Role of Mitanin community health workers in improving complementary feeding practices under scaled-up home-based care of young children in a rural region of India.

BACKGROUND: A large proportion of young children in developing countries receive inadequate feeding and face frequent infections. Global research has established the need for improving feeding practices and management of child illnesses. Interventions involving home visits by community health workers (CHWs) for caregiver education have been attempted in many countries. Indian government rolled out an intervention called home-based care of young children (HBYC) in 2018 but no studies exist of its scaled-up implementation. The current study was aimed at assessing the coverage of HBYC in Chhattisgarh state where it has been implemented through 67,000 rural CHWs known as Mitanins. METHODS: This cross-sectional study was based on a primary household survey. Households with children in 7-36 months age were eligible for survey. A multi-stage sample of 2646 households was covered. Descriptive analyses were performed and key indicators were reported with 95% confidence intervals. To find out the association between caregiver practices and receiving advice from the CHWs, multivariate regression models were applied. RESULTS: Overall, 85.1% children in 7-36 months age received at least one home visit from a CHW within the preceding three months. Complementary feeding had been initiated for 67% of children at six months age and the rate was 87% at eight months age. Around one-third of the children were fed less than three times a day. Around 41% households added oil in child's food the preceding day. CHWs were contacted in 73%, 69% and 61% cases of diarrhea, fever and respiratory infections respectively in children. Among those contacting a CHW for diarrhea, 88% received oral rehydration. The adjusted models showed that receiving advice from CHWs was significantly associated with timely initiation of complementary feeding, increasing the frequency of feeding, increasing diet diversity, addition of oil, weighing and consumption of food received from government's supplementary nutrition programme. CONCLUSIONS: Along with improving food security of households, covering a large share of young children population with quality home visits under scaled-up CHW programmes can be the key to achieving improvements in complementary feeding and child care practices in developing countries.

Assessing competence of mid-level providers delivering primary health care in India: a clinical vignette-based study in Chhattisgarh state.

BACKGROUND: The global commitment to primary health care (PHC) has been reconfirmed in the declaration of Astana, 2018. India has also seen an upswing in national commitment to implement PHC. Health and wellness centres (HWCs) have been introduced, one at every 5000 population, with the fundamental purpose of bringing a comprehensive range of primary care services closer to where people live. The key addition in each HWC is of a mid-level healthcare provider (MLHP). Nurses were provided a 6-month training to play this role as community health officers (CHOs). But no assessments are available of the clinical competence of this newly inducted cadre for delivering primary care. The current study was aimed at providing an assessment of competence of CHOs in the Indian state of Chhattisgarh. METHODS: The assessment involved a comparison of CHOs with rural medical assistants (RMAs) and medical officers (MO), the two main existing clinical cadres providing primary care in Chhattisgarh. Standardized clinical vignettes were used to measure knowledge and clinical reasoning of providers. Ten ailments were included, based on primary care needs in Chhattisgarh. Each part of clinical vignettes was standardized using expert consultations and standard treatment guidelines. Sample size was adequate to detect 15% difference between scores of different cadres and the assessment covered 132 CHOs, 129 RMAs and 50 MOs. RESULTS: The overall mean scores of CHOs, RMAs and MOs were 50.1%, 63.1% and 68.1%, respectively. They were statistically different (p < 0.05). The adjusted model also confirmed the above pattern. CHOs performed well in clinical management of non-communicable diseases and malaria. CHOs also scored well in clinical knowledge for diagnosis. Around 80% of prescriptions written by CHOs for hypertension and diabetes were found correct. CONCLUSION: The non-physician MLHP cadre of CHOs deployed in rural facilities under the current PHC initiative in India exhibited the potential to manage ambulatory care for illnesses. Continuous training inputs, treatment protocols and medicines are needed to improve performance of MLHPs. Making comprehensive primary care services available close to people is essential to PHC and well-trained mid-level providers will be crucial for making it a reality in developing countries.

Catastrophic health expenditure due to hospitalisation for COVID-19 treatment in India: findings from a primary survey.

OBJECTIVE: The COVID-19 pandemic has caused widespread illness and a significant proportion of the infected required hospitalisation for treatment. People in developing countries like India were vulnerable to high hospitalisation costs. Despite its crucial importance, few primary studies are available on this aspect of the pandemic. This study was aimed at finding out the out of pocket expenditure (OOPE) and incidence of catastrophic expenditure on hospitalisation of persons infected with COVID-19. A primary survey of 492 randomly selected hospitalisations of individuals tested positive for COVID-19 in high-burden districts during August to November 2020 was carried out telephonically in Chhattisgarh state of India. RESULTS: Public hospitals accounted for 69% of the hospitalisations for COVID-19 treatment. Mean OOPE per hospitalisation was Indian Rupees (INR) 4871 in public hospitals and INR 169,504 in private hospitals. Around 3% of hospitalisations in public hospitals and 59% in private hospitals resulted in catastrophic expenditure, at a threshold of 40% of non-food annual household expenditure. Enrolment under publicly or privately funded health insurance was not effective in curtailing OOPE. Multivariate analysis showed that utilisation of private hospitals was a key determinant of incurring catastrophic expenditure.

Application of a Non-Linear multi-model Ayurveda Intervention in elderly COVID-19 patients- a retrospective case series.

The COVID-19 pandemic is ravaging the world, leaving the mainstream medical system handicapped with no proven treatment at one end and the ambiguities regarding the efficacies of vaccines at the other. The elderly population is at greater risk in terms of complications and death. The use of complementary and alternative medicine (CAM) against COVID-19 has already been documented in countries like China with a national participation rate of 90%. In this regard, the practice of CAM especially Ayurveda is relevant in India. The current report is a case series of 64 elderly COVID-19 patients managed through a Non-Linear multi-modal Ayurveda Intervention (NLMAI) via online consultation. NLMAI is a combination of herbal and herbo-mineral drug interventions, lifestyle modifications, and psychological support done in 2 phases. The post-management analysis revealed a mean duration of 11 symptoms of COVID-19 assessed through survival function as 0.577 days [SE=0.39] with a CI of 95% [0.500-0.653] which was considerably low when compared to global statistics. Moreover, none of the cases advanced to complications or death. Hence, novel approaches like NLMAI can be utilized to counter the gravity of the COVID-19 after scientific validation.