General practitioners' knowledge, attitude, and practices regarding optional immunization in urban area of Sangli District: A cross sectional study.

Introduction: Immunization is one of the most effective, safest, and efficient public health interventions. Thousands of children are still dying from vaccine-preventable diseases every year. Administration of optional vaccines such as Hib, Inactivated polio vaccine (IPV), typhoid, hepatitis A, chickenpox, and rotavirus at appropriate age helps them in protecting from various diseases in under 18 population. Also, the attitude and practices of general practitioners have an important role in preventing modern diseases in children. Objective: This study was undertaken to assess the level of knowledge, attitude, and practices regarding optional vaccines among the general practitioners. Material and Methods: Study type: Cross-sectional. Study setting: Sangli-Miraj-Kupwad corporation area. Study subject: Practicing General Practitioners willing to participate. Study period: July 2018-Sep 2019. Study tools: predesigned, pretested questionnaire. Statistical analysis: by using Microsoft Excel and SPSS 22.0 version software. Results: Out of 162 general practitioners, 105 were males and 57 were females. A total of 83 (51.23%) general practitioners had good knowledge about optional vaccines in their practice. Good knowledge was found to be highest among MBBS practitioners 38 (55.9%). A total of 118 (72.84%) general practitioners were counseling the parents regarding optional vaccines. Conclusion: There is a need to create training programs and continuing medical education (CMEs) for general practitioners (GPs) on optional vaccination practices to improve knowledge.

Prevalence of the Acute Respiratory Infections and Associated Factors in the Rural Areas and Urban Slum Areas of Western Maharashtra, India: A Community-Based Cross-Sectional Study.

Acute respiratory infections (ARIs) continue to be the most important cause of morbidity and mortality among under-five children. Some demographic and environmental factors are associated with ARIs among under-five children. This study was conducted with the objective to estimate the prevalence of ARIs among under-five children in the rural areas and densely populated urban slum areas in Maharashtra, India and to assess the association of the selected sociodemographic and household environmental factors with ARI. This study was conducted in 16 selected clusters from the rural areas and densely populated urban slum areas of the two districts in Maharashtra, India. Structured and validated proforma was used for collecting the data on the sociodemographic and household environmental risk factors. A total of 3,671 under-five children were surveyed. The prevalence of ARIs for the preceding month was 50.4%. It was higher among the children living in the rural areas (54.2%) compared to the children living in the urban areas (46.7%) (p = 0.01). The prevalence of ARIs was reported to be 51.4 and 49.4% in boys and girls, respectively. In the multivariate analysis, the researchers found that living in rural areas (p = 0.01) and parental smoking (p = 0.04) were significantly associated with the ARIs. An intervention such as reducing parental smoking habits at the household level may reduce ARIs.

Effect of Behavior Change Communication on the Incidence of Pneumonia in Under Five Children: A Cluster Randomized Controlled Trial.

BACKGROUND: Improving health education of the mother by providing community-based interventions is known to help control pneumonia. OBJECTIVES: To determine the effect of behavior change communication (BCC) activities for mothers in reducing the incidence of childhood pneumonia. DESIGN: Open-label cluster randomized controlled trial. SETTING: Urban slums and villages in two districs of Maharashtra. PARTICIPANTS/CLUSTER: Under-five children and their mothers from households in the randomly selected 16 clusters out of total 45 clusters, stratified into Pune and Sangli districts and further into rural and urban areas before randomization. INTERVENTION: Three forms of BCC activities were imparted, viz., interactive sessions of education using pictorial mothers' booklet, screening of a audio-visual film, and virtual hand wash demonstration and use of flashcard. Routine care under the National health program was provided by the Accredited Social Health Activists (ASHA) workers in both the arms. OUTCOME: The primary outcome was pneumonia as per the IMNCI criteria assessed during fortnightly visits of the ASHA/anganwadi workers to the houses of under-five children, who received at least one follow-up visit in a period of one year. RESULTS: The incidence of pneumonia in 1993 and 1987 under-five children in the intervention and control arm was 0.80 and 0.48 episodes per child per year, respectively (P=0.03). CONCLUSIONS: BCC for mothers is not sufficient to reduce the incidence of childhood pneumonia.

Prevalence and determinants of undernutrition among under-five children residing in urban slums and rural area, Maharashtra, India: a community-based cross-sectional study.

BACKGROUND: Undernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India. METHODS: A community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas. RESULTS: The mean age of the children was 2.38 years (±SD 1.36) and mean age of mothers was 24.25 years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p < 0.001) and acute diarrhea (p = 0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p < 0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p < 0.05) was associated with wasting, sex of the child (p < 0.05) and type of family (p < 0.05) were associated with stunting,and low income of the family (p < 0.05) was associated with underweight. CONCLUSIONS: Factors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community. TRIAL REGISTRATION: Trial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.

Reported incidence and risk factors of childhood pneumonia in India: a community-based cross-sectional study.

BACKGROUND: Pneumonia is responsible for high morbidity and mortality amongst children under five year of age. India accounts for one-third of the total WHO South East Asia burden of under-five mortality. There is a paucity of epidemiological studies indicating the true burden of pneumonia. Identification of the risk factors associated with pneumonia will help to effectively plan and implement the preventive measures for its reduction. METHODS: It was a descriptive cross-sectional study conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. All mothers of under-five children in the selected clusters were included. A validated pretested interview schedule was filled by trained field supervisors through the house to house visits.WHO definition was used to define and classify clinical pneumonia. Height and weight of children were taken as per standard guidelines. Quality checks for data collection were done by the site investigators and critical and noncritical fields in the questionnaire were monitored during data entry. For continuous variables mean and SD were calculated. Chi-square test was applied to determine the association between the variables. Level of significance was considered at 0.05. RESULTS: There were 3671 under five-year children, 2929 mothers in 10,929 households.Unclean fuel usage was found in 15.1% of households. Mean birth weight was 2.6 kg (SD;0.61). Exclusive breastfeeding till 6 months of age was practiced by 46% of mothers. Reported incidence of ARI was 0.49 per child per month and the reported incidence of pneumonia was 0.075 per child per year. It was not associated with any of the housing environment factors (p > 0.05) but was found to be associated with partial immunization (p < 0.05). Poor practices related to child feeding, hand hygiene and poor knowledge related to signs and symptoms of pneumonia amongst mother were found. CONCLUSIONS: Very low incidence of pneumonia was observed in Pune and Sangli districts of Maharashtra. Partial immunization emerged as a most important risk factor. Reasons for low incidence and lack of association of pneumonia with known risk factors may be a better literacy rate among mothers and better immunization coverage. TRIAL REGISTRATION: Registration number of the trial- CTRI/2017/12/010881 ; date of registration-14/12/2017.

Knowledge about diabetes and relationship between compliance to the management among the diabetic patients from Rural Area of Sangli District, Maharashtra, India.

INTRODUCTION: Diabetes is an important public health problem of India. Studies have shown that increase in patients' knowledge regarding the disease results in better compliance to treatment and decrease in complications. This study was planned to assess the knowledge about diabetes and its correlation with pharmacological and non-pharmacological compliance, among the diabetic patients attending rural health center from Sangli District, Maharashtra (India). MATERIALS AND METHODS: The study was conducted during September to November 2014. The study subjects were all willing adult patients with type II diabetes mellitus attending a selected rural hospital. The study tool was pretested and self-administered questionnaire. Analysis was done using Microsoft Excel and SPSS-22. RESULTS: Total study participants were 307 in number, with the mean age of 55.6 years. The mean morbidity with diabetes was 10.7 years. Only 23.8% had good knowledge regarding diabetes, while 19.2% participants had poor knowledge. Knowledge was significantly associated with the compliance to the pharmacological and non-pharmacological management. CONCLUSION: Although most of the patients were suffering with diabetes for many years there is lack of knowledge regarding the disease and self care. The compliance to the management of diabetes was better in patients with good knowledge. Seminars, counseling sessions and workshop should be arranged periodically for diabetic patients to increase their awareness.

Barriers for early detection of cancer amongst Indian rural women.

CONTEXT: Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but actually they are largely preventable diseases. Healthcare providers in developing countries regularly see women with advanced, incurable cancers. Health of a rural Indian women and her access to health facility is compromised due to sociocultural, economical, and environmental factors. AIMS: To know the problems associated with early detection of cancers in rural women. SETTINGS AND DESIGN: Rural area and cross-sectional. SUBJECTS AND METHODS: STUDY SUBJECT: Women of 35 years and above. EXCLUSION CRITERIA: Not willing to participate. SAMPLE SIZE: All eligible women of selected villages. SAMPLING TECHNIQUE: Random selection of villages. Study duration: 2 months. Study tools: Pretested questionnaire. STATISTICAL ANALYSIS USED: Percentages, χ(2) test, analysis of variance (ANOVA), multivariate analysis. RESULTS: Awareness about symptoms, possibility of early detection, available tests, possibility of cure of disease was low. Main barrier for screening was cognitive, that is, 'don't know' answer by 83.99% women for cancer cervix, 84.93%, for cancer breast, and 67.26% for oral cancer. Awareness score was significantly associated with age (χ(2) = 17.77, P = 0.001), education (χ(2) = 34.62, P = 0.000), and income (χ(2) = 16.72, P = 0.002); while attitude score with age (χ(2) = 16.27, P = 0.012) and education (χ(2) = 25.16, P = 0.003). Practice score was significantly associated with age (χ(2) = 11.28, P = 0.023), education (χ(2) = 32.27, P = 0.003), and occupation (χ(2) = 10.69, P = 0.03). Awareness, attitude, and practice score of women having history of cancer in family or relative was significantly high than women without history. CONCLUSIONS: Cognitive barrier was the important barrier which has to be taken care of.