Prevalence of Psychological Distress Among Quarantined People in Trivandrum District During the COVID-19 Pandemic: A Cross-sectional Study

Background: Quarantine is considered the most effective way to reduce the transmission of an infectious disease. The outbreak of coronavirus disease-19 (COVID-19) in 2020 led to many people being quarantined at various locations. The literature shows that people who undergo quarantine face psychological problems, such as depression, anxiety and stress. The aim of this study was to estimate the prevalence of psychological issues among quarantined people during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in Trivandrum, Kerala, India. Adults aged 18 years and above who underwent quarantine in the area of the Pangappara Medical Health Centre were included. A semi-structured questionnaire and the Depression Anxiety Stress Scale-21 were administered to those who had given their informed consent. Quantitative variables were summarized using mean, standard deviation, and categorical variables with proportions. Significance of association was tested using the chi-square tests. Results: There were 143 participants included in the study. It was found that 23.8% had depressive symptoms, 14% had anxiety symptoms and 16.8% had significant stress. People from the age group of 26-40 years (p = 0.017), people from the higher educated group (p = 0.010) and non-resident Keralites (Keralites who were residing elsewhere and returned to Kerala during the pandemic) (p = 0.041) had the highest prevalence of depressive symptoms. Conclusion: People who undergo quarantine face many psychological issues. The health care system should provide adequate psychosocial support to quarantined people suffering from psychological problems. Health care workers should undergo appropriate training to provide these supports

Knowledge, Attitude and Practices Among Mothers of Infants Regarding Breastfeeding

Objective: This study aims at understanding the level of knowledge, attitude, and practice of breastfeeding among mothers and the factors associated with good knowledge about breastfeeding. Materials and methods: A cross-sectional study among 251 mothers of infants admitted in the pediatric wards of SAT Hospital, Thiruvananthapuram was conducted during November-December 2019. The mothers of infants born between 37 and 42 weeks of gestation and without major birth defects were included in the study. The data were entered into an MS Excel sheet and analyzed using Statistical Package of Social Sciences version 26.0. Significance of association was tested using Chi-square test and multivariate analysis was done using binary logistic regression test. Results: The mean age of the participants was 26.25 (SD 4) years. On multivariable analysis, higher education and older age were found to be significantly associated with good knowledge. Independent sample T-Test results show that there was a statistically significant difference between the mean age of mothers with good knowledge (26.4(±4), 25.14(±3.7)), p-0.015 and statistically significant association was found between the mean attitude scores (34.07(5.58)) with current breastfeeding practices (p=0.002). Chi-square test shows that exclusive breastfeeding was significantly associated with the mother’s age (p=0.006); 64.2% of women practicing exclusive breastfeeding were less than 25 years of age. This study also demonstrated a significant association between the initiation of breastfeeding within an hour and exclusive breastfeeding (p=0.003). Conclusion: This study shows that mothers with higher age and higher educational qualifications were significantly associated with good knowledge about breastfeeding. Even though mothers have good knowledge, nearly half the mothers only exclusively breastfeed their infants for six months. Improving the educational qualification of women and increasing awareness about the benefits of breastfeeding among young women will promote breastfeeding practices

What our children lost and gained at the time of school closure during the Covid-19 pandemic: a study on psychological distress, behavioural concerns and protective factors of resilience among preschool children in Kerala, India

Abstract Background The pandemic has put at risk the social and emotional development of children on account of the paucity of arenas for social interaction. This study from Kerala, India was conducted to assess the resilience factors, behavioural concerns, psychological distress symptoms among the children aged 3 to 5 years. We also tried to look into the lost opportunities that could have aided the social and emotional development of children like peer interaction, child care hours. Methods The cross-sectional study was conducted among the children aged 3 to 5 years. A total of 535 children attending the immunisation clinics were enrolled by consecutive sampling. Devereux Early Childhood Assessment P2 (DECA P2) questionnaire was used to assess the levels of resilient factors and behavioural concerns in the study population. Results We observed a high proportion of children in the area of need category of protective factors under DECA P2. The proportion of children falling under area of concern was 64.5%, 49%, 68.4% for attachment/relationship, self-regulation, and initiative respectively. 24.9% study subjects have a behavioural concern score that puts them in the area of need category. The logistic regression model we created identified ‘Male Gender,’ ‘Mothers could spend only less time for child care’ and ‘electronic devices used as pacifier’ as significant predictors for belonging to Area of need Behavioural Concerns T score category. Conclusion A large proportion of children aged between 3 to 5 years with reported behavioural concerns and lack of protective factors for socioemotional development. This can be attributed partly to the ongoing pandemic and its associated restrictions. The increased child care hours invested by parents or grandparents could have sized down the full impact that the pandemic would have had on the socio emotional development of the child. Increased time spent using electronic devices coupled with dwindled opportunities for interaction with peers have been notable challenges

The burden of dengue and force of infection among children in Kerala, India; seroprevalence estimates from Government of Kerala-WHO Dengue studyResearch in context

Summary: Background: Dengue shows high geographic heterogeneity within and across endemic countries. In the context of increasing burden and predicted outbreaks due to climate change, understanding the heterogeneity will enable us to develop region specific targeted interventions, including vaccination. World Health Organisation (WHO) suggests standard methodologies to study the burden and heterogeneity at national and subnational levels. Regional studies with robust and standard methodology to capture heterogeneity are scarce. We estimated the seroprevalence of dengue in children aged 9–12 years and the force of infection in Kerala, India, from where Zika cases also have been reported recently. Methods: We conducted a school-based cross-sectional survey in 38 clusters; selected by stratified random sampling, representing rural, urban, high burden and low-burden administrative units. Validation of Indirect IgG ELISA was done by Plaque Reduction Neutralization Test (PRNT90) using the local isolates of all four serotypes. Force of infection (FOI) was estimated using the WHO-FOI calculator. We conducted a follow-up survey among a subsample of seronegative children, to estimate the rate of sero-conversion. Results: Among 5236 children tested, 1521 were positive for anti-dengue IgG antibody. The overall seroprevalence in the state was 29% (95% CI 24.1–33.9). The validity corrected seroprevalence was 30.9% in the overall sample, 46.9% in Thiruvananthapuram, 26.9% in Kozhikkode and 24.9% in Kollam. Age-specific seroprevalence increased with age; 25.7% at 9 years, 29.5% at 10 years, 30.9% at 11 years and 33.9% at 12 years. Seroprevalence varied widely across clusters (16.1%–71.4%). The estimated force of infection was 3.3/100 person-years and the seroconversion rate was 4.8/100 person-years. 90% of children who tested positive were not aware of dengue infection. All the four serotypes were identified in PRNT and 40% of positive samples had antibodies against multiple serotypes. Interpretation: The study validates the WHO methodology for dengue serosurveys and confirms its feasibility in a community setting. The overall seroprevalence in the 9–12 year age group is low to moderate in Kerala; there are regional variations; high burden and low burden clusters co-exist in the same districts. The actual burden of dengue exceeds the reported numbers. Heterogeneity in prevalence, the high proportion of inapparent dengue and the hyperendemic situation suggest the need for region-specific and targeted interventions, including vaccination. Funding: World Health Organization