Barriers and Solutions Pertaining to Pradhan Mantri Matru Vandana Yojana (PMMVY) Implementation in A Block of West Bengal: A Mixed-Methods Approach

Introduction: Improvement of maternal health care services will not only put a positive impact on maternal health, but also on the health of the new born. Objectives: This study was conducted to estimate the proportion of eligible beneficiaries who received the benefits provided by the scheme, to identify the barriers faced by the beneficiaries and health providers related to the scheme and to find possible solutions to overcome the barriers found as suggested by them in a block of West Bengal. Method: A cross-sectional study with sequential explanatory mixed-method approach was conducted in a block of West Bengal from January-December 2021. Quantitative data was collected from the digital portal of PMMVY. All beneficiaries who had their Last Menstrual Period (LMP) on and after 1st March 2020 up to 31st December 2020 were included. To identify the barriers faced and suggest possible solutions, Focused Group Discussions (FGDs) were held with the beneficiaries, ANMs and ASHAs and Key-Informant Interviews (KIIs) with the Block Medical Officer and Data Entry Operator. Data were analyzed using SPSS version 25.0. Descriptive statistics were used to summarize quantitative data while qualitative data were analyzed in the form of themes, codes and verbatim. Results: Total eligible beneficiaries for the three installments were 1066, 917 and 708 respectively. About 95.5% beneficiaries received the first installment, 93.0% received the second and 98.3% had received the third installment. The broad themes [codes] generated from the FGDs were challenges during antenatal care [ANC refused, home visit preferred, home ANC difficult, lockdown], challenges related to the PMMVY scheme [documents unavailable, incomplete forms, payment issues], possible solutions [prepare pre-requisites beforehand, provide cash]. Widely two main themes emerged from the KIIs: Form related issues and Payment issues. Conclusion: Coverage of PMMVY scheme in the block was satisfactory. However, speeding the payment process and stricter monitoring of the scheme is required

Depression among type-II diabetes mellitus attending a tertiary hospital, Kolkata, evaluated by patient health questionnaire-9

Back ground and Objectives: India has the largest number of diabetic patients turning it a capital for Diabetes in recent days. Depression is a major public health problem associ¬ated with chronic disease like diabetes and co existence of Diabetes and depression is as¬sociated with significantly increases risk of morbidity and mortality. This study was conducted to determine the prevalence and the level of depression and to identify the associated factors related with the disease among the study population attending the Diabetic OPD of SSKM Hospital. Methodology: A cross-sectional study was conducted among 406 diabetic patients attending diabetic OPD of SSKM Hospital using a pre-designed, pre-tested, structured schedule by face-to-face interview method and reviewing of investigation records. Data were analysed using SPSS v16.0. Multi-variable binary logistic regression was performed to find the factors associated depression. Results: The prevalence of depression among adult diabetic patient in this study was found to be 44.4 %. Statistically significant factors associated with depression were fasting sugar, post pandial sugar, HbA1c, medication socioeconomic class, gender and duration of diabetes. Conclusion: This study confirms the link between depression and Diabetes where the prevalence of depression was inevitable as a co-morbid condition with Diabetes. Universal screening for depression and management of depres¬sion in Diabetes can improve the health status and reduce the economic burden of the community

Out-of-pocket Expenditure and its Impact on the Quality of Life among Patients Attending the Anti-retroviral Therapy Centre of a Tertiary Care Hospital in Kolkata

Introduction: Out-of-pocket expenditure (OOPE) has a negative impact on Quality of life (QoL) of People Living with HIV (PLHIV)which can increase the risk of slipping into poverty. Objectives: Primary Objective of this study was to estimate the burden of OOPE in seeking health care among HIV patients attending the Anti-retroviral therapy (ART) centre of a tertiary care hospital; and secondary objectives were to assess their QoL, to identify the association of socio-demographic characteristics with the OOPE & QoL and to find out the correlation between OOPE and QoL. Method: A cross-sectional study was conducted among 232 patients attending ART centre of a tertiary care hospital in Kolkata using a pre-designed, pre-tested, structured schedule. Multivariable binary logistic regression was done to identify the association of their socio-demographic characteristics and clinical profile with the OOPE and QoL. Results: About 41.4% of the study population rated their QoL as neither poor nor good, 18.9% as ‘good’. All the participants reported OOPE; 20.7% in the form of direct health expenditure. Participants belonging to the age group 18-39 years, residing in a joint family, had family member infected with HIV and had associated co-morbidity were statistically significant covariates of direct health expenditure; whereas participants belonging to the age group ≥40 years, living in a joint family, involved in an unskilled occupation, and belonging to middle and lower middle were statistically significant covariates of poor QoL. Conclusion: OOPE was experienced by all participants. As per the study findings Qol was neither poor nor good among participants. With increase in OOPE, the QoL worsened

India's insurance sector: Challenges and opportunities

India's insurance sector has been growing dynamically in the last couple of years. Despite the suite of reforms that have been implemented to stoke the sector's growth, it still has a long way to go, as its share in the global insurance market remains abysmally low. In this paper, we analyse the Indian insurance sector and trace its evolution and growth. We also identify the key challenges facing the sector. As underlined in the paper, low penetration and density rates, less investment in insurance products, the dominant position of public sector insurers and their deteriorating financial health are some of the challenges facing the sector. Since India's economic growth depends on how shock-absorbent India's economy is, addressing these challenges assumes importance for developing a sound insurance sector

UDP-Glucose 4-epimerase from Saccharomyces fragilis. Involvement of sulfhydryl group(s) at the active site

UDPglucose 4-epimerase (EC 5.1.3.2) from Saccharomyces fragilis is inactivated by 0.1 mM 5,5'-dithiobis-(2-nitrobenzoate) in 6 min. Unlike p-chloromercuribenzoate-inactivated or heat-inactivated enzymes, the dithiobisnitrobenzoate-inactivated enzyme retains the dimeric structure and NAD is not dissociated from the protein moiety. Inactivation of the enzyme by dithiobisnitrobenzoate can not therefore be attributed to any subsequent loss of structural integrity or to be detachment of the cofactor from the apoenzyme. The inactivated enzyme can be almost fully reactivated in the presence of mercaptoethanol and characteristic properties of native enzyme are regained. The inactivation by dithiobisnitrobenzoate can be substantially protected by UDPglucose or UDPgalactose indicating a possible critical involvement of one or more sulfhydryl groups at the active site

Liberalisation of the insurance sector: An analysis of India and BRICS

Global diversification of financial institutions, including the insurance sector, has proven beneficial to many economies by providing them with increasing capital flow, higher competition, and introduction of newer technologies and distribution channels. This paper aims to critically evaluate the liberalisation process of India's insurance sector and the impact it has had on the sector, both life and non-life segments. As India is in the process of opening its insurance sector to increasing foreign participation, we compare the liberalisation approach taken up by the BRICS countries for their own insurance sectors. Finally, a brief section has been included on the impact of the insurance sector on an economy's performance in the World Bank's Ease of Doing Business (EODB) index rankings

Nutrient adequacy and its correlation in a sub-Himalayan region of West Bengal, India

Introduction: Nutrient adequacy is the level of intake of an essential nutrient in relation to the nutrient requirement for adequate health, which is expressed as the percentage of recommended dietary allowance. To develop an effective nationwide preventive program to combat malnutrition, it is necessary not only to assess the nature and magnitude of the problem of nutrient inadequacy but to identify factors affecting it especially at the household level. Objective: To estimate the prevalence of nutrient adequacy in a sample of households in a rural area of Darjeeling district and to find out the factors associated with nutrient adequacy. Materials and Methods: A community-based cross-sectional study was carried out from January 2014 to December 2014 in 821 households of Darjeeling district, India. The major dependent variable used in this study was the mean nutrient adequacy ratio of a household and the independent variables were number of family members, number of under-five children in the family, literacy of head of the family, literacy of the wife of the head of the family, income of the family, and percentage expenditure on food. Results: The prevalence of nutrient adequate households was found to be 35.3% among the study households. It was observed that the percentage expenditure on food had the highest contribution toward nutrient adequacy, followed by number of under-five children in the family and literacy of the wife of the head of the family. Undernutrition was found to be prevalent in 56.6% of the households. Conclusion: Majority of the study population had a diet less than the required amount and expectedly, undernutrition was also present in huge proportions

Awareness and utilization of social security and other government schemes by elderly population of Budge-Budge II block of West Bengal

Introduction: : Geriatric population are most vulnerable population, they suffer from various physical illness, mental issues, inancial crisis etc. WHO report showed that the world's population of people aged 60 years and older will be doubled by 2050 (2.1 billion). According to census 2011report, India has 10.1% elderly population and West Bengal has 11.3%. The purpose of the study is to assess the level of awareness on social security& other government schemes, its utilization and to explore the barrier of utilization. Method: An explanatory sequential mixed methods observational study, cross-sectional in design was conductedin Budge-Budge II block of West Bengal among 150elderly population (≥ 60 years) selected by 30 cluster random sampling from March-May 2023 using a pre-designed, pre-tested, structured schedule by face-toface interview. Quantitative data was analysed by SPSS v25.0, and binary logistic regression was performed. Qualitative data was analyzed thematically with IDI guide. Results: Out of 150 elderly, mean age group of the study population was 67.5±4.24 years, 53% were male, and 87% of the study population had awareness on old age pension scheme. However, 83% showed bad utilization. Socioeconomic status [AOR 5.27 (1.98- 13.97)],current employment status [AOR 6.48 (1.12-37.30)] economic dependency [AOR 7.59 (1.71-33.79)] had statistically signiicant higher odds of adequate awareness in the multivariable model. Current employment status, economic dependency showed signiicant association with good utilization and socio demographic characteristics. Conclusion: Majority of the study population were between 65 to 70 years and were aware of old age pension scheme. Old age pension scheme was maximally utilized schemes

‘Violence against Women’: Evidence from a Cross Sectional Study in Urban Area of North Bengal

Background: Violence against women has emerged as the most pressing and intractable social problem across regional, social and cultural boundaries; with long term impact on physical, sexual, social health and mental well being. Objectives: The study was carried out to estimate the prevalence of different types of ‘life time’ violence against women (VAW) among women of reproductive age group, and to find out specific violent behaviour as well as to identify the related consequences of the affected women and help seeking following violence. Methodology: A cross-sectional observational study was undertaken by interviewing 284 women of reproductive age group residing in two urban wards under Siliguri Municipal Corporation with a pre-designed and pre-tested schedule. Data was analysed by simple proportion. Results: out of 284 women 52.1% had ever faced physical violence. The most common form of violence was slapping, kicking, choking, and punching followed by ‘insisted on knowing where she was at all times’ (48.9%). Among of 222 abused, 54.5% suffered from mental problem followed by 39.2% were experienced to physical injury. Only 4.9% consulted physician and 3.6% have reported to police. Conclusion: Little progress in reducing levels of violence may be achieved without significant changes in prevailing individual and community attitudes toward violence

Water, Sanitation, and Hygiene (WASH) practices among residents of different slum settlements in a ward of Kolkata: A mixed-methods study

BACKGROUND: Access to safe water, sanitation, and hygiene (WASH) is the most basic need for mankind. Poor WASH practices are associated with various waterborne diseases, especially in developing countries such as India. The aim of the study was to assess WASH practices among residents of different slum settlements in a ward of Kolkata, identify the factors associated with WASH practice, and explore the barriers faced by the families and municipal staff in providing adequate WASH services to the community. MATERIALS AND METHODS: An observational study, cross-sectional in design with a convergent parallel mixed–methods approach, was conducted in different slum settlements in a ward of Kolkata. Quantitative data were collected by face-to-face interview, spot observation, and measuring the living area, door, and window spaces. Key informant interviews were conducted with the medical officer, ward vector-control coordinator, and municipal waste handlers, in addition to in-depth interviews with respondents who had unsatisfactory WASH practices. SPSS version 25.0 was used to analyze the quantitative data. Qualitative data were analyzed thematically using Atlas.ti 22. RESULTS: The overall WASH practices were considered satisfactory in 58.8% of the households. Education of the respondents up to the secondary level, presence of overcrowding, and inadequate ventilation in the house had statistically significantly higher odds of unsatisfactory practice. Poor living conditions, difficulty in collecting and storing water, waterlogging, blocked sewage drains, common toilets for men and women, and lack of motivation were the primary obstacles identified by the residents. CONCLUSION: Unsatisfactory WASH practices were observed among a high proportion of the slum population. Community engagement and education regarding WASH in communities is strongly recommended along with improvement of infrastructure and capacity building