Prevalence and predictors of vaccine hesitancy in an urbanized agglomeration of New Delhi, India.

BACKGROUND: The immunization program has been an important part of Indian public health policy for three decades; yet only 62% of children are being fully immunized. Vaccine hesitancy is a major contributor to the immunization gap that needs to be addressed. METHODS: A cross-sectional descriptive study of prevalence and predictors of vaccine hesitancy was conducted in 350 households having at least one child in the age group of 13-24 months. Statistical analysis was done using chi-square test and logistic regression. RESULTS: The prevalence of vaccine hesitancy was 28.9%. Fear of needles, concern about pain during vaccination, lack of family support, and apprehension regarding side effects were ascertained as reasons for vaccine hesitancy. The type of family, time taken to reach the health facility and antenatal care received by the mother were significant predictors of vaccine hesitancy. CONCLUSION: The prevalence of vaccine hesitancy was found to be high. In 2019, the World Health Organization earmarked vaccine hesitancy as one of the major roadblocks to better global health. A better understanding of the subject can help public health agencies enhance vaccination coverage, not just in children but also as a tool to protect entire populations in this age of re-emerging epidemics.

Ultrasonographic diagnosis and surgical management of double intestinal intussusception in 3 dogs.

The diagnosis and treatment of double intestinal intussusception in 3 pups with persistent vomiting, diarrhea, dehydration, anemia, leucocytosis, and electrolyte imbalance are described. Ultrasonography confirmed intussusception and laparotomy revealed double intussusceptions. Intussusceptions were corrected by manual reduction in 1 pup and intestinal resection and anastomosis in 2 pups. Two pups survived and 1 pup died on the 4th day after surgery.

RésuméDiagnostic échographique et gestion chirurgicale de l'intussusception intestinale double chez 3 chiens. Le diagnostic et le traitement d'une intussusception intestinale double chez 3 chiots avec des vomissements persistants, de la diarrhée, de la déshydratation, de l'anémie, de la leucocytose et un déséquilibre électrolytique sont décrits. L'échographie a confirmé l'intussusception et une laparatomie a révélé des intussusceptions doubles. Les intussusceptions ont été corrigées par une réduction manuelle chez 1 chiot et une résection intestinale et une anastomose chez 2 chiots. Deux chiots ont survécu et 1 chiot est mort le quatrième jour après la chirurgie.(Traduit par Isabelle Vallières).

Prevalence, patterns, and determinants of body image dissatisfaction among female undergraduate students of University of Delhi.

Background: Body image is an essential aspect of young girls' self-definition and individual identity and is influenced by multitude of factors including cultural, social, cognitive, affective, and biological. In recent times, excessive concern about the body image has been reported and the prevalence of body image dissatisfaction (BID) has increased among adolescent and young girls. Objectives: The objective of this study was to estimate the prevalence of BID, its pattern and the factors associated with it among female undergraduate students and also to assess the level of concern about their body image. Methods: This cross-sectional study was conducted among 180 female undergraduate students using a contour drawing rating scale and a body shape questionnaire to assess BID and its pattern, and the level of concern about body image, respectively. Binary logistic regression was applied to identify the factors determining body image perception. Results: The prevalence of body mage dissatisfaction was 76.7% with overweight and obesity, and media influences being significantly associated with it. Nutritional status, mother's educational status, and media influences were the determinants. Body shape concerns were found among 30.6% of the participants out of which 7.3% reported marked to moderate concerns. Conclusions: Our findings highlighted a higher prevalence of perceived dissatisfaction with the body image and also that it is not simply the outcome of sociocultural pressure to conform to a certain body type but is the result of a complex interaction between individual differences in actual body mass and preference for a thin body ideal.

Relationship of eating behavior and self-esteem with body image perception and other factors among female college students of University of Delhi.

BACKGROUND: Eating disorders (EDs) can lead to life-threatening nutritional deficiencies whereas self-esteem influences interpersonal relationships and academic performance. Excessive concerns about body image resulting in body dissatisfaction not only affect psychological well-being but also predisposes to disordered eating behaviors. The objective of this study is to assess the eating behavior and level of self-esteem, their relationship with body image perception and also identify factors associated with them among undergraduate female college students. MATERIALS AND METHODS: This cross-sectional study was conducted among 180 female undergraduate students of University of Delhi. Sociodemographic characteristics and anthropometric measurements were recorded. Eating Attitude Test-26, Rosenberg Self-esteem Scale, Contour Drawing Rating Scale and Body Shape Questionnaire 34 were used to assess eating behavior, self-esteem, body image dissatisfaction and body shape concerns, respectively. Both descriptive and inferential statistics were used and binary logistic regression was applied to identify the factors determining high risk eating behavior and low self-esteem. RESULTS: In this study, 27.8% of the study participants were overweight or obese, 30.6% had body shape concerns and 76.7% had body image dissatisfaction. Significant proportion (13.9%) of the participants was identified as high risk for the development of EDs and having low self-esteem (12.8%). Body shape concern and family influences were significant predictors of high risk eating behavior whereas type of college and family influences significantly predicted low self-esteem. CONCLUSIONS: The study concluded that factors such as nutritional status, family influences, type of college and body shape concerns lead to high risk eating behavior and low self-esteem. These findings will help in creating awareness on importance of concept of positive body image, healthy weight control behaviors and in developing future interventions.

Prevalence of Non-Exclusive Breastfeeding and Associated Out-of-Pocket Expenditure on Feeding and Treatment of Morbidity Among Infants Aged 0-6 Months in an Urban Slum.

OBJECTIVE: To estimate the prevalence of non-exclusive breastfeeding (NEBF) and quantify the out-of-pocket expenditure (OOPE) associated with NEBF and treatment of morbidity among infants up to six months of age. METHODS: Community based in an urban slum, among 172 mother-infant dyads selected by systematic random sampling. Current breast-feeding practices and OOPE over last one month was recorded using a pre-validated, interviewer administered schedule. Independent sample t-test subsequent to bootstrapping was used to test the statistical significance of the difference in mean out of pocket expenditure between NEBF and exclusively breastfeeding (EBF) infants. The main outcome measures was non-exclusive breastfeeding rate and out of pocket expenditure associated with infant feeding and treatment of morbidity. RESULTS: 67 (38.9%) infants were found to be non- exclusively breastfed. The median (IQR) total monthly OOPE incurred on non-breastmilk feeding and healthcare was found significantly higher among NEBF infants vs EBF infants [440 (80-982) vs [0 (0-290); P<0.001]. The median (IQR) monthly OOPE incurred on healthcare was also significantly higher among NEBF infants than EBF infants [INR 140 (0-540) vs 0(0-150); P=0.002]. CONCLUSION: The prevalence of NEBF was high, and it was associated with higher financial burden on the families.

Pilot Study of Chronic Obstructive Pulmonary Disease in an Industrial Town in India.

BACKGROUND: The burden of chronic obstructive pulmonary disease (COPD) in India is not well understood. Due to geographical and environmental heterogeneity, the epidemiological profile of COPD may not be uniform across the country. Studies carried out in small geographical areas can help to determine the prevalence and risk factors of COPD. OBJECTIVES: The present study was conducted in one city in northwest India in order to calculate prevalence in small geographically determined areas within the city as well as across socio-economic strata and adjoining neighborhoods. METHODS: The present study was conducted in Ludhiana, an industrial town in Punjab, India. Residential colonies were identified in an industrial and nonindustrial area and all households were screened for COPD using the Global Initiative for Chronic Obstructive Lung Disease criteria and confirmed by spirometry. Information about exposure to possible risk factors was also collected from suspected cases of COPD. Cases were mapped on a digital map of the city and hotspots were identified. RESULTS: Fifty-six cases of COPD were detected. More than half (71%) were in the industrial area. The overall prevalence rate of COPD in the city was 3.17 per 1 000. The highest prevalence (5.6-9.4 per thousand) was observed in the colonies of the industrial area. All surveyed colonies in the nonindustrial area showed a low prevalence (0.0 to 0.9 per thousand). CONCLUSIONS: Hotspots were located in the industrial area and there was no such aggregation in the nonindustrial area. This suggests a potential association of industrial air pollutants with COPD. A strength of the present study is that it provides important baseline data. However, the study was limited, as it did not show a temporal association of exposure to air pollution and smoking with COPD. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the Institutional Ethics Committee for Human Research of the University College of Medical Sciences, Delhi, India. INFORMED CONSENT: Obtained. COMPETING INTERESTS: The authors declare no competing financial interests.

Pattern of severe maternal morbidity in a tertiary hospital of Delhi, India: a pilot study.

Severe maternal morbidity also known as 'near miss' may be a good indicator of the quality and effectiveness of obstetric care, as it may identify priorities in maternal care more rapidly than mortality alone. The objective of the study was to observe the pattern of severe maternal morbidity and its associated factors in a tertiary care hospital in Delhi. All patients admitted to the obstetrics and gynaecology department who fulfilled the definition of severe maternal morbidity conditions were included. A proforma was used to record sociodemographic, obstetric, antenatal care treatment and outcome details. A total of 63 women were included for analysis. The incidence of severe maternal morbidity was 3.3/100 deliveries. The mean age of the patients was 26.3 +/- 5 years. More than half (55.5%) were uneducated: almost one-third (32%) were from outside Delhi - the median distance travelled was 10 km. The majority were antenatal admissions (68.3%). The proportion of postdelivery or abortion cases were greater among women who came from outside Delhi. Only 38.1% were registered during the antenatal period. The diagnoses were: eclampsia/pre-eclampsia (35%); haemorrhage (35%); sepsis (13%); obstructed labour (9.5%) and other medical conditions (11%). Severe anaemia was observed in 22% of cases. Only 43.5% were normal vaginal deliveries and 54.5% were delivered by caesarean section or with the use of instruments; 61.3% were live births. Hysterectomy was performed in 14.8%: the proportion of hysterectomy was higher in obstructed labour. Severe maternal morbidity cases constitute a significant burden on health resources.

Surgical Repair of Radial-Ulnar Fracture by Static Intramedullary Interlocking Nailing in a Crossbred Heifer.

OBJECTIVE: Study included surgical management of radius and ulna fracture in a 2-year-old, 220 kg crossbred heifer presented with a 2-day-old history of injury resulting in severe, non-weight bearing lameness of the left forelimb. METHODS: The condition was diagnosed clinically and confirmed radiographically as a middle third oblique comminuted fracture of the left radius and ulna. Static intramedullary interlocking nailing was performed for fracture fixation. An interlocking nail of 12-mm diameter and 26-cm length was introduced in a retrograde manner from the distal aspect of the radius. RESULTS: The animal was able to bear weight on the affected limb within 7 days post surgery. Good callus formation and complete weight bearing were observed by 35th day. Bending of the screws and osteophytic reaction were the major postoperative complications observed radiographically. CLINICAL SIGNIFICANCE: From this case study, it was established that static intramedullary interlocking nailing can be used as an alternative technique for fracture repair of the radius and ulna in cattle where stable fracture fixation by bone plating is questionable.

Comparison of radiography and ultrasonography in the detection of lung and liver cysts in cattle and buffaloes.

AIM: Echinococcosis is the major cause of lung and liver cysts in ruminants. This study compared usefulness of radiography and ultrasonography (USG) in the detection of lung and/or liver cysts in sick bovine animals. The study also worked out cooccurrence of lung and liver cysts, and whether these cysts were primary cause of sickness or not. MATERIALS AND METHODS: This study was conducted on 45 sick bovine (37 buffaloes and 8 cattle) suffering from lung and liver cysts. A complete history of illness and clinical examination was carried out. Lateral radiographs of chest and reticular region were taken. In radiographically positive or suspected cases of cysts, USG of the lung and liver region was done. Depending on the location of cyst and clinical manifestations of the animal, the cysts were categorized as primary or secondary causes of sickness. RESULTS: Using either imaging technique, it was observed that 46.7% of the animals had both lung and liver cysts, whereas 33.3% had only lung and 20% had only liver cyst. Cysts were identified as primary cause of sickness in 31.1% animals only. For diagnosing lung cysts, radiography (71.1%) and USG (62.2%) had similar diagnostic utility. However, for detecting liver cysts, USG was the only imaging tool. CONCLUSION: The lung and liver cysts, depending on their number and size may be a primary cause of sickness in bovine. Radiography and USG are recommended, in combination, as screening tools to rule out echinococcosis.

Device-Associated Infection Rates in 20 Cities of India, Data Summary for 2004-2013: Findings of the International Nosocomial Infection Control Consortium.

OBJECTIVE: To report the International Nosocomial Infection Control Consortium surveillance data from 40 hospitals (20 cities) in India 2004-2013. METHODS: Surveillance using US National Healthcare Safety Network's criteria and definitions, and International Nosocomial Infection Control Consortium methodology. RESULTS: We collected data from 236,700 ICU patients for 970,713 bed-days Pooled device-associated healthcare-associated infection rates for adult and pediatric ICUs were 5.1 central line-associated bloodstream infections (CLABSIs)/1,000 central line-days, 9.4 cases of ventilator-associated pneumonia (VAPs)/1,000 mechanical ventilator-days, and 2.1 catheter-associated urinary tract infections/1,000 urinary catheter-days In neonatal ICUs (NICUs) pooled rates were 36.2 CLABSIs/1,000 central line-days and 1.9 VAPs/1,000 mechanical ventilator-days Extra length of stay in adult and pediatric ICUs was 9.5 for CLABSI, 9.1 for VAP, and 10.0 for catheter-associated urinary tract infections. Extra length of stay in NICUs was 14.7 for CLABSI and 38.7 for VAP Crude extra mortality was 16.3% for CLABSI, 22.7% for VAP, and 6.6% for catheter-associated urinary tract infections in adult and pediatric ICUs, and 1.2% for CLABSI and 8.3% for VAP in NICUs Pooled device use ratios were 0.21 for mechanical ventilator, 0.39 for central line, and 0.53 for urinary catheter in adult and pediatric ICUs; and 0.07 for mechanical ventilator and 0.06 for central line in NICUs. CONCLUSIONS: Despite a lower device use ratio in our ICUs, our device-associated healthcare-associated infection rates are higher than National Healthcare Safety Network, but lower than International Nosocomial Infection Control Consortium Report.

Feasibility of C-arm guided closed intramedullary pinning for the stabilization of canine long bone fractures.

AIM: To evaluate the feasibility of C-arm guided closed intramedullary pinning (simple Steinmann and end threaded) techniques for the stabilization of various canine long bone fractures. MATERIALS AND METHODS: The present study was conducted on 19 dogs with long bone fractures which were stabilized using simple Steinmann (Group I; n=6) and end threaded (Group II; n=13) pinning under C-arm guidance. Signalment, history of trauma, clinical examination, and hematobiochemical findings were recorded at the time of presentation. Radiography of the affected limb was carried out in two views to determine type and site of the fracture. Treatment of all the fractures was attempted using simple Steinman and end threaded pinning under the C-arm guidance. The success and failure of the closed technique were correlated with age, site, and type of fractures. RESULTS: The mean body weight and age of the dogs were 18.53±2.18 kg and 21.58±5.85 months, respectively. Early presented cases at a mean day of 2.84±0.54 were included. Out of 19 cases, it was possible to place implant successfully in 10 cases (success rate 52.63%) only. The remaining 9 cases had serious intraoperative complications like a misdirection of the pin after engaging the proximal fragment (n=3), missing the proximal fragment completely, and formation of the false tract (n=6). The majority of these complications were associated with younger age and proximal or distal third oblique fractures. High success rate of C-arm guided closed pinning was observed in midshaft fractures (75%) and transverse fractures (77.78%) in dogs of more than 1 year of age (77.78%). Simple Steinmann pinning was better feasible in a closed manner with a high success rate (66.70%) but also had implant related complications. Although, C-arm guided end threaded pinning was less (46.15%) successful, slightly tedious and time-consuming but had better implant stability than that of simple intramedullary pinning. CONCLUSIONS: From the present study, it was concluded that C-arm guided closed pinning is recommended in transverse and midshaft fractures of the long bones in dogs older than 1 year of age. Furthermore, there is need to improve traction devices for enhancing the success of C-arm guided intramedullary pinning in dogs.

A Critical Appraisal of Kuppuswamy's Socioeconomic Status Scale in the Present Scenario.

The socioeconomic status (SES) is widely recognized as one of the important factors affecting the health condition of an individual or a family. One of the scales widely used and quoted even today is the one developed by Kuppuswamy. The Kuppuswamy scale in its various forms has held steady over three decades now and is still widely used as a measure of socioeconomic status in the urban population. However, it is important to discuss the applicability in the changed modern scenario.

Impact of an international nosocomial infection control consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India.

OBJECTIVE: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India. METHODS: This was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods. RESULTS: During the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31-0.70; p=0.0001). CONCLUSIONS: Implementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up.

Findings of the International Nosocomial Infection Control Consortium (INICC), Part I: Effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infection rates in pediatric intensive care units of 6 developing countries.

DESIGN: A before-after prospective surveillance study to assess the impact of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infection (CAUTI) rates. SETTING: Pediatric intensive care units (PICUs) of hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of the following 6 developing countries: Colombia, El Salvador, India, Mexico, Philippines, and Turkey. PATIENTS: PICU inpatients. METHODS: We performed a prospective active surveillance to determine rates of CAUTI among 3,877 patients hospitalized in 10 PICUs for a total of 27,345 bed-days. The study was divided into a baseline period (phase 1) and an intervention period (phase 2). In phase 1, surveillance was performed without the implementation of the multidimensional approach. In phase 2, we implemented a multidimensional infection control approach that included outcome surveillance, process surveillance, feedback on CAUTI rates, feedback on performance, education, and a bundle of preventive measures. The rates of CAUTI obtained in phase 1 were compared with the rates obtained in phase 2, after interventions were implemented. RESULTS: During the study period, we recorded 8,513 urinary catheter (UC) days, including 1,513 UC-days in phase 1 and 7,000 UC-days in phase 2. In phase 1, the CAUTI rate was 5.9 cases per 1,000 UC-days, and in phase 2, after implementing the multidimensional infection control approach for CAUTI prevention, the rate of CAUTI decreased to 2.6 cases per 1,000 UC-days (relative risk, 0.43 [95% confidence interval, 0.21-1.0]), indicating a rate reduction of 57%. CONCLUSIONS: Our findings demonstrated that implementing a multidimensional infection control approach is associated with a significant reduction in the CAUTI rate of PICUs in developing countries.