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October-December 2018
Volume 62 | Issue 4
Page Nos. 251-320

Online since Tuesday, December 11, 2018

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EDITORIAL  

Spiritual health: Need for its mainstreaming in health-care delivery in India p. 251
Chandrakant S Pandav, Rakesh Kumar
DOI:10.4103/ijph.IJPH_319_18  PMID:30539884
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ORIGINAL ARTICLES Top

Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India p. 253
Pallabi Dasgupta, Sharmistha Bhattacherjee, Abhijit Mukherjee, Samir Dasgupta
DOI:10.4103/ijph.IJPH_397_17  PMID:30539885
Background: Despite evidence regarding the beneficial effects of vaccines, vaccination uptake has not been up to the mark across the globe in various sociocultural and sociodemographic groups. Logistics and workforce have been issues of concern to public health managers, but the latent issue of vaccine hesitancy leading to vaccine delays and refusals has not been widely addressed particularly in the Indian context. Objectives: The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for childhood vaccinations in slums of Siliguri, India. Methods: A cross-sectional study was carried out among 194, 0–59 months' children residing in slums of Siliguri in 2016. Data were collected at the household with interviews of mothers/primary caregivers using a predesigned pretested interview schedule developed based on the validated version of vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts working group on vaccine hesitancy. Associations were analyzed using logistic regression. Results: Majority 161 (83%) of the families were vaccine-hesitant and only 33 (17%) were not hesitant. Nuclear families and mothers of lower educational status had significantly higher odds of vaccine hesitancy. Reluctance to vaccinate (26.1%) and to be unaware/having no reliable information (20.5%) were the major reasons cited for vaccine hesitancy. Conclusion: Most of the families of the children were vaccine-hesitant in the area. Uniformity in schedules in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mothers' education can address the issue of vaccine hesitancy.
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Assessment of health management information system for monitoring of maternal health in Jaleswar Block of Balasore District, Odisha, India p. 259
Ranjit Kumar Dehury, Suhita Chopra Chatterjee
DOI:10.4103/ijph.IJPH_203_17  PMID:30539886
Background: In 2005, the Government of India implemented the National Rural Health Mission for reduction of maternal mortality. One of the major impediments in improving maternal health since then has been a poor management of the Health Management Information System (HMIS) at grass-roots level which could integrate data collection, processing, reporting, and use of information for necessary improvement of health services. Objective: The paper identifies the challenges in generating information for HMIS and its utilization for improvement of maternal health program in the tribal-dominated Jaleswar block in Odisha, India. It also aims to understand the nature and orientation of the HMIS data generated by the government for the year 2013–2014. Methods: The study is a cross-sectional type which used observation and interview methods. Primary data were gathered from health professionals to understand the challenges in generating information for HMIS and its utilization. Next, to understand the nature and orientation of HMIS, data pertaining to tribal block were analyzed. Results: The findings show that there are challenges in generation of quality data, capacity building of workforce, and monitoring of vulnerable tribal population. The discrepancies between HMIS data and field reality display the gap in formulation of policy and its implementation. Conclusion: The study unearths the existing politics of knowledge generation. This shows highly standardized procedures and information gathering by use of dominant biomedical concepts of maternal health with limited inclusion of local birthing conceptions and needs of vulnerable tribal pregnant women.
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Risk behaviors contributing to recent serious unintentional injuries among school-going adolescent boys in Kolkata: Application of zero-inflated count model p. 265
Arup Chakraborty, Arista Lahiri
DOI:10.4103/ijph.IJPH_6_18  PMID:30539887
Background: Unintentional injuries have become a major noncommunicable disease burden, especially among the adolescents. Objective: The current study was conducted to estimate the effect of different aspects of daily activities of adolescence for sustaining serious unintentional injuries in the past 1 year. Methods: A cross-sectional survey with multistage sampling with validated pretested questionnaire was done among the school-going adolescent boys in Kolkata. Poisson regression was used to model the counts of serious injuries. To account for the excess of zero in the outcome, zero-inflated Poisson regression was performed. Results: Among the participants, 73.5% did not report any serious unintentional injury sustained in the past 1 year, 11.9% reported to have sustained serious unintentional injury once in the past 1 year, and rest had more than one count. Statistically significant higher chance of sustaining an episode of injury was found among frequent users of motorbike (incidence rate ratio [IRR]: 1.183), frequently walking on roads (IRR: 1.910), and frequently crossing major roads on bicycle (IRR: 2.181) were observed. A statistically significant protective rate ratio was also obtained for those frequently obeying traffic signals while crossing roads (IRR: 0.493) and frequent users of bicycles (IRR: 0.384). Significantly lower rate ratio for sustaining a serious injury was observed with frequently getting into fight at home (IRR: 0.343) and getting beaten up at school (IRR: 0.595). Conclusions: The study revealed traveling in a car and obeying traffic rules were protective from sustaining serious injury. However, walking and participation in sports appeared to be risky, especially for sustaining another episode of serious injury.
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Oral health-related quality of life among male subjects with oral submucous fibrosis in a tertiary care hospital p. 271
Ashok Kumar Jena, Subhalaxmi Rautray, Mounabati Mohapatra, Sombir Singh
DOI:10.4103/ijph.IJPH_179_17  PMID:30539888
Background: Oral submucous fibrosis is very common in Asia. It has many deleterious effects on individual's oral functions. Thus, there is a need to assess the effect of oral submucous fibrosis on quality of life. Objective: To assess the oral health-related quality of life (OHRQoL) in male subjects with oral submucous fibrosis. Methods: Two hundred and thirty male subjects in the age range of 20–40 years were recruited in the cross-sectional, two-group comparative study. Of 230 male subjects, 115 were oral submucous fibrosis subjects who were included in the study group and 115 healthy subjects formed the control group. English version of the oral health impact profile-14 (OHIP-14) was used to assess the OHRQoL. Wilcoxon signed-rank, Kruskal–Wallis, and Bonferroni tests were applied, and the P = 0.05 was considered as level of significance. Results: The mean and median OHIP-14 scores were 19.10 ± 0.66 and 18.00 in the study group and 3.98 ± 3.80 and 3.00 in the control group subjects, respectively (P < 0.001). Mean score of all the seven domains of OHIP-14 was significantly more in oral submucous fibrosis subjects (P < 0.001). All the oral submucous fibrosis subjects had one or more negative effects on OHRQoL compared to 64.34% of healthy subjects. Stage-4 of the oral submucous fibrosis had maximum effect on quality of life compared to other stages (P < 0.001). Conclusions: The quality of life among males is severely affected by oral submucous fibrosis, and Stage-4 of oral submucous fibrosis has maximum effect on the quality of life.
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Body mass index and body fat percentage in assessing obesity: An analytical study among the adolescents of Dibrugarh, Assam p. 277
Dimpymoni Saikia, Sultana Jesmin Ahmed, Hiranya Saikia, Ratna Sarma
DOI:10.4103/ijph.IJPH_24_18  PMID:30539889
Background: Body mass index (BMI) is one of the most commonly used indices to measure the weight status of an individual. However, it takes only height and weight of individual into account. The relative body composition can be calculated regardless of height and weight by body fat percentage (BF%). Objectives: The objectives of the study are (1) To assess the prevalence of obesity using BMI and BF% among early adolescents studying in schools of Dibrugarh. (2) To assess the relationship between BMI and BF%. Methods: A cross-sectional analytical study was conducted among 1200 school going adolescents of 10–14 years in Dibrugarh town for 1 year. Weight status was assessed using the World Health Organization-2007 reference for BMI and the McCarthy's body fat reference. Data were presented using percentages and mean with standard deviation. The correlation between the anthropometric variables was calculated using Pearson's correlation coefficient. Kappa statistics was used to analyze the agreement. Results: Total participants included in the analysis were 1096 with a response rate of 91.3%. The prevalence of overweight and obesity by BMI was 20.9% and 10.2%, respectively. According to BF%, overweight was present in 16.4% participants and 10.9% were obese. Of the 625 normal weight participants (according to their BMI), 9.0% were overweight and 1% were obese under BF% criteria. Again, of 682 participants who were normal by BF%, 15.2% were categorized as obese by BMI criteria. BMI and BF% had a significant high positive correlation (r = 0.70 and P < 0.001). The measurement of agreement by Kappa statistics was 0.621 which was significant (P < 0.001). Conclusions: BMI and BF% positively correlate with each other. BMI accompanied by BF% in the studies might give a better picture of the adiposity of an adolescent.
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Influence of tobacco chewing on oral health: A hospital-based cross-sectional study in Odisha p. 282
Shilpa Mahapatra, Preetha Elizabeth Chaly, Smruti Chandan Mohapatra, M Madhumitha
DOI:10.4103/ijph.IJPH_327_17  PMID:30539890
Background: Smokeless tobacco use in the Indian subcontinent is a part of many religious and cultural rituals and has gained a degree of social acceptance. The deleterious effects of smokeless tobacco are not as well-known as those produced by smoking. Objectives: The study was carried out to assess the influence of tobacco chewing on the oral health of adult patients attending the dental outpatients department of Khordha district headquarter, Odisha. Methods: A hospital-based cross-sectional study was conducted among 25–64-year-old patients attending the dental outpatient department of Gopabandhu Khordha district headquarter hospital. A total of 512 study participants, who were age and sex matched, were stratified into four age groups such as 25–34 years, 35–44 years, 45–54 years, and 55–64 years old. Oral health status of the participants was assessed using modified WHO Oral Health Assessment Form (2013). Pearson's Chi-square test, binary and multinomial logistic regression was performed to determine the relationship between oral health problems and tobacco chewing. Results: Among the tobacco chewers, 59.8% had gingival bleeding, 40.6% had periodontal pockets, 30.1% had loss of attachment, 48.4% had attrition, and 4.3% had potentially malignant disorders. Compared to the nonchewers, these oral problems were significantly higher among the chewers. Whereas dental caries experience was significantly lower among the chewers (40.6%) compared to the nonchewers (54.7%). Compared to the nonchewers, chewers had 1.71 times increased odds for gingival bleeding, 1.71 times increased odds for periodontal pockets, 2.39 times increased odds for loss of attachment, and 2.49 times increased odds for attrition, which were statistically significant. Conclusion: Hence, the study revealed that tobacco chewing definitely had an influence on oral health, with statistically significant increase in oral health problems in chewers compared to nonchewers. Moreover, loss of attachment and potentially malignant disorders increased significantly with the frequency of tobacco chewing. Periodontal pockets, attrition, and loss of attachment significantly increased with the duration of the chewing habit.
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Effect of directly observed oral iron supplementation during pregnancy on iron status in a rural population in Haryana: A randomized controlled trial p. 287
Farhad Ahamed, Kapil Yadav, Shashi Kant, Renu Saxena, Mohan Bairwa, Chandrakant S Pandav
DOI:10.4103/ijph.IJPH_313_17  PMID:30539891
Background: In India, more than half of the pregnant women suffer from anemia. Low compliance to iron supplementation is one of the important reasons. Objectives: The objective of the study is to estimate the reduction in the prevalence of anemia, improvement in iron status, and to compare the compliance to oral iron supplementation during pregnancy between directly observed iron-folic acid (IFA) supplementation group and control group. Methods: This was a community-based open labeled parallel block-randomized controlled trial including 400 pregnant women in a rural setting of north India. In the intervention group, the first dose of IFA every week was supervised by ASHA and women were instructed to take the remaining tablets during the week as per the prescription. In control group, IFA tablets were supplemented without direct supervision. Results: After 100 days of IFA supplementation, the reduction in anemia in the intervention group was 6% higher as compared to control group (P = 0.219). The increase in the mean hemoglobin level over and above control group was 0.52 g/dl in intervention group (P < 0.001). However, the mean increase in serum ferritin level in the intervention group was similar to the control group. The mean percentage compliance in the intervention group was almost 9% higher than that of control group (P = 0.001). Conclusion: Directly supervised oral iron (IFA) supplementation improves compliance to oral iron (IFA) supplementation and also improves hemoglobin status among pregnant women. However, the mean increase in serum ferritin and reduction in the prevalence of anemia in the intervention group were not higher than the control group.
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Social capital as a mediator of the influence of socioeconomic position on health: Findings from a population-based cross-sectional study in Chandigarh, India p. 294
Manmeet Kaur, Venkatesan Chakrapani, Ariarathinam Newtonraj, P VM Lakshmi, Pandara Purayil Vijin
DOI:10.4103/ijph.IJPH_274_17  PMID:30539892
Background: Social capital has been recognized as part of the WHO's Social Determinants of Health model given that social connections and relationships may serve as resources of information and tangible support. While the association between socioeconomic position and health is relatively well established, scant empirical research has been conducted in developing countries on the association between social capital and health. Objective: Based on the WHO's Social Determinants of Health framework, we tested whether social capital mediates the effect of socioeconomic position on mental and physical health. Methods: A population-based study was conducted among a representative sample (n = 1563) of men and women in Chandigarh, India. We used standardized scales for measuring social capital (mediator variable) and self-rated mental and physical health (outcome variable). Results: A socioeconomic position index (independent variable) was computed from education, occupation, and caste categories. Mediation model was tested using path analysis in IBM SPSS-Amos. Participants' mean age was 40.1 years. About half of the participants were women (49.3%), and most were relatively well educated. The results showed that socioeconomic position was a significant predictor of physical and mental health. Social capital was a significant mediator of the effect of socioeconomic position on mental health but not physical health. Conclusion: Besides removing socioeconomic barriers through poverty alleviation programs, interventions to improve social capital, especially in economically disadvantaged communities, may help in improving population health.
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COMMENTARY Top

Moving from maternal death review to surveillance and response: A paradigm shift p. 299
Amrita Kansal, Suneela Garg, Malvika Sharma
DOI:10.4103/ijph.IJPH_37_18  PMID:30539893
In the era of the sustainable development goals, India is committed to reduce its maternal mortality ratio to less than 70 per one lakh live births by 2030. An important strategy that was adopted in the Reproductive and Child Health Programme in 2010 was maternal death review. Analysis of the progress so far has brought to light certain gaps which have prompted the paradigm shift toward Maternal Death Surveillance and Response (MDSR), which focuses on taking action on information obtained from every maternal death so as to prevent further maternal deaths. The new guidelines on MDSR were released by the Ministry of Health and Family Welfare in 2017.
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A review on Noncommunicable Diseases (NCDs) burden, its socio-economic impact and the strategies for prevention and control of NCDs in India p. 302
Manas Kumar Kundu, Suprakas Hazra, Dipak Pal, Malavika Bhattacharya
DOI:10.4103/ijph.IJPH_324_16  PMID:30539894
Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. A large national survey in India found that spending on NCDs accounted for 5.17% of household expenditure. According to a macroeconomic analysis, it is estimated that each 10% increase in NCDs is associated with a 0.5% lower rate of annual economic growth. The income loss due to hypertension is the highest, followed by diabetes and cardiovascular diseases. The macroeconomic impact of NCDs is profound as they cause loss of productivity and decrease in gross domestic product. Since the health sector alone cannot deal with the “chronic emergency” of NCDs, a multisectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.
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Report from a symposium on accelerating policy-driven action against excessive sugar consumption for the prevention of early childhood caries and noncommunicable diseases p. 305
Om P Kharbanda, Paula Moynihan, Harsh Priya, Anupama Ivaturi, Arpit Gupta, Desmia Haldane
DOI:10.4103/ijph.IJPH_314_17  PMID:30539895
Dental diseases and other noncommunicable diseases (NCDs) share common risks. Omnipresent and easily available sugars are a contributing risk factor for overweight, obesity, and diabetes. In addition, sugar consumption is known to cause dental caries in early childhood (early childhood caries) and in adults. It has been noticed that the prevalence of NCDs is increasing each year, leading to 70% of deaths. A symposium of diverse academicians was convened to identify the gaps in evidence, policy, and advocacy for action on sugars, emphasizing on its detrimental effects on oral health. Existence of policies on sugars, experiences of other countries, feasibility in India, and the role of public health dentists, public, and stakeholders were discussed. Policy priorities in India and advocacy to strengthen action against inappropriate sugar intake could help address the growing burden of sugar-related NCDs. Recommendations to this end were put forth by the panel of experts.
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Sources of finance for hospitalized treatment in India: Evidence for policy p. 308
Mukesh , Mohita Gupta, Sarvesh Singh
DOI:10.4103/ijph.IJPH_239_17  PMID:30539896
A study of sources of finance which the household resorts to, in order to meet the hospitalization expense can be of use to policy makers who may want to work in the direction of providing financial security against hospitalization expenses to the masses. In this view, an attempt has been made to study the sources of finance for hospitalized treatment at an individual level based on criteria such as level of living, socio-economic background, level of care in India, as well as at state level through unit level data of the survey on “Social Consumption related to Health”, conducted by National Sample Survey (NSS) during January, 2014 to June, 2014. It has been found that the household's income or saving is not sufficient to meet the expenditure for hospitalized treatment and people have to borrow or arrange finance by other means for hospitalized treatment across the country. The results thereby suggest inputs to policy makers and re-establish the necessity of appropriate policy in order to provide financial security against escalating medical expenses.
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BRIEF RESEARCH ARTICLES Top

Depression, anxiety, stress, and stressors among rural adolescents studying in Pune and a rural block of Nanded district of Maharashtra, India p. 311
Balan Mahetab Shaikh, PP Doke, JS Gothankar
DOI:10.4103/ijph.IJPH_174_17  PMID:30539897
Adolescent population is the major demographic and economic force of a nation. Adolescent mental health not only affects overall health at present but also in future life. In this cross-sectional study, 461 rural adolescent students studying in Pune city and the rural area from a block in Nanded district, Maharashtra, were administered a prevalidated, pretested Marathi depression anxiety and stress scale-21 tool including correlated factors to assess the magnitude of depression, anxiety, and stress and its stressors. The prevalence of depression, anxiety, and stress among these students was 54%, 60%, and 44%, respectively. Rural students in Pune city were having significantly higher levels of stress than the students studying in the rural area. Disturbed family, harsh parenting, past adverse event experiences, negative feeling about academic performance and tobacco use were significantly associated with higher rates. Findings indicate that the mental health status of these students is alarming needing prompt measures.
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Anemia at the time of delivery and its association with pregnancy outcomes: A study from a secondary care hospital in Haryana, India p. 315
Shashi Kant, Ravneet Kaur, Akhil Dhanesh Goel, Sumit Malhotra, Partha Haldar, Rakesh Kumar
DOI:10.4103/ijph.IJPH_40_18  PMID:30539898
Maternal anemia has been reportedly associated with increased risk of maternal and fetal morbidity and mortality. Adverse pregnancy outcomes such as preterm birth, low birth weight, and stillbirth have been reported to be associated with anemia. However, different studies have shown inconsistent results. In the present study, we report the association between maternal hemoglobin levels at the time of delivery and outcomes among women at a secondary care hospital in northern India. Secondary analysis of routinely collected hospital data from January 2015 to December 2016 was carried out. Sociodemographic details, hemoglobin levels at the time of admission, and birth outcomes were retrieved from the records of women admitted for delivery. The outcomes were compared among anemic and nonanemic women. About 78% of the women were found to have anemia at the time of delivery. A significantly higher proportion of anemic women had preterm labor.
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LETTER TO EDITOR Top

Ethical issues in sharing patients' information on social media p. 319
Sirshendu Chaudhuri, Aniruddha Basu
DOI:10.4103/ijph.IJPH_76_18  PMID:30539899
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