Unmet needs for family planning in a municipal area in North Kerala, India

Background: An important concept to describe effectiveness of family planning programme is unmet need for family planning. Most married women want to limit childbirth and space deliveries but many are unable use contraceptives for varying reasons leading to unmet need. According to national survey in India (NFHS 3), the total unmet need is 13.2% (unmet need for spacing- 6% and limiting- 7%). According to district survey (DLHS 3), in Malappuram district, Kerala, India, the total unmet need was 19.7% (11.4% for spacing and 8.3% for limiting) higher than national unmet need. The objective of this study was to find out unmet need for family planning and its causes and the contraceptive practices among married women of reproductive age group (15-49 years) in Perinthalmanna municipality in northern Kerala, India.Methods: A cross sectional study was conducted in 35 wards of Perinthalmanna municipality between 8 April to 6 June 2015. The sample size was calculated as 725. From each of the 35 wards, 21 houses were selected randomly and married women in the reproductive age group 15-49 were interviewed using a semi structured questionnaire. Data was analyzed using epi- info version 7.Results: Among the 753 married women, the total unmet need was 21.2% (spacing 16.9, limiting 4.3). Among 87 (11.6%) currently pregnant women, 66 wanted to conceive, 20 wanted to delay and one didn’t want at all. Among the 666 non-pregnant women, 69 were considered in fecund. Among 326 (48.94%) contraceptive users 26.9% had undergone sterilization; 47.5% were using copper T; 13.5% used condoms and 11.9% used oral pills. Out of 340 non pregnant women not currently using any contraceptives, 24% did not want to conceive ever; 27% wants to conceive but later and 38.8% were ready to conceive now. Fear of complications, considering it against religious faith, lack of knowledge and partner’s opposition were common reasons for not using contraception.Conclusions: The unmet need for Family Planning is high and in order to reduce the gap, the program should address the above reasons

Tobacco Smoking among Male Medical Students in a Teaching Hospital in North Kerala

Despite scientific evidences linking tobacco to adverse health outcomes and smoking being banned in college campuses, a good proportion of youth is using tobacco products. College students are especially vulnerable due to their independent living away from home, making own choices and attraction to new lifestyle. Healthcare providers who smoke send ambiguous message to patients whom they have encouraged to cease smoking or are less likely to provide patients with antismoking advice. The objective of the study is to find the proportion of male medical undergraduate students who smoke tobacco in a medical college in North Kerala. Among the 200 male undergraduate medical students, 31% were current tobacco smokers. Among them, (46.88%) smoked daily, (39.06%) occasionally and (14.06%) rarely. Most reported no specific reason for initiation, while about one-fourth gave reasons like curiosity, tension relief and peer pressure. 38.71% initiated after joining college. 85.5% were aware of harmful effects of tobacco. Family, friends and social media were found to be the common sources of information. 84 (42%) knew about Stop-Smoking Clinic functioning in the hospital. Around half expressed the desire to quit. One-fifth reported peer pressure as reason for not quitting. To conclude, it would be ideal to counsel medical students and highlight the importance of being role models

Prevalence of depression among married women in a rural area of North Kerala: A cross-sectional study

Depression is a common illness, it being the fourth-leading cause of disability in the world. The global lifetime prevalence falls between 8% and 12%, with female preponderance. A cross-sectional study was designed to assess the burden of depression among married women in a rural setting in North Kerala and identify its sociodemographic risk factors. The sample size was calculated to be 453 (prevalence = 24.9%; error = 20%; design-effect = 1.5). Systematic random sampling was used to select the participants from the eligible couple register. They were interviewed using MINI and Montgomery–Ashberg Depression Rating Scales. Descriptive analysis showed that 24.2% was suffering from current depression, mostly mild and none severe. Two percent reported past depression and 5.4% experienced spousal violence. Poor family support, experience of domestic violence, morbidity, and older spouses were found to be significant risk factors. The provision of mental health services by trained personnel and strict vigilance against the marriage of girls below the legal age and domestic violence are need of the hour

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