Tracking progress toward elimination of iodine deficiency disorders in Jharkhand, India

Research question: What is the current status of Iodine Deficiency Disorders (IDD) in the state of Jharkhand? Objectives: (1) To determine the status of iodine deficiency in the state. (2) To determine the availability and cost of adequately iodized salt at the retail shops. (3) To study the perceptions of the community regarding iodine deficiency, salt and iodized salt. Design: A cross-sectional community-based survey. Study setting: Thirty clusters selected through the probability proportion to size (PPS) sampling in the state of Jharkhand. Study participants: Children aged 6-12 years, households, retail shopkeepers and opinion leaders. Study tool: Quantitative and qualitative methodology using a pretested questionnaire and focus group discussion used to carry out the community-based survey. Results: Total goiter rate (TGR) was 0.9%. Median urinary iodine level was 173.2 µg/L. The proportion of individuals with urinary iodine levels less than 100 and 50 µg/L were 26.4% and 10%, respectively. Slightly less than two-thirds (64.2%) of the households were found to be consuming adequately iodized salt as measured by titration (greater than 15 ppm). Iodized salt was available across the state and the cost varied between Re. 1 and Rs. 8 per kilogram. A common belief among the community was that iodized salt is equivalent to refined packet salt that is further equivalent to expensive salt. Conclusion: The results of the present survey show that the iodine nutrition in the state of Jharkhand is optimal. Considering that the consumption of adequately iodized salt should increase from 64.2% to the goal of more than 90%, sustained efforts are required in this place to consolidate the current coverage of adequately iodized salt and increase it to greater than 90%

Tracking progress toward elimination of iodine deficiency disorders in Jharkhand, India

RESEARCH QUESTION: What is the current status of Iodine Deficiency Disorders (IDD) in the state of Jharkhand? OBJECTIVES: (1) To determine the status of iodine deficiency in the state. (2) To determine the availability and cost of adequately iodized salt at the retail shops. (3) To study the perceptions of the community regarding iodine deficiency, salt and iodized salt. DESIGN: A cross-sectional community-based survey. STUDY SETTING: Thirty clusters selected through the probability proportion to size (PPS) sampling in the state of Jharkhand. STUDY PARTICIPANTS: Children aged 6-12 years, households, retail shopkeepers and opinion leaders. STUDY TOOL: Quantitative and qualitative methodology using a pretested questionnaire and focus group discussion used to carry out the community-based survey. RESULTS: Total goiter rate (TGR) was 0.9%. Median urinary iodine level was 173.2 µg/L. The proportion of individuals with urinary iodine levels less than 100 and 50 µg/L were 26.4% and 10%, respectively. Slightly less than two-thirds (64.2%) of the households were found to be consuming adequately iodized salt as measured by titration (greater than 15 ppm). Iodized salt was available across the state and the cost varied between Re. 1 and Rs. 8 per kilogram. A common belief among the community was that iodized salt is equivalent to refined packet salt that is further equivalent to expensive salt. CONCLUSION: The results of the present survey show that the iodine nutrition in the state of Jharkhand is optimal. Considering that the consumption of adequately iodized salt should increase from 64.2% to the goal of more than 90%, sustained efforts are required in this place to consolidate the current coverage of adequately iodized salt and increase it to greater than 90%

Integrated approach for survival and development during first 1000 day of life: Assessing Health Systems Readiness in three Aspirational Districts of Jharkhand (India)

Introduction: With increased evidence of the association between early child-rearing practices and children's health, growth, and development, the government of India has introduced several policies and strategies, of which the home-based care for young child (HBYC) is the most recent. An assessment was conducted in three aspirational districts in Jharkhand to see system preparedness for implementation of the program. Material & Methods: Eight district key health personnel from 3 districts were interviewed on health systems readiness components. A total of 100 Sahiyas (Accredited Social Health Activists) and 100 mothers were selected across 8 villages in 2 blocks in each of the 3 districts of Lohardaga, Simdega, and West Singhbhum, and interviewed with a structured questionnaire on knowledge and practices. In addition, 24 auxiliary nurse midwifes, Sahiya Sathis, and Anganwadi workers were interviewed. Data collection teams underwent an orientation. Results: Most nodal persons were recruited; however, orientation to HBYC and awareness of key components such as incentives, supervision mechanism, and monitoring indicators was lacking. Supply of prophylactics and equipment was inadequate. Knowledge of community health workers was inadequate for many child care indicators except Oral Rehydration Salt (ORS) preparation (96%) and initiation of complementary feeding (97%). Knowledge of danger signs requiring referrals was particularly low (30%). Mothers' knowledge and practices were low on all the indicators. Conclusion: The HBYC program can build its success on the present health system functioning by tailoring trainings to focus on gaps in knowledge, addressing specific gaps in supplies, improving supervision, and integration effort

Safe Delivery application with facilitation increases knowledge and confidence of obstetric and neonatal care among frontline health workers in India

Background: Digital learning tools have proliferated among healthcare workers in India. Evidence of their effectiveness is however minimal. We sought to examine the impact of the Safe Delivery App (SDA) on knowledge and confidence among frontline health workers (HW) in India. We also studied whether facilitation to address technical challenges enhanced self-learning. Methods: Staff nurses and nurse-midwives from 30 facilities in two states were divided into control and intervention groups through randomization. Knowledge and confidence were assessed at baseline and after 6 months. Three rounds of facilitation addressing technical challenges in downloading and usage along with reminders about the next phase of learning were conducted in the intervention group. A user satisfaction scale along with qualitative interviews was conducted in the intervention group at the endline along with qualitative interviews on facilitation. Results: The knowledge and confidence of the healthcare workers significantly increased from the baseline to endline by 4 percentage points (P < 0.001). The participants who received facilitation had a higher mean score difference in knowledge and confidence compared to those who did not receive facilitation (P < 0.001). The participants were highly satisfied with the app and video was the most-watched feature. They reported a positive experience of the facilitation process. Conclusion: The effectiveness and acceptability of the SDA indicate the applicability of mHealth learning tools at the primary healthcare level. In a time of rapid digitalization of training, facilitation or supportive supervision needs further focus while on-ground digital training could be invested in to overcome digital illiteracy among healthcare workers