Comparison of Vaginal Birth Rate between Induction of Labour and Expectant Management at 40 Weeks in Women with a Previous Caesarean Section: A Pilot Randomized Controlled Trial.

Background: The optimum time of labour induction among women with a previous caesarean without any pregnancy complication and eligible and willing for vaginal delivery is not specified. This study compares the vaginal birth rates between induction at 40 weeks and expectant management till 41 weeks. Method: We conducted this parallel design nonblinded, randomized controlled trial in a tertiary care teaching institution in South India on women with a previous lower segment caesarean section eligible for a trial of labour with singleton foetus without any pregnancy complication at recruitment. We screened 1886 women. Sixty women underwent block (of 6 each) randomization into two groups of thirty each at 40 weeks. We induced the women in the intervention group at 40 weeks with oxytocin or a single 24-hour application of a Foley catheter followed by oxytocin infusion and amniotomy. The expectant group underwent maternal and foetal surveillance and induction at 41 weeks with the same protocol if not delivered by then. We compared the primary outcome of the proportion of vaginal birth rate with a chi-square test. Result: Data from all sixty women were analyzed. Twenty (66.67%) in the induction compared to ten (33.33%) in the expectant group delivered vaginally. This difference was significant (RR 2.0, 95% CI: 1.13-3.52; P = 0.016). One woman in the expectant group had scar dehiscence. Conclusion: Among women with a previous caesarean scar, labour induction at 40 weeks has a significantly higher vaginal birth rate than those managed expectantly till 41 weeks. More extensive trials are feasible and recommended. Trial Registry. The trial was prospectively registered with the clinical trial registry of India. This trial is registered with CTRI/2018/09/015719 (date of registration 14th September 2018).

Soil-Transmitted Helminth Infections among Antenatal Women in Primary Care Settings in Southern India: Prevalence, Associated Factors and Effect of Anti-Helminthic Treatment.

Community-based studies from India on prevalence of soil-transmitted helminth (STH) infections have reported estimates as high as 50% in children. However, prevalence estimates during pregnancy in India are lacking. We aimed to describe the burden, associated factors of STH and cure rate after deworming in primary care settings. Pregnant women were recruited from four urban and five rural centers in Puducherry, South India, from December 2019 to April 2022. One stool sample was collected from each participant before deworming and one repeat sample was collected from STH positive woman after three weeks of deworming. The samples were processed with saline; iodine wet mount, and microscopic concentration techniques. Cure rate (CR) was assessed using Kato-Katz thick smear. Of 650 women included, 49 (7.5%, 95% CI 5.6-9.8) had one of the STH infections; the prevalence of Ascaris lumbricoides, hookworm and Strongyloides was 5.4%, 1.8% and 0.3%, respectively. The prevalence of any STH was higher among ages 26-30 years (9.1%), working women (8.3%), multigravida (8.3%), urban setting (8.3%), those who did not wash their hands before food (9%) and anemic women (8.9%), compared to their counterparts, but not statistically significant. The CR for hookworm was 100% and Ascaris lumbricoides was 88.6%. To conclude, the prevalence of STH was low among pregnant women compared to school aged children. Continued deworming activities along with improved sanitation could further reduce the burden.

Prevalence and association of depressive symptoms with spiritual intelligence among older adults: A community-based study in rural Puducherry, South India.

INTRODUCTION: Depression is more common among older adults, but there is a paucity of information about its association with spiritual intelligence. This study aimed to determine the prevalence and association of depressive symptoms with spiritual intelligence among older adults. MATERIALS AND METHODS: This community-based cross-sectional analytical study was conducted among 292 older adults in a rural area of Puducherry, India. A structured questionnaire was used to collect each participant's socio-demographic and behavioral factors; the presence of depressive symptoms was assessed by using Geriatric Depression Scale (short form), spiritual intelligence by the Spiritual Intelligence Self-Report Inventory-24 questionnaire and activities of daily living by Katz Index of Independence scale. Proportion for prevalence estimate, bivariate and multivariable log binomial regression analysis were done. RESULTS: The prevalence of depressive symptoms was 64.1 % (187/292; 95 % CI 58.3-69.3). Of total, 103 (35.3 %) had low, 92 (31.55 %) had moderate and 97 (33.2 %) had high spiritual intelligence. About 11 % (32/292) were partially or fully dependent. Depressive symptoms showed a significant association with marital status, education, sleep pattern, relationship with family members and spiritual intelligence in bivariate analysis. Depressive symptoms were high among those with low spiritual intelligence and disturbed sleep pattern with Adjusted Prevalence Ratio of 1.33 (95 %CI 1.26-1.4) and 1.06 (95 %CI 1.0-1.14) respectively. CONCLUSION: Majority of the older adults had depressive symptoms and significantly more among those with low spiritual intelligence and disturbed sleep. This study gives new evidence on spiritual intelligence among older adults in a community setting and the magnitude of association of depressive symptoms with spiritual intelligence.

Willingness and yield of screening for hepatitis B among outpatients of a tertiary care centre, Puducherry, South India.

India's National Viral Hepatitis Control Programme recommends screening outpatients for hepatitis B at tertiary care centres. We aimed to assess the yield of screening and reasons for refusal for testing. We included adult outpatients at a tertiary care centre, South India during September and October 2019. Participants' willingness to be tested and the reasons for refusal were noted. Fingerstick blood sample was tested for HBsAg using rapid kit. Of a total of 700 participants, 157 (22%, 95% CI: 19.4-25.7%) were unwilling to be tested. Men were more unwilling (26%) compared to women (19%) (aPR 1.90 95% CI: 1.22-2.94; p = 0.004). 'Lack of time' was the most common reason reported for refusal (10%). Of 543 participants tested, 15 (2.8%, 95% CI: 1.6-4.5%) were positive for HBsAg. Similar studies from other regions in India are required for the estimation of yield of opportunistic approach.

Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India.

BACKGROUND AND AIMS: COVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care. METHODS: This cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity. RESULTS: A total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress. CONCLUSIONS: Majority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.