Role of Dietary Management and Physical Activity in Control of Hypertension in Rural Areas of Punjab-A Cross-sectional Study

Introduction: As reported by WHO, hypertension is the third ‘killer’ disease, accounting for one in every eight deaths worldwide. Many modifiable and non-modifiable risk factors are found to be associated with the disease. The present study aims to determine the role of dietary management and physical activity in the control of hypertension in a given population. Material and Methods: A cross-sectional study was conducted that. Study included all hypertensive patients (290) from the field practice area of a tertiary care institute. A self-constructed, pretested questionnaire was used to enquire about the socio- demographic factors and other risk factors associated with hypertension. The data was analyzed using SPSS 23 and valid conclusions were drawn by using the chi-square test. Results: Out of 290 patients, 204 (70.3%) were females and 86 (29.7%) were males. Univariate analysis identified decreased salt intake, decreased fatty food consumption, physical activity, stress management, and spiritual help as highly significant factors affecting hypertension. On multivariate analysis, physical activity, stress management and spiritual help were found to be significant. Conclusion: The study showed that physical activity, stress management and spiritual help were significantly associated with hypertension control among the elderly. Measures should be taken to create awareness about lifestyle modifications in the control of hypertension

Direct Benefit Transfer Scheme for Tuberculosis Patients – Performance Challenges observed by the Providers and Patients

Introduction: Government of India launched an Aadhar-linked Direct Benefit Transfer (DBT) scheme from 1st April, 2018. Under this scheme, all notified TB patients would receive Rs 500 per month (~US$7) throughout the course of their treatment for nutritional support. Aim and Objectives: To determine the challenges faced by the health providers and patients in the implementation of Direct Benefit Transfer scheme. Methods: This was a mixed method cross-sectional study conducted on all public and private TB patients notified during the year 2019 under RNTCP (now NTEP) in district Amritsar, Punjab. Quantitative data about the availability and validation of bank accounts was obtained from the Nikshay portal after having permission from the District TB Officer. Qualitative data was obtained from the focus group discussion and in-depth interviews with the involved staff members (17) and patients (20) registered in Tuberculin units of Amritsar. Results: From the Nikshay reports, it was observed that there was significant difference between the public and private sector and between rural and urban areas. Focus group discussion was done with the TB Health Visitor (TBHV) and Senior TB supervisors (STS) and asked about the hurdles they faced. Items were identified and tabulated. In-depth interviews were conducted on 20 patients, 10 each from public and private sector respectively. Data collected was transcribed and arranged as per the themes or questions and then the information was recorded under those sub-headings. Conclusion: The major challenges observed by the providers were lack of support from the private sector, lack of awareness among people, technical issues and more work burden. Patients mostly mentioned about confidentiality issues, lack of awareness, social stigma of the disease, less amount and long and complex process

Socio-Epidemiological Parameters Influencing the Treatment Outcome in Newly Diagnosed Smear Positive Cases Under Dots in District Amritsar

Introduction: Tuberculosis has brought untold miseries to generations and even today, when newer modalities for diagnosis and treatment have made the disease curable, people are still suffering and dying from this disease. The present study is an attempt to know about the socio-epidemiological parameters affecting the treatment outcome in new smear positive patients under DOTS. Methods: The study was conducted on new smear positive patients registered under DOTS in two Treatment Units (TUs) present in Amritsar city. House to house visits were done and socio-epidemiological parameters were studied by completing a pre designed proforma evolved for this purpose. Results: Out of 250 patients, 149 (59.6%) were males and 101(40.4%) were females. 75.8% of the cases among males and 87.2% among females were in the age group of 15-45 years. Male preponderance, with male to female ratio of 1.5:1 was seen. Socio-demographic factors affecting the treatment outcome were age, sex and marital status. Conclusion: On statistical analysis, it was observed that favourable outcome was significantly associated with mean age of 29.2 ± 13.3 years (p = 0.013), female sex (OR = 2.19, p = 0.04) and unmarried cases (χ2 = 7.186, p = 0.027). Family size, literacy status and socio-economic status were not significantly associated with the treatment outcome

Impact Of Socio-Demographic Factors on Age-Appropriate Immunization of Infants in Slums of Amritsar City (Punjab), India

Introduction: Vaccination status of slum newborn and infant is far from being satisfactory. Hence, the present study was conducted to assess the age appropriate immunization status of infants and to explore the impact of socio-demographic factors on immunization status in various slum areas of Amritsar city. Methods: A total of 30 clusters of 7 infants each were studied to make a sample of 210 units. Age appropriate immunization status of infants and socio-demographic factors related to it were studied. Results: Out of 210 infants, 42.9% infants were completely immunized appropriate to their age, 27.1% were partially immunized and 30% were unimmunized. On bivariate analysis, age and birth order of infants, nativity, socio-economic status, place of delivery, planning of pregnancy, literacy status of mothers and fathers were statistically significant factors influencing age appropriate immunization. But, on multivariate logistic regression analysis, only age of the child (OR= 2.8, CI= 1.4 to 5.4, p= 0.002) and nativity (OR= 2.0, CI= 1.04 to 3.9, p= 0.04) emerged as significant factors affecting age appropriate immunization. Conclusion: Age appropriate immunization of infants in slums remains very low especially infants of more than six months of age and infants belonging to migrant families

Socio-Demographic Factors Influencing Antenatal Care Practices in Urban Slums of Amritsar City, Punjab, India

Objective: The study was conducted to explore socio - demographic factors influencing antenatal care in various slum areas of Amritsar city in Punjab. Methods: A total of 30 clusters of 7 units each were taken to make a sample of 210 units. The women who had delivered within one year before the interview were taken as study units. They were interviewed with the help of a pretested proforma and regression analysis was applied to evaluate the effect of various socio-demographic factors on antenatal care. Results: On univariate analysis nativity, possession of identity proof, socio-economic status of women, type of family, age of women, literacy status of women and their husbands, parity and pre-planning of pregnancy emerged as significant factors influencing antenatal care practices of the women. But, multivariate regression analysis identified only literacy of the women (OR=3.02, CI=1.36 - 7.57, p=<0.01), literacy of their husbands (OR=2.52, CI=1.13 - 5.6, p=<0.05) and socio-economic status of the household (OR= 2.25, CI=1.5 - 5.5, p=<0.05) as significant factors affecting the antenatal care practices. Conclusion: Literacy of women and their husbands and socioeconomic status of households are significant factors determining antenatal care. Therefore, efforts should be made to improve upon these factors

Assessment of 10 Year Risk of Fatal or Non-Fatal Cardiovascular Disease Using WHO/ISH Charts in District Amritsar of Punjab (India)

Introduction: World Health Organization recommends use of WHO/ISH risk prediction charts for identifying those who are at high risk of cardiovascular disease. Hence, the current study was conducted to assess 10 year risk of cardiovascular disease among adult population of Amritsar. Materials & Method: The study was conducted in Urban Health Training Centre of Sri Guru Ram Das Institute of Medical Sciences and Research Amritsar. The Attendants of patients coming to the centre for treatment in the age group of 40-65 years were included in the study. The sample size of 400 was calculated. WHO/ISH charts for South East Asian Region in the setting were used to es- timate fatal or non-fatal cardiovascular risk prediction for 10  years. Results: Nearly half of study subjects (55.8%) were having low risk, 15.5% had moderate risk and 28.8% had high risk of cardio- vascular disease. The risk was found to be higher among men, in urban areas, among those who had lower level of education and among those who were belonging to medium or high income group. Conclusion: There is a high risk of cardiovascular disease. Further research on larger population is required for appropriate intervention

Perception of care givers regarding danger signs of illness and practices followed in young infants (0–2 months) as per IMNCI at selected areas of Amritsar, Punjab: A qualitative study

Background: In India, neonatal mortality contributes to over 64% of infant deaths, mostly occurring during the first week of life. Mortality rate in second month of life is also higher than at later ages. Delay in identification of warning signs of neonatal illness naturally postpones the initiation of treatment and referral to hospital. Materials and Methods: The study aimed to explore the perception of care givers regarding danger signs of illness and practices followed in young infants. Care givers who cared for the sick young infants during last six months were recruited using a convenient sampling technique and qualitative research approach. Five semi-structured interviews and one FGD were conducted using an interview and FGD guide. Data was analyzed manually by reading and rereading the transcribed verbatim leading to the emergence of themes, subthemes, and codes. Results: Data explored that excessive crying was perceived as a danger sign by entire mothers, and many of them were unable to recognize important warning signs. The delay in decision making for medical care-seeking also shows dwindling awareness. Additionally, mothers were adapting few unhygienic practices as home remedies leading to worsening the symptoms and making a call for additional infections which needs to be addressed by the health authorities at community level. Conclusion: Pronounced efforts are expected to raise mindfulness of mothers toward the significance of early identification of neonatal danger signs to stave off the high magnitude of neonatal mortality. Inclusion of excessive crying as neonatal danger sign is recommended as well

Burden of care on family care givers of patients of gastrointestinal cancers in a tertiary care institute

Abstract Background Gastrointestinal tract cancers are one of the leading causes of morbidity and mortality globally causing significant physical and mental suffering to not only the patient but also to the primary care giver. In the traditional Indian value system, family members become or are forced to become primary caregivers. Method The observational cross- sectional study was conducted using a pretested questionnaire and BSFC short form scale on 156 primary family care givers of patients suffering from and seeking treatment for cancer of the gastrointestinal tract from May 2021 to April 2022 in a tertiary care institute after taking approval from the Institutional Ethical Committee vide letter number SGRD/IEC/2021-04 dated 04/05/2021. Result Mean age of family caregiver was 48.6 (4.7) years and the majority were female 111 (71.1 %).&nbsp; Average duration of primary care given was 2.62(1.24) years. 94 (60.2%) family care givers provided &gt; 8hr duration of care. 103 (66%) of the family caregivers suffered from moderate burden, 39 (25%) from heavy burden and only 14 (8.97%) family caregivers considered burden as mild. Significant association was found between &gt;8 hours of caregiving, caregiver having a comorbid illness, treatment outcome and financial distress borne during the course of treatment and burden of caregiving. Conclusion Burden of caregiving in the family caregivers of cases of gastrointestinal cancer has the capacity to create ripples in the primary life domains of the caregiver and needs to be looked into. Key words: Family care giver, Burden, Cancer, Short version of burden scale for family caregiver &nbsp

Performance Of Directly Observed Treatment Provider Affecting the Treatment Outcome of Tuberculosis Cases in Amritsar City

Introduction: DOT providers are the key persons in the implementation of the RNTCP at ground level. Objective: To assess the working of DOT providers and DOT centre affecting the treatment outcome in sputum positive TB patients under RNTCP. Materials and Methods: With the help of self designed questionnaire, patients were asked about the working, availability and behaviour of the DOT provider, the distance, timing of DOT, facilities for taking drugs and privacy at the DOT centre. Data management and analysis was done by using Microsoft excel and SPSS version 17.00. Results: Of 250 patients, 149 (59.6%) were men and 101 (40.4%) women. It was found that the initial verification of the address by the DOT provider, availability of the DOT provider and the availability of clean water, disposable cups and privacy for the patient were significantly associated with the treatment outcome (p = 0.021, p = 0.006 and p = 0.04 respectively). Behaviour of the DOT provider and the distance of the DOT centre were not significantly associated with the outcome. Conclusion: Direct observation alone is not sufficient for treating TB, quality of working of the DOT provider and facilities at the DOT centre are significantly associated with treatment success

Profile of Children Suffering from HIV/AIDS in Amritsar, Punjab- A Cross-Sectional Study

Introduction: HIV/AIDS in paediatric age group is a major cause of childhood morbidity and mortality. Mostly infection is acquired in vitro and mother-to-child transmission remains the most significant route of transmission in children <15 years. Lack of awareness about the disease and occurrence of opportunistic infec- tions are common hinderances in the successful management of disease. Materials and methods: The study was conducted on less than 15 years children registered and being treated with Anti-retroviral therapy (ARV) registered with Government ART centre from 1st Jan 2016 to 31st December 2017. Socio-demographic profile, birth history, mode of transmission, side effects of anti-retroviral ther- apy and opportunistic infections were assessed. Data management and analysis was done by using SPSS. Results: Of the total 46 children, 25 (54.3%) were males and 21 (45.7%) were females. Commonest mode of transmission was mother to child (91.3%). Common side-effects observed were skin rashes, nausea/vomiting, diarrhoea, fever/headache, jaundice and anaemia. Opportunistic infections observed were tuberculosis, candidiasis, recurrent diarrhoea, failure to thrive and recurrent respiratory infections. Conclusion: On statistical analysis, it was observed that side ef- fects were significantly higher among cases from lower middle socio-economic status (p=0.015) than cases from low socio- economic status