Intra-natal Care Practices in Rural Areas of Gaya District, Bihar

Context: Antenatal care (ANC) effectively reduces infant and maternal mortality rates mainly by promoting institutional deliveries. In view of this, the Government of India introduced Janani Suraksha Yojna (JSY) in 2005 and Janani Shishu Suraksha Karyakram (JSSK) in 2011. Aims: To estimate the proportion of home and institutional deliveries in the district, assess the impact of JSK and JSSY on institutional deliveries, and identify the different intranatal care providers. Settings and Design: This cross-sectional study was conducted in the Gaya district, Bihar. A total of 657 females of the reproductive age group (15-49 years) were included in the study. Methods and Material: Predesigned, pre-tested & semi-structured questionnaire was used to collect information on place of delivery, type of delivery, knowledge regarding JSY and JSSK schemes and source of information Statistical analysis used: Data was entered into excel sheets and analyzed using SPSS version 23 utilizing appropriate statistical methods. Results: Out of 519 deliveries, 63% were institutional and 37% were home deliveries. About 91 and 11.4% of respondents were aware of JSY and JSSK schemes. There was a significant association between those who opted for institutional delivery and awareness regarding JSY and JSSK services. Conclusion: Despite awareness and running of various government programs, the percentage of institutional deliveries is still less. An increase in institutional deliveries at primary care level through JSY and JSSK will not only decrease the Out of Pocket expenditure of the population but also help build faith in the government health facilities

Evaluation Of Urban Primary Health Centres Operating Under The Public-Private Partnership Model In The State Of Uttarakhand

Background: The National Urban Health Mission (NUHM) was launched to improve the health status of the urban poor. Aim: This study assessed the performance of Urban Primary Health Centres (UPHCs) functioning within the PPP healthcare delivery model. Methodology- We evaluated 27 UPHCs facilities based on the indicators like infrastructure as per IPHS / NUHM guidelines, human resources position as per norm, accessibility, utilization of services, client satisfaction, outreach activities, and comparative assessment between UPHCs under different zonal NGOs. Results- All evaluated UPHCs operated in rented buildings, lacking key infrastructure elements like cold chain rooms, AYUSH facility, generator room and separate offices. Human resources were inadequate, with all 2nd Medical Officer positions and 81.5% of LHV roles vacant. Community awareness of services like ANC (56.6%), PNC (51.1%), immunization (65.9%), and non-communicable diseases (63.6%) was notable. The availability of drugs at most UPHCs was not as per the demand placed. The irregular flow of funds restricted the smooth functioning of UPHCs. Conclusion: The study revealed that most community members preferred UPHCs for their health needs. The main challenges that deferred the functioning of the UPHCs were the irregular flow of funds, lack of human resources, and lack of required drugs

Pharmacotherapeutic audit meetings as a tool of improving prescribing practices

Background: Pharmacotherapeutic audit meeting (PTAM) is a good tool to review prescriptions for rationality and suggest measures for improving quality of prescriptions. To promote this, World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD) provided drug prescribing and drug use indicators. To assess the impact of PTAMs as an intervention for improving quality and rationality of prescriptions.Methods: This was a single centre, prospective study conducted from December 2018-February 2020. Prescriptions from outpatient surgical departments were collected, screened using WHO/INRUD core indicators and discussed in PTAMs. The same process was repeated over next 2 months to assess change in prescribing patterns after PTAM. Chi-square and Student’s t-test was used for statistical analysis.Results: The difference in proportions for antibiotic prescribing was 8.7% [95% CI (1.0%-16.7%), p=0.02]; injectable preparation use was 0.7% [95% CI (-0.4%-2.3%) p=0.23]; prescriptions with generic name drugs was 10.9% [95% CI (5.6-16.2%) p<0.0001] and prescriptions from Essential drug list (EDL) was 8.1% [95% CI (2.5%-13.5%) p=0.0046].Conclusions: Our research showed PTAM could be an effective tool to implement WHO/INRUD drug prescribing indicators robustly. Hence, it could be included in WHO/INRUD policies as an intricate part of institutional healthcare delivery system

Iodine deficiency during preconception period of adolescent girls residing in a district of Rajasthan, India

Background: In India, iodine deficiency (ID) still remains a serious concern even after five decades of enormous efforts. ID during the preconception period of adolescent girls may negatively affect future neonates, resulting in neonatal hypothyroidism. Hence, the present study was conducted to assess the prevalence of goiter and associated factors among adolescent girls in a poor socioeconomic district of Rajasthan. Methodology: A cross-sectional study was conducted during January–March 2015 in Tonk district of Rajasthan. A total of 1912 adolescent girls were selected from thirty schools using population proportionate to size sampling. Adolescent girls were clinically examined for thyroid using palpation method. Casual urine (n = 344) and salt samples (n = 370) were collected from a subgroup of girls for the estimation of urinary iodine concentration (UIC) and iodine content in salt, respectively. Results: The overall goiter prevalence was 15.3% (95% confidence interval 13.6%–16.9%) and the median UIC was 266 μg/l (interquartile range: 150–300 μg/l) among 1912 adolescent girls (age, 15.7 ± 1.4 years). Around 16.8% of the families of adolescent girls were consuming salt with inadequate iodine (<15 ppm). Goiter prevalence was statistically significantly different with respect to age groups (P = 0.03). There was no statistically significant difference in goiter prevalence with respect to iodine content of salt (P = 0.98) and UIC (P = 0.41). The median UIC increased with an increase in consumption of iodine content of salt from inadequacy to adequacy (P = 0.15). Conclusion: Adolescent girls, residing in an underdeveloped district, are in the transition phase from mild ID (goiter prevalence 15.3%) to iodine sufficiency (median UIC 266 μg/l)

Strengthening health systems to support family resilience in post-pandemic India: Report of a Group Concept Mapping study with AIIMS (All India Institute of Medical Sciences)

Introduction: The Family Resilience Assessment Instrument and Tool (FRAIT) (Wallace et al, 2018) is used in Wales UK by Health Visitors (public health nurses) to assess a family’s resilience, and to identify interventions which can strengthen resilience. Researchers from the University of South Wales (USW) FRAIT team (Prof. Carolyn Wallace, Emeritus Prof. David Pontin, Dr Michelle Thomas and Mrs Anitha Livingstone) and All India Institute of Medical Sciences (AIIMS) in Rishikesh (Prof. Vartika Saxena, Dr. Ajeet Singh Bhadoria and Dr. Aprajita Mehta) came together to identify the concept of family resilience as understood by Indian community health workers. This concept will be used to develop a culturally relevant tool to measure the resilience of families with children under 6 years living in India (FRAIT India). The culturally relevant tool may be used by Indian community health workers working with families in India

Public Health Student Evaluation of Teaching Qualitative Research Using Interactive Methods

Background: Interactive teaching methods aid post graduate students in learning qualitative research. Four academic researchers from the United Kingdom had an opportunity to teach qualitative research methods, specifically consensus methods, to the Master of Public Health students (MPH) during a visit to India. This teaching formed part of a work package with All India Institute of Medical Sciences Rishikesh, India exploring the concept of family resilience among families with children under 6 years. Aims: To use the experiences of the MPH students to gain knowledge and create meaning about using the consensus methods. Participants: The participants were the MPH students.Methods: We used the workshop method to introduce the concept of family resilience by using the question, ‘What will be the three top public health priorities in India to support family resilience in the 21st century?’ as a central theme for all the workshops. Furthermore, we introduced qualitative research methods and hands on experience of consensus methods to the students. The students were introduced to Delphi and Group Concept Mapping (GCM) methods during workshop 1. Workshop 2 introduced Nominal Group Technique (NGT) through a short presentation followed by a practical hands on session using GCM data from workshop 1. The last workshop (3) focused on the World Café method. Results: The students evaluated the workshops highly and asked for online sessions on GCM, NGT, and World Café which will be planned in the future. Conclusion: We concluded that the post graduate curriculum for master’s in public health studies would benefit from teaching using interactive research methods which will enhance their critical thinking and autonomy. Second, although the MPH curriculum had quantitative methods in place, introducing qualitative consensus methods will open new avenues into future research. Finally, teaching using practical demonstration gives students a voice and makes learning effective and enjoyable

Evaluating diaphragmatic dysfunction and predicting non-invasive ventilation failure in acute exacerbation of chronic obstructive pulmonary disease in India

Background Baseline diaphragmatic dysfunction (DD) at the initiation of non-invasive ventilation (NIV) correlates positively with subsequent intubation. We investigated the utility of DD detected 2 hours after NIV initiation in estimating NIV failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods In a prospective-cohort design, we enrolled 60 consecutive patients with AECOPD initiated on NIV at intensive care unit admission, and NIV failure events were noted. The DD was assessed at baseline (T1 timepoint) and 2 hours after initiating NIV (T2 timepoint). We defined DD as ultrasound-assessed change in diaphragmatic thickness (ΔTDI) <20% (predefined criteria [PC]) or its cut-off that predicts NIV failure (calculated criteria [CC]) at both timepoints. A predictive-regression analysis was reported. Results In total, 32 patients developed NIV failure, nine within 2 hours of NIV and remaining in the next 6 days. The ∆TDI cut-off that predicted NIV failure (DD-CC) at T1 was ≤19.04% (area under the curve [AUC], 0.73; sensitivity, 50%; specificity, 85.71%; accuracy; 66.67%), while that at T2 was ≤35.3% (AUC, 0.75; sensitivity, 95.65%; specificity, 57.14%; accuracy, 74.51%, hazard ratio, 19.55). The NIV failure rate was 35.1% in those with normal diaphragmatic function by PC (T2) versus 5.9% by CC (T2). The odds ratio for NIV failure with DD criteria ≤35.3 and <20 at T2 was 29.33 and 4.61, while that for ≤19.04 and <20 at T1 was 6, respectively. Conclusions The DD criterion of ≤35.3 (T2) had a better diagnostic profile compared to baseline and PC in prediction of NIV failure

Psychosocial and stress-related risk factors for abnormal menstrual cycle pattern among adolescent girls: A case-control study

BACKGROUND: Menstruation is a normal physiological process among reproductive age group females. Although some of them show the abnormal menstrual pattern, which is influenced by several factors, including sociodemographic status, psychosocial stress, improper sleep level, etc. The identification of these risk factors associated with abnormal menstrual patterns may permit risk stratification among adolescent girls. This study was planned to determine various factors which depict menstrual cycle pattern among adolescent girls in urban India. MATERIALS AND METHODS: A school-based case–control study was carried out in urban India from May to December 2019. Urban locality and schools were randomly selected, and data were collected in two phases. Adolescent girls in the age group of 10–19 years studying in government and private (both Hindi medium and English medium) schools of urban India were screened for the abnormal menstrual pattern. Equal numbers of age-matched controls were also enrolled. Data were collected with the help of self-administered predesigned pretested semi-structured questionnaire. Chi-square test, Fisher's exact test, unpaired t-test, and McNemar tests were used to analyze data using SPSS version 23.0. RESULTS: A total of 100 cases and 100 age-matched controls (mean age 14.8 ± 1.5 years) were included in the study, almost half of the cases and controls have normative menarche. Improper sleep patterns increased stress levels, and low education status of mothers show statistically significant (P = 0.047) association with abnormal menstrual patterns. CONCLUSION: More stress, improper sleep levels, and low education status of mothers among school-going adolescent girls were strongly associated with abnormal menstrual patterns with more symptoms during menstruation

Perceptions of Medical Students on Research Curriculum: A Cross-sectional Study

Introduction: Medical colleges promote research by incorporating it into the curriculum, which enables students to acknowledge it as a career prospect. The aim of the study was to assess the perceptions of medical students on research curriculum. Methods: This cross-sectional study was conducted among 544 medical students (interns and post-graduates) at AIIMS Rishikesh in 2020. Data was collected thorough online self-administered questionnaire. A comparison between groups was made using the Mann-Whitney test or chi-square test p &lt; 0.05 was considered statistically significant. Results: Out of 544 participants, 218 (40.1%) responded with complete data. The total median score for the self-perceived ability of study participants regarding performing the research tasks differed significantly between interns and post-graduates [29.5 (24.0–34.2) vs 33 (25.2–39.7), p = 0.03]. They suggested that mandatory research projects, workshops, and training should be included in the curriculum. Conclusion: Feedback from medical students regarding the need for guided research projects, hands-on training, and inclusion of research methodology as a course in UG curriculum and provision of support in the form of incentives, academic credits, and motivation are well noted and guide the resource faculties to modify their teaching and student support programs

Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity. Interpretation: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. Funding: Bill & Melinda Gates Foundation