Iodine intake among pregnant mothers residing in hilly terrains of two districts of Himachal Pradesh, India.

BACKGROUND: Under programmatic settings, routine monitoring and evaluation of household consumption of iodized salt are recommended to track the reach of universal salt iodization strategy. The program needs evaluation in different settings and locations. OBJECTIVE: The objective of this study was to assess urine-based estimation for recent iodine intake among pregnant women living in hilly terrains of two districts of northern state of India. METHODS: A community-based cross-sectional observational study was conducted during September- December 2019 among 202 randomly selected pregnant women in two districts of Himachal Pradesh. With a predesigned schedule, data regarding sociodemographic and behavioral factors and salt consumption were collected by interview. Iodine level of salt was assessed by spot iodine testing kit and urinary iodine concentration (UIC) was measured using ammonium persulfate digestion using spectrophotometer. RESULTS: Women had a mean age of about 26 years, and the period of gestation was of mean 163.7 days. The consumption of iodized salt (>15 ppm) at family level was found to be 83.7%, and the median UIC was 169.0 µg/L. Among assessed, 26.7% had an acceptable level of UIC, whereas 41.1% and 32.2% of women had less (<150 µg/L) and excessive (>250 µg/L) level of UIC, respectively. CONCLUSION: Recent iodine intake among pregnant women was observed to be adequate, but efforts are to be done to assess the reasons for less and excessive UIC among women.

Coinfections as an aetiology of acute undifferentiated febrile illness among adult patients in the sub-Himalayan region of north India.

BACKGROUND & OBJECTIVES: In India, certain geographic regions witness simultaneous outbreaks of two or more diseases like scrub typhus, dengue fever, malaria, leptospirosis and chikungunya during monsoon and post-monsoon period, sharing common indication of acute febrile illness. The objective of the present study was to assess the prevalence of coinfections among patients with acute undifferentiated fevers (AUF) admitted in a tertiary care hospital in the northern hilly state of Himachal Pradesh, India. METHODS: This was a hospital based open cohort study conducted over a period of two months (September and October) in 2016. All the patients above the age of 18 yr admitted in medical wards and fulfilling the definition of AUF were included. The patients diagnosed with dual infections were the subjects of the study. Standard guidelines were used for case definitions of scrub typhus, dengue, chikungunya, malaria and leptospirosis. RESULTS: Dual infections were noted in 16 patients admitted with AUF. The most common coinfection was scrub typhus and dengue, reported in 10 patients. Scrub typhus and leptospirosis coinfection was observed in three patients. Dengue and chikungunya was observed in one patient. Scrub typhus, dengue and vivax malaria was detected in one patient. Scrub typhus and vivax malaria was detected in one patient. Out of the 10 cases positive for both scrub and dengue, four had no history of travel outside Himachal Pradesh. All three cases positive for both scrub and leptospirosis were indigenous without any history of travel outside Kangra, Himachal Pradesh. The outcome of all the patients was with full recovery. INTERPRETATION & CONCLUSION: The study established the presence of coinfections (mainly dengue fever and leptospirosis) as a cause of AUF in the study area, which is a nonendemic region. The role of easily available and widely performed serological tests in the aetiological diagnosis of AUF is significant. Studies are required to determine the normal titres in the local population before using the imported commercially available serological tests in the diagnosis of AUF.

Effectiveness of randomized control trial of mobile phone messages on control of fasting blood glucose in patients with type-2 diabetes mellitus in a Northern State of India.

Limited availability of randomized control trial warranted the conduct of a present study to demonstrate the effectiveness of mobile phone-based short message services (SMSs) on reduction in mean fasting blood glucose (FBG) in patients with type-2 diabetes mellitus. A total of 955 patients were recruited from primary and secondary health-care facilities and randomized to intervention (479) and control (476) group. Messages were delivered to patients for 12 months tailoring to their recent FBG values. SMS included information to maintain the desired FBG levels and next due date for FBG assessment. Patients were statistically similar for their age, socioeconomic status, smoking, and alcohol use. After the intervention, an average FBG declined from 163.7 to 152.8 mg/dl (P = 0.019) in intervention and from 150.5 to 149.2 mg/dl (P = 0.859) in control group. Adjusted for the baseline FBG, the intervention was found to be significantly effective (odds ratio: 1.7; 95 confidence interval: 1.2-2.6).

Predictors of seizures in patients with posterior reversible encephalopathy syndrome.

PURPOSE: Although seizures are common in patients with posterior reversible encephalopathy syndrome (PRES), epilepsy is rare. Our objective was to identify predictors and impact of seizures in patients with PRES. METHODS: A retrospective review of the clinical and radiological parameters of all patients diagnosed with PRES from 2007 to 2014 was performed. Patients were divided into two groups based on the occurrence of PRES-related seizures at presentation or during their hospital course. Univariate and multivariate analyses were performed to determine factors associated with the occurrence of PRES-related seizures. RESULTS: Of 100 patients, 70% experienced at least one seizure from PRES. On univariate analysis, the factors associated with seizures were the following: high Charlson comorbidity index (4.16±2.89 vs. 2.87±2.20, p=0.03), systemic malignancy (41.4% vs. 16.7%, p=0.02), occipital lobe involvement (97.1% vs. 83.3%, p=0.02), more lobes involved (4.6±1.48 vs. 3.9±1.32, p=0.03) but less likely in patients with visual disturbances (15.7% vs. 46.7%, p=0.005), and facial droop (12.9% vs. 16.7%, p=0.002). On multivariate analysis, only occipital lobe involvement was significantly (odds ratio: 9.63, 95% CI: 1.45-64.10, p=0.02) associated with the occurrence of PRES-related seizures. Despite the occurrence of seizures, they were less likely to require a nursing home placement upon hospital discharge (odds ratio: 0.17, 95% CI: 0.03-0.91, p=0.04). CONCLUSION: We conclude that seizures are common in patients with occipital lobe involvement from PRES.

Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India.

BACKGROUND: The existence of an endemic goiter belt along the southern slopes of the Himalayas has been known for a long time. Prevalence of neonatal hypothyroidism is high and there has been little work on the prevalence of mental retardation in this part of India. OBJECTIVE: The study was conducted with the aim to know the prevalence of mental retardation in the urban and rural populations of Himachal Pradesh, India and to generate a hypothesis on the differential distribution (geographical) of mental retardation. METHODS: This cross-sectional study was conducted in the rural and urban areas of the district of Kangra, Himachal Pradesh, India among children of 1-10 years of age. In the first phase, the children in the age group of 1-10 years were screened for mental retardation using the Ten Questions Screen, whereas in the second phase the suspects were evaluated clinically. RESULTS: The prevalence of mental retardation was found to be 1.71% in the study population with higher prevalence (3.3%) in the 73-120 months age group. The prevalence was higher among the males in all study populations [rural: 1.9%, urban (nonslum): 1.6%, and urban slum: 7.14%). The prevalence was similar among the urban (nonslum) (1.75%) and rural (1.11%) populations, whereas it was higher (4%) in the urban slum population. A prevalence of 2% was seen in families from the lower middle class and 1.8% among families from the lower class in the rural population, whereas a prevalence of 2% was seen among lower middle class families of urban (nonslum) areas. CONCLUSION: The prevalence of mental retardation was higher in our study than in other parts of the country. The study concludes with the hypothesis that the prevalence of mental retardation is differentially distributed geographically with socioeconomic factors being important predictors.

Measuring the Effect of Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) on Health Expenditure among Poor Admitted in a Tertiary Care Hospital in the Northern State of India.

Background: Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) as a financial risk protection scheme intends to reduce catastrophic health expenditure (CHE), especially among poor. The current study was carried out to assess the utility of AB-PMJAY in terms of reduction in CHE from before and after admission in a tertiary hospital in the northern state of India. Methodology: It was a hospital-based cross-sectional study carried out from August 2020 to October 2021 at a public tertiary hospital of Himachal Pradesh, India. Data were collected from surgery- and medicine-allied (SA and MA) specialties. Along with socio-demographic details, information for total monthly family expenditure (TMFE), out-of-pocket expenditure (OOPE), and indirect illness-related expenditure (IIE) was recorded before and after hospital admission. CHE was considered as more than 10.0% OOPE of THFE and more than 40.0% of capacity to pay (CTP). Results: A total of 336 participants with a mean age of 46 years were recruited (MA: 54.6%). The majority (~93.0%) of participants had illness of fewer than 6 months. The mean TMFE was observed to be INR 4213.1 (standard deviation: 2483.7) and found to be similar across specialties. The OOPE share of TMFE declined from 76.1% (before admission) to 30.0% (after admission). Before admission, CHE was found among 65.5% (10.0% of THFE) and 54.2% (40.0% of CTP) participants. It reduced to about 29.0% (based on both THE and CTP) after admission to hospital. Conclusion: AB-PMJAY scheme found to be useful in reducing CHE in a tertiary hospital.

Scoring satisfaction among patients, attending ART Centre of a medical college in North-West India.

Patient satisfaction is a measurable concept comprising multidimensional elements such as access to care, quality of the provider patient interpersonal relationship and affordability of care. This further influences the decisions to seek care and outcomes of diseases. Although stigma and discrimination are potential barriers to effective implementation of the antiretroviral therapy (ART) programme, higher satisfaction levels of patients are also crucial for treatment adherence. A hospital-based cross-sectional study was conducted at the ART centre of IG Medical College, Shimla from November 2008 through May 2009. Three hundred and eighty four consecutive adult (≥18 years) patients attending the ART centre and on ART who consented to participate in the study were enrolled. Of the 384 patients, 209 (54.4%) were males. Majority were in the age bracket of 25-44 years. About 61.6% of the patients were satisfied to the services being provided. Mean Patient Satisfaction Questionnaire (PSQ) scores were the highest for technical quality of care and lowest for financial aspects. About 69.4% of the patients were satisfied towards their care provider. Although a majority of the patients were satisfied, several areas of patient care need improvement.

Need to involve relevant stakeholders -lessons from NFHS data.

Contextualizing data to their settings is perhaps the most important step in deriving a meaning from them. This is no less true for health data. The National Health Survey data are an excellent source of information; however, its strength may not be its contextualization. Our habit of, for example, doing primary care without family physicians or doing public health without understanding the complete domain and involvement of its proponent seems to have extended to this exercise (collection of National Health Survey data) as well. Relegating health data to statistics and calculus alone should be a pitfall all of us must avoid. Identifying the right stakeholders to understand the complexity of health data is the key.

Risk of Childhood Obesity in Children With High Birth Weight in a Rural Cohort of Northern India.

OBJECTIVE: To compare the risk of early childhood obesity (BMI z-score of ³+2SD) among children of more than 7 years of age with a birth weight of more than 3500 g to a birth weight of 2500-2999 g. METHODS: Retrospective birth cohort study among children of 7 to 10 years of age in 22 villages of Himachal Pradesh with not-exposed (birth weight: 2500 to 2999 g) and exposed (> 3500 g) group. RESULTS: A total of 379 and 377 participants were enrolled in not-exposed and exposed group, respectively. Adjusted relative risk (aRR) between exposed and high BMI (>+2SD) was 4.9 (95%CI: 1.3-17.5) adjusted for mean age, gender, mean years of schooling, consumption of butter, fruits, vegetables, and indoor playing. CONCLUSION: High birth weight (>3500 g) increases and normal birth weight decreases the risk of childhood obesity up to five times in rural India.

Development, standardization, and contextualization of qualitative tools for possible use in the assessment and valuation of snakebite envenomation.

Background: Snakebite envenoming, a neglected tropical disease (NTD), is an important public health problem that is responsible for more than 1 lakh deaths annually across the world. However, the majority of the data in this regard is from health institutions and data from community settings are scarce. The aim of the current study was to develop valid and reliable qualitative tools for assessing the burden of snakebites and the health-seeking behavior of the community. The tools developed thus will serve in creating a community connection and thereby strengthen primary care teams engaged in managing snakebites at the primary care level. Methods: A four-step design was used; (a) review of the available literature on the burden of disease, tools used to assess the burden, and the guidelines on snakebite (b) development, laying out, and contextualization of questions/items for the tools (c) pilot testing and establishment of validity. Results: A focus group discussion guide, key informant interview schedule for health professionals, community leaders, and traditional faith healers were matured for the implementation. Conclusion: A reliable and valid qualitative tool was developed to discern the speculations related to snakebites and its management in rural field settings.

Inbreeding as a cause for deafness: Dadhkai study.

BACKGROUND: We report on the higher prevalence of deaf-mutes from a village in Jammu and Kashmir State of India. MATERIALS AND METHODS: A cross-sectional study among 79 deaf mutes using pedigree analysis, audiometry, imaging and molecular analysis. RESULTS: A high rate of hereditary deafness with 79 individuals diagnosed to be suffering from non-syndrome deafness in a total population of 2452 individuals residing in the village. INTERPRETATION: Flourishing of intermarriages led to a population with high prevalence of deafness.

Herd immunity in COVID-19: Needs de-emphasizing.

Despite the evolving science on Covid-19 pointing to the contrary, the concept of Herd immunity continues to influence decision making in this pandemic. This paper attempts to evolve an understanding of the concept of herd immunity and its relevance in context of pandemics in general and Covid-19 in particular.

Multi-sectoral implementation interface framework (MIIF) to achieve the objective of tobacco-free Himachal Pradesh.

The limitations observed in achieving the goal of a tobacco-free Himachal Pradesh have necessitated the need to contextualize the existing policy directives in tobacco reduction. Our observation has been that despite having clearly defined policy guidelines and laws, the implementation may not have followed suit. An analysis of the gaps observed had led us to develop an implementation interface framework involving stakeholders from multiple sectors.

Prevalence of cerebral palsy in children < 10 years of age in R.S. Pura town of Jammu and Kashmir.

OBJECTIVE: To determine the prevalence of cerebral palsy in children aged <10 years. METHODS: The study was conducted in the framework of a population-based, single-centre, cross-sectional surveillance at R.S. Pura town, 22 km south-west of Jammu city. RESULTS: A total of 11 cases of cerebral palsy were ascertained yielding a crude prevalence rate of 2.27/1000 in the age group of <10 years. The proportion of cerebral palsy occurring in males was higher than that in females. INTERPRETATION: The prevalence rates of cerebral palsy among children <10 years of age in R.S. town compare favorably with studies from developed countries.

"Covishield and Covaxin" - India's contribution to global COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic continues to bring in its wake not only morbidity and mortality but also an unprecedented challenge to public health, food systems, human dignity, and work across the world. The availability and possible delivery of a safe and effective vaccine to populations across the world are not only being seen as a hope to surmount these challenges but also as a show of human resilience in the face of adversity. Nations need to galvanize their resources and make the availability of vaccines universal, without which the real benefits of its development cannot be realized. Despite its large domestic needs, our country is being looked upon with both hope and expectation to deliver at this crucial juncture in the evolution of human civilization, and India is more than willing to do its part.

The confusion is killing Public Health, Community Medicine and Family Medicine; all critical to India's healthcare delivery system.

The clarity on the structure and functioning of academic Public health, Community Medicine and Family Medicine appears to missing to a large extent. The confusion appears more visible now than ever before. The dichotomy in regulating medical training by India's regulators, the National Medical Commission (NMC) and National Board of Examination (NBE) does not seem to be helping the situation either. Added to it is the confusion created by academic institution not directly regulated by the NMC.

Teleophthalmology as a Model for Detecting Ocular Diseases in Tribal Areas of a North West State in India.

BACKGROUND: Lahaul and Spiti district of Himachal Pradesh, a high altitude tribal district, situated at altitudes varying from 10,000 to 15, 000 ft. above mean sea level is cut off from the rest of the country for nearly 6 months due to heavy snowfall in the mountain passes. In the absence of any ophthalmologist and ophthalmic technician, the provision of eye care is virtually absent. The current study (part of a research project funded by the Indian Council of Medical Research) was conducted with the aim to explore teleophthalmology as a model for detecting posterior segment eye diseases in tribal and inaccessible areas. MATERIALS AND METHODS: Fundus images (taken through fundus photography) of 1000 individuals above 5 years of age with no improvement in vision to 6/6 on refraction and individuals with known history of diabetes mellitus, systemic hypertension, or long standing headache with features of raised intracranial tension irrespective of whether their vision improved to 6/6 or not were sent to tertiary care center (base hospital) from regional hospital (field hospital). Transmitted images (through internet after attaching the details and patient particulars on the excel sheet) were analyzed by the ophthalmologists and the final diagnosis along with the line of management if any was transmitted back. RESULTS: Eighty-five percent of the images transmitted were of good quality. Retinal, vitreous, optic nerve head, and choroidal diseases could be detected. CONCLUSIONS: In the present situation, where trained workforce is unavailable in these areas, teleophthamology is an appropriate tool by which a number of eye diseases can be detected at early stages. Most of them can be treated in these early stages by lifestyle modification and medical management.

Broad guidelines for primary care practitioners/standalone private health facilities/frontline healthcare facilities in view of COVID-19 pandemic.

In view of India unlocking, to secure a large population of this country, the healthcare facilities delivering primary care as well standalone health facilities need to be secured from impacts of COVID-19 pandemic. This document dwells on the broader guidelines for primary care practitioners/standalone private health facilities/frontline healthcare facilities to mitigate the impact of COVID-19 Pandemic. The authors understand that the situation is evolving, so the guidelines too will keep evolving.