Attitude about mental illness of health care providers and community leaders in rural Haryana, North India

Background: Attitude about mental illness determines health seeking of the people. Success of National Mental Health Programme (NMHP) is dependent on attitude about mental illness of various stakeholders in the programme. Material & Methods: A community based cross-sectional study was carried out in Ballabgarh block of Faridabad district in Haryana. We aimed to study attitude about mental illness of various stakeholders of health care providers (HCP), community leaders in rural area of Haryana, north India. Study area consisting of five Primary Health Centers (PHCs) serving 2,12,000 rural population. All HCP working at PHCs, Accredited Social Health Activist (ASHA) and community leaders in study area were approached for participation. Hindi version of Opinion about Mental illness Scale for Chinese Community (OMICC) was used to study attitude. Results: In total, 467 participants were participated in the study. Of which, HCP, ASHAs and community leaders were 81 (17.4%), 145 (31.0%) and 241 (51.6%) respectively. Community members reported socially restrictive, pessimistic and stereotyping attitude towards mentally ill person. ASHA and HCP reported stereotyping attitude about person with mental illness. None of the stakeholders reported stigmatizing attitude. Conclusion: Training programme focusing on spectrum of mental illness for HCP and ASHA working in rural area under NMHP programme is needed. Awareness generation of community leaders about bio-medical concept of mental illness is cornerstone of NMHP success in India

Association of second hand smoke exposure and depression: A systematic review and meta-analysis

Aim & Objective Impact of exposure of smoking on mental health conditions is well studied, but not of second hand smoke exposure. This is an attempt to find the association between second hand smoke exposure and depression. Methods A systematic search was conducted for published studies in English till June 2017. Independent two electronic searches were carried out in Medline, IndMED using key words “second hand smoking”, “passive smoking”, “environmental tobacco smoke” & “depression”. We have included articles reporting adjusted relative risk (RR) or odds ratio. References of the selected articles were also traced. Meta-analysis was performed to calculate pooled estimate using random effects model. Results We have got 165 records from searched databases. Of which, 20 records were included for full text review after screening abstract and removing duplicates. Finally, fifteen articles were included for meta-analysis. Second hand smoke exposure exposure was found to be associated with depression (RR=1.37, 95 CI: 1.26, 1.48) with heterogeneity, I2: 83%. Conclusions We have found modest strength of association for second hand smoke exposure and depression. Unknown confounders might have reduced the pooled estimate in the longitudinal studies

Adherence to treatment among hypertensive individuals in a rural population of North India

Background: Hypertension affects nearly a quarter of adults in India. While there are issues related to diagnosis and treatment gap, even among those who received treatment, adherence is a problem resulting in poor control. Aim & Objective: To study the adherence to treatment of hypertension and its determinants among rural population Methods and Material: A community based cross-sectional study was carried out in twenty-eight villages in Ballabgarh block of Faridabad district of Haryana. Sample size of 300 was calculated. Adults (≥ 18 years) with self-reported hypertension were recruited by simple random sampling at community level. Adherence to treatment was studied by both recall and pill count methods. Information about socio-demographic characteristic was also obtained. Results: In total 350 participants were recruited in the study. Adherence (100%) by recall method was reported among 27.4% subjects and by pill count among 18.9% subjects. Symptom-free period was identified as most common reason for non-adherence. Statistically significant poor adherence to treatment of hypertension was reported among subjects belonging lower social strata.  Conclusions: Very low adherence to hypertension treatment was reported in rural community in northern India. There is urgent need for awareness generation about treatment adherence and developing adherence-monitoring mechanisms at community leve

Attitude about mental illness of health care providers and community leaders in rural Haryana, North India

Background: Attitude about mental illness determines health seeking of the people. Success of National Mental Health Programme (NMHP) is dependent on attitude about mental illness of various stakeholders in the programme. Material & Methods: A community based cross-sectional study was carried out in Ballabgarh block of Faridabad district in Haryana. We aimed to study attitude about mental illness of various stakeholders of health care providers (HCP), community leaders in rural area of Haryana, north India. Study area consisting of five Primary Health Centers (PHCs) serving 2,12,000 rural population. All HCP working at PHCs, Accredited Social Health Activist (ASHA) and community leaders in study area were approached for participation. Hindi version of Opinion about Mental illness Scale for Chinese Community (OMICC) was used to study attitude. Results: In total, 467 participants were participated in the study. Of which, HCP, ASHAs and community leaders were 81 (17.4%), 145 (31.0%) and 241 (51.6%) respectively. Community members reported socially restrictive, pessimistic and stereotyping attitude towards mentally ill person. ASHA and HCP reported stereotyping attitude about person with mental illness. None of the stakeholders reported stigmatizing attitude. Conclusion: Training programme focusing on spectrum of mental illness for HCP and ASHA working in rural area under NMHP programme is needed. Awareness generation of community leaders about bio-medical concept of mental illness is cornerstone of NMHP success in India

Knowledge and behaviors related to dietary salt and sources of dietary sodium in north India

Sodium, an element needed for the normal human physiology is known to be associated with high blood pressure and other consequences if consumed in excess. The assessment of knowledge and behavior related to sodium that is consumed in the form of salt plays an important role in the control of cardiovascular diseases. To control the intake of sodium, dietary sources of sodium need to be identified. To address this, a community-based cross-sectional study was conducted among women aged 20 to 59 years in north India, where knowledge, attitude, and behavior questionnaire given by the World Health Organization and 24-h dietary recall were used. The mean age of the participants was 34.5 years, and the majority of them were homemakers. Approximately, 80% of the participants believed that high salt diet causes serious health problems, and only 5% of the participants were aware of the existence of a recommendation for daily salt intake. Less than 20% of the participants took measures to control their salt intake. Vegetable-based dishes were found to be the major contributors to the daily salt intake followed by pulse-based and cereal-based dishes. This is because of the high quantity in which they are consumed. Food cooked at home contributed to 90% of the daily salt intake. To control the salt intake, we should cut- down the discretionary salt use. Dietary advice should be customized to the individual, and the family physician plays an important role in this. Behavioral change is the need of the hour to control the epidemic of non-communicable diseases

Genome profiling of uropathogenic E. coli from strictly defined community-acquired UTI in paediatric patients: a multicentric study

Abstract Background Urinary tract infection (UTI) in children is a common bacterial infection. The emergence of extended-spectrum beta-lactamases (ESBLs) poses a major challenge against the treatment of uropathogens. We aimed to characterize the E. coli isolates recovered from children with UTI for their resistance profile and circulating sequence types (ST). Methods Children (> 1.5–18 years of age) from different community health centres of India with symptoms of UTI were enrolled. Isolates causing significant bacteriuria were identified by Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) and tested for antimicrobial susceptibility by the automated system, VITEK-2 (Biomeriux, Durhum, US). Nineteen E. coli isolates (15 ESBL positive and 4 ESBL negative) were sequenced in Oxford Nanopore platform followed by core-genome phylogeny, accessory genome cluster analysis, identification of sequence types, mobile genetic elements, genetic antimicrobial resistance markers. The correlation between detection of antimicrobial resistance genes with phenotypic resistance profiles was also investigated. Results Eleven percent of children had significant bacteriuria [male:female—1:1, > 50% were 11–18 years of age group]. E. coli was predominant (86%) followed by K. pneumoniae (11%). Susceptibility of E. coli was highest against fosfomycin (100%) followed by carbapenems (90.7%) and nitrofurantoin (88.8%). ST131 (15.8%) and ST167 (10.5%) found as high-risk clones with the presence of plasmid [IncFIB (63.1%), IncFIA (52.6%)], and composite transposon [Tn2680 (46.6%)] in many isolates. Few isolates coharboured multiple beta-lactamases including bla NDM-5 (33.3%), bla OXA-1 (53.3%), bla CTX-M-15 (60%) and bla TEM-4 (60%). Conclusions This study highlights horizontal transmission of resistance genes and plasmids in paediatric patients at community centers across the nation harbouring multidrug-resistant genes such as bla NDM-5 and bla CTX-M-15 associated with high-risk clones ST131 and ST167. The data is alarming and emphasizes the need for rapid identification of resistance markers to reduce the spread in community. To our knowledge, this is the first multicentric study targeting paediatric UTI patients from the community setting of India

National noncommunicable disease monitoring survey (NNMS) in India: Estimating risk factor prevalence in adult population.

BackgroundThe primary objective of National NCD monitoring survey (NNMS) was to generate national-level estimates of key NCD indicators identified in the national NCD monitoring framework. This paper describes survey study protocol and prevalence of risk factors among adults (18-69 years).Materials and methodsNNMS was a national level cross-sectional survey conducted during 2017-18. The estimated sample size was 12,000 households from 600 primary sampling units. One adult (18-69 years) per household was selected using the World Health Organization-KISH grid. The study tools were adapted from WHO-STEPwise approach to NCD risk factor surveillance, IDSP-NCD risk factor survey and WHO-Global adult tobacco survey. Total of 8/10 indicators of adult NCD risk factors according to national NCD disease monitoring framework was studied. This survey for the first time estimated dietary intake of salt intake of population at a national level from spot urine samples.ResultsTotal of 11139 households and 10659 adults completed the survey. Prevalence of tobacco and alcohol use was 32.8% (95% CI: 30.8-35.0) and 15.9% (95% CI: 14.2-17.7) respectively. More than one-third adults were physically inactive [41.3% (95% CI: 39.4-43.3)], majority [98.4% (95% CI: 97.8-98.8)] consumed less than 5 servings of fruits and / or vegetables per day and mean salt intake was 8 g/day (95% CI: 7.8-8.2). Proportion with raised blood pressure and raised blood glucose were 28.5% (95% CI: 27.0-30.1) and 9.3% (95% CI: 8.3-10.5) respectively. 12.8% (95% CI: 11.2-14.5) of adults (40-69 years) had ten-year CVD risk of ≥30% or with existing CVD.ConclusionNNMS was the first comprehensive national survey providing relevant data to assess India's progress towards targets in National NCD monitoring framework and NCD Action Plan. Established methodology and findings from survey would contribute to plan future state-based surveys and also frame policies for prevention and control of NCDs

Combating the COVID-19 pandemic in a resource-constrained setting: insights from initial response in India

The low-and-middle-income country (LMIC) context is volatile, uncertain and resource-constrained. India, an LMIC, has put up a complex response to the COVID-19 pandemic. Using an analytic approach, we have described India’s response to combat the pandemic during the initial months (from 17 January to 20 April 2020). India issued travel advisories and implemented graded international border controls between January and March 2020. By early March, cases started to surge. States scaled up movement restrictions. On 25 March, India went into a nationwide lockdown to ramp up preparedness. The lockdown uncovered contextual vulnerabilities and stimulated countermeasures. India leveraged existing legal frameworks, institutional mechanisms and administrative provisions to respond to the pandemic. Nevertheless, the cross-sectoral impact of the initial combat was intense and is potentially long-lasting. The country could have further benefited from evidence-based policy and planning attuned to local needs and vulnerabilities. Experience from India offers insights to nations, especially LMICs, on the need to have contextualised pandemic response plans