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   Table of Contents - Current issue
January-March 2021
Volume 65 | Issue 1
Page Nos. 1-90

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Contribution of public health in prevention and control of cancers in India: A time to redeem ourselves Highly accessed article p. 1
Atul Kotwal, Arun K Yadav
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Severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibody: Seroprevalence among contacts of COVID-19 cases Highly accessed article p. 5
Om Prakash, Bhavin Solanki, Jay Kirtikumar Sheth, Mina Kadam, Sheetal Vyas, Serosurveillance Research Team*
Background: Multiple serosurveillance studies have focused on the presence of antibodies against severe acute respiratory syndrome coronavirus 2 in the general population and confirmed cases. However, seroprevalence of immunoglobulin G (IgG) among contacts of confirmed cases can add further value to the scientific findings. Objectives: The objective is to estimate COVID-19 seropositivity among contacts of COVID-19 cases and to compare the seropositivity between types of contact for the assessment of differential risk and transmission dynamics. Methods: Large scale population-based serosurveillance on contacts of COVID-19 cases was carried out during the second half of August 2020 in Ahmedabad using the COVID-Kavach. The seropositivity among contacts was estimated and correlated-compared with type of contact and other demographic factors. Results: With 1268 positive for IgG antibodies from 3973 samples, the seropositivity against COVID-19 among contacts of cases in Ahmedabad was 31.92% (95% confidence interval 30.48%–33.38%). The seropositivity among family contacts was significantly higher (39.36%) as compared to other contacts (28.72%) (Z = 6.60, P < 0.01). This trend is seen across all age groups and both the sex groups. The seropositivity has increasing trend with increasing age and is significantly higher among females (35.11%) than males (28.95%) (Z = 4.16, P < 0.01). Conclusion: Seropositivity of 31.92% among contacts indicates that a large proportion of contacts have already acquired immunity on account of their contact with the case. Higher seropositivity among family contacts justifies the risk categorization and testing strategy adopted for the contacts of the cases. This also reaffirms the need for contact tracing strategy for controlling the inevitable spread of pandemic.
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Assessment of respectful maternity care during childbirth: Experiences among mothers in Manipur p. 11
Bishwalata Rajkumari, Ningthoukhonjam Shugeta Devi, Joenna Ningombam, Dayananda Ingudam
Background: The relationship between the lack of quality care and adverse maternal outcomes is being highlighted globally. Respectful maternity care includes respect for women autonomy, dignity, feelings, privacy, choices and freedom from ill treatment, coercion, and consideration for personal preferences including option for companionship during the maternity care. Objectives: This study planned to determine the prevalence and types of disrespect and abuse among mothers during childbirth and its associated factors. Methods: This was a cross-sectional study conducted among 231 women having children <2 years, who had undergone institutional deliveries and accessing immunization clinics during October to December 2018 using a semi-structured questionnaire adapted from the Person-Centered Maternity Care Scale, a validated instrument which gives a holistic measure of women's experiences during childbirth wherein the questions were grouped under seven domains. Results: The mean (standard deviation) age of the respondents was 28.9 ± 5.8 years. The prevalence of any form of abuse present was 96.5% with the highest found in “Facility and Environment” Domain (77.5%). Women delivering in public tertiary care facility were significantly more likely to face more abuse in the domains of “Dignity and Respect,” “Support and Care,” “Facility and Environment,” “Predictability and Transparency,” as compared to other types of health facilities (P < 0.05). Conclusion: Nearly almost all of the respondents (96.5%) faced some form of abuse in one domain or the other. There is a need for greater action, dialog, research, and advocacy on this important public health issue for promoting dignified maternal health-care services.
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Maternal mental health and its determinants – A community-based cross-sectional study in Aligarh, Uttar Pradesh Highly accessed article p. 16
Nikhat Naaz, Saira Mehnaz, M Athar Ansari, Ali Amir
Background: Maternal mental health problems are one of the major public health challenges. Globally, depression and anxiety cause immense suffering and disability among mothers who later contribute to compromise parenting practices and increased unmet needs of their newborn and young children. Objectives: The aim of this study is to determine the prevalence and determinants of maternal common mental disorders (CMDs) among the study population. Methods: A community-based cross-sectional study was conducted in Aligarh, Uttar Pradesh, India, from July 2016 to June 2017, among 415 women of child-bearing age who had one or more children in the age group of 0–23 months. A World Health Organization prequalified questionnaire Self-Reporting Questionnaire 20 was used to assess the CMD of mothers. Binary logistic regression was used for finding out predictors of mental disorders. Results: Overall prevalence of maternal CMDs was 38.8%. The prevalence of maternal CMD was significantly higher among mothers in a higher age group, belonging to low socioeconomic class, nuclear type of family, living in the urban locality, having lower or no education, being single mothers, housewives, and having higher parity. Conclusion: Substantially, high prevalence of CMD among mothers suggests for further research to explore the factors affecting the mental health of mothers. Measures for the early identification, treatment, and prevention of maternal mental disorders should be taken.
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Hazardous practices related to blood borne viral infection transmission among male barbers: A study in a rural area of West Bengal p. 22
Soumit Roy, Aparajita Dasgupta, Madhumita Bhattacharyya, Bobby Paul, Sayanti Bandyopadhyay, Arkaprovo Pal
Background: Barbers are occupationally predisposed to blood borne viral infection (BBVI) such as human immunodeficiency virus, hepatitis B and C. Unhygienic workplaces, improper disinfection and inadequate wound-care can increase the susceptibility of both clients and barbers to BBVI. There is paucity of studies on practices regarding BBVI among barbers, especially in India. Objectives: To identify the pattern and predictors of practices related to BBVI transmission among male barbers in a rural area of West Bengal. Methods: A cross-sectional study was conducted from June 2017 to August 2019 in Indas block of Bankura district among 138 male barbers, who were permanent residents and worked for >6 months. Barbers, randomly selected from 10 Gram Panchayats according to probability proportionate to size, were interviewed. Two barbering sessions were observed. Data were analyzed using SPSS version 16 software. Univariate and multiple linear regression was carried out to identify predictors of better practices. P < 0.05 was considered for statistical significance. Results: Dangerous practices such as reuse of blades (8, 5.8%) and face-towel (77, 55.8%), sale/distribution of used blades (77, 55.8%), improper disinfection of sharps (79, 57.2%), reuse of alum without disinfection (129, 93.5%), and improper wound care (71, 51.4%) were observed. Predictors of better practice regarding BBVI were better attitude regarding BBVI (B = 0.172, standard error [SE] = 0.046, P = 0.000) and increased years of schooling (B = 0.054, SE = 0.021, P = 0.012). Conclusion: Inimical infection control practices were noticed. They are serving the general people and therefore they should be imbibed with correct BBVI knowledge and must do away with all hazardous practice during their barbering activities.
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Perceived effect of increased pricing on smoked tobacco products quit rates: A cross-sectional study in a block of Haryana p. 28
Kirtan Rana, Sonu Goel, Shankar Prinja
Background: The price of cigarettes and bidis is known to be related to the cessation of these products. Objective: To assess the perception of smokers about their quitting behavior on price increase in smoke tobacco product. Methods: A population-based cross-sectional study among people who were 18 years of age and above was conducted in 2017 among 277 participants in Haryana. Global adult tobacco survey 2009 questionnaire with objective oriented modification was used to examine the willingness to pay (WLP) for a smoked tobacco product, maximum price for quitting smoking, reinitiating smoking, and the knowledge about harmful effects of using tobacco products. Descriptive statistics and odds ratio (OR) with 95% confidence interval (CI) were used to find the relationship among various demographic characteristics and price of quitting smoking. Results: Among the participants, 65 (23.4%) were found to be current smoker and of them 48 (74%) smokers responded to quit smoking on increasing the price of smoked tobacco products. Average daily price paid by the smokers was Rs. 23 and Rs. 8 for cigarettes and bidis, respectively. The odds of quitting smoking among cigarette smokers were higher than those of among bidi smokers (OR = 5.2, 95% CI 2.877–10.04). The odds of quitting smoking among those spending more than Rs. 10/day were lower than those spending <Rs. 10 on these products (OR = 4.8, 95% CI 1.1–22.3). 72.9% of the smokers declared >100% increase in current price for quitting smoking. Conclusion: An increased magnitude of price increase on smoke tobacco products is invariably an effective method of decreasing smoking prevalence.
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The effect of a mhealth intervention on anti-tuberculosis medication adherence in Delhi, India: A quasi-experimental study p. 34
Sahadev Santra, Suneela Garg, Saurav Basu, Nandini Sharma, Mongjam Meghachandra Singh, Ashwani Khanna
Background: Suboptimal adherence to anti-tuberculosis medication in patients is associated with adverse treatment outcomes including treatment failure, relapse, and emergence of drug resistance. Objectives: We conducted the present study with the objectives of evaluating the effectiveness of a mHealth package on the medication adherence of patients with tuberculosis (TB) on antitubercular (directly observed treatment short-course [DOTS]) treatment. Methods: We conducted Quasi-experimental study at six DOTS centers of Delhi among 220 newly diagnosed TB patients. We included adult TB patients (18 years and above) who were on DOTS therapy ≥30 days, had access to a mobile phone and were able to read messages and receive calls. We excluded patients with impaired hearing, blindness and those on non-DOTS therapy or having multidrug-resistant/extensively drug-resistant TB. Participants in the intervention group received amHealth package for 90 days. The medication adherence of the study participants was measured using Morisky, Green, and Levine Adherence Scale. Results: A total of 130 men and 90 women were recruited for the study. Occupational interference and forgetfulness were the most common reasons for medication nonadherence in the patients. In the intervention group, the medication adherence to antitubercular medication (daily DOTS regimen) was 85.5% at baseline which increased to 96.4% at endline (postintervention) (P = 0.004). No significant change was observed in the control group (P = 0.328). The increase in adherence was observed across the following subgroups: age, gender, education, and Socioeconomic status. Conclusions: The mHealth intervention in TB patients was effective in improving the adherence to DOTS therapy.
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Measuring medical graduate behavioral intention for administering on-site care to road traffic accident victims: Development and validation of a questionnaire p. 39
Neeti Rustagi, Abhishek Jaiswal, Dervla Kelly, Naveen Dutt, Arvind Sinha, Pankaja Raghav
Background: Prehospital trauma care skills are often taught and assessed in undergraduate medical curricula but the intention to voluntarily offer these skills in out of hospital or primary care settings is poorly understood. Objectives: The objective is to develop and validate a questionnaire measuring behavioral intention among medical graduates for administering on-site care to road accident victims. Methods: A cross-sectional study was conducted from September 2018 to February 2019, among medical graduates of an academic institution in Jodhpur, Rajasthan. Items for “Measure of Intention to help road accident victim (MIHRAV) instrument” were framed as per the constructs of theory of planned behavior. A total of 150 candidates undergoing internship were approached for informed consent and a link for online questionnaire was shared. Statistical Analysis: Exploratory factor analysis (EFA) and tests for convergent, discriminant, and predictive validity was done using IBM SPSS version 23.0 for psychometric validation of scale. Results: Original version of MIHRAV included 29 items which were reduced to 18 items. EFA identified five factors which explained 72% of cumulative variance with high Cronbach's α (0.920). Discriminant validity showed adequate correlations ranging from 0.283 to 0.541. Predictive validity demonstrated that model was significantly able to predict “behavioural intention to help” (F (4128) = 24.139, P = 0.0001) and explained 43% of variance. Conclusion: The findings reveal that developed instrument “MIHRAV” is a reliable and valid scale for predicting behavioral intention among medical graduates for administering onsite care to road accident victims.
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A study on economic evaluation of an outreach health-care facility in Jhajjar District of Haryana: Service delivery model for increasing access to health care p. 45
Mohammad Kausar, Vijaydeep Siddharth, Shakti Kumar Gupta
Background: An outreach (OR) health-care facility providing broad specialty outpatient services was started by All India Institute of Medical Sciences (AIIMS), New Delhi, in rural area of district Jhajjar, Haryana. Objectives: This study aimed to ascertain the resource requirement for establishing an OR health-care facility and patient satisfaction with regard to the services being provided. Methods: A cross-sectional study was conducted in 2017 at an OR Outpatient Department (OPD) of AIIMS, New Delhi, at Jhajjar. Service delivery model adopted for health-care delivery was hub and spoke. Traditional method of costing was used for economic evaluation. Feedback pro forma of 400 patients who attended OPD services was analyzed to measure health service accessibility. Results: Capital expenditure to set up the facility was calculated to be approximately INR 17,57,49,074/- ($ 2,703,832) and operational cost per year was approximately INR 8,73,86,370/- ($ 1,344,406). Approximate per-patient cost for single OPD consultation was calculated to be INR 874 ($13.45) which included medicines and investigations. High scores for all domains of accessibility of health care were observed. Conclusion: The study provides a preliminary evidence that OR health-care facilities can be instrumental in increasing access to health-care delivery with lesser capital outlays, however, large-scale multicentric studies are needed to arrive at any conclusion. The services have been very well accepted by the local community members being quality medical care with highly subsidized health-care services.
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Efficacy of an online course in developing competency for prescribing balanced diet by medical students: A non - inferiority trial p. 51
Zinia T Nujum, P Devanand, G Remya, U Anuja
Background: In the COVID era, medical education has been hit hard. Paradoxically, the need for health professionals has increased. Online methods are being widely used, but its efficacy is rarely measured. Objectives: This study was conducted to find the efficacy of an online course in developing competency among medical students to prescribe balanced diet. Methods: An online module was hosted at A noninferiority trial was conducted among voluntary participants of the third MBBS students, in 2019. Stratified block randomization was done, so that ten students were allocated to the intervention arm of online sessions and ten students were allocated to the control arm of classroom sessions. Pretest assessments, seven assessments related to sessions conducted, and a postassessment were done. Generalized estimating equations were done to adjust for the effects of other confounders and see whether the intervention was a significant determinant of ability to prescribe balanced diet. Results: Baseline variables were comparable in the two groups. The pretest scores were not significantly different in the two groups. The mean total marks scored by the online group (47.33/70) was not significantly different (t=0.68; p=0.50) from that of the class room group (45.70/70). The posttest scores were significantly higher than the pretest scores. Ninety-percent of students in the online course agreed that they could effectively learn through an online course. Conclusion: Online teaching is effective to learn the prescription of balanced diet. Similar efforts in other domains can make medical education evidence based in the current scenario.
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Expounding on the concerns of indian politicians regarding fluorosis: A qualitative analysis of parliamentary questions on fluorosis over two decades p. 57
Nesa Aurlene, V Aravinth, I Nanda Balan, Sunder Kote
Fluorosis is a major public health problem in India affecting nearly 20 states. Despite more than three decades of fluorosis prevention efforts, fluorosis continues to be a widely prevalent disease in India. The debilitating effects of skeletal fluorosis are well documented and pose a serious health risk to people who consume excess fluoride. In order to understand whether fluorosis was being given importance as a public health problem by elected politicians, we analyzed parliamentary questions posed in both the houses of the Indian parliament during the question hour. Thematic analysis revealed three major themes, namely health hazards, fluorosis control, and magnitude of fluorosis. The analysis revealed that politicians have posed questions regarding all the aspects that are necessary for fluorosis control in India. However, we have identified the certain key issues which have to be improved and certain obligations that the Government of India has to fulfill for successful fluorosis mitigation in India.
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Trend, morbidity profile and immunization status of diphtheria admitted cases: A 5-years review from a sentinel centre in Kolkata p. 60
Samir Kumar Ray, Baisakhi Maji, Anima Haldar, Baijayanti Baur
Despite strengthening of the universal immunization program, diphtheria remains endemic in India. Diphtheria is under surveillance for vaccine-preventable diseases of the World Health Organization and also in India. The present record-based retrospective study was conducted on 241 confirmed diphtheria patients admitted in an infectious disease hospital of Kolkata over 5 years (2015–2019) with the objectives of assessing the admission trend, immunization status, and outcome of patients. Among the patients, majority (57.3%) were female; 50.6% were ≥15 years; 49.0% resided in rural areas. Five-year admission rate did not show any declining trend. Major number of cases occurred in 2016; another peak observed in 2019. Only 27.4% fully immunized rest either partiality immunized (44.4%) or nonimmunized (28.2%). Overall, 54% of the patients developed any complications, and case fatality was 9.5%. Gradual age shift toward adults reiterated the widespread use of adult immunization with Td vaccines. Early reporting to the hospital is necessary to reduce complications and case fatality.
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Prediction of mortality by age and multi-morbidities among confirmed COVID-19 patients: Secondary analysis of surveillance data in Pune, Maharashtra, India p. 64
Nikunj Kansara, Ashok B Nandapurkar, Rahul Maniyar, Arun Kumar Yadav
Maharashtra has reported the maximum number of COVID-19 cases in India. This study was conducted to describe the predictors of death among the confirmed cases of COVID-19 by carrying out a secondary analysis of surveillance data of 11,278 lab-confirmed COVID-19 cases and admitted in dedicated COVID hospitals and dedicated COVID health-care centers between April 4, 2020, and July 17, 2020, in Pune district of Maharashtra. A total of 1270 (11.2%, 95% confidence interval [CI]: 10.7–11.9) deaths out of 11,278 patients were reported. Out of the 1270 deaths, 825 (65%) were male and 788 (62%) had one or more comorbidities. Logistic regression was done for predictors of death, and males (adjusted odds ratio: 1.6, 95% CI: 1.4–1.8), those with symptoms at the time of admission (adjusted odds ratio: 2.9, 95% CI: 2.5–3.4), and those with the presence of two or more comorbidities (adjusted odds ratio: 2.7, 95% CI: 2.2–3.4) were having a higher risk of death.
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Adherence to the tobacco-free educational institution guidelines at schools of Raipur Rani, Haryana p. 67
Amit Kumar, Arpit Gupta, Sonu Goel, Krishan Gauba, Ashima Goyal
Tobacco-Free Educational Institution (ToFEI) guidelines are required to be followed by the schools. This cross-sectional study conducted in the year 2019 assessed the accordance with ToFEI guidelines among all the 84 schools of Raipur Rani educational block, Haryana. Investigators collected data from all the government (71) and private (13) schools during school working days. Tobacco sales within 100 yards of the school premises was covertly observed. None of the schools thoroughly complied with the tobacco-free school policy, though the compliance score for private schools (26.77 ± 19.15) was better than the government schools (13.65 ± 4.38). Only two private schools achieved the mandatory score of 50. All private schools and few government schools (42.3%) had successfully implemented the ban on tobacco sale within 100 yards of the school. None of the schools could achieve a ToFEI status in the present study. The policymakers and implementers should prioritize ToFEI agenda & support schools in achieving tobacco-free status.
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Industrially produced trans fat: Usage, health implications, global and indian regulations p. 71
Sakshi Chopra, Charu Arora, Anita Malhotra, Suresh Chander Khurana
Global momentum is growing for the total elimination of industrially produced trans fats from the food systems as they are known to have deleterious health effects on various body functions particularly the cardiovascular health. Many developed nations such as Denmark have completely eliminated the use of industrially produced trans fats from the food supply. India is undergoing a significant nutrition transition that has substantially increased the intake of processed and ready-to-eat foods, abundant in trans fats. The Indian regulator-Food Safety and Standards Authority of India is all set to reduce the industrially produced trans fats to <2% by the end of year 2021 in a phased manner. Multiple strategies such as reducing trans fat limit in oils and fats, mandatory labeling on food products, introduction of “Trans-fat free” claim and logo have been adopted by the Indian regulatory body, to achieve the goal of trans fat free India. This review comprehensively summarizes from a public health perspective the usage of industrially-produced trans fats in Indian food industry, its effects on health, the global strategies to limit its content, and the current Indian regulations.
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Herbal smoke: Next hurricane on horizon p. 76
Archna Agnihotri, Poonam Sood, Antervir Kaur
Unsupervised marketing strategies of alternative smoke have made the youth fall prey to herbal smoke in the form of herbal cigarettes and hookahs. The easy online access, exotic looks, and flavors; marketed as safer, healthy alternatives, as an aid to quit smoking has made global herbal cigarette and hookah market see soaring sales in the past decade. Various studies have proven their popularity among the youth and minors with perceptions of being safer and smart alternatives. The scientific studies have shown that herbal smoke is as harmful as tobacco smoke. The marketing strategies of smoke industry to capture the minors and young adults could result in another stronger lobby besides tobacco to be dealt with in coming years. This creates an urgent need for the laws to be reviewed and amended keeping in view the changing scenario.
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Meeting oxygen requirements of rural India: A self-contained solution p. 82
Nirupam Madaan, Biraj Chandra Paul, Randeep Guleria
Addressing oxygen requirements of rural India should aim at using a safe, low-cost, easily available, and replenishable source of oxygen of moderate purity. This may be possible with the provision of a self-sustaining oxygen concentrator (pressure swing adsorption with multiple molecular sieve technology) capable of delivering oxygen at high-flow rates, through a centralized distribution system to 100 or more bedded rural hospitals, with back up from an oxygen bank of 10 × 10 cylinders. This will provide a 24 × 7 supply of oxygen of acceptable purity (~93%) for the treatment of hypoxemic conditions and will enable hospitals to specifically provide for high-flow oxygen in at least 15% of the beds. It may also serve as a facility for a local refill of oxygen cylinders for emergency use within the hospital as well as to subsidiary primary health centers, subcenters, and ambulances, thereby nudging our health-care system toward self-sufficiency in oxygen generation and utilization.
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Scrub typhus with secondary hemophagocytic lymphohistiocytosis in a 3-month-old child from a tertiary care hospital of Odisha p. 85
Sanjay Kumar Sahu, Jyoti Ranjan Behera, Sushrith Kumar Yadav
Scrub typhus is one of the re-emerging infectious diseases in India, whereas hemophagocytic lymphohistiocytosis (HLH) results from an uncontrolled and ineffective hyperinflammatory response to a variety of triggers. HLH is categorized into primary and secondary type with infection being one of the leading causes of secondary HLH. Here, we report a case of 3-month-old girl diagnosed with scrub typhus associated with secondary HLH as both the age of presentation and the association are rarely reported in literature.
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Till we win: India's fight against the COVID-19 pandemic p. 87
Rajib Dasgupta
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Celebrating small victories – My journey through two decades of AIDS response p. 89
Sanjay Zodpey, Subhash Salunke
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