Factors influencing Janani Suraksha Yojana utilization in a Northern city of India

Background: Janani Suraksha Yojana (JSY) was launched by Government of India with an objective of increasing institutional delivery. After years of operationalization in the Union territory of Chandigarh, no studies have documented the extent of its utilization and in-turn, effectiveness of its implementation. The aim and objectives of the study was to ascertain the extent of utilization of JSY scheme and to explore the factors influencing its uptake.Methods: It was a community based cross-sectional mixed method concurrent study conducted from August 2012 to March 2014 in Chandigarh city. A total of 100 women residing in the catchment areas of primary and secondary level health care facilities of Chandigarh who gave birth in proceeding two years (2011 and 2012) were interviewed using a structured questionnaire and in-depth interview checklist by trained field investigators. Data analysis was done using SPSS software for windows (version 17).Results: A total of 100 mothers were approached out of which 94 delivered in institution and 34 received JSY benefit. Logistic regression model suggested that more than 3 ANC visits by women was significantly associated with the uptake of JSY benefit (OR= 17.4). The factors influencing decreased uptake of scheme were sub-optimal incentive, delayed payment, problem in arranging for a residence proof and lot of administrative paper work.Conclusions: Though the JSY scheme led to high rate of institutional delivery but the monetary incentive was not availed by most of the beneficiaries. There is a need to remove the bottlenecks and thus ensure smooth delivery of cash benefits.

Developing a capacity building training model for public health managers of low and middle income countries

BACKGROUND: The challenges faced by the low and middle-income countries (LMIC) in the field of public health management calls for the capacity building of qualified and trained public health managers in order to improve the effectiveness and efficiency of the health care delivery system. Most of the existing training programs for public health management are based in the settings of developed countries, which hinders their application in LMIC countries. The objective of this paper is to document the process of development and evaluation of a capacity building program for public health managers of various LMICs. MATERIAL AND METHODS: A training program was developed using Kern's six-step framework with several innovative learning and assessment methodologies and evaluation using Kirkpatrick training evaluation model. Delphi technique was used for program development. RESULTS: This five to ten-day partly/fully funded six International Public Health Management Development Programs (IPHMDP) programs was conceptualized which enrolled 178 participants from 42 countries between years 2016 and 2019. Based upon the elaborative discussion in four rounds of Delphi technique, the problem and challenges faced by public health mangers and eight key competencies (viz. Leadership and governance, Project/ program planning, financial management, supply chain management, quality management, Human Resource management, monitoring and evaluation, and communication.) were identified. The group consensually agree upon a blended teaching methodology comprising of chalk and talk approach, inquiry based learning, participatory student based learning, small group instructions, gamification, project-based learning and field-based learning. There was a significant increase in participants' knowledge score (P<0.0001) after all programs especially in the competencies of monitoring and evaluation, followed by project/ program planning, supply chain management and quality management. The majority (90%) submitted their action plan one week following the program, out of which 64% implemented their action plans within six months. A majority (54.7%) of participants were able to implement their learning once they went back by conducting similar training/ workshop/webinars in their settings. CONCLUSION: The comprehensive public health management program in LMIC settings strengthens the competencies of public health managers which can be replicated in similar settings across LMIC to mitigate diverse challenges in public health management

Evaluating the impact of comprehensive epilepsy education programme for school teachers in Chandigarh city, India

AbstractPurposeSchool teachers can play a key role in the first-aid management of school children experiencing a seizure. The teachers have a pivotal role in disseminating knowledge to the children of diseases experienced by them and developing positive attitudes among the children regarding the diseases. The present study investigated the knowledge and practices used by teachers to manage epileptic seizures. The study also tested an epilepsy intervention educational package to see whether it improved the knowledge and practices of the teachers regarding epilepsy.MethodsA total of 85 teachers in schools from Chandigarh, a city of northern India, participated in the study. At the start of the study the teachers completed a pre-tested, semi-structured questionnaire on the first-aid management of epileptic seizures. They were then presented with an intervention package that included audio-visual material on basic aspects of epilepsy. The teachers were then retested after the intervention (one immediately and another after three months from the intervention). A scoring system was devised to quantify the knowledge, attitude and skills of teachers.ResultsMore than 90% of the teachers had previously either heard or read about epilepsy. Nearly half of the teachers said that books and magazines were the most common source of their information, followed by the internet. A comparison of the knowledge, attitudes and skills about the first-aid management of epilepsy based on the before and after questionnaire scores showed significant improvements in the various domains (p<0.05).ConclusionThe epilepsy intervention educational package provided a positive, short term, impact on the knowledge and skills of teachers about epilepsy. There is a need for regular workshops to improve and reinforce the knowledge and skills of the teachers about health problems like epilepsy

Ecological Footprint: A tool for measuring Sustainable development

ABSTRACT Ecological footprint is a tool which is used to represent the amount productive land area which may be needed to regenerate the resource which are consumed by human population and it also represent the earths ecological capacity to regenerate the natural resources. Each country have its own ecological footprint and its need of the hour to manage the same. In the recent days researchers are focussing on identifying tools and technologies that may improve the environmental conditions and in turn increase overall sustainability. For India, the ecological deficit is 0.40 (bio-capacity of 0.51 against human footprint of 0.91gha/capita). Considerable empirical evidence are available which shows that, while developing nations often are the least eco-efficient in the sense that they consume a lot of resources per unit of GDP, they also consume the least amount of resources in absolute and/or per capita terms. Less affluent nations, such as China and India, need to shift their development strategies away from relentless economic expansion and focus on strategies that improve people&quot;s quality of life. In the recent times, stakeholders from around the world are concentrating more on ways to promote sustainability and decrease environmental degradation. By highlighting the inequities within and between people and nations, ecological footprint provides a useful tool that can help to raise public awareness and shape a healthier and more sustainable future. This paper elucidates the importance of ecological footprint and its importance in improving the environmental standards

Measuring the reasons that discourage medical students from working in rural areas

The sharply uneven distribution of human resources for health care across urban and rural areas has been a long-standing concern globally. The present study aims to develop and validate an instrument measuring the factors deterring final year students of Bachelor of Medicine and Bachelor of Surgery (MBBS) in 3 northern states of India, from working in rural areas. The medical student's de-motivation to work in rural India (MSDRI) scale was developed using extensive literature review followed by Delphi technique. The psychometric properties of the questionnaire were assessed in terms of content validity, construct validity, data quality and reliability. Exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) was performed to identify the primary deterrents. Thirty-three items were generated from literature search followed by Delphi exercise. After assessing psychometric properties, the final instrument included 29 items whereas the EFA and CFA highlighted 5 main factors, namely lack of professional challenge, social segregation, socio-cultural gap, hostile professional environment, and lack of financial incentives as underpinning students' demotivation towards working in rural areas. The MSDRI instrument is the first valid and reliable measure for identifying deterring factors for MBBS students to work in rural areas of India. The use of it may be very helpful for policymakers as well as healthcare organizations in formulating effective measures to encourage medical students to work in rural areas, which suffer from a chronic shortage of medical personnel

Development and validation of the motivations for selection of medical study (MSMS) questionnaire in India

Background and Objective Understanding medical students' motivation to select medical studies is particularly salient to inform practice and policymaking in countries-such as India-where shortage of medical personnel poses crucial and chronical challenges to healthcare systems. This study aims to develop and validate a questionnaire to assess the motivation of medical students to select medical studies. Methods A Motivation for Selection of Medical Study (MSMS) questionnaire was developed using extensive literature review followed by Delphi technique. The scale consisted of 12 items, 5 measuring intrinsic dimensions of motivations and 7 measuring extrinsic dimensions. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), validity, reliability and data quality checks were conducted on a sample of 636 medical students from six medical colleges of three North Indian states. Results The MSMS questionnaire consisted of 3 factors (subscales) and 8 items. The three principal factors that emerged after EFA were the scientific factor (e.g. research opportunities and the ability to use new cutting edge technologies), the societal factor (e.g. job security) and the humanitarian factor (e.g. desire to help others). The CFA conducted showed goodnessof-fit indices supporting the 3-factor model. Conclusion The three extracted factors cut across the traditional dichotomy between intrinsic and extrinsic motivation and uncover a novel three-faceted motivation construct based on scientific factors, societal expectations and humanitarian needs. This validated instrument can be used to evaluate the motivational factors of medical students to choose medical study in India and similar settings and constitutes a powerful tool for policymakers to design measures able to increase selection of medical curricula

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation