Tobacco use in currently married pregnant & lactating women in India; key findings from the National Family Health Survey-5.

Background: Tobacco use among pregnant and lactating women carries dangerous repercussions for women and their children. Limited information is available at the national level on the prevalence and determinants of tobacco use in this vulnerable sub-population of women. This study aims to estimate the prevalence of tobacco use among currently married pregnant and lactating women and its association with demographic, behavioural and regional determinants in India. Methods: A cross-sectional study was conducted during which secondary data from the fifth National Family Health Survey, 2019-2020, was analysed. The prevalence and associated 95% confidence intervals (CI) for different forms of tobacco use were documented among currently married pregnant and lactating women. Adjusted Odds Ratio and 95% CI were calculated using multivariate logistic regression to identify the independent factors associated with different forms of tobacco use among respondents after applying sampling weights. Findings: In India, the prevalence of tobacco use among currently married pregnant and lactating women was 2.5% and 3.2%, respectively, with over 85% of tobacco-using currently married pregnant (85.6%) and lactating (85.6%) women using smokeless tobacco (SLT) only. Age group 30-34 years, working women and the richest wealth quintile were found to be independent predictors of smoked tobacco use among currently married pregnant women. In contrast, among the currently married lactating women, the middle wealth quintile and South Indian region were found to be independent predictors of smoked tobacco use. Interpretation: Smokeless tobacco was found to be the most prevalent type of tobacco consumed by pregnant and lactating women in India. There is an urgent need to curb tobacco use in this vulnerable sub-population of women in the country by sensitising them to the harmful consequences of tobacco use by integrating tobacco awareness and cessation services during routine ante-natal examinations. Funding: No funding was received for this study.

Assessment of the risk of developing type 2 diabetes using the Indian diabetes risk score in an urban community in Chandigarh, India: A cross-sectional study.

BACKGROUND: The urban poor is a group that is known to be vulnerable to the adoption of a more urbanized lifestyle that places them at a higher risk for diabetes. Identification of at-risk individuals using simple screening tools like the Indian diabetes risk score developed by Madras Diabetes Research Foundation (MDRF-IDRS) and appropriate lifestyle interventions could greatly help in preventing or postponing the onset of diabetes and thus reducing the burden of the disease on the community and the nation as a whole. MATERIALS AND METHODS: A cross-sectional study was conducted on individuals ≥30 years (n = 1533) of both genders in an urban colony of Chandigarh during a period of 1 year. A stratified two-stage systematic random sampling was adopted. The risk of developing Type 2 diabetes mellitus was assessed using IDRS. The total risk score of each participant was analyzed and compared. Biochemical investigations, including blood glucose and lipid profiles for detecting diabetes, were conducted. Data were presented in percentages and proportions. The statistical analysis of the data was performed by using the Chi-square test and logistic regression analysis. RESULTS: The prevalence of diabetes was 3.1% in the present study. Overall, the mean IDRS was found to be 52.14 ± 16.01. Elderly persons aged 60 years and above had higher IDRS. IDRS showed significant variability with age (P < 0.001). Females had significantly higher IDRS as compared to males (P = 0.002). The association between socioeconomic class and risk status was highly significant statistically (P < 0.001). IDRS among individuals with diabetes was found to be significantly higher (64.29 ± 13.92) as compared to non-diabetics. Among all, 749 (48.7%) had high IDRS, whereas 54 (3.5%) had low IDRS. There were 734 (47.8%) with moderate IDRS. CONCLUSION: IDRS was found to be highly sensitive for detecting the risk of diabetes, suggesting its potential use as a screening tool in community setup for the purpose of detecting diabetes.

Prevalence and predictors of low bone mineral density among adults aged 50 years and above in Chandigarh, India.

Background: Osteoporosis, defined as skeletal disorder characterized by reduced bone density and strength, is prevalent in both developing and developed countries. Dual energy X-ray absorptiometry (DEXA) is an effective tool to diagnose low bone mineral density (BMD). Objective: This study objective was to know the prevalence and predictors of low BMD in a community-based screening program among the adult population using DEXA scan. Methods: In this community-based study conducted between January and June 2016, a population-based screening program was offered to both males and females of age 50 years and above. BMD was measured to derive T-scores and classify as normal, osteopenic, and osteoporotic individuals. Results: A total of 455 subjects were enrolled where 62.4% proportion was women; 42.6% subjects were in the age group of 50 to 59 years. The prevalence of osteoporosis and osteopenia was 20.9% and 48.1%, respectively. Hypertension (23.7%) and diabetes (8.4%) were common comorbidities. Age and gender (female) were independent predictors of low BMD. Conclusion: Osteoporosis/osteopenia is present in both genders with increasing trend with age advancement. Institution of timely screening will prevent the morbidity associated with fractures due to low BMD.

Introducing Communication Skills Training among Interns using Attitude, Ethics, and Communication Module.

Background: Communication skills are the backbone for patient care services such as patient interviews, counseling the patient, and explaining treatment options. The present study was conceived to evaluate the communication training program and perceptions of medical interns and faculty regarding the same. Methodology: Sixty medical interns were included in this cross-sectional study. Training on communication skills was imparted which was later assessed on the basis of Kalamazoo scale. Attitude of the interns regarding communication skill training was assessed using Rees and Sheard Scale. The attitude of faculty regarding introduction of communication skill was also assessed. Results: The mean score on Kalamazoo Consensus Scale was 19.65 ± 4.97 with a range of 10-29. Females had a higher score (21.09 ± 5.80) as compared to males (17.88 ± 3.21), but this was not statistically significant (P = 0.157). The mean score for positive and negative attitude scale was 59.15 ± 5.51 and 25.20 ± 9.60. Conclusion: The ability to communicate effectively is a core competency expected of medical graduates and communication skills training of medical students and interns with the help of didactic lectures, role plays, and videos, etc., can go a long way in improving their communication skills.

Contraceptive awareness and practices in reproductive age couples: A study from urban slums of Punjab.

Introduction: Developing countries are characterised by high birth rates and explosive population growth. With a lower contraceptive usage rate among eligible couples and resistance towards family planning methods, the goal of population stabilisation looks distant. The present study was conceived to assess knowledge, attitude and practices regarding contraceptive usage and to identify the barriers in reproductive-age couples in an urban slum area. Methods: The present study was cross-sectional in nature and was conducted in an urban slum. Three hundred married subjects were enrolled through a convenient sampling technique. One member of the married couple was interviewed for the present study. Data were collected through a semi-structured proforma. Results: 67% of the participants were using one or another contraceptive. Higher contraceptive usage was seen in more educated participants. Awareness was higher in males regarding contraception. Condom was the most known method for contraception. Three fourth of the participants agreed with two-child norm. Preference for a male child was less than 50% in both genders. Current users of condoms and oral contraceptive pills were 71.8% and 7.1%, respectively. Wanting children, fear of side effects and lack of knowledge were cited as reasons for not choosing family planning methods. Conclusion: With a suboptimal level of awareness and attitude among respondents regarding contraceptive methods, there exists a gap between awareness and practice. Misconceptions regarding contraceptive methods can be allayed through health education, involvement of the community and religious leaders and peer counselling.

Gap between awareness and practices regarding maternal and child health among women in an urban slum community.

OBJECTIVE: To investigate the knowledge of ever-married women regarding maternal and child health and to assess existing gap between awareness and practice levels of lactating mothers. METHODS: Community based cross sectional study with 283 ever-married women in the reproductive age. RESULTS: Low levels of awareness and practice of TT immunization (74.2% awareness, 58.1% practice), five-cleans (31.9% awareness and 14.4% practice), trained birth attendant (69.6% awareness 39.1% practice), and post-natal care (75.4% awareness and 51.0% practice) among lactating mothers. Knowledge regarding optimal infant and young child feeding practices was very poor: initiation of breast-feeding within six hours (17.4%), colostrum feeding (34.8%), exclusive breastfeeding (5.8%) and significant gaps between knowledge and practice were observed. Highly significant difference (P<0.001) between proportions of women aware of ICDS (59.4%) and of beneficiaries (21.7%). High levels of awareness regarding reproductive health parameters except for contraception: desire for two children (81.6%), legal ages at marriages for girls (84.5%), desired birth interval of three or more years (71.7%). CONCLUSION: Wide gaps exist between awareness and practices related with MCH due to non-adoption of knowledge into actual practice, except some selected components lacking in both knowledge as well as practice. Need for bridging the existing gaps avoiding socio-cultural barriers and misconceptions prevailing in the community and by promoting and protecting healthy MCH care practices.

Treatment outcomes of patients placed on treatment under directly observed therapy short-course (dots).

BACKGROUND: Tuberculosis continues to be a pressing health problem in India. The Revised National Tuberculosis Programme (RNTCP), an application of Directly Observed Treatment Short-course (DOTS) in India, launched in 1997 needs continuous evaluation. OBJECTIVE: To study the outcomes of treatment among the patients put on DOTS under RNTCP in Chandigarh, UT. MATERIAL #ENTITYSTARTX00026; METHODS: A Longitudinal study was conducted during 2004-2005 in 13 Microscopic centres (MC's) spread over 2 Tuberculosis Units (TU's) under District Tuberculosis Centre (DTC) in Union Territory (UT), Chandigarh. A sample of 265 respondents, selected by two-stage stratified random sampling technique, was recruited in the study cohort. Data analysis was done using SPSS-10 statistical software package. RESULTS: For Category I and Category II patients, the Success rate was 98.6% and 90.4% respectively. The overall default rate was 1.1% and failure rate was 2.6%. For re-treatment cases, failure rate was higher i.e. 5.8%. The sputum conversion rate among the new smear positive cases was 93.8% at 3 months of treatment. For the re-treatment cases, spu-tum conversion rate at 3 months was 94.1%. CONCLUSION: The study concludes that RNTCP is running successfully in UT Chandigarh, having high success rate and low default rate. The reasons for high failure rate should be explored in depth.

Surveillance of communicable diseases in tertiary health care system in Chandigarh, UT.

BACKGROUND: Communicable disease surveillance is to have baseline data which will be helpful for planning and also for identifying epidemics under non-evident conditions. OBJECTIVE: To delineate the pattern of occurrence of communicable diseases so as to enable early identification, followed by appropriate and timely response to outbreaks. MATERIALS AND METHODS: Reports of listed communicable diseases from various departments and centers of Government Medical College, Chandigarh, involved in clinical care and laboratory diagnosis, were collected by the Department of Community Medicine on a weekly basis. Analysis of surveillance data was done for a period of 1 year--including reports from March 2005 to February 2006. STATISTICAL ANALYSIS: Percentage, normal test of proportions, time series analysis. RESULTS: Out of 19,378 cases of various communicable diseases, 11,575, i.e, more than half, were dealt with by health centers. Thus maximum cases of acute respiratory infections (ARIs) [8,278 (71.87%)] and acute diarrheal diseases (ADDs) [3,148 (54.4%)] were dealt with by health centers. Of 19,378 cases, 11,518 (59.44%) were of ARIs, 5,786 (29.86%) of ADDs and 550 (2.84%) of pulmonary tuberculosis. There was no significant difference in the incidence of either disease between two sexes. Most, i.e, 4,413 (38.31%), cases of ARIs and 512 (86.49%) cases of pneumonia were reported in winter; ADDs--2,607 (45.05%) in summer; and typhoid--94 (41.04%) in the monsoon season. CONCLUSION: Maximum workload of common communicable diseases was borne by health centers. The most common morbidity was ARIs, followed by ADDs and pulmonary tuberculosis. No significant gender predilection was seen. Overall reporting of communicable diseases observed in three different seasons was found to show a gradual increase from winter to summer through monsoon. Some specific seasonal trends were demonstrated by various morbidities.