Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis.

Background & objectives: The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district. Methods: A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed. Results: Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement. Interpretation & conclusions: The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

Risk factors for SARS-CoV-2 infection among health workers in India: a case control study.

Background: COVID-19 was declared as a Public Health Emergency of International Concern on 30th January 2020. Compared to the general population, healthcare workers and their families have been identified to be at a higher risk of getting infected with COVID-19. Therefore, it is crucial to understand the risk factors responsible for the transmission of SARS-CoV-2 infection among health workers in different hospital settings and to describe the range of clinical presentations of SARS-CoV-2 infection among them. Methodology: A nested case-control study was conducted among healthcare workers who were involved in the care of COVID-19 cases for assessing the risk factors associated with it. To get a holistic perspective, the study was conducted in 19 different hospitals from across 7 states (Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Gujarat, and Rajasthan) of India covering the major government and private hospitals that were actively involved in COVID-19 patient care. The study participants who were not vaccinated were enrolled using the incidence density sampling technique from December 2020 to December 2021. Results: A total of 973 health workers consisting of 345 cases and 628 controls were recruited for the study. The mean age of the participants was observed to be 31.17 ± 8.5 years, with 56.3% of them being females. On multivariate analysis, the factors that were found to be significantly associated with SARS-CoV-2 were age of more than 31 years (adjusted odds ratio [aOR] 1.407 [95% CI 1.53-1.880]; p = 0.021), male gender (aOR 1.342 [95% CI 1.019-1.768]; p = 0.036), practical mode of IPC training on personal protective equipment (aOR 1. 1.935 [95% CI 1.148-3.260]; p = 0.013), direct exposure to COVID-19 patient (aOR 1.413 [95% CI 1.006-1.985]; p = 0.046), presence of diabetes mellitus (aOR 2.895 [95% CI 1.079-7.770]; p = 0.035) and those received prophylactic treatment for COVID-19 in the last 14 days (aOR 1.866 [95% CI 0.201-2.901]; p = 0.006). Conclusion: The study was able to highlight the need for having a separate hospital infection control department that implements IPC programs regularly. The study also emphasizes the need for developing policies that address the occupational hazards faced by health workers.

Facilitators and barriers to the uptake of COVID-19 vaccine precaution dose among adult population: qualitative analysis across six different states of India.

Introduction: India launched the COVID-19 vaccination drive on 16th January 2021 by vaccinating the adult population above 18 years of age. This was followed by the introduction of an additional precaution dose. As on 18th October 2022, 1,02,66,96,808 (1.02 Billion) first dose and 94, 95, 39,516 (949 Million) second doses of COVID-19 vaccine were administered. However, when compared to the uptake of the primary doses, the precaution dose uptake lagged behind with only 21,75, 12,721 (217 million) doses administered. Even though, the uptake of the primary doses remained optimal, irrespective of different interventions by the Government of India, the uptake of the precaution dose remained poor. In this context, the Ministry of Health & Family Welfare wanted to understand the facilitators and Barriers for precaution dose uptake among adults so that future immunization campaigns could address these issues. Methods: An exploratory qualitative study was conducted to assess the facilitators and barriers for COVID-19 precaution dose uptake at community level across 6 different states in India. From each of the states, two districts with the highest and lowest rates of COVID-19 vaccine precaution dose uptake were selected. In each of these districts, 2 block Primary Healthcare Centres (PHCs), one with high and one with low uptake were identified. Within these block PHCs, a PHC field area with high and low precaution dose uptakes was identified. From the identified sites a minimum of four IDIs, four FGDs were conducted among the community members. KIIs of the State Immunization Officers, District Immunisation Officers, PHC Medical Officers, healthcare workers like Accredited Social Health Activist/Auxiliary Nurse Midwife were also conducted. The data was audio recorded and it was transcribed, translated and analysed using framework approach. Results: It was observed that rise in COVID-19 cases prompted the community to take the precaution dose, this along with the cost of hospitalization and the number of productive days being lost as a result of being infected resulted in vaccine uptake. The fear of non-availability of COVID-19 vaccines latter on also prompted people for vaccine uptake. While the barriers were, poor accessibility to vaccination centers, long hours of travel, poor road connectivity and lack of transportation facilities. However, the most prominent barriers observed across all study sites was that a sense of pandemic fatigue and complacency had developed both among the providers as well as the beneficiaries. Other barriers include differences in vaccination schedules and longer duration between the primary doses of some vaccines. Media was identified to be both a barrier and facilitator for Covid-19 Precaution dose uptake. Even though media played an important role in disseminating information in the beginning of the campaign, it was soon followed by the circulation of both misinformation and disinformation. Discussion: The study identified that dissemination of accurate information and community involvement at each stage of planning and implementation are crucial for the success of any campaign. Efforts should be constantly made to address and re-invent strategies that will be most suitable for the needs of the community. Therefore, in order to ensure successful vaccination campaigns, it is crucial that along with political will it is also important to have a decentralized approach with inter-sectoral coordination with different stakeholders such as healthcare workers, community members and the different departments such as the local self-governments, education department, law & order department etc. These lessons learnt from COVID-19 vaccination campaigns must not be forgotten and must be applied in future vaccination campaigns and while framing public health policies.

Development of the India COVID-19 vaccine tracker.

COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO's emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ≥18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India's COVID-19 vaccination drive.

Experiences and challenges faced by the working population during COVID-19 Lockdown: A qualitative study.

Background: The largest COVID-19 national lockdown was declared on 25 March 2020 in India with a total shutdown of workplaces and transport sectors. A complete lockdown deemed the entire population of the country to stay wherever they were residing at that point of time with no entry or exit movements being permitted thereafter. This unique situation betwixt a menacing health crisis rolled out a scenario uncustomary to the nation`s citizens. The varied responses of the masses to the lockdown need to be captured in order to understand the difficulties and dilemmas faced by them. Hence, this qualitative analysis aimed to capture the immediate challenges and experiences faced by the working population during the first-ever declared nationwide lockdown. Methodology: After obtaining institutional ethical committee clearance, a qualitative study was conducted using grounded theory approach. Using purposive sampling, people representative of the working-class population in Kerala were selected from three districts of the state. Equal representation of males and females were maintained. In-depth interviews were conducted via telephone using an interview guide till data saturation was obtained. The audio recorded data were later transcribed verbatim and translated to English. The transcripts were then manually coded to identify the emerging themes and subthemes and conclusions were drawn after triangulation. Results: The age of the study participants ranged from 32 to 71 years, they were occupied in different vocations and belonged to middle-class families across three districts of Kerala. All of them were aware and were mentally prepared for a national lockdown. They also made arrangements such as purchase of food, drinking water, medicines, etc., for home but also for office as well. Even though most of them were initially excited about the lockdown it was then followed by fear of contracting the disease, worries about loss of work and financial security. The study participants identified the advantages of lockdown as having more time for self & for family, use of the online/digital medium for routine activities and many also appreciated the support provided by the government in the form of food kits and loans. The lockdown was found to have increased the workload especially for women who had to manage not only family but also online work from home. Conclusion: The study was able to capture the different experiences and challenges faced by the middle-class working population. Even though they went through a cascade of initial excitement followed by fear of contracting the disease, it eventually turned into concerns of job and financial insecurities. The united frontline work of various sectors like police, health sector, local self-government, Kudumbashree and voluntary groups collectively aided in building community resilience enabling the southern state of Kerala to overcome the devastating effects of the pandemic and lockdown.

Assessment of prevalence of depression and its associated factors among tuberculosis patients in Ernakulam district, Kerala.

BACKGROUND: India is one of the few countries where Tuberculosis is still widely prevalent. People with TB, often suffers from depression. It is estimated that more than 300 million people suffer from depression at the global level, accounting to 4.4 percent of the world's population. OBJECTIVES: Primary objective-To assess the prevalence of depression among tuberculosis patients in Ernakulam district using PHQ9. Secondary objective-To assess the factors associated with depression among tuberculosis patients in Ernakulam district. METHODOLOGY: A cross sectional study was carried out among the tuberculosis patients who were currently under treatment from December 2019 to March 2020 in Ernakulam district of Kerala. From the 8 TUs of Ernakulam, 8 clusters were selected using PPS. 485 adult TB patients from these clusters were interviewed using PHQ9 questionnaire to assess prevalence of depression. RESULTS: The prevalence of depression among the TB patients in Ernakulam district was found to be 16.1%. The proportion of TB patients with depression were significantly higher among the age group of 18-40 years (36.3%), unmarried (54%) and from urban area of residence (19%). It was also significantly higher among previously treated patients (45.7%) & MDR TB patients (43.8%). CONCLUSION: It was observed that one-sixth of TB patients suffered from depression. Hence it is crucial that TB patients need to be regularly assessed for depression and managed appropriately. Since depression has affects adherence to TB treatment & thereby result in delay of TB elimination in the state.

Role of male partners in birth preparedness and complication readiness: A qualitative study.

Background In familial and societal matters, men are the decision-makers and economic resource providers in many patriarchal societies. It is important to assess the involvement of men in birth preparedness and complication readiness (BPCR), as men act as gatekeepers to women's health. We examined the role, motivators and barriers for participation of male partners of pregnant women in BPCR. Methods This qualitative study was based on the grounded theory approach. Data were collected through 29 in-depth interviews conducted among husbands (n=8), mothers (n=8), mothers-in-law (n=8), health professionals (n=5) and focus group discussions (FGDs) with pregnant women (FGD, n=3). Interviews and FGDs were transcribed; themes and sub-themes were generated and conclusions were drawn by triangulation of the data. Results Men were found to have a major role in BPCR. They supported their pregnant wives by maintaining their health, providing financial support and helping them in the decision-making process regarding treatment. They also provided complication readiness support by arranging transportation and facilitating the process of hospital admission. Conclusions Our study emphasizes how changes have occurred in the attitudes and practices over generations regarding men's role in BPCR and their participation during delivery. However, there is a long way to go for which transference of knowledge and cultural transformation have become necessities.

Response of the health system in Nipah outbreak in Ernakulam district: A qualitative analysis.

BACKGROUND: Nipah is an emerging zoonotic disease that is transmitted through contaminated food or directly between people. Recently, Nipah virus infection was confirmed in Kochi, Kerala, making it the fourth outbreak reported in India. However, due to its good epidemic response, the health system of Kerala was able to control it in a timely manner. OBJECTIVE: To qualitatively analyse the response of the health system of Kerala in controlling the Nipah outbreak (2019) by identifying the enabling factors and the challenges faced by it. METHODS: A qualitative study was conducted using grounded theory approach. Key informant interviews were conducted till data saturation was reached. The audio recorded data was translated, transcribed and was manually coded and thematically analysed. RESULTS: The major enablers for its apt response were identified to be effective communication, good line of control, effective division of work, intersectorial coordination, strong leadership, political commitment, resilient public private partnership and support groups, past experiences in disaster management, quick procurement of medicines and availability of lab facilities. On the other hand, the challenges identified were initial confusions, lack of standard operating procedures/guidelines for epidemic management, complacency, lack of effective zoonotic surveillance, media management and community participation. CONCLUSION: This study attributes the success of the outbreak response to the strong leadership and political commitment. In order to prevent recurrences in the future, there is a need to build a resilient health system through capacity building and further strengthening of the surveillance system.

Motivators and Barriers for Physical Activity among Health-Care Professionals: A Qualitative Study.

BACKGROUND: Physical inactivity is one of the critical risk factors for lifestyle-related diseases. In Kerala, the life expectancy of doctors who are considered the gatekeepers of health was found to be 13 years lower than the general population. OBJECTIVE: The objective was to identify the motivators and barriers for physical activity among doctors and nurses belonging to public and private health-care sectors in Ernakulam district. METHODOLOGY: Qualitative study was conducted using a grounded theory approach. A total of 30 in-depth interviews and 8 focus group discussions were conducted among doctors and nurses, respectively. The audio-recorded data were transcribed, coded, and thematically analyzed. RESULTS: The main themes identified were motivators, barriers, and future considerations for physical activity. The factors motivating doctors were the fear of noncommunicable diseases and to stay fit, while the nurses were more concerned about their body image. The common barriers were gender, lack of time, laziness, bad climate, and safety issues. Overreliance on medication and prioritizing their patients' health over their own were additional barriers. CONCLUSION: Physical activity among doctors and nurses is severely compromised. Provision of a favorable environment and behavior change is needed to combat the silent epidemic of physical inactivity.

TB patient support systems in Kerala: A qualitative analysis.

INTRODUCTION: Tuberculosis (TB) is one of the leading causes of death due to infectious diseases in the world. Kerala a southern state in India aims to eliminate TB in the near future. In order to achieve its goal Kerala is providing various social support services to TB patients to ensure their smooth transition as they pass through the treatment cascade. Therefore, the objective of the current study was to qualitatively analyse the support systems provided for TB patients in Kerala and to assess the enablers and challenges faced during the provision of these services. METHODOLOGY: A qualitative study using grounded theory approach was carried out among TB survivors, current TB patients and healthcare workers from all 14 districts of Kerala along with district health officials. A total of 14 in depth interviews were conducted among healthcare workers from all the districts of Kerala. Three FGDs were conducted, out of which two were among TB survivors and another one among current TB patients. The data was collected till data saturation was reached. The audio recorded data was transcribed, translated, manually coded and emerging themes and sub themes were identified. Using data triangulation, conclusions were made. RESULTS: It was observed that different TB support services were being provided across all the 14 districts of Kerala. Each of these initiatives were found to be unique in their own way for bridging the gaps in the in the continuum of care provided for TB patients. The main domains identified were grouped as support services provided for getting diagnosis, services provided after diagnosis of TB, prevention of TB and support provided to the patients reaching private sector. Under each of these domains a wide range of TB support initiatives that facilitated early diagnosis, good adherence to treatment, minimising patient inconveniences, stigma reduction, prevention out of pocket expenditure and emotional support were identified. Majority of these supportive measures were found not to be uniform throughout. Those are locally customised initiatives, evolved at different time periods with common objective of patient support. Community ownership, proactive health care system and political commitment contributed to these patient support systems. CONCLUSION: These support services offered to TB patients were found to be very effective in paving the way towards the goal of TB elimination in Kerala.

Developing consensus of evidence to target case finding surveys for podoconiosis: a potentially forgotten disease in India.

BACKGROUND: Podoconiosis is a non-infectious geochemical lymphoedema of the lower legs associated with a significant burden of morbidity. There are historical reports of podoconiosis in India, but its current endemicity status is uncertain. In this investigation we aimed to prioritise the selection of districts for pilot mapping of podoconiosis in India. METHODS: Through a consultative workshop bringing together expert opinion on podoconiosis with public health and NTDs in India, we developed a framework for the prioritisation of pilot areas. The four criteria for prioritisation were predicted environmental suitability for podoconiosis, higher relative poverty, occurrence of lymphoedema cases detected by the state health authorities and absence of morbidity management and disability prevention (MMDP) services provided by the National Programme for Elimination of Lymphatic Filariasis. RESULTS: Environmental suitability for podoconiosis in India was predicted to be widespread, particularly in the mountainous east and hilly southwest of the country. Most of the districts with higher levels of poverty were in the central east and central west. Of 286 districts delineated by state representatives, lymphoedema was known to the health system in 189 districts and not recorded in 80. Information on MMDP services was unavailable for many districts, but 169 were known not to provide such services. We identified 35 districts across the country as high priority for mapping based on these criteria. CONCLUSIONS: Our results indicate widespread presence of conditions associated with podoconiosis in India, including areas with known lymphoedema cases and without MMDP services. This work is intended to support a rational approach to surveying for an unrecognised, geographically focal, chronic disease in India, with a view to scaling up to inform a national strategy if required.

Social stigma associated with TB and HIV/AIDS among Kudumbashree members: A crosssectional study.

INTRODUCTION: TB and HIV/AIDS are the two major public health problems. Stigma and discrimination has an enormous impact on the sufferers. The impact is felt at home, in workplace, and at the institutions. The objective of the current study was to measure the stigma and discrimination associated with TB and HIV/AIDS and to determine the underlying factors related to it among women self-help group members in Kochi city Kerala. METHODS: A cross-sectional study was carried out among the women self-help group members in Kochi city. A total of 135 participants were included in the study. The study tool was a pretested self-administered questionnaire which captured information regarding the sociodemographic profile and stigma towards TB and HIV/AIDS. RESULT: All the respondents were women with mean age group 47.1(SD- 10.7). Majority (60%) belonged to APL category and were Hindus (52.1%). All the members have heard about HIV/AIDS and TB. The respondents reported that they would not send their children for playing with infected people (TB-49.3%; HIV-37.1%), would stay away from infected people (TB-84.3%; HIV-67.1%), and had discomfort while approaching those are infected (TB-62.1%; HIV-59.3%). Stigma toward TB and HIV was found not to have any association with any of the socio demographic factors. Correlation was observed between stigma scores of TB and HIV/AIDS (r = 0.853; P = <0.001). CONCLUSION: Stigma toward TB and HIV still exists as a major issue even among women self-help group members in Kochi. It was observed that those who had stigma toward TB also had stigma toward HIV/AIDS. Therefore is need to create holistic awareness about these diseases among women self-help groups.

Prevalence of diabetes mellitus and HIV/AIDS among tuberculosis patients in Kerala.

INTRODUCTION: It is estimated that 10 million people fall ill with Tuberculosis (TB) every year worldwide. TB continues to be in the top 10 causes of death globally with India being the home to the world's largest number of TB patients. One of the major factors attributing to this is the presence of comorbidities such as Diabetes Mellitus and HIV/AIDS. AIM: The aim of this study was to determine the prevalence of comorbidities such as Diabetes mellitus & HIV/AIDS among the newly diagnosed TB patients in Kerala in 2019 and also to determine the factors associated with it. MATERIALS AND METHODS: A cross-sectional study was carried out using the secondary data from NIKSHAY portal. There were a total of 16,527 cases of pulmonary and extrapulmonary TB cases reported from 14 districts of Kerala from January to September 2019. Using a checklist, data regarding the age, gender, type of case, Type of patient, site of disease, drug resistance were collected separately for TB patients suffering from Diabetes mellitus and HIV/AIDS. The data was then entered into Excel sheet and was analyzed using SPSS version 23. RESULTS: Out of the total 16,527 study population, most of the patients were elderly above the age of 60 years (28.6%). The prevalence of Diabetes mellitus (22.6%) was higher among TB patients when compared to HIV/AIDS (1.2%). Males in the age group between 50-59 years were found to be significantly associated with TB- Diabetes Mellitus comorbidities. Diabetes was significantly associated with Pulmonary TB patients, while HIV/AIDS was significantly associated with extrapulmonary TB. CONCLUSION: Both Diabetes Mellitus and HIV/AIDS are comorbidities that have a strong impact on the diagnosis and management of Tuberculosis patients. Therefore, there is an urgent need to prevent these comorbidities from occurring along with the implementation of early diagnosis and appropriate management strategies. This study is of prime importance especially among Primary care Physicians who are treating TB patients on routine basis. They are particularly important in TB control since they are usually the first to meet a TB suspect, before diagnosis occurs. Both HIV/AIDS and Diabetes mellitus are immunocompromised conditions and these comorbidities can affect the treatment outcomes of TB. Primary care physicians are essential in detecting TB suspects and treating them, thus contribute significantly to reducing the burden of TB.

HIV Related Stigma and Discrimination among People Living with HIV/AIDS in Ernakulam District: A Qualitative Study.

INTRODUCTION: Human immunodeficiency virus (HIV)-related stigma refers to the negative beliefs, feelings, and attitudes, while discrimination is the unfair and unjust treatment of people living with HIV/acquired immunodeficiency syndrome (PLHA). Their manifestations are context-specific and have varied impacts. OBJECTIVES: (1) To determine the different contexts in which PLHA face stigma and discrimination. (2) To study the impact of stigma and discrimination on the health of the PLHA. METHODOLOGY: A qualitative study was conducted among PLHA at the office of the network for positives. Fourteen key informant interviews were conducted on PLHA and the peer counselors to determine the contexts in which they faced stigma and discrimination. To understand its impact on health, two Focus Group Discussions were carried out separately for male and female PLHA. The data were collected using a semi-structured interview guide and were audio recorded. They were then transcribed, manually coded, thematically analyzed, and triangulated. RESULTS: The themes that arose showed that stigma and discrimination were context-specific and were experienced in different levels such as an individual, family, community, health-care system, and media. They experienced violence in addition to the loss of shelter and economic support. Stigma and discrimination was found to have a negative impact on the health of the PLHA. It was a major hindrance to health-care utilization resulting in worsening of health conditions and indirectly contributed to the spread of diseases. CONCLUSION: PLHA experience different forms of stigma and discrimination which have an adverse impact on their health. Behavior change communication initiatives for the community are required.

Drivers and barriers for measles rubella vaccination campaign: A qualitative study.

BACKGROUND: The measles-rubella (MR) vaccination campaign was launched in Kerala on 3rd October 2017 aiming to eliminate MR by 2020. The drive was carried out in schools, community centers, and medical institutions. The initial phase of the MR campaign met with many controversies that affected its coverage. OBJECTIVES: The objectives of the study were to analyze the drivers and barriers for acceptance of MR vaccination in the field area of a primary health center (PHC), which reported a low coverage (62%) during the initial phase of the campaign. METHODS: A qualitative study consisting of key informant interviews of parents of vaccinated and unvaccinated children, medical officers of the PHC, Junior Public Health Nurse (JPHN), and Accredited Social Health Activist (ASHA) workers, and the principals of government and private schools where the campaign was conducted was also interviewed. RESULTS: The major barrier to acceptance of MR campaign was the anti-vaccination propaganda in social media. The messages falsely linked fertility issues with the vaccine. The purpose of this campaign was not properly understood by the parents. The campaign was implemented within a short span of time resulting in coordination issues between the stakeholders. However, it was observed that religious affiliations played a major role in reducing coverage. The drivers to acceptance of MR vaccination campaign were the team effort of the healthcare providers who constantly motivated parents to vaccinate their children. CONCLUSION: Addressing the anti-vaccination propaganda has become the need of the hour. The inclusion of all stakeholders including religious leaders in the planning and implementation of the campaign is essential for its success.

Anemia Among School Children in Ernakulam District, Kerala, India.

Anaemia has significant negative impact on the health of school children including poor scholastic performance and cognitive impairment. The present study was done with the objective to estimate the prevalence of anemia among school going children in Ernakulam district, Kerala and to determine a few factors associated with anemia. Hemoglobin of 880 students of 6th to 9th standard in 11 randomly selected schools of Ernakulam district was estimated using HemoCue 201 photometer. Prevalence of anaemia was expressed using frequencies and percentages. Univariate analysis for factors associated with anemia was done. Selected variables were entered into a logistic regression model. The prevalence of anemia was estimated to be 44% (95% CI 40.67-47.33). Among them 0.8% had severe anemia, 3.5% had moderate anemia and 39.7% had mild anemia. Among them 21.3% and 52.6% reported not in the habit of consuming green leafy vegetables and citrus fruits respectively, at least three times on a usual week. Anemia among children was associated with female gender (adjusted OR 1.53, 95% CI 1.16-2.04), higher age group (adjusted OR 2.24, 95% CI 1.69-2.91) and regular intake of tea/coffee along with major meals (adjusted OR 1.62, 95% CI 1.20-2.04). Anemia among school going children in Ernakulam remains a public health problem and was more among females, higher age groups (12-15 years) and those reported regular intake of tea/coffee along with major meals. The consumption of iron rich foods among the students was poor. Behavior change communication for dietary modification and universal supplementation of iron is warranted.

Prevalence of Neglected Tropical Diseases (Leishmaniasis and Lymphatic Filariasis) and Malaria Among a Migrant Labour Settlement in Kerala, India.

Neglected tropical diseases (visceral leismaniasis, lymphatic filariasis) and malaria are endemic in northern states of India. Kerala has become a hub of construction activities employing a large number of migrants from these endemic states. Studies on morbidity pattern among migrants in Kerala are lacking. It is essential to look into the burden of these infections among migrant laborers who can act as reservoirs and are a threat to native population. A cross sectional study was done among migrant laborers in Ernakulam district, Kerala. After getting informed consent, a questionnaire was administered to each participant to collect sociodemographic details and 5 ml of blood was collected for detection of antigens using rapid diagnostic tests (RDT). Of the 309 migrants tested, none of them were positive for leishmaniasis, while 3.8% were positive for malaria and 3.6% for filariasis. With 2.5 million migrant laborers in Kerala, the magnitude of the problem in absolute numbers is enormous. Active surveillance and treatment is needed to prevent the reemergence of these diseases in Kerala.

Morbidity pattern and its sociodemographic determinants among elderly population of Raichur district, Karnataka, India.

CONTEXT: India is an "aging nation" with 7.7% of its population being above 60 years of age. It has resulted in a rise of both physical and mental health morbidities. AIMS: This study aimed to gather information regarding the morbidity pattern and its sociodemographic determinants among the elderly residing in the rural villages of Raichur, to understand the need for geriatric health-care facilities. SETTINGS AND DESIGN: This community-based cross-sectional study was carried out in six rural villages of Raichur District, of which 230 elderly were selected randomly. SUBJECTS AND METHODS: The data were collected using a questionnaire, clinical history, examination, and cross-checking of medical records. STATISTICAL ANALYSIS USED: Data were analyzed using Epi Info version-3.5.3. RESULTS: The prevalence of morbidity was 91.7% with an average of 3/person. Females (58.9%) had more morbidities than men (41.1%). The 3 most common morbidities were orthopedic (50.5%), cataract (50.4%), and respiratory (31.3%). 26.6% suffered from gastrointestinal morbidities while 23.9% had dental problems. 20.9% had hypertension with equal prevalence among both sexes. Only 17.4% were diabetics with majority being women. Central nervous system morbidities were 14.2% while 9.6% suffered from hearing loss and varicose veins. 8.2% had genitourinary-urinary morbidities and incontinence (1.7%) was common among both sexes. Depression (71.1%) and dermatological morbidities (4.7%) were prevalent among women. Only 3.5% suffered from cardiac morbidity and 0.4% from cancer. Significant association was found between age and morbidity and also between socioeconomic class and morbidity pattern. CONCLUSIONS: Geriatric care should become an integral part of primary health care. Regular screening and Information, Education, and Communication activities need to be provided early in life for ensuring healthy aging.