A conceptual framework on health professionals' engagement towards pharmacovigilance: a qualitative exploration

Background: With the growing reliance on drug therapy in the recent era, the safety of medications is one of the vital parameters for the success of any medicine. Considering this, pharmacovigilance (PV) was developed to provide adequate identification, reporting, evaluation, and understanding of adverse drug reactions (ADR). The objective of this study was to understand the opinion of health care providers on PV, the current reporting mechanisms, identifying the causes for underreporting, and the existing process in clinical practice.Methods: A qualitative study using pretested interview guide was conducted among 20 different cadres of healthcare personnel (doctors, pharmacists, and staff nurses) from various hospitals such as government, private, corporate, and medical college of Odisha state. The data were analysed using a thematic analysis. The meaning units have been identified from the transcript and coded with MAXQDA software (MAXQDA Analytics Pro 2020, VERBI GmbH Berlin).Results: Participants showed a lack of awareness regarding the concept of PV. A cluster of challenges such as lack of ADR monitoring, non-conducive work atmosphere and lack of cooperation between staff, lack of knowledge among the health professionals, and fear of legal liability as major pitfalls causing poor ADR reporting. To enhance the pharmacovigilance practice, participants suggested context-specific strategies such as IEC activities, innovative ideas to improve ADR monitoring, regular monitoring.Conclusions: Capacity building through training, regular monitoring and supervision to strengthen the pharmacovigilance practices is the current need in India

Social and biological evaluation of antimicrobial resistance (SOBEAR) in rural India: a study protocol

BackgroundAntimicrobial resistance (AMR) has been one of the biggest global health threats in recent years, mostly in low- and middle-income countries, which requires urgent research using a multidisciplinary research approach. The use of large quantities of antimicrobial drugs inappropriately for humans, poultry and agriculture has been recognized as a leading cause of antibiotic resistance and the predominance of drug-resistance pathogens in the environment. This protocol aims to describe the use/misuse of antibiotics (ABs) in the community and evaluate clinical samples from healthcare settings to detect genes associated with antimicrobial resistance.MethodsWe will conduct a community-level survey in different villages of the Tigiria block to assess knowledge and awareness on ABs and AMR. We will conduct in-depth interviews (IDIs) with doctors, pharmacists, nurses and drug sellers, as well as focus group discussions (FGDs) with ASHA and ANM workers who are involved in antibiotic supplies to the community. Quantitative data from the community survey and qualitative data of IDIs and FGDs will be linked and analyzed using statistical modeling and iterative thematic content analysis. Specimens (stool, urine, blood and wound/pus) will be collected from clinically diagnosed patients of different healthcare centers of Tigiria block. The samples will be cultured for bacterial isolation and antibiotic sensitivity testing. Genomic DNA will be isolated from positive bacterial cultures and sequenced using PCR to evaluate high-threat multi-drug resistance organisms (MDROs), screening of plasmid-mediated quinolone resistance (PMQR) genes, antimicrobial genes responsible for MDR and quinolone resistance-determining regions (QRDRs).ConclusionThis is the community-based protocol to evaluate the knowledge, attitudes, awareness and practices regarding ABs and AMR. The study protocol establishes a foundation for evaluating population-based prevalence and risk factors for AMR and MDROs in rural areas of the Odisha state, India

Epidemiology of obesity and its related morbidities among rural population attending a primary health centre of Odisha, India

Context: Overweight and obesity has become a major contributor to global burden of chronic diseases and disability. Obesity among rural India is emerging as a major health problem because of change in lifestyle and food habits, thereby increases the risk of multiple morbid conditions among rural population. Aims: This study aims to find out the association of overweight/obesity with different socio-demographic factors and explore the co-morbidities among overweight and obese in a rural setting. Settings and Design: A cross-sectional study was done in a randomly selected primary health centre of Khurda district, Odisha for 4 months. Materials and Methods: This study was done among 183 patients aged >20 years with BMI >25 kg/m2 after taking their consent. Anthropometric measurements were done and data were collected using a semi-structured questionnaire. Statistical Analysis Used: Descriptive statistics such as proportion, mean and standard deviation were calculated and inferential statistics such as Chi-square test, univariate and multivariate regression was done using the SPSS version 20.0. Results: Mean age of participants was 45.7 (±13.8) years. About 93.4% were Grade II obese while 51.9% were at risk according to their waist–hip ratio. Around 53.6% of participants had multi-morbidity. Age, occupation and number of children were significantly associated with obesity. Morbidity was significantly associated with age, occupation, marital status and number of children. Increased grade in obesity the more is the probability of having morbidity. Conclusions: There is an urgent need to screen for obesity at rural health facility and early management for prevention from co-morbidities

Prevalence and determinants of hysterectomy in India

Abstract Increase in the prevalence of hysterectomy among low-and middle-income countries (LMICs) such as India has become a significant concern. Reports based on either a particular group or region show an increasing trend in hysterectomy, but there is a dearth of national-level data in this domain. Hence, there seems to be an urgent need to garner evidence on the prevalence and determinants of hysterectomy, which could pave the way for future programs and policies. We aimed to estimate the prevalence of hysterectomy and assess its determinants using a nationally representative sample. An observational analysis was conducted using data from Longitudinal Aging Study in India (LASI), 2017–2018. 38,154 women aged > 18 years were included. A multivariable logistic regression, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI), was used to predict the association between various socio-demographic characteristics and hysterectomy. A separate multivariable logistic regression model was executed to determine the association between selected non-communicable diseases (NCDs) and hysterectomy. Survey weights compensated the complex study design. The overall prevalence of hysterectomy was around 11.35%. Excessive menstrual bleeding followed by fibroids emerged as the leading causes of hysterectomy. The various determinants of hysterectomy were urban residents [AOR: 1.54 (1.21–1.96)], other backward class [AOR: 2.19 (1.72–2.78], working women [AOR: 1.19(1–1.42)] and the most affluent (rich) group [AOR: 2.06 (1.62–2.63)]. Hysterectomy was associated with cancer [AOR: 4.83 (2.51–9.29)], diabetes [AOR: 1.79 (1.25–2.57)], hypertension [AOR: 1.48 (1.27–1.71)] and joint diseases [AOR: 1.43 (1.09–1.88)]. Hysterectomy is considerably prevalent in India, which cannot be overlooked. Health promotion regarding hysterectomy and its implications is needed especially among urban residents, affluent groups and those with a higher body mass index. Health programmes aimed at women should follow a life course approach by prioritizing health and overall well-being even after reproductive years

Challenges in Maternal and Child Health Services Delivery and Access during Pandemics or Public Health Disasters in Low-and Middle-Income Countries: A Systematic Review

Maternal and child health (MCH) has been a global priority for many decades and is an essential public health service. Ensuring seamless delivery is vital for desirable MCH outcomes. This systematic review outlined the challenges in accessing and continuing MCH services during public health emergencies—pandemics and disasters. A comprehensive search approach was built based on keywords and MeSH terms relevant to ‘MCH services’ and ‘pandemics/disasters’. The online repositories Medline, CINAHL, Psyc INFO, and Epistemonikos were searched for studies. We included twenty studies—seven were on the Ebola outbreak, two on the Zika virus, five related to COVID-19, five on disasters, and one related to conflict situations. The findings indicate the potential impact of emergencies on MCH services. Low utilization and access to services have been described as common challenges. The unavailability of personal safety equipment and fear of infection were primary factors that affected service delivery. The available evidence, though limited, indicates the significant effect of disasters and pandemics on MCH. However, more primary in-depth studies are needed to understand better the overall impact of emergencies, especially the COVID-19 pandemic, on MCH. Our synthesis offers valuable insights to policymakers on ensuring the uninterrupted provision of MCH services during an emergency

Prevalence and predictors of dementia and its effect on functional dependency among community-dwelling older adults in rural Odisha: Finding from AHSETS study

Background Life expectancy at birth in India has improved from 67.5 yrs during 2009 to 70.4 yrs during 2019 and country’s geriatric population is likely to reach 19% by 2050. Physical and psychological abnormalities among elderly impact negatively and act as a challenge for health system. Estimating the magnitude of dementia and determining its risk factors would help in developing better preventive and control strategies. Methods A cross-sectional study among 725 rural elderly was carried out in the Tigiria block of Cuttack district, Odisha, India, using standardized questionnaires and various cognitive and activity assessment tools. Data were recorded using android tablets installed with open data kit software and statistical analysis (Chi-square and multinomial logistic regression) was done using SPSS v.23. Results Among the study participants, 58.3% and 34.8% had risk of dementia and dementia respectively, with prevalence more among females. Increased age, illiteracy, low socio-economic status, low occupation, widowed/separated, female gender, low BMI, and extended family type were associated factors for dementia. Dementia was significantly associated (p<0.001) with activities of daily living and instrumental activities of daily living. Conclusion Cognitive impairment affects majority of the rural elderly and impacts ability to perform their daily activities. With increased age of living, this is becoming a major public health issue. The findings from the present study would help policymakers and program implementers in developing appropriate strategies for early case identification and prompt management to improve quality of life among elderly

Knee Osteoarthritis in Rural Elderly of Cuttack district: Findings from the AHSETS study

Background In India, it is predicted that the elderly population will be increased from 8% in 2015 to 19% in 2050. Geriatric population contributes around 9% of total Odisha population and 86.3% of them residing in rural areas. Estimating the prevalence of osteoarthritis knee and determining its risk factors would help in developing better preventive and control strategies. Methods A cross-sectional study among 725 rural elderly was carried out in the Tigiria block of Cuttack district, Odisha, India. Previous medical history of arthritis diagnosed by medical professional was taken as positive for osteoarthritis knee (OA Knee). Data were recorded using android tablets installed with open data kit software and statistical analysis such as chi-square test and binary logistic regression was done using SPSS v.23. Results the prevalence of OA knee was 56.7% where both the sexes were similarly affected. Major portion of the OA knee participants were illiterates and doesn’t working currently also more among poor socio-economic group. Factors like extended family type, poor socio-economic status, both underweight as well as overweight, and diabetes mellitus had shown significant association with OA knee. Conclusion Osteoarthritis of knee joint affects majority of the rural elderly and impacts their ability to perform daily activities. With increased age of living, this is becoming a major public health issue. The findings from the present study would help policymakers and program implementers in developing appropriate strategies for prevention, early case identification and prompt management to improve the quality of life among elderly

Reach, accessibility and acceptance of different forms as communication channels for health promotion: a community-based analysis in Odisha, India

Introduction: To achieve universal health coverage, improving demand generation at community is necessary. Media plays an important role by acting as a linking pin between service providers and the community. This study is planned to assess the penetration of various media types in the state of Odisha. Methods: This cross-sectional mixed method study was undertaken in the state of Odisha, India. Following a desk review, a situational analysis through multi stakeholder perspective was carried out at the state, district and sub-district level. Both qualitative and quantitative technique was used for data collection through direct observation of study sites using checklist, interview with the help of a semi structured questionnaire, FGDs and IDIs. Results: The major source for information related to identification and prevention of disease was television (63.6%) followed by health wall (36.6%), newspaper (21.6%), health facility/service providers (17.7%), radio (9.2%) , other media like posters, pamphlets and folk dance (5.5%). Information on treatment or management of the diseases was received mostly from television (61.2%), poster/leaflets (39.2%), health wall (35.2%) and newspaper (19.7%). Only 8% of people have received any health related message in mobile in past one year.  Boards and hoarding provided information to only 16.5% of the study population. Heath wall was seen in almost all villages of four districts. These walls contain information on various health topics. Nearly 36% respondent get health related information from the health wall. For immunization related information interpersonal communication through grassroot health workers was found to be more effective and preferred. Conclusion: Interpersonal communication is believed to be most acceptable source of information on maternal and child health, immunization and neonatal care. For people with low literacy, health wall campaign, folk media and interpersonal communication was found to be effective.   &nbsp

Factors Associated with Chronic Kidney Disease of Unknown Etiology (CKDu): A Systematic Review

(1) Background: Despite ample research, the factors, specific causes, and pathways associated with chronic kidney disease of unknown etiology (CKDu) remain elusive. Therefore, we performed a systematic review to explore the potential etiologies for the development of CKDu globally. (2) Methods: A systematic literature review was conducted using databases CINAHL, Cochrane Library, Embase, Google Scholar, MEDLINE, and PsycINFO on the specific causes and pathophysiology related to CKDu from inception until April 2021. Study selection, data extraction of included articles, and quality appraisal were assessed. The narrative approach was used to summarize and comprehend the findings. (3) Results: Our study included 25 studies, considering 38,351 participants. Twelve studies were case–control, ten were cross-sectional, and three were cohort designs. All articles were from low-and middle-income countries (LMICs). The findings suggest 12 factors are associated with CKDu. Most studies (n = 8) identified farming and water sources as the factors related to CKDu, with heavy metal toxicity coming in second (n = 7). (4) Conclusion: The systematic review reported various factors associated with CKDu, from which most studies reported farming, water sources, and heavy metal poisoning. Considering the findings, the study recommends future strategies and public health initiatives to prevent the epidemiological/environmental factors contributing to CKDu