Implementation challenges of Pradhan Mantri Jan Arogya Yojana: A Cross- Sectional study in Meerut, Uttar Pradesh

Background: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana has been launched to provide financial protection expenditure to nearly 500 million vulnerable Indians. For expanding the coverage under the scheme, it is necessary to understand the perspective of health care service providers involved in the scheme. Aim & Objective: To find out the bottlenecks in implementation of PMJAY scheme using empanelled hospitals’ perspective Settings and Design: Cross sectional study Methods and Material: 8 Public and 23 Private hospitals were selected through Simple Random Sampling from the list of PMJAY empanelled hospitals. The PMJAY Medical Officer co-ordinators in the empanelled hospitals were interviewed using a predesigned and pretested questionnaire. Statistical analysis used: Data was analysed using descriptive statistics in Epiinfo software. Results: Among the 31 empanelled hospitals studied, 93.5% were satisfied with the process for empanelment under PMJAY. 64.5% hospitals were not satisfied with the Health Benefit Packages. 77.4% hospitals perceived the PMJAY to be poorer as compared to private health insurance with reasons being poor grievance reprisal, poor claim processing and settlement, denial of reimbursement of health packages, poor rates of health packages and little information about the scheme. Conclusions: Various hurdles are being faced in the implementation of the scheme. There definitely remains a huge scope for further improvements so as to enhance the insurance coverage in the country

Impact of Supplementary Nutrition on Undernourished Children In An Urban Area Of Meerut- A Longitudinal Study

Background: Infants and pre-school are most susceptible to undernutrition. Integrated Child Development Services is the programme focussing undernourished children by providing them supplementary nutrition. Aim& Objective: To study prevalence of undernutrition in 0-6 year old children and to study factors associated with it. To study impact of supplementary nutrition on undernourished children. Settings and Design: A longitudinal study. Methods and Material: The present longitudinal study was conducted in randomly selected Anganwadis of urban Meerut. Children found to be suffering from under nutrition were followed up at interval of six months to see the impact of supplementary nutrition provided to them at the anganwadi centre. A detailed history of relevant underlying factors responsible for causation of under nutrition were taken from mothers of these children. Statistical analysis used: chi square test was used to find out association between risk factors and undernutrition. Risk factor found statistically significant were further analysed using step wise multiple logistic regression analysis. The impact of supplementary nutrition was assessed using paired t test. Results: Iron folic acid supplementation during pregnancy, exclusive breast feeding in children, immunization and time of initiating complementary feed were found statistically significant on both chi-square and multiple logistic regression analysis. No impact of supplementary nutrition was found on anthropometric measurements of children. Conclusions: The main focus for fighting undernutrition in children (0-6 years) should be on preventing risk factors associated with mothers in antenatal period and during child rearing practice

Indian Diabetes Risk Score (IDRS): An effective tool to screen undiagnosed diabetes

Background: Diabetes is an insidious public health problem. India has the second largest number of adults living with diabetes worldwide (77 million). Indian Diabetes Risk Score (IDRS) is a simple, cost-effective and feasible tool for mass screening programme at community level. Aim & Objective: To assess diabetes risk in adults aged 30 years and above and to identify high risk subjects for screening undiagnosed diabetes in an urban population of Meerut. Settings and Design: Community based cross-sectional study. Methods and Material: All adults who were ?30 years of age and non-diabetic were interviewed using pre-designed, pre-tested questionnaire for their socio-demographic profile and lifestyle. Fasting Blood glucose of all study subjects were done to screen undiagnosed diabetics. Statistical analysis used: Centers for Disease Control (CDC), Epi Info TM 7.2.3.1 was used. Pearson’s Chi Square were applied. Results: 33.4% were found to have high diabetes risk. Risk of diabetes increases with age. 7.6% of the study subjects were found to be diabetic and were unaware of their diabetic status. Physical inactivity and increasing waist circumference were found to be significantly associated with risk of diabetes. Diabetes risk was also significantly associated with positive family history. Conclusions: Screening and early identification of high risk individuals would help in early diagnosis and treatment to prevent or to delay the onset of diabetes mellitus and its complications

Obesity in Adolescents: Prevalence and Association with Sociodemographic and Lifestyle Factors

Introduction: Overweight and obesity has become a worldwide epidemic and is a growing public health concern. The increase in prevalence and severity of obesity among children and adolescents has been attributed largely to behavioral factors such as changing eating habits and sedentary lifestyles. Objective: To determine prevalence of obesity and abdominal obesity among adolescents and its association with sociodemographic factors and lifestyle. Methods: Present cross-sectional study was conducted in the urban field practice area under the Community Medicine Department of LLRM Medical College, Meerut, among 872 adolescents. All localities in the field area were covered and house to house survey was done. Questions were asked about eating patterns, physical activity and sedentary lifestyle. Data was collected and analyzed using appropriate statistical tests. Results: The prevalence of overweight and obesity was 17.43, 6.88%, respectively. Obesity was significantly higher among females, those who indulged in unhealthy eating habits were physically inactive, watched television for a longer duration and ate junk while watching television. Conclusion: In the present study, we found that high junk food consumption and a sedentary lifestyle were found to be significantly associated with childhood overweight/obesity. As a result, timely interventions should be taken to improve awareness about healthy lifestyle behavior to prevent obesity and its complications among adolescents

Universal Health coverage – a reality or mirage

Providing quality health services to everyone and everywhere is the dream of many countries and India is one of them. Universal health coverage means that everyone is able to access essential quality health services without facing financial hardship (1). On the other hand it does not mean that every health service will be provided free of cost to everyone everywhere. With the advancement in medical science the cost of treatment is increasing day by day and it is pushing people specially the marginalized one into poverty. It is has been said that poverty breeds diseases and diseases breeds poverty. If one has to provide minimum plethora of essential quality health services to all in India then one has to make efforts to decrease out of pocket expenditure on health. As per WHO tracking universal health coverage global monitoring report 2017 (2), 17. 3 % Indians spend more than 10% of their annual income for treatment and 3.9 % spend more than 25% of their annual income on treatment. In fact when we look at the data provided by National Sample Survey round 71 (3) it is apparent that expenditure on free medicines for In patients has reduced from 31% to 8.99% and for out-patients from 17.98% to 5.34 % in two decades that’s from 1986 to 2004. While the government spending on health as percentage of GDP is almost stationary. It clearly indicates that either the cost of treatment is increasing or the number of patients have increased tremendously due to increase in population. This issue of increasing population needs to be addressed at war footing otherwise despite increasing the government spending on health it will not be able to reduce out of pocket expenditure

Impact of Sociodemographic factors on prevalence of overweight and obesity among adolescents of urban Meerut

Background: Adolescent obesity is becoming a major public health problem in urban areas of India and its prevalence is increasing in all socioeconomic groups irrespective of religion, region and caste. Aims & Objectives: To find out prevalence of overweight & obesity among adolescents and to study its association with sociodemographic factors. Material & Methods: This cross-sectional study was carried out in the area covered by Urban Health and Training Centre of Lala Lajpat Rai Memorial Medical College, Meerut. Sample size was estimated by keeping the prevalence as 10% with 95% confidence interval and relative precision of 20%. A total of 872 adolescents were selected randomly using proportional allocation method. Results: The prevalence of overweight was found to be 17.4% and obesity 6.9%. The prevalence was significantly higher among females and in those belonging to nuclear families as well as higher socioeconomic status. Conclusion: The prevalence of overweight and obesity is quite high in the urban area and there is a need to develop an effective programme for the prevention of obesity in these areas

Current trends in eye diseases and its correlates in an urban population

Background: The trend of ocular diseases in urban areas is changing. Eye diseases due to chronic medical problems are being detected more in urban population. Therefore, there is a need to check for ocular diseases in each age group. Objectives: The study aimed to find the prevalence and causes of ocular morbidity and blindness and their associated factors in urban population. Methods: This study was done in an urban area of Meerut. All the age groups covering 1613 subjects were interviewed and simple torchlight examination of the eyes, followed by testing of vision was done. Results: Prevalence of ocular morbidity was 53.0% and blindness 3.4%. The most common ocular morbidity was refractive error (86.4%), followed by cataract (22.5%) and conjunctivitis (6.0%). The causes of blindness were cataract (72.7%), posterior segment pathologies (20.0%), ocular injury (5.5%) and corneal opacities (1.8%). Both ocular morbidity and blindness were significantly higher in smokers, hypertensives and diabetics. Blindness was more prevalent in alcoholics and in those with history of ocular injury

Socio- demographic correlates of overweight and obesity among adults in rural Meerut

Background:  Obesity is most common nutritional disorder in developed countries and is assuming significant dimensions in developing countries. Objectives:  To find out the prevalence of overweight and obesity in adults aged 18 years and above and socio-demographic factors affecting overweight and obesity in rural population of Meerut. To suggest measures for prevention of overweight and obesity in adults population of rural Meerut. Material and Methods:  In present community based cross sectional study 1382 individuals aged 18 years and above were covered from 400 families spread over 5 villages with the help of systemic random sampling in rural area of Meerut District. The Individuals were interviewed and examined personally using Pre-designed and Pre-tested Questionnaire. Results:  Out of 1382 individuals 244 (17.7%) were having BMI ≥ 25. Prevalence of obesity in females (22%) was found more than males (13.8%). Prevalence of Overweight and Obesity increased with advancing age, maximum being in age group 50-59 years (22.2%). Maximum numbers of males (19.9%) were overweight in their most productive life (30 -39 years) whereas maximum females were overweight in their menopausal decade i.e. 40-49 years (32.8%). Overweight was more in persons who were married (18.9%), professional/Technical person (33.3%), Savarna upper caste (23.1%), belonging to high standard of living index (21.0%), person living in joint families (18.2%), and Alcoholics (18.6%) while smokers were having lower prevalence of overweight (10.6%). Conclusion: The prevalence of Overweight and Obesity is increasing in adult population of rural area. Various socio-demographic correlates are affecting the prevalence of Overweight and Obesity in Rural population

Overweight and Obesity above 18 years of Age in An Urban Population

Background: Today however, as standard of living continues to rise, weight gain and obesity are posing a growing threat to health in both developed and developing countries and affecting children as well as adults. Indeed, it is now so common that it is replacing the more traditional public health concern including under nutrition and infectious diseases. Overweight and obesity is a major risk factor for high morbidity and mortality. Obesity is an independent risk factor for chronic heart disease related morbidity and mortality. Aims and Objectives: To find out the prevalence of overweight & obesity and to suggest measures for prevention of overweight and obesity in adult population. Material and Method: To cover a sample size of 1152 in Urban Health Centre area population ≥18 years every fifth family was selected by systematic random sampling from the total of 1698 families registered at Urban Health Centre. They were interviewed personally and information was collected about sociodemographic characteristics, personal factors, and measurements of weight, height, waist and hip circumference of the individuals were taken to calculate Body Mass Index (BMI) and Waist Hip Ratio (WHR). Results: Prevalence of overweight (BMI -25-29.99) and obesity (BMI ≥30) being 28.0% and 8.0% respectively. Prevalence of abdominal obesity was 25.8%. About two-third (66.9%) of abdominal obesity rightly corresponded with the high BMI (25+). Conclusion: The prevalence of overweight and obesity is increasing in urban area of Meerut, more in females than males and it is being affected by various socio-demographic correlates

Overweight and Obesity above 18 years of Age in An Urban Population

Background: Today however, as standard of living continues to rise, weight gain and obesity are posing a growing threat to health in both developed and developing countries and affecting children as well as adults. Indeed, it is now so common that it is replacing the more traditional public health concern including under nutrition and infectious diseases. Overweight and obesity is a major risk factor for high morbidity and mortality. Obesity is an independent risk factor for chronic heart disease related morbidity and mortality. Aims and Objectives: To find out the prevalence of overweight & obesity and to suggest measures for prevention of overweight and obesity in adult population. Material and Method: To cover a sample size of 1152 in Urban Health Centre area population ≥18 years every fifth family was selected by systematic random sampling from the total of 1698 families registered at Urban Health Centre. They were interviewed personally and information was collected about sociodemographic characteristics, personal factors, and measurements of weight, height, waist and hip circumference of the individuals were taken to calculate Body Mass Index (BMI) and Waist Hip Ratio (WHR). Results: Prevalence of overweight (BMI -25-29.99) and obesity (BMI ≥30) being 28.0% and 8.0% respectively. Prevalence of abdominal obesity was 25.8%. About two-third (66.9%) of abdominal obesity rightly corresponded with the high BMI (25+). Conclusion: The prevalence of overweight and obesity is increasing in urban area of Meerut, more in females than males and it is being affected by various socio-demographic correlates