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   2016| January-March  | Volume 60 | Issue 1  
    Online since February 23, 2016

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Is mother and child tracking system (MCTS) on the right track? An experience from a northern state of India
Pallavan Nagarajan, Jaya Prasad Tripathy, Sonu Goel
January-March 2016, 60(1):34-39
DOI:10.4103/0019-557X.177298  PMID:26911215
Background: Effective monitoring and supervision of health care programs depend on complete, accurate, and timely flow of data. Mother and Child Tracking System (MCTS) is a centralized information technology (IT)-based application launched in 2009 for improving the delivery of maternal and child health care services through name-based tracking. There is minimal evidence in the literature evaluating the operational aspects of such a name-based tracking system even after 5 years of its implementation. Objective: The present study was thus conducted to understand the opportunities and challenges in the operationalization of MCTS strategy in a district in Haryana and to understand the stakeholder's perspectives. Materials and Methods: Performance of Routine Information System Management (PRISM) framework was used. This cross-sectional study was conducted in Shahzadpur block of Ambala district, Haryana, India involving in-depth interviews of health care providers and clients in 12 subcenters (SCs) and two primary health centers (PHCs). Results: Lack of appropriate training, overburdened data entry operator (DEO) and auxiliary nurse midwife (ANM), poor Internet connectivity, slow server speed, and frequent power failures were revealed as major limitations for the effective implementation of MCTS. Nearly 18% of the clients reported receiving short message service (SMS) and only 6% could understand the SMS. Conclusion: MCTS has led to accountability and improved supervision of health workers, apart from empowering the community.
  10,564 853 -
Application of GIS in public health in India: A literature-based review, analysis, and recommendations
Marilyn O'Hara Ruiz, Arun Kumar Sharma
January-March 2016, 60(1):51-58
DOI:10.4103/0019-557X.177308  PMID:26911217
The implementation of geospatial technologies and methods for improving health has become widespread in many nations, but India's adoption of these approaches has been fairly slow. With a large population, ongoing public health challenges, and a growing economy with an emphasis on innovative technologies, the adoption of spatial approaches to disease surveillance, spatial epidemiology, and implementation of health policies in India has great potential for both success and efficacy. Through our evaluation of scientific papers selected through a structured key phrase review of the National Center for Biotechnology Information on the database PubMed, we found that current spatial approaches to health research in India are fairly descriptive in nature, but the use of more complex models and statistics is increasing. The institutional home of the authors is skewed regionally, with Delhi and South India more likely to show evidence of use. The need for scientists engaged in spatial health analysis to first digitize basic data, such as maps of road networks, hydrological features, and land use, is a strong impediment to efficiency, and their work would certainly advance more quickly without this requirement.
  7,667 1,188 1
Prevalence of nonalcoholic fatty liver disease in an adult population in a rural community of Haryana, India
Anindo Majumdar, Puneet Misra, Sanjay Sharma, Shashi Kant, Anand Krishnan, Chandrakant S Pandav
January-March 2016, 60(1):26-33
DOI:10.4103/0019-557X.177295  PMID:26911214
Background: Though nonalcoholic fatty liver disease (NAFLD) is increasingly becoming prevalent in the Indian population, knowledge regarding the burden and risk factors of NAFLD is limited, more so from rural areas. This study was thus conducted to estimate the prevalence of NAFLD among adults in a rural community of Haryana, India and to measure the association of diet, physical activity, and other selected risk factors with NAFLD. Materials and Methods: The present study was conducted in a rural community of Haryana, India among resident adults ≥35 years of age. Eight out of 28 villages were selected by probability proportion to size sampling. The number of eligible and consenting participants randomly selected from each village was 27. Out of 216 participants thus recruited, 184 participants reported for undergoing ultrasonography (USG) of the liver, anthropometry, blood pressure recording, and blood sample collection. Finally, 176 participants were analyzed. Results: Prevalence of NAFLD was 30.7%. There was no significant difference in the calorie intake and average total physical activity between participants with and without NAFLD. On multivariate analysis, hypertension [adjusted odds ratio (OR): 2.3, 95% confidence interval (CI): 1.1-5.0, P 0.03] and an increased waist circumference (adjusted OR: 4.9, 95% CI: 1.5-7.0, P < 0.001) were independently associated with NAFLD. A normal high-density lipoprotein (HDL) level was protective against NAFLD (adjusted OR: 0.4, 95% CI: 0.2-0.8, P 0.001). Conclusions: The high prevalence of NAFLD is already a public health problem, even in the rural parts of India. Urgent public health interventions are required to prevent its development by controlling the cardiometabolic risk factors associated with it.
  7,066 1,027 3
Draft national health policy 2015: A critical appraisal
Faruque U Ahmed
January-March 2016, 60(1):40-50
DOI:10.4103/0019-557X.177304  PMID:26911216
Revising a health policy of any country is a periodic procedure dependent on the change of demographic profile, current health status of the population including epidemiological changes in disease prevalence pattern, and progress made under the earlier policies. Along with it, newer research revelation of the natural history of the existing and emerging health problems, availability of newer technology as well as changing sociopolitical commitment to improve the health status of the population are the driving forces in the change of policy. Draft National Health Policy (NHP) 2015 is an attempt for the same. A review of the draft has been undertaken. The chapter on introduction is crisp and clear. Situation analysis of the draft is sketchy and without any reference of sources. Shifting the health goal is without any basis, and the objectives defined for the policy change are incongruous with the introduction. A detailed description does not give a clear picture but rather confuses the reader as it talks of comprehensive universal health-care services to be provided with a holistic concept but maximum emphasis is made in the implementation of a national program. Private health-care services are an area to reckon but except for mere references on the involvement in private-public mode, nothing concrete is observed, especially in the primary care level. Involvement envisaged in the secondary and tertiary levels is nebulous. The implementation health insurance program as well as regulatory mechanISM with the existing is also not defined exclusively in the context of a newer health policy.
  6,329 909 -
Prevalence of risk factors for non-communicable diseases in Bangladesh: Results from STEPS survey 2010
Mohammad Mostafa Zaman, Md. Mujibur Rahman, Md. Ridwanur Rahman, Mahfuzur Rahman Bhuiyan, Md. Nazmul Karim, Md. Abdul Jalil Chowdhury
January-March 2016, 60(1):17-25
DOI:10.4103/0019-557X.177290  PMID:26911213
Background: Nationally representative data on noncommunicable disease (NCD) risk factors are lacking in Bangladesh. This study was done to determine the prevalence of common risk factors for major NCDs among men and women of rural and urban areas of Bangladesh. Materials and Methods: This survey was done with 9,275 individuals aged 25 years or older randomly drawn from all over the country. Information on diet, physical activity, tobacco and alcohol, and treatment history for hypertension and diabetes were collected. Height, weight, waist circumference, and blood pressure (BP) were measured. Results: There were 4,312 men and 4,963 women with the mean age of 42 years (standard deviation 13 years). Half of them (54%) used tobacco in some form, <1% consumed alcohol within the past 30 days, 92% did not consume adequate fruit and vegetables (five servings or more), and 35% had low physical activity level [<600 metabolic equivalent (MET) min per week]. Documented diabetes was found in 4% of the participants. Seventeen percent were overweight [body mass index (BMI) ≥25 kg/m 2 and 21% had abdominal obesity (men ≥94, women ≥80 cm). Overall, 21% people had hypertension (blood pressure ≥140/90 mmHg or medication). Physical inactivity, alcohol intake, hypertension, obesity, and diabetes were more prevalent in urban areas, as opposed to tobacco. Tobacco intake showed a decreasing gradient, but hypertension, obesity, diabetes, and low physical activity showed an increasing gradient across the wealth quartiles. Conclusion: Risk factors are widely prevalent in Bangladeshi people across sexes and across both rural and urban areas of residences. NCD prevention through risk factor control, and early detection and treatment of hypertension and diabetes are warranted.
  4,320 824 7
Global scenario of HIV/AIDS: Declining trend and moving toward cure
Ramalingam Sekar, Manoharan Mythreyee
January-March 2016, 60(1):59-63
DOI:10.4103/0019-557X.177310  PMID:26911218
People living with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) (PLH/PLHA) are increasing worldwide (29.8 million in 2001 and 36.9 million in 2014) mainly owing to the aversion of AIDS related deaths by effective antiretroviral therapy (ART). Although the prevalence is increasing, the new HIV infections decreased from 3.4 million in 2001 to 2 million in 2014, and AIDS-related deaths were decreased from the peak of 2.4 million in 2005 to 1.2 million in 2014. Implementation of ART with wide coverage and free access, especially in low- and middle-income countries is an important reason for the decline of AIDS-related deaths. Further, it is expected that the recent understanding in the mechanisms of latent infection and importance of reservoir could help to achieve a "functional cure" from HIV infection in near future.
  4,032 367 1
Students' perception of quality of medical education in a medical college in west Bengal, India
Dipta Kanti Mukhopadhyay
January-March 2016, 60(1):4-9
DOI:10.4103/0019-557X.177256  PMID:26911211
Background: Students' perceived quality of educational service is an important field of educational research. Objectives: To identify the gaps in the quality of educational services as perceived by students in a medical college in West Bengal, India. Materials and Methods: In a cross-sectional study, educational quality was measured using validated SERVQUAL instrument between two randomly selected groups of undergraduate medical students (n = 179). This five-point Likert scale questionnaire measured the expectation and perception of students on 26 items under five dimensions of quality of educational services, viz., tangible (physical facilities, equipment, and appearance of personnel), reliability (accuracy and consistency of a department in providing educational services), responsiveness (eagerness to help and commitment), assurance (ability of teaching departments to earn students' confidence), and empathy (ability to communicate care and understanding). Dimension-wise difference in the mean scores for expectation and perception was calculated and was considered as quality gaps in educational services. Results: Significant negative quality gaps were noted in all five dimensions. The highest gap was found in tangible (-1.67) followed by empathy (-1.64) although the mean score of perceived quality in the dimension of empathy was the lowest (2.53). This indicates the need for improvement in physical facilities as well as behavior of teachers and staff toward students. The smallest gap was noted in the dimension of assurance (-1.29), which indicates the students' overall confidence in teaching departments regarding their management or content expertise. Conclusion: These findings underscore students' aspiration for the overall improvement of educational services that can be taken into consideration during development planning.
  3,315 889 1
Identification and exploration of the needs for health care in tuberculosis patients dropping out from therapy in Malang city: A qualitative phenomenological study
Nrs. Kumboyono
January-March 2016, 60(1):10-16
DOI:10.4103/0019-557X.177260  PMID:26911212
Background: Tuberculosis (TB) is a chronic infectious disease that remains a major public health issue in the world, including Indonesia. Various efforts have been made by governments to cope with increase of TB. However, various obstacles are found that hinder the goal of the treatment program, such as patients dropping out from treatment. Phenomenological study on TB patients dropping out from treatment in Malang City was greatly required and could be achieved through exploration of perceptions and experiences of TB patients dropping out from treatment. Objective: The purpose of this study is to identify requirements for health care among TB patients dropping out from treatment, based on the perspective of TB patients in Malang City. Materials and Methods: The study is of a qualitative phenomenological design in which samples were drawn using convenience sampling technique. In-depth interviews were used for collection of data by asking semistructured open-ended questions during 6 months from March to August 2014. Results: Problems that induce the failure of TB therapy are delay of treatment, inability to complete sufficient therapy, and various internal and external factors that affects patients' compliance. Conclusion: It was concluded that there were themes in the requirements of health care to prevent and deal with dropping out from therapy: More attention from health workers, accurate examination, clinic opening hours and availability of health workers at working hours, anti-TB drugs of branded patent granted for free, and other drugs in addition to those already known.
  2,340 472 -
Intention toward optimal breastfeeding among expecting mothers in Angul district of Odisha, India
Deepanjali Behera, Anil Kumar Kuttappan Pillai
January-March 2016, 60(1):81-85
DOI:10.4103/0019-557X.177350  PMID:26911223
This paper aims to assess the prenatal breastfeeding intention and its predictors in Odisha, a state in India. Data were collected from 218 rural pregnant women of Angul district of Odisha, India in 2012. About 33% of the women lacked the intention to exclusively breastfeed their babies for 6 months. Prelacteal feeding was intended by one-third of the women while 61.5% of the women intended to feed water during the first 6 months of birth. Women of an older age [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.09-1.55], with more education (OR = 1.14; 95% CI = 1.08-1.32), belonging to lower castes [other backward caste (OBC)-OR = 21.33; 95% CI = 4.29-106.0, scheduled caste (SC)-OR = 22.77; 95% CI = 2.47-199.1, scheduled tribe (ST)-OR = 26.16; 95% CI = 4.10-174.8), and lesser number of living sons (OR = 0.59; 95% CI = 0.22-0.94) were more likely to have a higher intention for optimal breastfeeding than those of a lower age, with less education, belonging to a higher caste, and with more number of living sons. Awareness generation programs need to be strengthened to educate pregnant women with appropriate and recommended breastfeeding guidelines to establish optimal breastfeeding practices.
  2,100 305 -
Improving the quality and use of routine health data for decision-making
Sanjay P Zodpey, Himanshu N Negandhi
January-March 2016, 60(1):1-3
DOI:10.4103/0019-557X.177248  PMID:26911210
  1,778 605 -
Patient and health system delays among adult smear-positive tuberculosis patients diagnosed at medical colleges of Puducherry in south India
Anil Jacob Purty, Ramesh Chand Chauhan, Murugan Natesan, Johnson Cherian, Zile Singh, Yogesh Sharma
January-March 2016, 60(1):77-80
DOI:10.4103/0019-557X.177349  PMID:26911222
Early diagnosis and prompt initiation of treatment are essential for an effective tuberculosis (TB) control program. This study was done to assess the extent of various delays among TB patients diagnosed at medical colleges of Puducherry. A cross-sectional study involving retrospective medical record review and prospective patient interviews was conducted in and around the union territory of Puducherry during the period 2009-10. Various delays and adjusted odds ratios (ORs) were calculated. Level of significance was determined at 95% confidence interval (CI) (P value <0.05) and all tests were two-sided. Among 216 new sputum smear-positive TB patients, 11.1% and 10.6% were smokers and alcohol users, respectively. The median patient delay, health system delay, and total delay was 37 days, 28 days, and 65 days respectively. Being a resident of Puducherry (OR = 0.39, 95% CI = 0.18-0.87) and family size of ≤5 (OR = 0.45, 95% CI = 0.21-0.97) were found as the determinants of patient delays and total delays, respectively.
  1,975 310 2
Exploring the multidimensional nature of anthropometric indicators for under-five children in India
Ashish Kumar Gupta, Kakoli Borkotoky
January-March 2016, 60(1):68-72
DOI:10.4103/0019-557X.177319  PMID:26911220
This study examined the multidimensional nature of the association of stunting, wasting, and underweight for children below 5 years of age in India using data from the National Family Health Survey (NFHS)-3 (2005-2006). Multiple correspondence analysis (MCA) was applied to examine the association of the indicators. Additionally, log-linear model was used to find out the model of best fit to examine the nutritional status of children. It was found that underweight is associated with both stunting and wasting, whereas there was no consistent pattern of association between stunting and wasting. The results also confirmed that children suffered from multiple anthropometric failures. The results showed that height-for-age, weight-for-height, and weight-for-age taken together give the model of best fit for analysis of nutritional status. The study concluded that the three indicators of nutritional status should be considered simultaneously to determine the percentage of undernourished children.
  1,943 341 2
Community medicine: Desperate times calling for desperate measures
Shailendra Singh Chaudhary, Manisha M Nagargoje
January-March 2016, 60(1):64-67
DOI:10.4103/0019-557X.177313  PMID:26911219
This article is an attempt by authors to find the solutions for some of the common queries and problems faced by postgraduate students and young faculty members of department of Community Medicine. Topics which are discussed here include: nomenclature of the department, teaching and training of undergraduate and postgraduate students, services to the community and job opportunity after completion of degree/diploma in Community Medicine/PSM/Public Health.
  1,790 289 -
Agreement between international classification of disease (ICD) and cause of death and associated conditions (CODAC) for the ascertainment of cause of stillbirth (SB) in the rural areas of north India
Madhvi Kaistha, Dinesh Kumar, Ashok Bhardwaj
January-March 2016, 60(1):73-76
DOI:10.4103/0019-557X.177348  PMID:26911221
International Classification of Diseases-10 th version (ICD-10) has been used to ascertain the cause of death but its use for stillbirths (SBs) is limited. Cause of Death and Associated Conditions (CODAC) as a detailed system expected to provide the exact cause of SB, so a community-based study was planned to study the level of agreement between ICD-10 and CODAC for ascertaining the cause of SB. A verbal autopsy (VA) tool was used to collect the information and then the cause of each SB was assigned using ICD-10 and CODAC separately. Each tool was used for 87 SBs and found that prolonged singleton labor, maternal pregnancy induced hypertension (PIH), and central nervous system (CNS) related congenital malformations were considered the top three causes. There was a significant agreement between ICD-10 and CODAC but the latter offers a scope to delineate the causes more precisely due to its hierarchal nature.
  1,698 213 3
Janani Shishu Suraksha Karyakram and out of pocket expenditure
Manas Pratim Roy, Ratan Gupta, Meetu Salhan
January-March 2016, 60(1):86-87
DOI:10.4103/0019-557X.177352  PMID:26911224
  1,520 314 -
Does Janani-Shishu Suraksha Karyakram ensure cost-free institutional delivery? A cross-sectional study in rural Bankura of West Bengal, India
Janmenjoy Mondal, Dipta K Mukhopadhyay, Sujishnu Mukhopadhyay, Apurba Sinhababu
January-March 2016, 60(1):88-89
  818 203 -