating breastfeeding were related to mothers, followed by 30% related to babies. Conclusion: Upon regression analysis, it was found that urban residence, higher educational status of the mothers, and those mothers who were not counselled on breastfeeding during antenatal visits had higher odds of not initiating breastfeeding and that was statistically significant.

Awareness and Hesitancy of COVID-19 and other Vaccines among People Living with HIV/AIDS Attending Antiretroviral Therapy (ART) Center in North India.

Introduction: Approximately 40 years have passed since we first learned about the human immunodeficiency virus (HIV), but several people living with HIV (PLHIV) in developing countries such as India cannot avail treatments. This makes preventive measures, such as vaccinations, critical in these persons to avoid vaccine preventable diseases (VPDs). However, little is known about the willingness and perceptions of PLHIV regarding these vaccines. Therefore, we explored vaccine awareness and hesitancy, especially during the recent COVID-19 pandemic. Objectives: The primary objective was to determine the uptake of the Covid-19 vaccine and other VPD's among PLHIV and factors affecting the same in Antiretroviral therapy (ART) centers in a tertiary care hospital in North India. Research Design and Methods: This was a cross-sectional study of HIV patients who attended our Antiretroviral Therapy center (ART). Clinical data were collected using a questionnaire on general profile, disease information, knowledge, attitude, and practice (KAP) regarding vaccinations, and vaccination status for different VPDs. Results/Findings: We enrolled 300 subjects and found that 82% of the patients attending our ART center were aware of vaccinations, most of whom were aware of the polio vaccine (n=91, 30.33%), followed by tuberculosis (n=61, 20.33%), and the majority of them were not aware of vaccines indicated in PLHIV. We also found that the majority (n= 240, 80.23%) of patients had vaccine hesitancy, especially regarding the new COVID-19 vaccine. Conclusion: There is a need to create awareness among people about the benefits and uses of vaccination to achieve the greater goal of reduced morbidity and mortality among PLHIV. There is a need for free vaccination programs for VPDs in PLHIV patients.

A Study to Assess Symptom Profile and Break Through Infections Among Health Care Workers Post Covid Vaccination at Tertiary Care Health Facility.

Introduction: Breakthrough infections in fully vaccinated persons pose a major challenge to the ongoing vaccine campaign against SARS-CoV-2 globally. Objectives: To investigate the occurrence of breakthrough infections and the association of Covid symptoms with the vaccination status of health care workers (HCWs). Material and Methods: Done in Government Medical College, Patiala among Covid-positive HCWs who have received one or both doses of Covid vaccine, using pretested semi-structured validated Proforma and telephonic interview from April 1, 2021 to June 15, 2021. Results: Among 3388 HCWs, 115 vaccinated HCWs (1st or 2nd dose) became Covid positive. Among vaccinated Covid positive HCWs, 54 received the first dose and 61 both doses. Breakthrough infections (≥14 days post 2nd dose) occurred in 4.6% (47 of 1021) HCWs. The vaccine is significantly protective as shown by an odds ratio of 0.27; thus, vaccinated HCWs are 73% less likely to get Covid infection as compared to non-vaccinated HCWs. There was no statistically significant difference between symptom profiles of cases whether they took one or both doses of vaccine, except headache. Only tiredness and headache were reported significantly higher in the unvaccinated group in comparison to vaccinated HCWs. Conclusion: Research is needed on tracking the immune response and viral genomic sequence of samples of vaccinated Covid-positive HCWs to have constant vigilance on remerging new strains of the SARS-CoV-2.

Assessment of knowledge of ASHA workers regarding MCH services and practices followed by mothers - A field study.

Background: Accredited social health activist (ASHA) workers act as a "bridge" between rural people and health service outlets and play a central role in achieving national health and population policy goals. According to the National Family Health Survey (NFHS) V (2019-2021) data, infant mortality rate (IMR) is still high in rural areas (32.4 per 1000 live births) in Punjab, compared to urban areas (20.1). Maternal mortality ratio (MMR) is also high (129 per lakh), according to sample registration system (SRS) 2016-2018 data. Materials and Methods: In this descriptive, cross-sectional study conducted at RHTC, Bhadson, we assessed the knowledge of ASHA workers regarding maternal and child health (MCH) services and their provision by them to their beneficiaries (mothers with children aged 0-6 months). Out of the total 196 ASHA workers, 72 were selected randomly to assess their knowledge, while 100 beneficiary mothers were interviewed face to face to assess the services provided by the ASHA workers. Results: Almost 65.2% of ASHA workers were above 35 years of age. Majority of the ASHA workers (40/72) replied that average weight gain in pregnancy is 10 kg. Very few, that is, 17 (23.6%), ASHA workers knew that breastfeeding should be started within the first hour after delivery of the baby. Counseling regarding nutrition, birth preparedness, institutional delivery, and birth registration was given by ASHA workers to 75%-85% of mothers. There was statistically significant improvement in the practices by mothers with the counseling given by ASHA workers regarding pre-lacteal feed, utilization of family planning methods, and delaying early bathing. Conclusions: The study concludes that ASHA workers have good knowledge regarding various aspects of antenatal period, but when it comes to postnatal period and care of the newborn, there are some lacunae. These aspects of newborn care need to be reinforced into the refresher trainings of the ASHA workers.

Vaccine wastage at primary, secondary, and tertiary level of healthcare system-A study from Northern India.

BACKGROUND: High vaccine wastage results in escalation of budget of immunization program. OBJECTIVE: To analyze vaccine wastage at three levels of service delivery under public sector, such as at district level, community health Centre (CHC), and sub center (SC). STUDY DESIGN: A retrospective cross-sectional record based study in a north Indian state. MATERIALS AND METHODS: The record from January to June 2016 was taken from randomly selected 5 districts of the state at 3 levels; for number of doses of vaccine used and number of children vaccinated for BCG, OPV, Hepatitis B, Pentavalent, DPT, IPV, Measles, and TT (vaccines being given in state in the study year). A total of 67,550 vaccine doses in routine immunization were studied. STATISTICAL ANALYSIS USED: Data were presented in mean ± standard deviation. One-way ANOVA test was used to compare the means among three levels. RESULTS: Vaccine wastage for Pentavalent was remarkably low (4.86% at district level, 8.35% at CHC and 11.50% at SC) in contrast to other similar 10 dose vials of vaccines like DPT, TT, Hep B. For both the lyophilized vaccines, interestingly BCG wastage was not only significant but over the permissible levels at 60.39%, whereas it is not so for measles. Result indicated that mean difference of the vaccine wastage among three levels was significant for the BCG, OPV, Hepatitis B, Pentavalent, and TT (P < 0.05); while insignificant for the DPT, IPV, and Measles (P > 0.05). CONCLUSIONS: Not all vaccine wastage is preventable, but pruning the corners where feasible and allowing where it is desirable should depend on prioritizing stakeholders at the receiving end.

Factors affecting nutritional status of Anganwadi children: A cross-sectional study.

INTRODUCTION: As per the National Family Health Survey (NFHS) 2015-16, 35.7% children below 5 years of age are underweight. In light of Malnutrition rates still remaining alarming in children, it becomes pertinent to elicit the factors that affect nutritional status of children. So, this study was undertaken. MATERIALS AND METHODS: After obtaining ethical approval from institutional ethics committee, data were collected on a pretested questionnaire. Information from mothers of 1085 children attending Anganwadi center in an urban block of Patiala was collected and analyzed. RESULTS: Among females, 35.85% were underweight, whereas the proportion for males was 28.68%. The proportion among immunized children who were underweight was 31.34%, whereas the proportion among unimmunized children was 38.91%. Those who received supplementary nutrition were also in more in numbers in normal weight range than those who did not. CONCLUSION: Gender, birth order, and immunization status of child are significantly associated with nutritional status. This study showed that prevalence of malnutrition was less among those who received supplementary nutrition as compared to ones who did not.

Are adolescents ready for future responsibilities? Experience from a cross-sectional study regarding Breastfeeding knowledge and attitude.

BACKGROUND: Breastfeeding plays an important role in the holistic development of a child. Current knowledge and attitude of future parents will significantly influence breastfeeding practices. Therefore, ascertaining current knowledge and attitude of both soon-to-be parents will help to formulate breastfeeding promotion strategies. RESEARCH AIM: To ascertain the knowledge and attitude of adolescents towards breastfeeding and its correlates with socioeconomic and demographic factors. MATERIALS AND METHODS: A cross-sectional institutional based study in which participants were recruited from Punjab, state of India. A total of 392 adolescents from January to June 2017 were evaluated on the basis of a pretested, reliable, and valid instrument. The instrument consisted of questions on knowledge and attitude regarding breastfeeding. RESULTS: One-hundred two (26%) participants had good knowledge and 290 (74%) had poor knowledge regarding breastfeeding. A bothersome fact is that only 25% of the participants knew about the age till which a child should be breastfed. There was a statistically significant (OR = 2.93; 95% CI: [1.45--5.93]) association between high knowledge and positive attitude. CONCLUSION: The level of knowledge amongst adolescents showed variation ranges from 15.82% to 93.11% on various aspects of breastfeeding. Despite this glaring variation, 75% of the participants had a positive attitude towards breastfeeding. Thus, there is a need for implementing modified and improved breastfeeding promotion strategies in India.

Positive impact of rescheduling Bacillus Calmette-Guérin vaccination on vaccinations at birth.

CONTEXT: Inimitable among the trio of recommended immunizations administered to newborns at delivery centers of institutions is hepatitis B. While it is necessary for hepatitis B to be given within 24 hours of birth, the same cannot be said for Bacillus Calmette-Guérin (BCG) and zero-dose oral polio vaccine (OPV). OBJECTIVE: To assess the impact of rescheduling of BCG vaccination from the current twice weekly to daily to cover newborn vaccinations at the Government Medical College, Patiala, India. MATERIALS AND METHODS: Until 2015, the delivery of BCG vaccine was restricted to twice a week, but from the year 2015, the schedule was changed from twice weekly to daily. Records for the 2 years, 2014 and 2015, were obtained, i.e., before and after the change. Data on 7065 babies born from January 2014 to December 2015 were statistically analyzed for the coverage of birth dose of hepatitis B, BCG, and OPV using Microsoft Excel. Chi-square test was applied, and p < 0.05 was considered significant. RESULTS: Rescheduling of BCG dose, from twice weekly to daily, the coverage of BCG and OPV zero dose increased from 54% (in 2014) to 78% (in 2015), and a marked increase from 8.2% to 42.9% was noted for the birth dose of hepatitis B. By rescheduling BCG (twice weekly to daily), the vaccine wastage increased from 21.5% to 26.2%, the difference found to be statistically insignificant. CONCLUSIONS: Modification in the delivery of immunization service from twice a week to daily has had a good impact on the vaccination of newborns though the goal of achieving the ideal 100% coverage is yet to be reached. Apart from the immunization of newborns, improving parental awareness, better coordination between immunization staff and maternal health staff, improved communication, and clear delineation of responsibility and answerability in the immunization service delivery will have a good impact on the vaccination of newborns.

Understanding health seeking behavior.

Leaving conventional "Dai" assisted home delivery to opt for institutional delivery is not unusual followed by shift from rural to urban living. However, this case, in particular, is oddly different. Hence, a deeper insight is warranted leading to a view that is unique. While analyzing the reasons it stands as a pointer in policy formulation, a necessity to understand such cases. Health belief model is applied in arriving at the inferences. It is often not just what is offered that makes bait but how it is perceived by the recipient matters. This can be visualized by this case study.