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   2015| July-September  | Volume 59 | Issue 3  
    Online since September 7, 2015

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Strategies for attraction and retention of health workers in remote and difficult-to-access areas of Chhattisgarh, India: Do they work?
Suchitra Lisam, Sulakshana Nandi, Kanica Kanungo, Prem Verma, Jay Prakash Mishra, Dilip Singh Mairembam
July-September 2015, 59(3):189-195
DOI:10.4103/0019-557X.164656  PMID:26354394
Background: To address the acute shortages of health workers in underserved, remote, and difficult-to-access areas, the Government of Chhattisgarh and the National Rural Health Mission (NRHM) launched the Chhattisgarh Rural Medical Corps (CRMC) in 2009. CRMC has enabled provisions such as financial incentives, residential accommodation, life insurance, and extra marks during admission at the postgraduate (PG) level to eligible doctors for the attraction and retention of health workers, i.e., doctors, staff nurses, auxiliary nurse midwives (ANMs), and rural medical assistants (RMAs) in underserved areas. Objectives: This study aims to understand the CRMC scheme in terms of implementation, challenges, gaps, and outcome in achieving the attraction and retention of health workers in the remote and difficult-to-access areas of Chhattisgarh. Materials and Methods: The study adopts a mix of both qualitative and quantitative research methods. The purposive sampling method was used for the selection of three districts having normal, difficult, and inaccessible areas. Data were collected through key informant (KI) interviews with beneficiaries and non-beneficiaries of CRMC or district and state government officials, and reviews of document were analyzed using a thematic analysis approach. Results: CRMC has made positive outcome as 1319 health workers, including doctors, have joined the service in 2010-11, reducing the vacancy of doctors from 90% to 45%. The scope of CRMC was primarily limited to payment of monthly financial incentives. The fund utilization rate of CRMC has increased (from 27% in 2009-10 to 98% in 2011-12), though there are delays in payment of incentives. The majority of staff lack awareness about CRMC during job applications. The payment of incentives based on facility performance has demotivated staff. Conclusions: Establishment of a performance management system, activating the CRMC cell to make it functional, and wide publicity of CRMC benefits are likely to improve attraction and retention of staff.
  5 3,978 553
Interpersonal communication and contraception: Insights and evidences from Bangladesh demographic and health survey, 2011
Manoj Kumar Raut
July-September 2015, 59(3):220-224
DOI:10.4103/0019-557X.164666  PMID:26354400
This paper examines the role of exposure to mass media and interpersonal communication in predicting the current use of contraception in Bangladesh. Bivariate and multivariate analyses were carried out using the Bangladesh Demographic and Health Survey (BDHS), 2011 data to explore the association between communication and the current use of contraception. After adjusting the related socioeconomic and demographic factors, the mass media did not seem to have any role in predicting contraceptive use behavior while the findings revealed that interpersonal communication [prevalence ratio (PR): 1.0984, 95% confidence interval (CI) 1.0801-1.1170] is a strong positive predictor of the current contraceptive use. It is a well-known fact that mass media performs only the knowledge function while interpersonal communication performs an additional function of persuasion. This analysis corroborates the statement that the role of interpersonal communication is quite important in predicting contraceptive use.
  3 2,031 266
Growing quackery in dentistry: An indian perspective
Sukhvinder Singh Oberoi, Avneet Oberoi
July-September 2015, 59(3):210-212
DOI:10.4103/0019-557X.164661  PMID:26354397
Dental disease restricts activities in school, work, and home and often significantly diminishes the quality of life for many children and adults, especially those who have low income or are uninsured. Though the overall dentist population ratio in India is 1:10,000, at present in rural India, one dentist is serving 2.5 lakhs of people. Only 15-20% of people in India are able to get dental services through national schemes, and 80-85% are spending money from their pockets, providing an ideal breeding ground for quackery into dental practice in India. Dental quacks cater to the lower-middle and lower socioeconomic classes that cannot afford qualified dental practitioners. A large number of people visiting these quacks seek care only when in pain, have a restricted budget, and are not very quality conscious. Dentistry has come a long way in the last one and a half century; today it is ranked as one of the most respected professions. It is incumbent upon dentists everywhere to protect this hard-earned reputation by weeding out quacks from among them. The government should urge fresh graduates to practice in rural areas and provide more incentives to them. Public health dentists should take the initiative of adopting more community-oriented oral health programs to increase the awareness among rural populations.
  3 3,926 426
Undoing ignorance: Reflections on strengthening public health institutions in India
Chandrakant Lahariya
July-September 2015, 59(3):172-177
DOI:10.4103/0019-557X.164653  PMID:26354392
  3 2,366 308
Spiritual health of students in government medical colleges of Kolkata and their coping skills in a crisis situation
Shibotosh Sen, Dipak Pal, Suprakas Hazra, Girish Kumar Pandey
July-September 2015, 59(3):196-203
DOI:10.4103/0019-557X.164657  PMID:26354395
Background: The status of spiritual health of the population of India at large including that of young medical undergraduates who are the caregivers of the future and its association, if any, with coping skills in crisis situations is yet to be explored. Objectives: To measure the spiritual health status of the study population, describe the coping skills used by them in crisis situations, identify the sociodemographic factors associated with their spiritual health, and to determine the association of spiritual health status of the study population and their coping skills. Materials and Methods: An institution-based cross-sectional study was performed among the third semester medical students in government medical colleges of Kolkata, West Bengal, India. The study was conducted among 362 medical students by the survey questionnaire method. The Spiritual Health Scale 2011 (SHS 2011) and the Brief COPE Scale were used to measure the spiritual health and coping status, respectively. Results: Of all the respondents, 75.7% had refined spiritual health. The mean spiritual health score of the female students was significantly higher than that of the males. Of all the students, 66.1% showed good coping scores. Of all the respondents, 86.2% and 24.5% had higher adaptive and maladaptive coping scores, respectively. Refined spiritual categories were seen more among those students whose fathers had higher education and whose families arranged rituals at their homes. The spiritual health, self-evolution, and self-actualization scores of the respondents were significantly related to the adaptive coping scores and the fathers' education. Conclusion: The coping skills and hence, the spiritual health of the medical students were greatly influenced by the education of the father and cultural factor(s) like arranging annual rituals at home.
  3 3,088 466
Wealth index and maternal health care: Revisiting NFHS-3
Manish Kr Goel, Pritam Roy, Sanjeev Kumar Rasania, Sakhi Roy, Yogesh Kumar, Arun Kumar
July-September 2015, 59(3):217-219
DOI:10.4103/0019-557X.164665  PMID:26354399
The third National Family Health Survey (NFHS-3) is a large dataset on indicators of family welfare, maternal and child health, and nutrition in India. This article using NFHS-3 data is an attempt to bring out the impact of economic status, i.e., the wealth index on maternal health. The study was based on an analysis of the NFHS-3 data. Independent variables taken were the wealth index, literacy, and age at first child birth. Effects of these variables on the maternal health care services were investigated. Out of the total 124,385 women aged 15-49 years included in the NFHS-3 dataset, 36,850 (29.6%) had one or more childbirth during the past 5 years. The number of antenatal care (ANC) visits increased as the wealth index increased and there was a pattern for choice of place of delivery (for all deliveries during the last 5 years) according to the wealth index. Logistic regression analysis of the abovementioned variables were sought to find out the independent role of key determinants of the different aspects of maternal health care. It showed that the wealth index is the leading key independent determinant for three or more ANC received: Tetanus toxoid (TT) received before delivery, iron tablet/syrup taken for more than 100 days, and institutional delivery. Mother's literacy was the leading independent key determinant for early antenatal registration. The study suggested that along with the mother's literacy, the wealth index that is an important predictor of maternal health care can be added for categorization of the districts for providing differential approach for maternal health care services.
  2 3,082 451
Target intervention to increase measles vaccination coverage by identifying low-coverage areas using lot quality assurance sampling, Chennai, India, 2012
Tony Fredrick, Manoj V Murhekar, Yuvaraj Jayaraman, Manickam Ponniah, Kamaraj Pattabi, Joseph K David
July-September 2015, 59(3):232-233
DOI:10.4103/0019-557X.164669  PMID:26354403
  2 1,245 160
A reliable and accurate portable device for rapid quantitative estimation of iodine content in different types of edible salt
Kapil Yadav, Rakesh Kumar, Arijit Chakrabarty, Chandrakant S Pandav
July-September 2015, 59(3):204-209
DOI:10.4103/0019-557X.164658  PMID:26354396
Background: Continuous monitoring of salt iodization to ensure the success of the Universal Salt Iodization (USI) program can be significantly strengthened by the use of a simple, safe, and rapid method of salt iodine estimation. This study assessed the validity of a new portable device, iCheck Iodine developed by the BioAnalyt GmbH to estimate the iodine content in salt. Materials and Methods: Validation of the device was conducted in the laboratory of the South Asia regional office of the International Council for Control of Iodine Deficiency Disorders (ICCIDD). The validity of the device was assessed using device specific indicators, comparison of iCheck Iodine device with the iodometric titration, and comparison between iodine estimation using 1 g and 10 g salt by iCheck Iodine using 116 salt samples procured from various small-, medium-, and large-scale salt processors across India. Results: The intra- and interassay imprecision for 10 parts per million (ppm), 30 ppm, and 50 ppm concentrations of iodized salt were 2.8%, 6.1%, and 3.1%, and 2.4%, 2.2%, and 2.1%, respectively. Interoperator imprecision was 6.2%, 6.3%, and 4.6% for the salt with iodine concentrations of 10 ppm, 30 ppm, and 50 ppm respectively. The correlation coefficient between measurements by the two methods was 0.934 and the correlation coefficient between measurements using 1 g of iodized salt and 10 g of iodized salt by the iCheck Iodine device was 0.983. Conclusions: The iCheck Iodine device is reliable and provides a valid method for the quantitative estimation of the iodine content of iodized salt fortified with potassium iodate in the field setting and in different types of salt.
  2 2,393 370
Tuberculin skin testing: Spectrum of adverse reactions
Ramar Praveen, Amit Bahuguna, Bhumesh Singh Dhadwal
July-September 2015, 59(3):213-216
DOI:10.4103/0019-557X.164663  PMID:26354398
Tuberculin skin testing (TST) is one of the primary diagnostic modalities recommended by the World Health Organization (WHO) and the National Institute for Health and Care Excellence (NICE) study conducted in the United Kingdom (UK) for diagnosing tuberculosis (TB). Even after acceptance as a diagnostic modality and stern standardization, TST has its own flaws that include a spectrum of adverse reactions. We report a series of cases with a spectrum of adverse reactions occurring with a higher frequency than present in the available evidence. The study has some demerits such as being a retrospective one with interobserver variation and lack of histopathological confirmation. The observation is presented to accentuate the fact that adverse reactions are not a rarity and that further studies are required to establish the cause and exact incidence of the same.
  1 5,447 245
Community empowerment: Holistic approach for sustainable improvements in population health
Tirunagari Sri Ranga Sai, Sai Shankar Prathap
July-September 2015, 59(3):163-166
DOI:10.4103/0019-557X.164647  PMID:26354390
  1 4,315 499
Author's Reply
Prabir Ranjan Moharana
July-September 2015, 59(3):238-238
  - 538 81
Public health beyond the millennium development goals
Hindol Maity, Deepu Dowarha, Piya Paul Mudgal
July-September 2015, 59(3):239-241
DOI:10.4103/0019-557X.164673  PMID:26354406
  - 1,320 246
Pediatricians' perspectives on pneumococcal conjugate vaccines: An exploratory study in the private sector
Sanjay Zodpey, Habib Hasan Farooqui, Maulik Chokshi, Balu Ravi Kumar, Naveen Thacker
July-September 2015, 59(3):225-229
DOI:10.4103/0019-557X.164667  PMID:26354401
There is a lack of information on supply-side determinants, their utilization, and the access to pneumococcal vaccination in India. The objective of this exploratory study was to document the perceptions and perspectives of practicing pediatricians with regard to pneumococcal conjugate vaccines (PCVs) in selected metropolitan areas of India. A qualitative study was conducted to generate evidence on the perspective of pediatricians practicing in the private sector regarding pneumococcal vaccination. The pediatricians were identified from 11 metropolitan areas on the basis of PCV vaccine sales in India through multilevel stratified sampling method. Relevant information was collected through in-depth personal interviews. Finally, qualitative data analysis was carried out through standard techniques such as the identification of key domains, words, phrases, and concepts from the respondents. We observed that the majority (67.7%) of the pediatricians recommended pneumococcal vaccination to their clients, whereas 32.2% recommended it to only those who could afford it. More than half (62.9%) of the pediatricians had no preference for any brand and recommended both a 10-valent pneumococcal conjugate vaccine (PCV10) and a 13-valent PCV (PCV13), whereas 8.0% recommended none. An overwhelming majority (97.3%) of the pediatricians reported that the main reason for a patient not following the pediatrician's advice for pneumococcal vaccination was the price of PCV. To reduce childhood pneumonia-related burden and mortality, pediatricians should use every opportunity to increase awareness about vaccine-preventable diseases, especially vaccine-preventable childhood pneumonia among their patients.
  - 1,743 207
Enabling public health education reforms in India
Sanjay Zodpey
July-September 2015, 59(3):167-171
DOI:10.4103/0019-557X.164652  PMID:26354391
  - 1,591 362
Reporting error in the use of multivariable logistic regression
Rajeev Kumar
July-September 2015, 59(3):230-231
DOI:10.4103/0019-557X.164668  PMID:26354402
  - 965 176
Concept of composite health status index
Prakash Prabhakarrao Doke
July-September 2015, 59(3):234-235
DOI:10.4103/0019-557X.164670  PMID:26354404
  - 1,960 229
Newer innovations in family planning service delivery: A comment on the mobile family planning units
Renu Chauhan
July-September 2015, 59(3):236-237
DOI:10.4103/0019-557X.164671  PMID:26354405
  - 1,158 165
Landscaping academic programs offered in demography and population studies in India
Ritika Tiwari, Ranjana Singh, Sanjay Zodpey
July-September 2015, 59(3):178-188
DOI:10.4103/0019-557X.164655  PMID:26354393
As per the United Nations 2013 report, India's population is expected to reach 1.2 billion by 2015. Thus, there is a need for professionals trained in demography and population studies to carry out research regarding population aspects and project population growth/trends. This study landscapes the academic courses being offered in demography and population studies in India (in regular and distance learning modes). It outlines the details of these courses with respect to available courses, fee structure, number of seats, eligibility criteria, duration, nature of the program, etc. The details of the institutes offering demography and population studies courses were collected and compiled. A systematic and predefined approach including Internet search, search in the leading newspapers and discussions with students, academicians, and faculties were used to collect information for different courses provided by institutes all over India. There are around 22 institutions currently offering certificate, diploma, Masters, Master of Philosophy (M.Phil), and doctoral courses in demography and population studies in India (through regular and distance learning modes). Based on the annual intake capacity of these academic institutions, around 1,052 qualified professionals are available to work in the field of demography and population studies in India. This work has helped us to identify and track various academic courses being offered in demography and population studies in India. However, the courses that are being offered are relatively small in number when compared with the number of demographers/population scientists required. A need was also felt to include demography at the Bachelor's degree level.
  - 4,396 351