Preferences for induction of labor methods in India: a qualitative study of views and experiences of women, clinicians, and researchers.

Background: Induction of labor (IOL) is an increasingly common intervention, but experiences and preferences of induction methods are under-researched particularly in low -and middle-income countries. Understanding these perspectives is important to improve the childbirth experience. Objective: To explore the experiences and preferences of IOL methods for women, clinicians, and researchers in the "Misoprostol or Oxytocin for Labour Induction" (MOLI) study. Study Design: This qualitative study was based in two government hospitals in the city of Nagpur, India-one tertiary referral hospital and one women's hospital. Fifty-three semi-structured interviews with women before and after induction (between days 1 and 5 postnatal), with women recruited to the "Misoprostol or Oxytocin for Labour Induction (MOLI)" randomized controlled trial (NCT03749902). Eight focus group discussions with doctors, nurses, and trial research assistants before and during trial delivery were conducted. Thematic analysis was conducted using the Framework approach. Results: Four themes emerged: (1) IOL methods, (2) impact of the study, (3) IOL and childbirth as one small part of the wider experiences in life, and (4) key moments in the childbirth experience. For women, the safety of their baby was more important than any IOL method. Clinicians had apprehensions over misoprostol use which could affect protocol implementation; they reported that changing perception is difficult as usual practice feels "comfortable." Women wanted to share their experiences and reported key moments during childbirth including vaginal examinations, "trying for normal," bearing the pain, waiting, and relationships with staff. Conclusion: Women did not have a strong preference for the IOL method and viewed childbirth positively when maternal and neonatal outcomes were good. Labor pain, vaginal examinations, a normal birth, and interactions with staff impacted women's experiences.

Prevalence and Determinants of Developmental Delay in Children of 12-36 Months in the Area of Primary Health Centre, Bela, Nagpur.

BACKGROUND: Developmental delay happens when a child fails to attain age-appropriate milestones. Identification of developmental delay in children is important to initiate early intervention in them which will facilitate the children to have a productive life in their later years. OBJECTIVES: The objective was to study the prevalence of developmental delay among 12-36-month-old children from the area of Primary Health Centre, Bela, in rural Nagpur, Maharashtra. MATERIALS AND METHODS: This was a community-based cross-sectional study design. A total of 314 children were selected through simple random sampling and assessed for delay using the Pediatric Development Screening Tool (PDST). RESULTS: 14.9% had developmental delay in at least any one domain and 3.5% had global developmental delay. Domain-specific developmental delay was highest for language delay (10%) followed by fine motor (5%). Gross motor and personal social delays had the same prevalence (3.1%). On multivariable lower literacy, level of mother and Composite Index of Anthropometric Failure were significant variables for any developmental delay. Hospitalization of the child during the 1st month of life and lower parenting scores were the significant factors associated with global delay. CONCLUSION: Development delay is present in a sizeable proportion of children <3 years of age which affects their future growth and achievement. We recommend annual community-based screening for delays to detect and manage such children.

Intention to Quit Tobacco due to Media Advertisements in India: Findings from Global Adult Tobacco Survey 2016-17.

BACKGROUND: Tobacco has been among the most important causes of morbidity and mortality worldwide. In reducing tobacco consumption, media campaigns are crucial in raising awareness and encouraging individuals to quit. The present study aimed to profile participants of GATS-2, including tobacco usage patterns and media exposure, and explore the factors associated with quitting in the presence of media exposure. METHODS: Secondary data analysis of Global Adult Tobacco Survey-India (2016-17) data was done among current daily cigarette smokers and smokeless tobacco users. The primary independent variable was an intention to quit, while media exposure was the primary independent variable. Respondents were profiled as per various socio-demographic variables, and exposure to media advertisements and intention to quit were assessed using weighted bivariate analysis and multivariate log regression analysis. RESULTS: Males, and respondents aged 15 to 45, had more exposure to media and advertisements than female respondents. Cigarette smokers with moderate consumption, better awareness, those who had made any quit attempts in the last 12 months, and moderate to high media exposure depicted better intention to quit. In SLT users, intention to quit depicted significant odds per education level quit attempts and exposure to media and advertisements. CONCLUSION: We report a high intention to quit among those exposed to advertisements. Media campaigns play an important role in promoting tobacco control. There is a need to assess the impact of such advertisements on behavioral aspects. At the same time, comprehensive tobacco control policies should go hand in hand in reducing smoking rates.

Teleconsultation for Children With Developmental Disabilities During the Coronavirus Pandemic: Caregivers' Experience.

Background The unprecedented situation due to the coronavirus disease 2019 (COVID-19) lockdown necessitated the need for teleconsultations with caregivers of children with disabilities. The objective of this study was to explore the acceptability, satisfaction, perceived relevance, and barriers to teleconsultation from a caregiver's perspective. Methodology This was a descriptive qualitative study (telephonic interviews) involving in-depth interviews (IDIs) with the caregivers of children with developmental disabilities who received teleconsultations. Manual content analysis of transcripts of IDIs was done. Results Eight IDIs were conducted with the caregivers of children with cerebral palsy, autism, and developmental delay. The respondents expressed increased challenges in managing their children during the pandemic and the need for professional consultation. They also expressed difficulty in accessing professional help during the pandemic due to poor healthcare access and fear of getting COVID-19. The following responses were noted: "For almost a year we couldn't take her for the therapy," "We were unable to take him to therapy which resulted in an increase in tightness of his limbs, and he became more irritable." All respondents preferred video teleconsultations during lockdown due to flexible timings, ease of communication, and no travel restrictions; "I can benefit from teleconsultation because she does not have any physical problem." However, caregivers of children with physical ailments preferred face-to-face consultation. Conclusions Teleconsultation was found to effectively support the treatment and rehabilitation of children with disabilities during the COVID-19 lockdown, although direct face-to-face consultation was preferred by caregivers of children with physical ailments. The use of modern mobile/digital technologies creates new opportunities to improve the quality and accessibility of such services.

Mapping the stability of febrile illness hotspots in Punjab from 2012 to 2019- a spatial clustering and regression analysis.

INTRODUCTION: Febrile illnesses (FI) represent a typical spectrum of diseases in low-resource settings, either in isolation or with other common symptoms. They contribute substantially to morbidity and mortality in India. The primary objective was to study the burden of FI based on Integrated Disease Surveillance Programme (IDSP) data in Punjab, analyze geospatial and temporal trends and patterns, and identify the potential hotspots for effective intervention. METHODS: A retrospective ecological study used the district-level IDSP reports between 2012 and 2019. Diseases responsible for FI on a large scale, like Dengue, Chikungunya, Malaria (Plasmodium Falciparum, P. Vivax), Enteric fever, and Pyrexia of Unknown Origin (PUO), were included in the analysis. The digital map of Punjab was obtained from GitHub. Spatial autocorrelation and cluster analysis were done using Moran's I and Getis-Ord G* to determine hotspots of FI using the incidence and crude disease numbers reported under IDSP. Further, negative binomial regression was used to determine the association between Spatio-temporal and population variables per the census 2011. Stable hotspots were depicted using heat maps generated from district-wise yearly data. RESULTS: PUO was the highest reported FI. We observed a rising trend in the incidence of Dengue, Chikungunya, and Enteric fever, which depicted occasional spikes during the study period. FI expressed significant inter-district variations and clustering during the start of the study period, with more dispersion in the latter part of the study period. P.Vivax malaria depicted stable hotspots in southern districts of Punjab. In contrast, P. Falciparum malaria, Chikungunya, and PUO expressed no spatial patterns. Enteric Fever incidence was high in central and northeastern districts but depicted no stable spatial patterns. Certain districts were common incidence hotspots for multiple diseases. The number of cases in each district has shown over-dispersion for each disease and has little dependence on population, gender, or residence as per regression analysis. CONCLUSIONS: The study demonstrates that information obtained through IDSP can describe the spatial epidemiology of FI at crude spatial scales and drive concerted efforts against FI by identifying actionable points.

Patterns of exposure to smoked tobacco advertisements among youths in India and its association with smoked tobacco use: a Latent Class Analysis.

OBJECTIVES: Youths are exposed to multiple sources of tobacco advertisements. We sought to examine patterns of exposure to smoked tobacco advertisements through various modes among Indian youths and its association with smoked tobacco use. STUDY DESIGN: Cross-sectional survey design. METHODS: We utilised data from the national Global Adult Tobacco Survey 2016-17 in India, which covered adults >15 years of age. Latent Class Analysis (LCA) was used to examine patterns of exposure to tobacco advertisements through various modes (television, radio, cinema, internet, posters, billboards, public transportation, public walls, stores, newspaper) among youths. Classes were compared across sociodemographic and tobacco use-related characteristics. Various model-fit statistics (Akaike, Bayesian and sample size-adjusted Bayesian Information Criteria, likelihood-ratio tests and, Entropy) and meaningfulness of the classes were used to select the number of latent classes. RESULTS: Three distinct latent classes were identified in terms of exposure to smoked tobacco products advertisements: "Multimodal exposure" (n = 448, 4.0%), "low exposure" (n = 9584, 86.0%), and "Television and stores" (n = 1116, 10.0%). There were significant differences between classes emerged on sociodemographics (age, sex, residence, education, wealth quintile, region). The "Multimodal exposure" class was associated with current tobacco smoking (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.4-3.0, P-value <0.001) and cigarette use (OR: 1.9, 95% CI: 1.3-3.4, P-value <0.001) compared to the "low exposure" class. CONCLUSIONS: Youths could be grouped into three classes based on their exposure to smoked tobacco product advertisements. The "Multimodal exposure" class with a distinct profile was significantly associated with smoked tobacco use among youths. This evidence supports complete ban on all forms of tobacco advertisements.

The Trend, Characteristics and Treatment Outcomes in Patients with Tuberculosis Undergoing Thoracic Surgery in the Kyrgyz Republic between 2017 and 2021.

Surgery has played an important role in managing complicated tuberculosis in former Soviet Union countries, including the Kyrgyz Republic. However, published information is limited. This study aimed to document the trend, characteristics and outcomes of tuberculosis patients who underwent thoracic surgery, using routinely collected data. Between 2017 and 2021, 4-7% of tuberculosis patients in the Kyrgyz Republic underwent thoracic surgery in two centres in Bishkek and Osh. In 2021, case records were retrieved in 264 (78%) of 340 patients undergoing thoracic surgery in the country. The most common indications for surgery were pleural exudate/empyema in 127 (44%) and tuberculoma in 83 (32%). Most patients (73%) underwent surgery within 30 days of starting TB treatment. Two-thirds of patients underwent radical surgery, and surgical outcomes were excellent in 99% of patients with one death. Post-operatively, 63 (23%) patients had no TB detected by the histology, with the two most common specified conditions being lung cancer and pulmonary hydatid disease. TB treatment was stopped in these patients. Of the 201 patients with confirmed TB after surgery, TB-treatment success was documented in 163 (81%), died/failure/lost to follow-up in 10 (5%) and not evaluated in 28 (14%). This study shows that thoracic surgery is feasible, safe and effective in the routine programme setting. Recommendations are made to strengthen referral and monitoring systems.

Discharge Outcomes of Severely Sick Patients Hospitalized with Multidrug-Resistant Tuberculosis, Comorbidities, and Serious Adverse Events in Kyrgyz Republic, 2020-2022.

Patients with multidrug-resistant tuberculosis (MDR-TB) who have comorbidities, complications, and experience serious adverse events (SAEs) are at substantial risk of having unfavorable hospital outcomes. We assessed characteristics and discharge outcomes of 138 MDR-TB patients hospitalized in the National Referral Center of Bishkek, Kyrgyz Republic, from January 2020 to August 2022. The main clinical characteristics included pulmonary complications (23%), malnutrition (33%), severe anemia (17%), diabetes mellitus (13%), viral hepatitis B and C (5%), and HIV infection (3%). Of those patients, 95% were successfully managed and discharged from hospital. Seven patients had unfavorable discharge outcomes (three patients died and four had a worsened clinical condition). Comorbidities (diabetes, and/or HIV), severe anemia, pulmonary complications, cardiovascular disorders, alcohol abuse, and SAEs were associated with unfavorable discharge outcomes. Sixty-five percent of the patients had SAEs, with electrolyte imbalance (25%), gastrointestinal disease (18%), hepatotoxicity (16%), and anemia (14%) being the most frequent. Successful resolution occurred in 91% of patients with SAEs. In summary, our study documented that sick patients who were hospitalized with MDR-TB were well managed and had good hospital discharge outcomes, despite the fact that they had comorbidities, complications, and SAEs. This information should assist in the referral and management of such patients in the future.

Analysis of Maternal and Infant Death Reporting System (MIDRS) in a North Indian State during 2013-2018.

Background: Haryana launched the Maternal and Infant Death Reporting System (MIDRS) in 2013 to report deaths and their causes. We evaluated the system in terms of its data quality, accuracy, and timing of reporting. Methods: Secondary data analysis of data about the maternal, infant, and child deaths from the state level MIDRS portal from 2013 to 2018. The portal combines infant and maternal deaths and stillbirths reported through passive and active surveillance. We used the descriptive measure of statistics (proportion) to describe the characteristics and causes of neonatal, post-neonatal, and maternal deaths. Results: Of 1,18, 028 neonatal deaths, 39% (46,140) neonates died at a government facility. Gender was not recorded in 7,093 (6.0%) deaths. "Others" was a predominant category (14,664, 53%) of death. Of 2,842 maternal deaths, the cause of death was unknown in 465 (16.4%) deaths and mentioned as "others" in 1,618 (56.9%) instances. Nearly 60% of maternal deaths occurred at a health facility. Stillbirth was published as a cause of death in 228 (7.8%) child deaths (1-5 years). Missing data were observed in critical variables such as the timing of maternal mortality (50, 1.8%) and sex of child (4884, 4.3%). Conclusion: Delay in reporting, inconsistencies in data, and missing information were some challenges. Ascertainment of the exact cause of death needs to be improved through better training.

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.

Second Hand Smoke Exposure among Children in Indian Homes: Findings from the Global Adult Tobacco Survey.

Children are vulnerable to second hand smoke (SHS) exposure because of limited control over their indoor environment, especially at homes. This study determines the magnitude, patterns and determinants of SHS exposure in the home among children in India. Data collected under the Global Adult Tobacco Survey (GATS) data, a household survey of adults ≥15 years of age during 2016-2017 conducted in India were analyzed to estimate the proportion of children exposed to SHS in their homes. GATS estimates and national census population projections for 2020 were also used to estimate the number of children exposed to SHS in the homes. Nearly half (46.5%) of the children <15 years of age were exposed to SHS in their homes in India which extrapolates to nearly an estimated 170 million. Children living in rural households, north-east and central regions and households with an adult smoker were more likely to be exposed to SHS. SHS exposure among children in home is high in India which calls for adoption of voluntary smoke-free homes initiative and promoting cessation among smokers.

Symptomatology and Relationship Between Symptoms and Duration Among COVID-19 Patients in a COVID-19 Care Hospital in Central India.

The COVID-19 pandemic has affected the world population across the globe. India has the second largest number of cases and the third largest number of deaths due to COVID-19 in the world. There have been close to 4.4 lakh deaths due to COVID-19 in India alone. The second wave in India has led to devastating consequences, particularly among the young population. The initial clinical symptoms of COVID-19 are similar to all types of viral pneumonia, with varying degrees of severity. The cases' clinical manifestations include fever, nonproductive cough, dyspnea, myalgia, and fatigue. This study was undertaken with the purpose of identifying the relationship between the symptoms and duration in COVID-19-affected patients. The common presenting symptoms were fever (44.5%), sore throat (38.7%), and cough (36.12%). Most of the cases presented with a combination of fever with cough (35%) and fever with sore throat (33%). The duration of symptoms varied from one to 17 days with a mean of 5.75 days. Despite vaccination being started, the risk of the imminent third wave in the country is existential. Mutations in the coronavirus pose a threat to the vulnerable population. It is important to identify the combination of symptoms most predictive of COVID-19 to help guide recommendations for self-isolation, testing, and preventing further spread of the disease. Further studies using these models can yield better results in surveillance and containing this infectious disease.

Impact of Health Warning Labels on Cigarette Packs in India: Findings from the Global Adult Tobacco Survey 2016-17.

Two rounds of Global Adult Tobacco Survey (GATS) were conducted in 2009-10 and 2016-17 in India. These two surveys provide national comparable data on tobacco usage and its related aspects in India. This study used the data from GATS 2016-17 to examine the salience and impact of cigarette pack pictorial health warnings (PHWs) on quit intention among current cigarette smokers in India. The nationally representative survey interviewed 74, 037 respondents aged ≥15 years with an overall response rate of 92.9% using a multi-stage sampling method. Results of multivariate analysis showed that the strongest predictor for quit intention because of health warnings was "ever made a quit attempt in the past 12 months" and buying cigarette packs instead of loose cigarettes. Compared to GATS 2009-10, GATS 2016-17 observed an increase in salience of cigarette health warnings by 16% and increase in the impact of PHWs on quit intention by 50%. PHWs have a significant impact on intention to quit among cigarette smokers in India with a rising trend. The efforts of Government of India in terms of periodic introduction of new PHWs and increase in the size of warning labels to 85% of the cigarette packs is laudable. The study results support ban on loose cigarettes and warrants stricter implementation of the act prohibiting sale of loose cigarettes.

National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India.

INTRODUCTION: Globally people pay out-of-pocket (OOP) to access Oral healthcare services. In India, there is limited evidence on estimates of OOP expenditure. We undertook an analysis of national sample survey data on household health care expenditure to understand the expenditure pattern for Oral healthcare services and the catastrophic burden. METHOD: The expenditure reported for Oral healthcare services from two surveys: 71st round and 75th round, published by National Sample Survey Office (NSSO) was extracted. Based on monthly household consumption expenditure three economic groups were made: poor, middle- and rich-income groups. The OOP expenditure pattern while accessing day-care services and hospitalization and in public and private sector and the catastrophic expenditure were analysed. RESULTS: A total of 204 and 155 households from two national surveys reported to have accessed day-care Oral services respectively. The median OOP expenditure in public sector remained same at US $ 4 in both surveys. Over 35% of 78 households in 71st round and 42% of 167 in 75th round used public sector hospitalization services. The median expenditure of hospitalization doubled from US$ 58 (IQR 21-263) in 71st round to US $ 125 (IQR 45-363) in 75th round. Households from poor income groups spent seven times more for Oral healthcare services during the recent survey and faced catastrophic expenditure. CONCLUSION: The OOP expenditure for Oral healthcare has significant catastrophic household expenditure among the poor. There is a need to increase investment in public sector and insurance to protect poor against hospitalization expenditure in private sector.

How effective was implementation of the package of essential non-communicable disease (PEN) interventions: A review of evidence?

AIMS: This paper reviewed the outcomes, cost-effectiveness and challenges of implementation of WHO PEN protocol in LMICs. METHODS: MEDLINE databases, the Cochrane Central Register of Controlled Trials and Google Scholar were searched and content analysis of the included studies was done. RESULTS: A total of 14 articles were included. Lack of essential medicines and manpower, poor recording and mis-calculation of CVD risk score, suboptimal recording of patient information and loss-to-follow-up were the key challenges reported in various PEN implementation settings. CONCLUSION: The study has highlighted concerns and recommendations which need to be addressed before scale up.

Insights from national survey on household expenditure for primary healthcare services availed through informal healthcare providers.

INTRODUCTION: Ensuring accessible and affordable primary healthcare services of optimal quality is a core component of universal health coverage (UHC). Though a substantial percentage of population avail healthcare services from informal healthcare providers (IHPs) in rural India, the information regarding the extent of out-of-pocket (OOP) expenditure during such encounters is limited. METHOD: The study analyzed publicly available data of 75th National Sample Survey (NSS) to understand the household expenditure pattern on availing service from IHPs. OOP expenditure for services availed from IHPs were extracted from main data sets and analyzed for both out-patient care and hospitalization. The OOP was summarized across the five wealth quintiles based on monthly per capita expenditure (MPCE) and disease groupings derived from the ailments recorded during the survey. RESULTS: In total, 721 households accessed IHPs as part of out-patient consultation for infectious disease (67%). Households from rural areas (78%), households belonging to backward groups (75%), households from the poorest quintile and women (52%) access the services of IHPs. The median OOP for all services was INR 240 (IQR 120-600) and more than 90% of total OOP is accounted for medical expenditure. CONCLUSION: The programs need to define healthcare packages to engage IHPs to increase the reach and reduce OOP expenditure on households.

Is publication ethics becoming a casualty of Covid-19?

Public health emergencies require real-time, accurate information to guide effective and timely responses. This calls for rapid and timely publication of information to promote both its scientific validity and societal value. On the other hand, rapid publication poses a potential threat to the integrity of the information published. Inaccurate or incomplete information arises due to the difficulty in conducting rigorous studies during an ongoing emergency, and the race for the fame and prestige that come with being first. The balance between the potential risks and benefits of rapid publication can be achieved by adhering to the principles of publication ethics that promote the integrity, accuracy and value of scientific literature (1). We highlight ten potential challenges related to scientific publishing and dissemination of information during this pandemic, and the underlying principles of publication ethics that could guide us.

Comparison of diagnostic accuracy of digital chest X-ray images between PACS and WhatsApp Messenger in resource poor setting.

PURPOSE: Many underserved remote locations without specialists would benefit from the ability to quickly and easily share images of radiographs with trained radiologists using WhatsApp messenger. However, there is limited evidence on the role of WhatsApp messenger for sharing chest x-ray (CXR) images to aid diagnosis and management. The objective of the study was to determine the diagnostic accuracy and inter-observer agreement of WhatsApp messenger images of digital CXR compared to viewing on Picture Archiving and Communication System (PACS) monitor. METHODS: Two pulmonologists reported 400 WhatsApp messenger images of digital CXR each. After a wash period of two weeks, they reviewed the original CXR images on PACS and again reported their findings. Diagnostic agreement was measured using kappa value, diagnostic accuracy was evaluated by sensitivity and specificity. RESULTS: The diagnostic agreement between WhatsApp and PACS images for both the readers was high in case of normal CXR (0.84), Pneumonia (0.85) and Active Koch's (0.79) and Old Koch's (0.71). The inter-observer agreement between two readers on WhatsApp images was good in cases of normal chest x-ray (0.74), Active Koch's (0.61) and Pneumonia (0.74) and low in COPD (0.31) and Pleural Effusion (0.28) and Carcinoma Lung (0.40). In terms of radiological lesion, inter-observer agreement between two readers on WhatsApp images was good in terms of the zonal involvement, moderate in case of infiltrates, consolidation, nodules, and fibrosis, fair in cavity, effusion (0.28) and poor in hilar lymphadenopathy (0.14). The sensitivity in the diagnosis of nodules, effusion and hilar lymphadenopathy was <50% in both the readers. CONCLUSION: CXR transmission via WhatsApp is able to identify clinical findings similar to viewing the same image on a PACS monitor in cases of Pneumonia and normal subjects. Active and old Koch's has good comparability whereas; diagnostic agreement is poor in COPD, cavity, pleural effusion and hilar lymphadenopathy, requiring more caution during interpretation.