Problems Associated with Menstruation among School Going Adolescent Girls and Their Health-Seeking Behavior

Introduction: Start of menstruation among adolescent girls is a major concern, which leads to stress and physical conditions. Objectives: To find menstruation-related problems among the school-going adolescent girls and to assess their health-seeking behavior in relation to these problems.Methodology: A descriptive cross-sectional study was conducted from September 2013 to December 2013 in a government higher secondary school of Pooth Khurd village in North West Delhi, near rural residential health training center of Maulana Azad Medical College. All adolescent girls who gave consent (196 girls) from class 7 to 10 of the selected government higher secondary school were included in the study. A predesigned, pretested, semi-structured questionnaire was used. One of the investigators explained the questions to the respondents. The data was entered in MS-Excel and analyzed using SPSS version 17. Chi-square test and Fischer’s exact test have been used for comparison between proportions. “P” value less than 0.05 is considered to be statistically significant.Results: The mean age of the study participants was 15.31 (±1.35) years, with a range from 13 to 19 years. The mean age of menarche was 13.24 years, minimum reported age of onset of menarche was 10 years and maximum was 16 years. Out of 196 girls, 191 (97.4%) girls have attained menarche, while 57 (29.8%) girls complained of menstrual cycle-related problems, either in the form of irregular menstruation (47) or a current missing period in 10 girls.The school girls also experience a lot of somatic complaints during or just a day prior to onset of menstruation. It was found that a great number (21) of girls expressed their inability to perform simple daily activities owing to painful menstruation along with attending school and playing outdoor games.Only 28 girls (14.7%) would discuss menstrual problems with their mother who most of the time simply advises them to take rest. It was found that only few of them (14%) consult a doctor and few girls told they take self-medication (17.3%) during their painful menstruation

Leadership Training for Nursing Professionals in India: A Workshop Evaluation

Introduction: Nurses are the backbone of the healthcare system, and an attempt can be made to improve the quality of care if every individual is empowered with leadership skills. While several leadership workshops and seminars have been conducted to sensitize doctors in India, there have hardly been any for nurses. A two-day workshop for orientation on leadership for nurses was conducted using multimedia presentations, talks by accomplished speakers and activities like role plays.Objective: The current study was undertaken to determine the impact of the workshop on the self-reported competence of nurses; with a secondary objective of evaluating the workshop and suggesting modifications for the future.Methodology: A pre- and post-workshop questionnaire (Crohnbach’s alpha: 0.874) was used to assess the impact of the workshop in self-reported competence. Self-administered structured questionnaires were used to evaluate the relevance of each session and suggestions for improvement. Paired t-test was used to assess difference in pre- and post-workshop competence. Weighted scores were used to rank sessions, and responses of qualitative data were grouped in suitable themes.Results: A total of 29 nurses participated in the workshop. There was a significant rise in knowledge in all the domains of the competence (p-value <0.05). The greatest increase in knowledge was in understanding the relevance of interpersonal skills. Maximum number of participants learnt the importance of effective communication (38%). Almost all the sessions were marked as relevant, and “conflict management” was the highest-ranking session, while the session on “planning and evaluation” was the least favored. The most popular suggested theme for further training was on stress management.Conclusion: The two-day workshop has been successful in raising self-reported competence of nursing professionals, and with minor modifications, regular trainings may go a long way in empowering nurses with leadership qualities

Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital

Background: Sputum microscopy is still used for diagnosis of drug-sensitive pulmonary tuberculosis (TB). Revised National Tuberculosis Control Program (TB programs) aims to rapidly diagnose and treat all cases of TB. The aim of this study is to find the proportion of loss to follow up during diagnosis of pulmonary TB after the patient reached hospital (was handed over sputum cups for sputum collection) from DOTS center after referral from respective outpatient department (OPD) at a tertiary care hospital. Methodology: Record-based data from designated microscopic center at a tertiary care hospital were collected regarding the number of patients who had been given sputum cup container for sputum collection for diagnosis of pulmonary TB referred from different OPDs from January to December 2015. Results: A total of 1518 presumptive patient for pulmonary TB had visited DOTS center after referral from different OPDs in the hospital for sputum examination during the above period. The loss to follow-up during diagnosis among presumptive pulmonary TB patient was 461 (30.04%), which was higher among those below 15 years of age. At this rate of loss to follow up of presumptive TB patient to submit sputum for diagnosis, it was estimated to be about 46 smear-positive pulmonary TB cases per year which will be missed out for diagnosis during the above period (considering sputum positivity rate is 10% in the hospital). The mean gap between sputum referral to submission of two sputum samples was 2.73 days (95% confidence interval 2.52–2.84) among those of submitted sputum for diagnosis. Conclusion: Approximately one-third of presumptive patient for pulmonary TB had loss to follow-up for diagnosis of TB even after consulting a doctor at a tertiary care hospital. There is a need to address this gap in diagnosis of pulmonary TB in this region

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020