HEALTH STATUS OF CHILDREN UNDER SCHOOL HEALTH SERVICES IN DOIWALA BLOCK, DEHRADUN

Background -The introduction of school health services in India dates back to 1909, when school children in the city of Baroda were given the first medical examination. School Health programme ,promoting basic check up of school children for a variety of health related problems, is a systematic effort in raising awareness about health issues among school children and their families. Good health increases enrollment and reduces absenteeism. It also ensures attendance of the poorest and most disadvantaged children to school, many of whom are girls. Aim- To study the morbidity status of the school children & elicit relationship of healthy habits with morbidity pattern. Study Type- Observational study Methodology- A cross sectional survey to find out the morbidity pattern was conducted on 757 school children (340 boys and 417girls), aged 5-16 years studying in class I-VIII in five different schools of Doiwala, Dehradun under Rural Health training centre, Rajeev Nagar. Results- Overall students attendance was 78.2%. Clinical anaemia was higher in Girls (46.7%) as compared to Boys (34.1%). Worm infestation was higher in boys (65.1%) as compared to Girls(57.3%). Over all abnormal Visual acquity(8.5%) or eye abnormality (14%) was noticed among study subjects. Dental Caries (53.1%) and dermatitis (16.3%) were more in boys. Healthy habits like daily bathing (82.6%), daily teeth brushing (61.1%), mouth rinsing after meal (53%) and hair clean/combed (80.2%) were more in girls as compared to boys while trimmed nail was equally (55%) noticed among both the groups. Conclusion- Morbidities found amongst students are basically due to low awareness & negligent behaviour about personal hygiene are the key areas of concern and by active involvement of school teachers improvement in personal hygiene of school children and reduction in related morbidities can be achieved

A STUDY ON ASHA –A CHANGE AGENT OF THE SOCIETY

Background: National Rural Health Mission started in the state of Uttarakhand with the objective to address the health needs of rural population, especially the vulnerable section of the society. Under this scheme, ASHA has been identified as one of the key strategy for wider coverage of services, considering her the first port of call for any health related demands, especially women and children. Objective: To find out the biosocial profile of ASHA and services provided by them. Material & Methods: A descriptive study was conducted in Imlikhera Block of Haridwar district in 2008 participated by all (150) ASHA. Data was collected by trained investigators of Rural Development Institute which is also a State ASHA resource Centre. Results: Maximum (42%) ASHA were in 26-30 Years of age group. However, 23% ASHA were in less than 25 years of age which is below than the stipulated selection criteria. About 6.3% ASHAs were not fulfilling the educational criteria of selection (education upto 8th class). Study reported that majority of ASHA consider care of pregnant women, vaccination and family planning as their prime services. 42% ASHA reported that they think this work can pave their ways for future employment. Conclusion: Supervisory body should see that selection of ASHA should be as per stipulated criteria and they should be sensitized about their major role of motivator & activist, for creating awareness and demand generation in the society

Challenges in Vaccine Acceptance– A Framework & Toolkit for the COVID -19 Battle

During the first wave of this COVID-19 pandemic, India’s performance was relatively superior among the countries that had their first cases in January 2020. We grouped these countries as ‘January Cohort’ and analysed their relative performance (IJCH, April 2020), supporting India’s management. Fast forward to the present, India’s performance is woefully lacking, accounting for 30% of daily cases and 31% daily deaths with 18% of the world population [Worldometer Coronavirus database, June1,2021). On this same day, 50% of the countries worldwide (110 of 222) reported no deaths and 25% (57) without any daily new cases. Thus, we have faltered with a series of public health missteps despite a good start. The latest and the most remarkable failure of India is the vaccination, despite being the world’s foremost producer. Many of the poor performers initially in the January Cohort, such as UK and USA, focused on ‘vaccinating their way out of the pandemic’ since the roll out of vaccines in December2020. The results are in display starting February 2021- to date, with cases/ deaths on decline in these countries, while India is in a reverse direction. On June 1st, UK reported no COVID-19 deaths and USA had about 31% decline of 14-day moving average

ASSESSMENT OF EFFECTIVENESS OF TB POSTING DURING THE COMPULSORY ROTATORY RESIDENTIAL INTERNSHIP (CRRI) PROGRAMME

Research Question: What is the effectiveness of TB posting during the Compulsory Rotatory Residential Internship (CRRI) programme? Objectives: To assess the effectiveness of TB posting during the CRRI programme. To find out the need of making Tuberculosis & Respiratory Diseases Department posting mandatory during CRRI Programme. Study Design: Cross Sectional study. Study Duration: 12 months i.e. 01st April 2009 till 31st March 2010 Participants: 90 students who joined the CRRI programme formed the study group. Out of these 90 interns only 57 (64%) of them joined their two months Compulsory Rotatory Internship in the Department of Community Medicine and these were posted in Tuberculosis & Respiratory Diseases Department for 15 days. Methodology: A pre-designed pre-tested self-administered questionnaire was administered to the participants on the first day and last day of their posting in Tuberculosis & Respiratory Diseases Department. The results were analysed by using suitable statistical package. Results: The mean pre-test score was 28 (49.6%) and the mean post-test score was 38 (61.5%). It was observed that there was a 27% improvement in the knowledge of the participants when the question about the year of launching of RNTCP programme in India was asked. A remarkable improvement (46%) was found in the difference between pre and post-test knowledge of the participants when the questions like “Who are the DOTS providers” and “What is the colour coding of boxes for different categories of patients” were asked. A significant difference in the knowledge was found in the pre and post-test assessment in reference to Tuberculosis and its National Program

Epi InfoTM a mHealth tool for primary field data collection in subsample population of Uttarakhand- A cross sectional study.

Background: A deficient data is among the biggest obstacle facing planners and policy makers. Health data collection in the developing world is often hampered by the high costs and inefficiencies of traditional large-scale paper-based surveys. mHealth using Epi-Info is most appropriate tool to create, share, deploy health surveys and for strengthening of health systems. The program runs on free and open software, is easy to use, and can be downloaded to handheld devices to be used by workers in the field.  Objectives: To find out the usefulness and limitations of data collection for mHealth by use of Epi InfoTM software.  Methods: The devices used Epi Info 7.1.5 (Android version), which has been modeled as a database with variables of the traditional form. A cross sectional survey among adolescents regarding their health needs was carried out in a sample of 200 adolescents (purposive sampling) of rural hilly (Jaunpur block of Tehri Garhwal district) and plain (Doiwala block of Dehradun district) areas of Uttarakhand by the use of Android tablets with Epi InfoTM.  Results: It was found that adolescent questionnaire tool developed in Epi InfoTM android tablet application is a powerful tool for data collection having numerable practical advantages like: Interview Time Tracking (ITT) that gives the reality check in field studies along with cases Geographical presentation by GIS mapping. In addition to this complete filling of data in field so no left over or guessing for data entry operator, paperless, bio-friendly. Despite of Tablet cost, it is cost effective as tablet can be repeatedly used for other surveys.  Conclusions: Epi InfoTM is a developing open access software for primary data collection and analyzing data from the field, with advantageous benefits of epidemiological surveys

Validation of Gender Friendly Breastfeeding Knowledge scale among young adults

Introduction: Breastfeeding is the most effective intervention to improve child health. Young adults, both genders play an important role in society supporting breastfeeding as they will be stepping towards parenthood in the near future. Bringing awareness and busting the myths among them is essential. This study aimed to develop a Gender Friendly Breastfeeding Knowledge scale based on a conceptual framework that reflected the knowledge of young adults and evaluates its validity and reliability. Methodology:  Development of the questionnaire for Conceptual framework and item generation was done using PubMed, Google Scholar, other sources and expert opinion. The type of measurement was structured as a 5-point Likert scale. The Lawshe technique to assess the content validity ratio. A cross-sectional survey in graduation colleges situated in Mangalagiri or within the radius of 30 km of Mangalagiri, Andhra Pradesh, India was conducted in 2020. 1400 Adult males and females aged 20-25 years and perusing full-time graduation course were recruited. For each item in the Gender Friendly Breastfeeding Awareness scale, we assessed individual item characteristics and item-test correlation. To check to construct validity, we performed exploratory factor analysis and confirmatory factor analysis. Results: Expert panel retained 23 items from initially 30 items. The content validity index score for the each of 23-items in the scale was more than 0.80. A four-factor structure perfectly fitted the data and illustrated 54 percent of the variation in knowledge of breastfeeding. Four stages of CFA were completed. The chi-square = 860.534 was significantly above the 0.01 level.  Cronbach's a = 0.787 based on standardized items reflected the overall internal consistency of the gender-friendly breastfeeding awareness scale. Conclusion: Gender-friendly breastfeeding knowledge scale is a valid and reliable tool, it is recommended that this scale be used in communities, educational institutions, and in relevant research to assess breastfeeding knowledge among young adults of both genders, thereby promoting breastfeeding practices in the future

Isolation and characterization of a novel mycobacteriophage Kashi-VT1 infecting Mycobacterium species

Mycobacteriophages are viruses that infect members of genus Mycobacterium. Because of the rise in antibiotic resistance in mycobacterial diseases such as tuberculosis, mycobacteriophages have received renewed attention as alternative therapeutic agents. Mycobacteriophages are highly diverse, and, on the basis of their genome sequences, they are grouped into 30 clusters and 10 singletons. In this article, we have described the isolation and characterization of a novel mycobacteriophage Kashi-VT1 (KVT1) infecting Mycobacterium >smegmatis mc2 155 (M. smegmatis) and Mycobacterium fortuitum isolated from Varanasi, India. KVT1 is a cluster K1 temperate phage that belongs to Siphoviridae family as visualized in transmission electron microscopy. The phage genome is 61,010 base pairs with 66.5% Guanine/Cytosine (GC) content, encoding 101 putative open reading frames. The KVT1 genome encodes an immunity repressor, a tyrosine integrase, and an excise protein, which are the characteristics of temperate phages. It also contains genes encoding holin, lysin A, and lysin B involved in host cell lysis. The one-step growth curve demonstrated that KVT1 has a latency time of 90 min and an average burst size of 101 phage particles per infected cell. It can withstand a temperature of up to 45°C and has a maximum viability between pH 8 and 9. Some mycobacteriophages from cluster K are known to infect the pathogenic Mycobacterium tuberculosis (M. tuberculosis); hence, KVT1 holds potential for the phage therapy against tuberculosis, and it can also be engineered to convert into an exclusively lytic phage

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case–control study

IntroductionExposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.MethodologyMulticentric case–control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).ResultsA total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29–4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43–3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.DiscussionThe results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed

EXPERIMENTAL DIABETES MELLITUS AND OXYGEN FREE RADICALS

Oxygen free radicals (OFRs) have been implicated as a causal or contributory factor in various disease states. These oxygen radicals are highly reactive species and cause cellular damage. In diabetes, various sources may lead to an increase in the production of OFRs. These sources include glucose oxidation, autoxidative glycosylation, alteration in sorbitol pathway activity and changes in level of inflammatory mediators. It is hypothesized that the complications in diabetes mellitus could be due to an increase in the levels of OFRs as a result of its increased production and/or its decreased destruction. To test this hypothesis diabetes was induced in male Sprague Dawley rats by streptozotocin (STZ). The rats were sacrificed after 1st, 2nd, 3rd, 4th, 5th and 6th week (wk) of development of diabetes. The various tissues (liver, heart, pancreas, aorta and kidney) and blood involved either in the development or in the complications were selected for the study. Plasma glucose levels were measured to confirm the diabetic state of the animal. Malondialdehyde (MDA) content (product of lipid peroxidation) and antioxidant enzymes [Catalase (CAT), Glutathione-peroxidase (GSH-Px) and Superoxide dismutase (SOD-Total, Cu-Zn and Mn)] were measured in blood and tissues in control and streptozotocin induced diabetic rats. An increase of 3-4 fold in plasma glucose levels and decrease in body weight was observed in diabetic rats as compared to controls at each time interval. MDA levels were increased in all tissues in the diabetic state. With the progression of the disease liver, aorta, kidney and blood showed significant increases in MDA, being maximal on the 6th wk. However, the pancreas showed the highest MDA levels up to the 4th wk. Catalase activity increased significantly in all diabetic tissues as compared to controls at most of the time intervals except the kidney which showed a significant increase on the 1st wk and after that the activity decreased. In aorta and blood the activity increased with time. However, activity decreased in the liver and the heart on the 5th and 6th wk as compared to the 4th wk. Its activity in pancreas decreased with time. GSH-Px activity increased significantly in all the diabetic tissues as compared to controls. Liver, aorta and blood showed increased activity of GSH-Px with progression of disease. Heart and pancreas showed lower activity on the 5th and 6th wk as compared to the 4th wk. The kidney did not show any change. Total SOD and Cu-Zn SOD activity in diabetic tissues showed a significant increase as compared to controls at most of the time intervals. Liver, pancreas and aorta showed decreasing trend after 4 wks; however heart and kidney showed no change. Mn-SOD activity was variable in control and diabetic tissues. While the activity decreased in liver and heart at 4th wk, it increased in heart at 6th wk. No changes were observed in pancreas and kidney. In general, pancreas and aorta showed the lowest antioxidant enzyme activities and higher MDA content as compared to other tissues. The results of the present study suggest that oxidative stress is associated with the diabetic state and starts at early onset of disease. The marked changes in MDA and antioxidant enzymes suggest higher production of OFRs in diabetes which may cause oxidative damage to tissues leading to various complications

Healthcare Scenario: Health for All to Sustainable Development Goals

Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. There is a huge cross section of the population that continues to struggle to gain access to affordable good quality healthcare. Although the rich can access healthcare by paying large sums of money, the poor are under major threat of financial duress. In Primary health care level public share is more with affordable cost but with compromised quality while in tertiary level private share is more with quality but at high cost and is focused in urban areas. Government has started spending at tertiary care level (newer AIIMS) to broaden the care spectrum but without much improvement at primary health care level.Accountable health care remains challenge for middle and low income countries. Accountability refers to “the principle that individuals, organizations and the community are responsible for their actions and may be required to explain them to others” (1). Low levels of public health financing, supply side gaps, an acute shortage of human resources and the rising cost of healthcare continue to severely affect access, affordability and quality of health services across the country. These issues make difficult for the public sector to remain accountable. The government has been attempting to address two main challenges: to ensure that all citizens can access healthcare equitably and to ensure that healthcare is made available at an affordable cost and without compromising on quality. So three important pillars for effective HCDS are cost, Access & Quality