Acceptability and effect of ShishuPoshan mHealth application on knowledge, attitudes and practice of breastfeeding among primi mothers availing postnatal care at a rural tertiary hospital.

Introduction: ShishuPoshan is a free Android application for mothers that provides scientific guidance on breastfeeding and baby care issues in the local language. We aimed to assess its effect and acceptability in primi mothers in a rural area of Maharashtra, India. Material and Methods: A before and after study was conducted in 50 primi mothers to study the acceptability and effect of ShishuPoshan mHealth application on knowledge, attitude and practice about breastfeeding in primi mothers in a rural tertiary care hospital. Results: Most participants (84%) downloaded the application, and 60% used it regularly. Major reason for not using the app was discomfort with mobile phone (7%) and not having anyone to read the content in the house (7%). The application was easy to use by 48%, and 10% did not find time to use it. Enablers were regional language, easy-to-understand content, simple interface, and frequently asked question (FAQ) format to give information. Barriers to adoption were that women preferred tips from family members, were uncomfortable with mobile phones, and did not have anyone to help them use them. Conclusion: It successfully delivered key messages like exclusive breastfeeding, colostrum use, proper maternal nutrition, and demand to feed, but it needs to further emphasise early initiation of feeding. Incorporation of feedback like adding videos, myth busters, and making app more interactive may further improve its effectiveness. mHealth interventions like ShishuPoshan are promising modalities for the dissemination of appropriate information.

Structured Lifestyle Modification Interventions Involving Frontline Health Workers for Population-Level Blood Pressure Reduction: Results of a Cluster Randomized Controlled Trial in India (DISHA Study).

Background Population-wide reduction in mean blood pressure is proposed as a key strategy for primary prevention of cardiovascular disease. We evaluated the effectiveness of a task-sharing strategy involving frontline health workers in the primary prevention of elevated blood pressure. Methods and Results We conducted DISHA (Diet and lifestyle Interventions for Hypertension Risk reduction through Anganwadi Workers and Accredited Social Health Activists) study, a cluster randomized controlled trial involving 12 villages each from 4 states in India. Frontline health workers delivered a custom-made and structured lifestyle modification intervention in the selected villages. A baseline survey was conducted in 23 and 24 clusters in the control (n=6663) and intervention (n=7150) groups, respectively. The baseline characteristics were similar between control and intervention clusters. In total 5616 participants from 23 clusters in the control area and 5699 participants from 24 clusters in the intervention area participated in a repeat cross-sectional survey conducted immediately after the intervention phase of 18-months. The mean (SD) systolic blood pressure increased from 125.7 (18.1) mm Hg to 126.1 (16.8) mm Hg in the control clusters, and it increased from 124.4 (17.8) mm Hg to 126.7 (17.5) mm Hg in the intervention clusters. The population average adjusted mean difference in difference in systolic blood pressure was 1.75 mm Hg (95% CI, -0.21 to 3.70). Conclusions Task-sharing interventions involving minimally trained nonphysician health workers are not effective in reducing population average blood pressure in India. Expanding the scope of task sharing and intensive training of health workers such as nurses, nutritionists, or health counselors in management of cardiovascular risk at the population level may be more effective in primary prevention of cardiovascular disease. Registration URL: https://www.ctri.nic.in; Unique identifier: CTRI/2013/10/004049.

The Habitual Additional Sodium Intake among Hypertensive Patients Visiting a Tertiary Health-care Center, Indore, Madhya Pradesh.

BACKGROUND: Hypertension prevalence is related to dietary sodium chloride intake. People are consuming much more sodium than is physiologically necessary. The consumption of processed food in urban India has led to a prevalence of 24%-30% of hypertension. The people have a special liking of such type of foods. This study aimed at assessing consumption of sodium among the study subjects to compare habitual additional consumption of sodium among hypertensive and normotensive patients and to find its associate factors impacting hypertension. MATERIALS AND METHODS: The hospital based, cross-sectional study was conducted on patients attending the outpatient department of general medicine. The sample size was 520 patients. Habitual additional intake of each patient was assessed by a food frequency table. RESULTS: As the age advances, the proportion of hypertensive patients increases (P < 0.05). Among hypertensive patients, 38.65% were not doing exercise (P < 0.05). The body mass index >25 was found among 11.92% normotensives and among 25.38% hypertensives (P < 0.05). There were 23% of hypertensive patients who could not receive dietary advice (P < 0.05). Habitual additional sodium consumption is more among 15-25 years age group (P < 0.05). Habitual additional sodium intake mean for those who were taking a pinch of salt is higher (P < 0.05). Habitual additional sodium intake is found to be significantly impacted by younger age, diagnosis, and lack of dietary advice (P < 0.05, P < 0.05, and P < 0.05). CONCLUSION: Most of the age groups are consuming more than 2 g habitual additional sodium which is more than the World Health Organization-recommended maximum levels. The dietary advice was given to hypertensives that had a positive impact on habitual additional sodium intake.

Chronic disease concordance within Indian households: A cross-sectional study.

BACKGROUND: The household is a potentially important but understudied unit of analysis and intervention in chronic disease research. We sought to estimate the association between living with someone with a chronic condition and one's own chronic condition status. METHODS AND FINDINGS: We conducted a cross-sectional analysis of population-based household- and individual-level data collected in 4 socioculturally and geographically diverse settings across rural and urban India in 2013 and 2014. Of 10,703 adults ages 18 years and older with coresiding household members surveyed, data from 7,522 adults (mean age 39 years) in 2,574 households with complete covariate information were analyzed. The main outcome measures were diabetes (fasting plasma glucose ≥ 126 mg/dL or taking medication), common mental disorder (General Health Questionnaire score ≥ 12), hypertension (blood pressure ≥ 140/90 mmHg or taking medication), obesity (body mass index ≥ 30 kg/m2), and high cholesterol (total blood cholesterol ≥ 240 mg/dL or taking medication). Logistic regression with generalized estimating equations was used to model associations with adjustment for a participant's age, sex, education, marital status, religion, and study site. Inverse probability weighting was applied to account for missing data. We found that 44% of adults had 1 or more of the chronic conditions examined. Irrespective of familial relationship, adults who resided with another adult with any chronic condition had 29% higher adjusted relative odds of having 1 or more chronic conditions themselves (adjusted odds ratio [aOR] = 1.29; 95% confidence interval [95% CI] 1.10-1.50). We also observed positive statistically significant associations of diabetes, common mental disorder, and hypertension with any chronic condition (aORs ranging from 1.19 to 1.61) in the analysis of all coresiding household members. Associations, however, were stronger for concordance of certain chronic conditions among coresiding household members. Specifically, we observed positive statistically significant associations between living with another adult with diabetes (aOR = 1.60; 95% CI 1.23-2.07), common mental disorder (aOR = 2.69; 95% CI 2.12-3.42), or obesity (aOR = 1.82; 95% CI 1.33-2.50) and having the same condition. Among separate analyses of dyads of parents and their adult children and dyads of spouses, the concordance between the chronic disease status was striking. The associations between common mental disorder, hypertension, obesity, and high cholesterol in parents and those same conditions in their adult children were aOR = 2.20 (95% CI 1.28-3.77), 1.58 (95% CI 1.15-2.16), 4.99 (95% CI 2.71-9.20), and 2.57 (95% CI 1.15-5.73), respectively. The associations between diabetes and common mental disorder in husbands and those same conditions in their wives were aORs = 2.28 (95% CI 1.52-3.42) and 3.01 (95% CI 2.01-4.52), respectively. Relative odds were raised even across different chronic condition phenotypes; specifically, we observed positive statistically significant associations between hypertension and obesity in the total sample of all coresiding adults (aOR = 1.24; 95% CI 1.02-1.52), high cholesterol and diabetes in the adult-parent sample (aOR = 2.02; 95% CI 1.08-3.78), and hypertension and diabetes in the spousal sample (aOR = 1.51; 95% CI 1.05-2.17). Of all associations examined, only the relationship between hypertension and diabetes in the adult-parent dyads was statistically significantly negative (aOR = 0.62; 95% CI 0.40-0.94). Relatively small samples in the dyadic analysis and site-specific analysis call for caution in interpreting qualitative differences between associations among different dyad types and geographical locations. Because of the cross-sectional nature of the analysis, the findings do not provide information on the etiology of incident chronic conditions among household members. CONCLUSIONS: We observed strong concordance of chronic conditions within coresiding adults across diverse settings in India. These data provide early evidence that a household-based approach to chronic disease research may advance public health strategies to prevent and control chronic conditions. TRIAL REGISTRATION: Clinical Trials Registry India CTRI/2013/10/004049; http://ctri.nic.in/Clinicaltrials/login.php.

Anti-inflammatory and antioxidant effect of ginger in tuberculosis.

BACKGROUND: Tuberculosis (TB) has reemerged to become the world's leading cause of death from a single infectious agent. Inflammatory cytokines play an important role during the course of the disease and may be responsible for tissue damage by lipid peroxidation. The study was aimed to explore the anti-inflammatory and antioxidant effect of ginger in pulmonary TB patients. METHODS: A total of 69 pulmonary TB patients participated in a randomized and placebo-controlled study. The intervention group received 3 g of ginger extract daily for 1 month and placebo group was supplemented with starch capsule. Participants of both groups were taking standard antitubercular treatment during the study. The concentrations of tumor necrosis factor (TNF) alpha, ferritin and malondialdehyde (MDA) in blood samples were analyzed before and after the intervention by using enzyme-linked immunosorbent assay for TNF alpha and ferritin and spectrophotometry for MDA. RESULTS: Ginger supplementation significantly reduced the levels of TNF alpha, ferritin and MDA in ginger supplemented group in comparison to baseline. Ginger supplementation with antitubercular treatment significantly lowered TNF alpha, ferritin and MDA concentrations in comparison to control group. CONCLUSIONS: Ginger was found to be effective as an anti-inflammatory and antioxidant supplement along with anti-TB therapy as it possesses strong free radical scavenging property.

Prospects of poisoning - a multi facet study.

Aim of the study is to find out demographic profile, clinical characteristics and analysis of poison in clinical set up. The study carried out in Sri Aurobindo Medical College and PG Institute Indore, Madhya Pradesh. Total 75 cases of poisoning were studied for demographic profile, vitals (BP, pulse, heart rate, pupils, etc.), clinical features (such as vomiting, salivation, consciousness, etc.), type of poison and its analysis. Results: Poisoning was more common in cases between 15 and 25 years of age, in males than in females and in Hindu religion. Poisoning cases were predominantly from rural areas and in married people. Majority of cases were discharged after proper treatment and counseling. Altered vitals and clinical features were found in most of the cases. Organophosphate and aluminum phosphide compound were evaluated in most of the cases. Conclusions: Preventive measures should be applied through educating people, proper counseling, promoting poison information centers, and introducing separate toxicological units in hospitals.

A study of serum malondialdehyde and cytokine in tuberculosis patients.

INTRODUCTION: Tuberculosis (TB) is a common and a deadly infectious disease which is caused by Mycobacterium tuberculi. Inflammatory cytokines play an important role during the course of the disease and they may be responsible for tissue damage which is caused by lipid peroxidation. METHOD: The present study was conducted in the Department of Biochemistry and patients were selected from Department of TB and Chest Sri Aurobindo Institute of Medical Sciences and also from Manorama Raje Tuberculosis Hospital, Indore. 32 healthy controls and 35 pulmonary TB patients were compared initially for their serum Malondialdehyde (MDA) and tumour necrosis factor alpha (TNF α) levels. Serum TNF α and MDA levels were correlated. RESULT: TNF α and MDA levels in serum were significantly increased (p<0.001) in pulmonary tuberculosis patients as compared to those of controls. Increased Serum TNF α was positively correlated to MDA levels and it was found to be statistically not significant (correlation coefficient r =0.282,p> 0.05 ). CONCLUSION: The present study supports the view that there may be a link between lipid peroxidation and cytokine response and relative roles of cytokines and lipid peroxidation in the pathogenesis of tuberculosis.

Breastfeeding practices in baby friendly hospitals of Indore.

An interview based cross sectional study was conducted in two of the designated Baby Friendly Hospitals of Indore in the year 2008. None of the hospitals were having a written breastfeeding policy, which is routinely communicated to all the health workers and no regular training regarding the Programme was being imparted. There is a need to develop a BFHI Monitoring System to ensure that the status is kept in check. Training regarding essential Criteria of BFHI should be there for all the staff.