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   2018| July-September  | Volume 62 | Issue 3  
    Online since September 12, 2018

 
 
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COMMENTARY
Urban health: Needs urgent attention
Satish Kumar, Sanjiv Kumar, Basab Gupta
July-September 2018, 62(3):214-217
DOI:10.4103/ijph.IJPH_90_18  PMID:30232971
Urban population in our country has increased at an annual rate of 2.7% during the last decade and it is estimated that by 2031, there would be about 600 million people living in urban India. The fast pace of urbanization has come to stay with increasing proportion of urban poor and vulnerable with health indicators much worse than their rural counterparts. The need to provide health care to urban poor has been emphasized in the past in various health committees' reports and National 5-year Development Plans, but no significant dent was made to improve the urban health scenario of the country. The National Urban Health Mission launched in May 2013 provides us a concrete mechanism to address special health needs of urban population with focus on urban poor. There is a strong need to set up primary healthcare system in urban areas and systematically deal with urban health challenges in terms of vector-borne diseases, rising incidence of noncommunicable diseases, air pollution and acute respiratory infections, road traffic accidents, trauma, and injuries. The initiatives to address these challenges do not remain confined to health sector alone but also need to be supported by sectors other than health such as social welfare, women and child development, road transport and highways, school education, drinking water, and sanitation. We really need to address wider and social determinants of health to effectively improve the urban health scenario.
  1 4,609 564
BOOK REVIEW
Community medicine: Prep manual for undergraduates
Parvinder Singh Chawla
July-September 2018, 62(3):242-242
DOI:10.4103/ijph.IJPH_301_18  
  - 527 189
BRIEF RESEARCH ARTICLES
Risk of relapse in clients with alcohol dependence syndrome in a tertiary care hospital
Pavithra Subash, Padmavathi Nagarajan, Shivanand Kattimani
July-September 2018, 62(3):218-220
DOI:10.4103/ijph.IJPH_57_17  PMID:30232972
Alcoholism is one of the major health problems seen all over the world. The risk of relapse was estimated among 94 clients with alcohol dependence syndrome (ADS) who attended both in- and out-patient units of a tertiary care hospital. The tools used were the sociodemographic and clinical variables, Clinical Institute of Withdrawal Assessment Alcohol–revised (CIWA–Ar), Alcohol Use Disorder Identification Test (AUDIT), and Advanced Warning of Relapse (AWARE) scale. Out of the 94 clients, 63 (67.7%) were in the low-risk group for getting relapse, 26 (27.7%) were in the moderate-risk group, and 5 (5.3%) were in the high-risk group. Family history of alcohol use was significantly associated with the AWARE score (P < 0.05). Nicotine use was reported by 56 (59.6%) clients. Clients with a positive family history of alcohol use, disturbed sleep pattern, and higher total score (>20) of AUDIT scale were at higher risk of relapse.
  - 1,367 210
Cancer trends in India: A review of population-based cancer registries (2005–2014)
Sumedha Mohan, Smita Asthana, Satyanarayana Labani, Gourav Popli
July-September 2018, 62(3):221-223
DOI:10.4103/ijph.IJPH_115_17  PMID:30232973
There is a constant rise in cancer cases, but the trends and pattern vary according to the geographical region. The aim of this brief research was to present an update of all cancer incidences through age-adjusted rates and their changes in different regions of the country. The data for this study were obtained from published reports of 28 population-based cancer registries (2005–2014) in India. Among males, currently, East/Northeast region ranked first, on the basis of incidence of cancer cases. Out of 28 registries, 11 registries encountered lung cancer as the leading site. Currently, East/Northeast regions were ranked first on the basis of incidence of cancer cases among females. Our study showed that 20 registries among the 28 had breast cancer as the leading one. Thus, the present overview revealed that all cancers in both males and females are consistent and had a high incidence in East/Northeast region of the country.
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Effectiveness of randomized control trial of mobile phone messages on control of fasting blood glucose in patients with type-2 diabetes mellitus in a Northern State of India
Dinesh Kumar, Sujeet Raina, Satya Bhushan Sharma, Sunil Kumar Raina, Ashok Kumar Bhardwaj
July-September 2018, 62(3):224-226
DOI:10.4103/ijph.IJPH_199_17  PMID:30232974
Limited availability of randomized control trial warranted the conduct of a present study to demonstrate the effectiveness of mobile phone-based short message services (SMSs) on reduction in mean fasting blood glucose (FBG) in patients with type-2 diabetes mellitus. A total of 955 patients were recruited from primary and secondary health-care facilities and randomized to intervention (479) and control (476) group. Messages were delivered to patients for 12 months tailoring to their recent FBG values. SMS included information to maintain the desired FBG levels and next due date for FBG assessment. Patients were statistically similar for their age, socioeconomic status, smoking, and alcohol use. After the intervention, an average FBG declined from 163.7 to 152.8 mg/dl (P = 0.019) in intervention and from 150.5 to 149.2 mg/dl (P = 0.859) in control group. Adjusted for the baseline FBG, the intervention was found to be significantly effective (odds ratio: 1.7; 95 confidence interval: 1.2–2.6).
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Water, sanitation and hygiene survey – Use of hydrogen sulfide strip at field level as a point-of-care test: A pilot study
PV Shilpa, Madhavi Bhargava
July-September 2018, 62(3):227-230
DOI:10.4103/ijph.IJPH_76_17  PMID:30232975
Safe drinking water is a basic element of primary health care. The government of India in its Indian Public Health Standards recommends the hydrogen sulfide (H2S) strip test as a desirable component at primary health centers for screening water for fecal coliforms. The objective of the present study was to conduct a water, sanitation and hygiene (WASH) survey followed by a H2S strip test of drinking water in a village with ninety households. The test was positive in 88% at the source and the point of consumption, with 100% concordance between both the points of test. A subsample of water samples was subjected to testing in microbiology laboratory, and fecal contamination was confirmed in all of them. To conclude, H2S strip test can be conveniently used at field level, and its ease of use and visual nature of results make it a useful point-of-care test of environmental and public health.
  - 1,558 222
Hepatitis E infection in Odisha, India: A descriptive analysis
Shantanu K Kar, Bhagirathi Dwibedi, Vijayalaxmi V Mogasale, Jyotsnamayee Sabat, Vittal Mogasale, Thomas F Wierzba
July-September 2018, 62(3):231-234
DOI:10.4103/ijph.IJPH_46_17  PMID:30232976
Up to 25% of hepatitis E virus (HEV)-infected pregnant women in their third trimester die. Despite HEV being an important cause of viral hepatitis, no robust surveillance exists in India. We reviewed jaundice outbreaks records and hospital records from jaundiced individuals seeking treatment and linked those records to laboratory results (HEV immunoglobulin M enzyme-linked immunosorbent assay) for January 2012 to September 2013 in Odisha state. A total of 14 HEV confirmed outbreaks were identified, of which 33% of 139 jaundiced cases were HEV positive. There were two deaths. An additional 495 jaundiced cases were identified through hospital records, of which 18% were HEV positive. Among HEV-positive women (n = 35), 34% were of childbearing age. While one may not be able to generalize our results, this finding suggests HE is widespread in Odisha and may represent hidden disease burden in this region. The policymakers should monitor HEV infections in similar geographical areas, especially among population of childbearing age women to initiate evidence-based control measures.
  - 1,402 198
“Near-Miss obstetric events” and its clinico-social correlates in a secondary referral unit of Burdwan District in West Bengal
Rakesh Kumar, Aparna Tewari
July-September 2018, 62(3):235-238
DOI:10.4103/ijph.IJPH_371_17  PMID:30232977
Near-miss obstetric events (NMEs) refers to the situations where women experience severe, life-threatening obstetric complications during pregnancy, delivery, or postpregnancy (up to 42 days) which they survive either by chance or because they receive good care at a facility. A cross-sectional study was conducted from May to June 2016 at the subdivisional hospital of West Bengal. The WHO near-miss criteria were followed for case identification. Data were collected by interview and record review. No maternal deaths were reported during data collection period; however, the frequency of NMEs was quite high (38%). Maternal near-miss ratio was 379.51/1000 live births, and maternal mortality index was 0%. Higher age group, below poverty line status, term pregnancy, and higher gravid and higher parity significantly favored the occurrence of NMEs, while ANC registration and Iron and Folic Acid consumption were significantly protective against it. Early identification of risk factors for NMEs and prompt initiation of treatment plays a critical role in the management of NMEs.
  - 883 193
CASE SERIES REPORT
Phthiriasis palpebrarum presenting as anterior blepharitis
Taskin Khan
July-September 2018, 62(3):239-241
DOI:10.4103/ijph.IJPH_296_17  PMID:30232978
In humans, Pthirus pubis or crab louse usually infests hair of pubic region. Phthiriasis palpebrarum (infestation of the eyelashes and eyelids) is not as rare as is reported in literature, especially in low socioeconomic communities. It is possible that the disease is being perhaps missed due to its clinical similarity with anterior blepharitis. The nits and adult lice adhering to the eyelashes can easily be overlooked. This study presents five cases of phthiriasis palpebrarum, coming from the same locality and socioeconomic background, presenting with itching, hyperemia of lids, and excoriation of skin. Two patients were misdiagnosed elsewhere. All were successfully treated. The presence of P. pubis reflects the low level of health and hygiene of that stratum of the society. Higher prevalence could be related to rapid urbanization, overcrowding, and extreme poverty. The health-care providers and policymakers should give more merit to this not so uncommon disease having high morbidity.
  - 1,108 131
COMMENTARY
Surgical conditions - A neglected aspect of public health: Call to action
Lalit Kant, Nobhojit Roy, Sanjay P Zodpey
July-September 2018, 62(3):211-213
DOI:10.4103/ijph.IJPH_3_18  PMID:30232970
The burden of surgical conditions is large, though unrecognized. Surgical interventions are cost – effective, but thought to be otherwise. Investments aimed at including surgery at primary care level are affordable. Globally, a momentum is being created to strengthen surgery infrastructure especially for the poor in the low and middle income countries – who bear the burden most. In India, the Association of Rural Surgeons of India, and a body for implementing Lancet Commission of Global Surgery, India are taking lead. A blue print of activities needed to bring surgery on the centre stage of public health in India has been developed. The IPHA can play a catalytic role and use its convening power in getting various associations of public health professionals in India to partner surgeons in this effort. Integration of surgery in public health has the potential to improve equity, access, and universal health coverage.
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DR. B.C. DASGUPTA MEMORIAL ORATION PAPER
Public health leadership in India: Reflections from my journey
Anand Krishnan
July-September 2018, 62(3):171-174
DOI:10.4103/ijph.IJPH_93_18  PMID:30232964
Public Health discipline has evolved and currently focuses on addressing social determinants of health and working multi-sectorally to promote health. Public Health Leadershipis the practice of mobilizing people, organizations, and communities to effectively tackle tough public health challenges. Leadership is a core competency of public health.Leaders are people with Vision, Influence, Values and Passion to achieve personal and organizational mission.Leadership is not a personal trait but is learnable skill. Leadership is a journey where one goes from being a member of a single team to lead health sector in working with other sectors. A leader moves from carrying out assigned tasks at the beginning of journey to providing a vision to motivate others to achieve their life goals. A true leader grooms leaders to establish a legacy of leadership. Ten lessons from my life would be: Believe in yourself; Seize the opportunities; present a vision of future; get out of comfort zone; expand capacity rather than define limits; strengthen communication and people to people skills; build a team; consider everyone as a potential collaborator; focus on deliverables and on relationships. We should start Public Health leadership course and develop core modules for teaching of leadership to post graduates in all medical schools.
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DR. K N RAO MEMORIAL ORATION
Universal health coverage in India: Newer innovations and the role of public health
Suneela Garg
July-September 2018, 62(3):167-170
DOI:10.4103/ijph.IJPH_221_18  PMID:30232963
The realization of Universal Health Coverage requires adequate healthcare financing and human resources to provide financial protection to the economically disadvantaged population by covering their medicine, diagnostics, and service costs. Conventionally, inadequate public healthcare financing and the lack of skilled human resources are considered as the major barriers towards achieving UHC in India. To strengthen the Indian healthcare system, there has been significant increase budgetary allocation towards healthcare, a national health protection scheme targeting low-income households, upgrading of primary health-care and expansion of the health work-force. Nevertheless, an evolving paradigm for improving holistic health, sanitation, nutrition, gender equity, drug accessibility and affordability, innovative initiatives in national health programs for reduction of maternal deaths, tuberculosis and HIV burden and the utilization of information technology in healthcare provision of the underserved and the marginalized is gaining rapid acceleration. These represent a genuine innovation towards fulfillment of UHC goals for India.
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DR. P.C. SEN MEMORIAL AWARD PAPER ON RURAL HEALTH PRACTICE
Sun exposure and Vitamin D in rural India: A cross-sectional study
Shobhit Garg, Aparajita Dasgupta, Swanya Prabha Maharana, Bobby Paul, Lina Bandyopadhyay, Aritra Bhattacharya
July-September 2018, 62(3):175-181
DOI:10.4103/ijph.IJPH_258_18  PMID:30232965
Background: Vitamin D deficiency/Vitamin D Insufficiency (VDI) is now recognized as a pandemic. Cutaneous exposure to ultraviolet-B causes photolysis of epidermal 7-dehydrocholesterol, converting it to pre-Vitamin D3 (precholecalciferol), which then undergoes isomerization to form the stable hormone Vitamin D3. Objectives: The objectives of the study is to determine the status of Vitamin D level among the adults residing in a rural area of West Bengal and to find out the optimal cutoff of the sun exposure for Vitamin D sufficiency. Methods: This study was a rural community based cross-sectional study. It was done from May 2016 to April 2017 among 197 adults residing in a rural block of West Bengal. Data were collected by interviewing the respondents with the help of a structured pre-tested pre-designed schedule. After interviewing, every individual was examined for height and weight and blood was collected for serum Vitamin 25-(OH) D. Receiver Operating Characteristic (ROC) curves were utilized to find out optimum cut-off for sun exposure using Youden's index. Binary logistic regression was performed to find out the associates of high sun exposure. All analysis was done using R. Results: Overall VDI was found in 133 (67.5%). Among them, 102 (51.8%) were female. On ROC curve for veritable sun exposure for Vitamin D sufficiency, area under curve was 0.7841 which signifies veritable sun exposure as a good screening tool. Conclusion: Proper information, education, and communication material regarding various aspects of sun exposure and Vitamin D should be prepared with due consultation of field experts and disseminated to increase awareness among the community.
  - 3,332 537
DR. S. D. GAUR BEST PAPER AWARD ON ENVIRONMENTAL HEALTH
Exposure to indoor air pollution and its perceived impact on health of women and their children: A household survey in a slum of Kolkata, India
Swanya Prabha Maharana, Bobby Paul, Shobhit Garg, Aparajita Dasgupta, Lina Bandyopadhyay
July-September 2018, 62(3):182-187
DOI:10.4103/ijph.IJPH_259_18  PMID:30232966
Background: One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health. Objective: The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India. Methods: It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing. Results: About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP. Conclusion: The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.
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EDITORIAL
Leadership in public health
VK Srivastava, R Kunwar
July-September 2018, 62(3):165-166
DOI:10.4103/ijph.IJPH_306_18  PMID:30232962
  - 1,635 383
ORIGINAL ARTICLE
Incidence of congenital anomalies in a rural population of Jammu - A prospective study
Anjum Ara, Dinesh Kumar, Deepika Dewan, Nasib C Digra
July-September 2018, 62(3):188-192
DOI:10.4103/ijph.IJPH_77_17  PMID:30232967
Background: Congenital anomalies (CAs) are a major cause of stillbirths and neonatal mortality in India. Its magnitude and pattern reportedly vary over time and across geographical locations. Objectives: The objective of the study is to estimate the incidence of CAs in community development block RS Pura of District Jammu. Methods: The present study is a community-based prospective study. The field workers were trained with the help of “Birth Defect Surveillance” Atlas issued by WHO and ICBDMS (International Clearinghouse for Birth Defects Monitoring Systems) 2014. Pregnant women (registered or unregistered) with all health institutions in RS Pura Block on or after April 1, 2014, were followed till September 2015 for the ascertainment of CAs. All CAs detected during antenatal period (by ultrasonography), after delivery and abortion at any site were counted as events and classified by organ system according to the 10th version of the WHO International Classification of Diseases-10. Results: A total of 1670 mothers were followed till their pregnancy outcome was recorded. Among 1600 live births recorded, 54 babies had CAs resulting in the incidence rate of 33.7/1000 live births. The incidence rate was comparatively higher among women aged <20 years (71.4/1000 live births) and with Para 4 (43.5/1000 live births) as compared to other women. Digestive system was the most common system involved (35%) followed by the Central nervous system (26.6%). The U-shaped pattern in the incidence of CAs with regards to parity and maternal age was observed. Conclusion: The study demonstrated that the CAs continue to occur in Jammu at a similar magnitude as reported from other parts of the country.
  - 1,542 372
REVIEW ARTICLES
Basis of science policies for infectious disease challenges in India
Kayzad Soli Nilgiriwala
July-September 2018, 62(3):193-196
DOI:10.4103/ijph.IJPH_306_17  PMID:30232968
With increase in drug resistance and related challenges in infectious diseases globally, it has become more important for a country like India with a high population to develop strategies to deal with such challenges. The literature review was conducted using the Google search engine to explore the contemporary science policies in India (since 2012) which are designed for tackling infectious diseases challenges in the country. This review article gives an insight into the strengths and limitations of the basis of some of the contemporary science policies in India that are drafted and implemented to combat the challenges of infectious diseases. The new national plans for controlling infectious disease challenges with bold strategies for their rapid and effective implementation hold promise in India.
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Problematic internet use among students in South-East Asia: Current state of evidence
Yatan Pal Singh Balhara, Ananya Mahapatra, Pawan Sharma, Rachna Bhargava
July-September 2018, 62(3):197-210
DOI:10.4103/ijph.IJPH_288_17  PMID:30232969
Problematic Internet use (PIU) among students has become a significant mental health concern. Our goals were to review the existing studies on problematic Internet from Southeast Asian Region and examine: the prevalence for PIU among students; explore for sociodemographic and clinical correlates; and assess the physical, mental, and psychosocial impact of PIU in this population. All studies conducted among population of the Southeast Asia, involving students (school students to postgraduate students) of any age which explored etiological factors and/or the prevalence or any other factor associated with PIU/Internet addiction were considered eligible for the present review. The electronic databases of PubMed and Google Scholar were systematically searched for the relevant published studies up to and including October 2016. Our search strategy yielded 549 articles, 295 of which were eligible for screening based on their publication in English language in a peer-reviewed journal. Of these, a total of 38 studies met the inclusion criteria and were included in the review. The prevalence of severe PIU/Internet addiction ranged from 0 to 47.4%, whereas the prevalence of Internet overuse/possible Internet addiction ranged from 7.4% to 46.4% among students from Southeast Asia. Physical impairments in the form of insomnia (26.8%), daytime sleepiness (20%), and eye strain (19%) were also reported among problem users. There is a need to conduct further research in this area to explore the protective and risk factors associated with it and also longitudinally assess the trajectories of the outcome.
  - 2,759 465
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