Health Needs of Ashram Schools in Rural Wardha

Objective: To assess the health needs for health promoting Ashram schools in rural Wardha. Methods: It was a cross sectional study undertaken in 10 Ashram schools, using qualitative (SWOT analysis, Transect walks and Semi-structured interviews of teachers) and quantitative (Survey) methods. Hemoglobin examination of all children was done by using WHO hemoglobin color scale. Anthropometric measurements such as height and weight of each child were obtained. Physical activity score for each child was calculated. The manual content analysis of qualitative data was done and the quantitative data was entered and analyzed using Epi_info (version 6.04d) software package. Results: Out of 1287 children examined, 724 (56.3%) were boys and 563 (43.7%) were girls. About 576 (44.8%), 213 (16.6%), 760 (59.1%) children had untrimmed nails, dirty clothes and unclean teeth respectively. More girls had (31.6%) lice infestation than boys (18.2%). Eighty six (6.7%), 75 (5.8%) and 110 (8.6%) children had scabies, fungal infection and multiple boils on their skin respectively and 158 (12.3%), 136 (10.6%) and 66 (18.3%) children had dental caries, wax in ears and worm infestation respectively. Notably, 988 (76.8%) children had iron deficiency anemia which was significantly more among girls (81.9%) than boys (72.8%). About 506 (39.3%) children consumed any tobacco product in last one month. About 746 (57.9%) children were classified to have sedentary physical activity. Among 774 children (>12 years), 183 (23.6%) and 34 (4.4%) children felt lonely ‘sometime’ and ‘most of the times’ respectively. About 398 (94.3%) boys and 342 (97.2%) girls did not know the modes of transmission of HIV/AIDS. Conclusions: In conclusion, there was high prevalence of risk factors for both communicable and non-communicable diseases in Ashram school environment. This dictates the urgent need for teacher driven, needs based and school based intervention that can screen and identify potentially preventable health conditions among underprivileged Ashram school children

An Approach to Monitor and Initiate Community Led Actions for Antenatal Care in Rural India – A Pilot Study

Background and Objective: Utilization of antenatal care in rural India is far from universal. It requires monitoring and identification of specific needs at field level for timely corrective actions. To pilot test the triangulation of rapid quantitative (Lot Quality Assurance Sampling) and qualitative (Focus Group Discussion) monitoring tools for ensuring antenatal care in a community based program. Methods: The present study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Centre (KRHTC), Anji, which is also a field practice area of Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. The monthly monitoring and action system of the study was based on the rapid quantitative monitoring tool (Lot Quality Assurance Sampling, LQAS)to find out poor performing supervision areas and overall antenatal service coverage and the qualitative methods (Focus group discussions (FGDs), and free listing) for exploring ongoing operational constraints in the processes for timely decision making at program and community level. A trained program supervisor paid house visit to 95 randomly selected pregnant women from 5 supervision areas by using pre-designed and pre-tested questionnaire. For poor performing indicators, semi structured FGDs and free listing exercise were undertaken to identify unmet service needs and reasons for its poor performance. Results: Registration of pregnancy within 12 weeks improved from 22.8% to 29.6%. The consumption of 100 or more IFA tablets during pregnancy significantly improved from 6.3% to 17.3%. There was significant improvement in awareness among pregnant women regarding danger signs and symptoms during pregnancy. Over three months period, the overall antenatal registration improved from 253 (67%) to 327 (86.7%). Conclusion: The present field based monitoring and action approach constructively identified the reasons for failures and directed specific collective actions to achieve the targets

Effect of use of socially marketed faucet fitted earthen vessel/sodium hypochlorite solution on diarrhea prevention at household level in rural India

Objective: To evaluate the effect of socially marketed faucet fitted to earthen vessel / sodium hypochlorite solution on diarrhea prevention at rural household level as a social intervention for diarrhea prevention under ‘Community Led Initiatives for Child Survival (CLICS) program. Methods: Unmatched case-control study was carried out in 10 villages of Primary Health Centre, Anji, located in rural central India. During the study period, 144 households used either faucet fitted earthen vessel to store drinking water or used sodium hypochlorite solution (SH) for keeping drinking water safe. These served as case households for the present study. 213 neighborhood control households from same locality who used neither of the methods were also selected. Results: Odds ratio for households who used faucets fitted to earthen vessel was 0.49 (95% CI= 0.25 – 0.95). Odds ratio for households who used sodium hypochlorite solution was 0.55 (95% CI= 0.31 – 0.98). Use of these methods by the community, would prevent about 27 percent and 22 percent cases of the diarrhea (Population attributable risk proportion = 0.25 by faucets fitted to earthen vessels and 0.22 by use of sodium hypochlorite solution) respectively. Conclusion: To ensure safe drinking water at household level, the effective and cheap methods like fitting faucet to traditionally used earthen vessel and/or use of sodium hypochlorite solution must be promoted through community participation at household level for cost and culture sensitive rural people in Indi

Formative exploration of students’ perception about Community Medicine teaching at Mahatma Gandhi Institute of Medical Sciences, Sewagram, India

Objective: The objectives of the present formative research were to explore the medical undergraduates’ study problems and their perceptions about various teaching approaches in currently practiced teaching curriculum of Community Medicine. Material and Methods: The present formative research was undertaken at Dr. Sushila Nayar School of Public Health incorporating Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram. The respondents were 17 (26.5%) conveniently selected final year exam appearing medical undergraduates from 2004 regular batch of 64 students. A triangulation of qualitative research methods like free listing, pile sort exercise and a Focus Group Discussion (FGD) were used. A two dimensional scaling and hierarchical cluster analysis was completed with the pile sort data. The data was analyzed by using software Anthropac 4.98.1/X software. Results: The medical undergraduates could understand the topics like Integrated Management of Neonatal and Childhood (IMNCI), Primary Health Care (PHC), cold chain system for vaccines, immunization and health education, dietary survey and cluster survey method taught in the community based camp approaches. Students found it difficult to comprehend the core of subject from the scattered lecture series over a long teaching period, especially using lengthy over head projector/liquid crystal display presentations. The major problems encountered in studying the subject of Community Medicine were difficulty in understanding the concepts of biostatistics, confusions due to apparently similar text in National Health Programs and difficulty to recall disease statistics due to vast syllabus. Conclusions: Students perceived the community based camp approach of teaching as a best method to understand the subject, which is an integration of task oriented assignments, integration of social sciences within medical domain and active community involvement. Hence, the community based camp approach can be scaled up as a best Community Medicine teaching approach. The active learning methods could be used to improve the lectures and the clinics which should be more concentrated in final year of teachin

Application of Qualitative Methods in Health Research: An Overview

Qualitative research is type of formative research that includes specialized techniques for obtaining in-depth responses about what people think and how they feel. It is seen as the research that seeks answer to the questions in the real world. Qualitative researchers gather what they see, hear, read from people and places, from events and activities, with the purpose to learn about the community and to generate new understanding that can be used by the social world. Qualitative research have often been conducted to answer the question “why” rather than “what”. A purpose of qualitative research is the construction of new understanding. Here, we present an overview of application of qualitative methods in health research. We have discussed here the different types of qualitative methods and how we and others have used them in different settings/scenarios; sample size and sampling techniques; analysis of qualitative data; validity in qualitative research; and ethical issues

A community based cross sectional study on feasibility of lay interviewers in ascertaining causes of adult deaths by using verbal autopsy in rural Wardha

Background & objectives: 1) To study the causes of adult (15 years and above) deaths using verbal autopsy (VA) and its socio-demographic characteristics. 2) To study the feasibility of use of the lay interviewer to ascertain causes of adult death using verbal autopsy and a simple algorithm. Methods: The present study was done in Wardha district, Maharashtra, India. Taking into account feasibility, out of 23 villages of Primary Health Centre, Anji, 15 villages were chosen having total population of 14,590. Out of 273 estimated adult deaths during the study period, 209 (77%) could be traced by house to house visit and a lay interviewer, interviewed the close caretakers of the deceased. Both lay interviewer and a physician individually derived their diagnosis using verbal autopsy report and a simplified algorithm. The data was entered and analyzed by using Epi_info 6.04. The inter-observer reliability between the lay interviewer and a physician for each possible diagnosis was assessed by using the Kappa statistics. Considering the diagnosis made by a physician as a gold standard, the diagnostic and predictive accuracy for each diagnosis made by the lay interviewer was calculated. Results: The communicable diseases accounted for 52 percent of the adult deaths while non-communicable for 32 percent and injuries for nine percent deaths. The overall agreement between the lay interviewer and a physician for communicable diseases was found to be good (k = 0.65 + 0.06) and for non-communicable diseases it was found to be excellent (k = 0.80 + 0.06). The lay interviewer using VA performed adequately for individual conditions of public health importance like acute febrile illness, diarrheal diseases, tuberculosis and injuries. Interpretation & conclusions: The present study has been successful to demonstrate feasibility of use of the lay interviewer to provide useful information on population-level estimation of broad causes of adult deaths and its socio-demographic characteristics that are reasonably reliable. The study suggests the possible utility of the method for rural India, where the majority of deaths occur at home. Further research work on development of sensitive and specific yet simple algorithms for lay interviewers to ascertain causes of adult deaths is required

An approach to hygiene education among rural Indian school going children

Objectives: To find out the prevalence of intestinal parasites and its epidemiological correlates among rural Indian school going (6-14 years) children and to study the effect of focused, need based child to child hygiene education on personal hygiene of school children. Materials and Methods: In September 2007, the present participatory action research was undertaken at a feasibly selected village Dhotra (Kasar) in Wardha district of central India. A triangulated research design of quantitative (survey) and qualitative (transect walk & pile sorting) methods was used for the needs assessment before initiating formal hygiene education. Out of enlisted 172 children, data of 118 children with complete information was used for final analysis. The quantitative and qualitative data was entered and analyzed using the Epi Info 6.04 software and Anthropac 4.98.1/X software package respectively. School based participatory life skills based child to child hygiene education was undertaken for message dissemination and behavior change. The effect of this hygiene education on identified key behaviors was assessed after one month Results: Out of the 118 (50 male and 68 female) subjects examined 21 (17.8%, 95%CI, 11.4 – 25.9%) had intestinal parasite infection. The prevalence of intestinal parasitic infection was significantly high among children having dirty untrimmed nails (47.4%, 95%CI, 30.9 – 64.1%) followed by those having poor hand washing practices (37.2%, 95%CI, 22.9 – 53.2%). One month after hygiene education, the proportion of children having practice of hand washing with soap after defecation significantly improved from 63.6 % to 78%. The proportion of clean and cut nails also improved from 67.8% to 80 % (p<0.05). Conclusions: The need based, focused, life skills based child to child hygiene education was effective for behavior change. An integrated approach of drug treatment and focused participatory hygiene education is required to control parasite load among rural Indian school going children

Tobacco consumption among adolescents in rural Wardha: Where and how tobacco control should focus its attention?

Objectives: The objectives of the present study were to study the pattern of tobacco use among rural adolescents (15-19 years) and to find out reasons for use and non use of tobacco products. Materials and Methods : In the present community-based research, triangulation of qualitative (free list, focus group discussions) and quantitative methods (survey) was undertaken. The study was carried out in surrounding 11 villages of the Kasturba Rural Health Training Centre, Anji during January 2008 where 385 adolescents were selected by simple random sampling and interviewed by house to house visits. After survey, six focus group discussions were undertaken with adolescent boys. Results: About 68.3% boys and 12.4% girls had consumed any tobacco products in last 30 days. Out of boys who had consumed tobacco, 79.2% consumed kharra, and 46.4% consumed gutka. Among boys, 51.2% consumed it due to peer pressure, 35.2% consumed tobacco as they felt better, and five percent consumed tobacco to ease abdominal complaints and dental problem. Among girls, 72% used dry snuff for teeth cleaning, 32% and 20% consumed tobacco in the form of gutka and tobacco &amp; lime respectively. The reasons for non use of tobacco among girls were fear of cancer (59%), poor oral health (37.9%). Among non consuming boys it was fear of cancer (58.6%), poor oral health (44.8%) and fear of getting addiction (29.3%). According to FGD respondents, few adolescent boys taste tobacco by 8-10 years of age, while girls do it by 12-13 years. Peer pressure acts as a pro tobacco influence among boys who are outgoing and spend more time with their friends. They prefer to consume freshly prepared kharra which was supposed to be less strong (tej) than gutka. Tobacco is being used in treatment of some health problems. Tobacco is chewed after meals for better digestion, given to ease toothache, pain in abdomen and to induce vomiting in suicidal insecticide poisoning. Conclusion: The current consumption of any tobacco products among rural adolescents was found very high. Hence, the multi-pronged intervention strategy is needed to tackle the problem

Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening.

INTRODUCTION: Squamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA. METHODS AND ANALYSIS: This is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged >25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm. ETHICS AND DISSEMINATION: The study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences. TRIAL REGISTRATION NUMBER: NCT03489707