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    Table of Contents - Current issue
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July-September 2021
Volume 46 | Issue 3
Page Nos. 363-579

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EDITORIAL COMMENTARY  

Evidence-based health policies and its discontents – Comparative global and Indian perspectives with a focus on the COVID-19 pandemic Highly accessed article p. 363
Saurav Basu
DOI:10.4103/ijcm.ijcm_622_21  
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VIEW POINTS Top

Medical termination of pregnancy (Amendment Bill, 2021): Is it enough for Indian women regarding comprehensive abortion care?? Highly accessed article p. 367
Sneha Kumari, Jugal Kishore
DOI:10.4103/ijcm.IJCM_468_20  
Medical termination of pregnancy (MTP) has been legalized in India since 1971 considering the huge burden of unsafe abortions. Even after about 50 years, Indian women continued to have unsafe abortions and face adverse and fatal consequences. At this point, only legislative amendments may not be sufficient but along with that, many other aspects need to be considered like awareness, availability, accessibility, affordability of quality MTP services, and contraceptives. People should know the adverse effects of taking unsupervised medical termination pills. Comprehensive abortion care should be provided at every level of health care to ensure the good reproductive health of the women.
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Improving treatment of substance use disorders through community drug treatment clinics: An experiential account p. 370
Ravindra Rao, Anju Dhawan, Arpit Parmar, Deepak Yadav, Roshan Bhad
DOI:10.4103/ijcm.IJCM_998_20  
India has a huge burden of substance use disorder (SUD). The national response to the problem of SUD has been to support addiction treatment centers either in government hospitals or in nongovernmental settings. The existing number of addiction treatment facilities is less compared to the burden of substance use in India. The existing models of treatment in India place undue emphasis on inpatient treatment of SUD. Community-based treatment aims to bring the treatment of SUD closer to the patients in their community. Community-based treatment of SUD utilizes existing services available in the community by establishing an integrated network of community-based services. There have been different models of community-based care for the management of SUD in India. Most of them, however, address short-term withdrawals and do not provide long-term treatment in community. National Drug Dependence Treatment Centre, AIIMS, New Delhi, has been providing community-based treatment for SUD since the 1990s. Two of the three community drug treatment clinics (CDTCs) are in operation for more than 5 years now and cater to the population residing within a defined catchment area. The CDTCs use infrastructure available in the community to operate the clinics. The clinics are run daily by a team of nursing staff, while the doctor is available only twice a week. A menu of options, ranging from short-term treatment to long-term agonist maintenance treatment is provided in the clinic. Both pharmacotherapy and psychosocial interventions are provided. Each clinic caters to hundreds of patients through these facilities. There is a need to expand CDTCs in India considering their cost-effectiveness, acceptability, and overall effectiveness, especially in urban colonies with higher substance-related problems.
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REVIEW ARTICLES Top

Approaches to assess e-health programs: A scoping review p. 374
Nitin Kumar Joshi, Pankaj Bhardwaj, Deepak Saxena, Praveen Suthar, Vibha Joshi
DOI:10.4103/ijcm.IJCM_340_20  
Context: With the increasing trend of adopting e-Health technologies, the need for evidence for assessing e-Health technologies has become crucial. The appraisal of the e-Health program is important as this could provide guidance on further e-Health investment and adoption. Aims: The aim of the study was to provide an articulated body of literature on the current state of knowledge about the assessment of e-Health interventions. Settings and Design: Scoping review was conducted based on the framework provided by Arksey and O'Malley (2005) and considering enhancements proposed by Peters et al. (2015). Subjects and Methods: We searched the electronic databases and available gray literature from inception until the last week of October 2019. PRISMA flowchart for the study selection process was used to guide reporting. Data extraction included information on study design, authors, year of study, country, and key findings in terms of approaches used for assessment of e-Health programs. Data were compiled and summarized narratively. Results: Searches were performed between October and December 2019. Seventy-one relevant papers published between the years until the last week of October 2019 were reviewed and analyzed. After considering all the eligibility criteria, 15 papers were included. We identified 15 approaches for assessing e-Health programs, which were summarized and tabulated. Conclusions: This review showed that available literature on the assessment of e-Health programs is heterogeneous in terms of the methodology used. e-Health interventions are highly contextual; therefore; the phase of maturity and objective of the assessment should be considered while carrying out the assessment of e-Health programs.
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A systematic review on the therapeutic relevance of hydroxychloroquine/chloroquine in the management of COVID-19 p. 380
Gerard Mccabe, Dhruv Satya Sahni, Srishti Ramsaha
DOI:10.4103/ijcm.IJCM_539_20  
Background: The coronavirus disease-2019 (COVID-19) pandemic is coming to the fore and has surfaced as a public health emergency of international concern. The lack of vaccines or an effective treatment has led to the global hunt for potential pharmaceuticals in adequately managing this disease. This systematic review highlights the efficacy of chloroquine and its derivative hydroxychloroquine in the treatment of COVID-19 and also explores the safety profile of these drugs. Methods: EMBASE, COCHRANE, and PubMed databases were searched for studies on the use of hydroxychloroquine or chloroquine in the treatment of COVID-19. Results: Twenty articles were selected including expert opinions, National Guidelines, three small randomized controlled trials, and one prospective study. Both hydroxychloroquine and chloroquine have shown promising results including reduction in hospital length of stay and overall mortality. Moreover, concomitant use with azithromycin seems to reduce viral load to a greater extent. Conclusions: Considering the known safety profile of these drugs in the treatment of other diseases, their availability and affordability, chloroquine and hydroxychloroquine are potential antiviral agents in the treatment of COVID-19. However, reported side effects of these drugs when used in conjunction with azithromycin in patients with comorbidities have raised significant safety concerns. High-quality randomized clinical trials are warranted to provide more comprehensive evidence of the safety of these drugs in patients infected with COVID-19.
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ORIGINAL ARTICLES Top

Correlates of cigarette smoking among adolescents in India p. 389
Jai Kishun, Anup Kumar, Uttam Singh
DOI:10.4103/ijcm.IJCM_168_20  
Background: The use of cigarettes/tobacco among adolescents is quite high in India. Worldwide, nearly, all (88%) initiation of smoking occurs before the age of 18 years. Smoking caused about 1 million deaths or 10% of all deaths in India, with about 70% of these deaths occurring at the ages of 30–69 years. Aims and Objectives: Different correlates of cigarette smoking among adolescents were investigated, which may help to improve public health interventions in India. Materials and Methods: Global Youth Tobacco Survey data collected in India during 2009 were taken. Bivariate analysis, logistic regression, receiver operating characteristic, and nomogram were used to examine association between exposure and outcome variables. Cigarette smoking within the past 30 days preceding the survey was the outcome variable while independent variables were age, education, gender, parental smoking, people smoking at home/smoking in the presence of adolescents, felt boys/girls who smoke have more friends, accepting cigarette offered by one of the best friends, perception of attractiveness of boys/girls who smoke, perception smoking makes one loss or gain weight, and perception cigarettes smoking harmful. Results: 11768 adolescents participated, of which 9951 (48% males and 52% female) responded on cigarette smoking. Current cigarette smoking was associated with female gender (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.52–0.90), parental smoking (OR: 1.00; 95% CI: 0.62–1.60), smoking cigarette at home (OR: 3.66; 95% CI: 2.64–5.09), and smoking cigarette in presence of adolescent (OR: 4.14; 95% CI: 2.92–5.87). Observed associations between the outcome and exposure variables reported in this study should be considered in the design of public health interventions. Conclusion: To eliminate smoking habits, efforts should also be made in the exploration of new ideas and their implementation by the public health experts in collaboration with international agencies, various nongovernmental organizations, and academic and research institutions. Let's plan for active action to make smoke-free environment based on evidence.
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Dietary risk with other risk factors of breast cancer p. 396
Vijith Shetty, Rashmi Kundapur, Sachin Chandramohan, Sharon Baisil, Deepak Saxena
DOI:10.4103/ijcm.IJCM_227_20  
Breast cancer is one of the most common and feared cancers. The incidence of breast cancer is persistently on the rise due to urbanization and lifestyle changes. Breast cancer cannot be prevented fully but can be effectively treated and controlled if risk factors are determined accurately. Detection of breast cancer at an early stage along with the advancement in treatment options has provided a greater chance of survival. Objectives: The objective of the study was (a) To determine the most common risk factors of breast cancer in women and (b) to identify the risk ratio of dietary risk factors among breast cancer patients. Methodology: A hospital-based case–control study was conducted at a tertiary care center in coastal Karnataka, India. Results: Total 240 participants were included in the study, 120 cases and 120 controls, who were matched by ± 2-year age range. All the study participants were between 34 and 70 years of age group; the occurrence of breast cancer was found more among females within the normal range of body mass index and with a history of breast cancer among first-degree relatives. A statistically significant association was found with consumption of red meat, fatty food consumption, and bad dietary habit. Conclusion: High fat-low fiber diet is the most important risk factor for breast Cancer.
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Pregaming on alcohol products among male college students in puducherry-mixed-methods study p. 401
Divya Rajaseharan, Amol R Dongre
DOI:10.4103/ijcm.IJCM_421_20  
Background: There are some risky practices such as preloading or pregaming which exist among college students. When students pregame, compared with drinking episodes when they do not, they consume a greater number of drinks and have higher blood alcohol concentrations. Objectives: (1) To explore the perceptions about pregaming among male college students in Puducherry. (2) To study the prevalence of pregaming among current alcohol users. Materials and Methods: A sequential exploratory mixed-method study (Qualitative-Focus Group Discussion [FGD] to explore pregaming followed by Quantitative-self-administered questionnaire [survey]) was conducted among 450 male engineering college students by simple random sampling. Results: The prevalence of pregaming among current alcohol users was 66.7%. Among all occasions, the students were involved in pregaming mostly on birthdays 92.5% and marriages 92.5% followed by college cultural events 90%. All of the students 100% wanted to pregame for anticipated alcohol cost problems, 100% pregamed for fun and 87.5% easy conversations with the opposite sex and majority 66.6% had the intention to quit pregaming among current users. Conclusion: The prevalence of pregaming is high among current users however, the majority of them had the intention to quit this behavior. Counselors and health care professionals working in alcohol de-addiction centers should specifically question pregaming and its associated symptoms. Tailor-made interventions should be promoted to target the concept of pregaming-related consequences of alcohol addiction.
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Differential and determinants of neonatal mortality: A comparative study in Northern and Southern Regions of India p. 405
Kamalesh Kumar Patel, Mukesh Kumar
DOI:10.4103/ijcm.IJCM_425_20  
Background: The Government of India initiated different programs to reduce neonatal mortality. However, the variability of neonatal deaths occurs among states of India. Objective: This study aimed to identify the differential determinants associated with neonatal deaths in northern and southern regions of India. Materials and Methods: Bivariate analysis and Cox regression analysis have been performed to evaluate the predictors of neonatal mortality from National Family Health Survey (NFHS-4) data. Results: For neonatal mortality, mother and child factors became more consistent in the southern region than northern regions of the country, while household factor was almost the same in both regions of India. Conclusions: Primary intervention is also required to reduce public health problem as neonatal mortality. It should be focused on education of mother, birth interval, age at birth, antenatal care, poverty reduction programs, and proper heath facility to pregnant mothers.
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Understanding social media usage and engagement among women to inform breast cancer knowledge and prevention practices: Cross - sectional study in Delhi -National Capital Region of India p. 411
Nibha Sinha, Alka Sharma
DOI:10.4103/ijcm.IJCM_429_20  
Background: Breast cancer is the major concern worldwide and in India too. Lack of awareness is one of the causes of increasing mortality rate in India. Social media is playing an important role in health communication including breast cancer information. In India, number of women are using social media. Objective: To explore the impact of social media usage and engagement in enhancing knowledge and practices to prevent breast cancer among women of India. Methodology: A cross-sectional study was conducted in Delhi-National Capital Region of India with a sample of 649 women (response rate 83.51%). The questionnaire consisted of three sections. In first section, sociodemographic details (four items) were collected, second section contained five items on social media use and engagement and third part included items on knowledge about risk factors (seven items), symptoms (eight items), and screening (six items) of breast cancer and practice (seven items). Descriptive statistics, Chi-square, Cramer-V test, and structural equation modeling-Analysis of a moment structure were used to identify the relationship between social media engagement and knowledge and practices of women. Results: Around 80% (431/542) of women have medium level of social media engagement and 20% are highly engaged. The slope coefficient of the relationship between social media engagement and knowledge is 0.805 and between knowledge and practice is 0.309, Chi-square value is 52.053 and 29.624, Cramer-V statistics is 0.310 and 0.165, respectively, which indicates significant relationship. Conclusion: The study result justified significant impact of social media engagement on knowledge and practices of women to prevent breast cancer.
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Challenges faced by primary caretakers of adolescent girls with intellectual disability during their menstrual cycle in Puducherry: A mixed method study p. 416
S Karthikayini, S Arun
DOI:10.4103/ijcm.IJCM_433_20  
Background: Adolescents with Intellectually Disability (ID) compared to their normal peers face greater challenges at menarche due to their caregiver dependence for their day-to-day personal care activities. Objective: The objective of the study was to know the sociodemographic characteristics of adolescent girls with ID and to explore the challenges faced by their primary caretakers during their menstrual cycle in Puducherry. Subjects and Methods: The study was conducted among primary caretaker of adolescent girls with ID from December 2018 to May 2019. The study adopted quantitative method to capture sociodemographic details among 73 primary caretakers of adolescent with ID who attained menarche and In-Depth Interview (IDI) was conducted to explore the challenges faced by primary caretakers. The caretakers of adolescents were selected using purposive sampling and conventional content analysis was followed for data analysis. Results: We discovered that 80.9% of adolescent with ID were not able to manage their menstruation of their own. Primary caretakers who were interviewed were mostly mother's 67.1%. Due to caretaker's dependency, 94.5% of the adolescent with ID were not going to school during their menstrual cycle. Conclusions: Majority of the caretakers faced problems such as rejection of sanitary napkins and inability to recognize about the start of period by their adolescents with ID.
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A review of maternal near miss cases in selected Hospitals in North-East India p. 421
Vizovonuo Visi, Brogen Singh Akoijam
DOI:10.4103/ijcm.IJCM_476_20  
Background: The major causes of maternal near miss (MNM) and maternal death (MD) are similar, so review of MNM cases is likely to yield valuable information regarding severe morbidity, which, if untreated may lead to maternal mortality. Objectives: The objective is to determine frequency of near miss cases and identify the risk factors associated with MNM. Materials and Methods: A cross-sectional study was done from June 2015 to October 2017 in three hospitals in Manipur and Nagaland. All cases of MNM, which occurred during this period, were included and were reviewed using their records. Family members and health care providers of 9 recent cases were interviewed. Data collected were coded and relevant themes were identified. Results: There were 32,110 deliveries, 147 near miss cases and 12 MDs, resulting in maternal mortality ratio of 38/100,000 live birth (LB), severe maternal outcome ratio of 5/1000 LB and MNM ratio of 4.6/1000 LB. MNM to mortality ratio was 12.2:1 and mortality index was 7.5%. 83% of the cases of MNM were pregnancy related while 15.6% were related to preexisting disorders. The three delays remain the decisive factors in maternal mortality. Conclusion: Most of the near miss cases experienced delay in decision to seek health care, which resulted from underestimating the severity of various pregnancy-related conditions. Poor knowledge of the risk of warning signs of pregnancy plays a major part in the delay of management.
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Discriminant function analysis of sleep quality and its determinants among general adult population of Ahmedabad City, Gujarat p. 425
Jayshree Tolani, Venu Tejas Shah, Nitinkumar D Shah, Prutha Bakul Desai
DOI:10.4103/ijcm.IJCM_533_20  
Background: Poor sleep quality harms the ability to think, lowers stress, and sustains a healthy immune system. The present study assessed sleep quality and its determinants in adult population using discriminant function analysis (DFA) in Ahmedabad city, Gujarat. Objectives: The objective of the study was (1) to assess the quality of sleep using the Pittsburgh Sleep Quality Index (PSQI) and (2) to determine various parameters affecting sleep quality using DFA. Materials and Methods: A cross-sectional study was conducted among the general adult population (18–60 years) residing at Ahmedabad city during July–December 2019. The interviewers conducted house-to-house visit among selected households for filling up the predesigned and pretested questionnaire. Results: Out of 600 participants, the mean age of participants was 37.8 ± 18.3 years. As per PSQI, overall sleep quality was poor among 31% of participants. Sleep quality was significantly associated with gender, education, occupation, social class, body mass index, Internet addiction, depression, and spirituality. Conclusion: Overall sleep quality was poor among the study participants. This article considered analysis of determinants of sleep quality among the urban adult population.
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Quality assessment of stillbirth review: A pilot study in ten high-priority Districts in Odisha p. 430
Snigdha Singh, Manas Kumar Nayak, Prashanta Kumar Routray, Sushree Samiksha Naik, Nirmal Kumar Mohakud
DOI:10.4103/ijcm.IJCM_547_20  
Background: Stillbirth rate has shown less or no improvement in developing countries. India was estimated to have the largest number of stillbirths globally in 2015. Systematic review of stillbirths is a strategy that helps in identifying gaps in the care of a pregnant mother, and is a useful and comprehensive indicator of the quality of maternity care. Objectives: The objective of this study was to assess the quality of maternal care, and factors causing stillbirth, and to provide some doable plans to reduce its incidence in the Odisha state. Materials and Methods: The stillbirth review was undertaken over 4-month timeline (August to November 2014) in ten high-priority districts (HPDs) of Odisha. It included development of tools, desk reviews, training of staffs, and data handling. The deaths were estimated from Annual Health Survey. It was compared to the estimated stillbirth of each district to get the underreporting/overreporting districts. A report was generated on stillbirth process indicators, and program indicators after completion of assessment. Results: In the selected HPDs of Odisha, 4689 stillbirths were observed during the study period. However, the labor room register stated the reason of death in only 408 cases (8.7%). Further, at the time of admission, a provisional diagnosis could be made for only 3038 (64.7%) cases, of which 11% diagnosed as safe delivery resulted in stillbirth. Conclusions: The present study could contribute to a larger extent to address some of the gaps in the stillbirth review process in Odisha.
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Prevalence and determinants of adverse pregnancy outcomes among women in India: A secondary data analysis p. 434
Kamalesh Kumar Patel, Rakesh Kumar Saroj, Mukesh Kumar
DOI:10.4103/ijcm.IJCM_569_20  
Objective: The present study aimed to identify the determinants of adverse pregnancy outcomes (abortion, miscarriage, and stillbirth) among women aged 15–49 years in India. Methodology: Data for the analysis were taken from the latest survey of the National Family Health Survey 2015–2016. The determinants associated with abortion, miscarriage, and stillbirth among women in the age group of 15–49 years were identified. The analysis was done using adjusted binary logistic regression. Results: The contributory variables such as age, level of education, type of residence, wealth status, caste, religion, body mass index (BMI), and anemia level were found to be significantly associated with adverse pregnancy outcomes. The risk of adverse pregnancy outcomes was significantly associated with all the selected predictors. Conclusion: This study revealed that high prevalence of adverse pregnancy outcomes was found in India. The association between sociodemographic variables and the pregnancy outcomes are attributed to the fact that there is a lack of availability of fundamental health-care services for young women.
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Prevalence of severe depression among adolescents in rural area of Odisha, India p. 438
Sai Chandan Das, Mallicka , Prabhudarsan Sahoo, Pragyan Priyadarshini, RV Manasa
DOI:10.4103/ijcm.IJCM_570_20  
Background: In adolescents, major depression is projected to rank the second most cause of human illness by the year 2022. Unfortunately, half of the depressed adolescents go undiagnosed in primary care settings. Objectives: The objective is to estimate the prevalence of severe depression among rural adolescents and also to identify few epidemiological determinants causing severe depression. Settings and Design: This cross-sectional study included 341 adolescents from a selected village of Balasore, Odisha. Materials and Methods: A semi-structured questionnaire, and “Beck's Depression Inventory II” questionnaire for screening depression. Results: Only 24 (7%) of adolescents were found to be having severe depression. The subcategories of depression showed mild mood disturbance in 8.8%, borderline depression in 15.2%, and moderate depression in 12% individuals. Almost 267 (78.2%) were between 15 and 19 years of age. The mean age (standard deviation) of the participants was 16 ± 1.9 years. Majority of the participants belonged to joint family and lower middle-class status as per the Modified Kuppuswamy Scale. Conclusion: Female gender was found to be significantly associated with depression (P = 0.006). Other contributory factors for depression were sleep duration (<6 h), parental fighting, and socioeconomic status.
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Frailty, disability, and mortality in a rural community-dwelling elderly cohort from Northern India p. 442
Rama Shankar Rath, Rakesh Kumar, Ritvik Amarchand, Giridara P Gopal, Debjani Ram Purakayastha, Reshmi Chhokar, Venkatesh V Narayan, AB Dey, Anand Krishnan
DOI:10.4103/ijcm.IJCM_616_20  
Introduction: With increasing proportion of the elderly in the world, detecting and preventing frailty assumes importance to improve the quality of life and health. The study aimed to estimate the prevalence of frailty, disability and its determinants and their relation with mortality among community dwelling elderly cohort. Materials and Methods: The study was conducted in a cohort in rural Haryana, India, and was followed till October 2018. Frailty was assessed using the Edmonton Frailty Scale and disability was assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scale by trained physicians. Results: The prevalence of frailty was found to be 47.3% (95% confidence interval [CI]: 44.0–50.8). The median WHODAS-2 score was found to be 10.4 (2.1–29.2). Those who were older (odds ratio [OR] – 2.5; 95% CI: 1.8–3.4), women (OR – 3.3; 95% CI: 2.2–4.9) and those with chronic disease (OR 2.3; 95% CI: 1.7–3.1) had higher rates of frailty. The adjusted hazard ratio of death among frail people was 4.7 (2.3–9.7). Conclusion: In this study we found the frailty is associated with the mortality among community dwelling elderly. Thus early identification of the frailty and its determinants may help us to reduce the mortality related to this.
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Study on factors associated with depression among elderly and comparison of two scales used for screening p. 446
Shashwat Nagar, Hirenkumar B Patel, Noopur Nagar, Darshan Mahyavanshi, SS Nagar, Naresh Godara
DOI:10.4103/ijcm.IJCM_627_20  
Background: Depression is one of the most frequent illnesses found among the elderly. ICD-10 scale and Geriatric Depression Scale (GDS) are used commonly for screening and hence it is important to identify the scale which can be used more effectively in community settings. Objectives: (1) To analyze the factors responsible for the elderly depression and (2) to compare two scales used for the screening (ICD-10 and GDS). Materials and Methods: A cross-sectional house-to-house survey was carried in Sayla taluka of Surendranagar district by directly questioning the subjects after oral and written consent. The selection of taluka was done using simple random sampling and sample size was calculated on the basis of estimated geriatric population. 306 subjects were interviewed using a predesigned, pretested, and validated questionnaire. Results: GDS showed the prevalence of 16% whereas ICD-10 showed 22%. The factors associated with depression were physical health, poor economical situation, and avoidance by family members. The agreement between the 2 scales using Cohen's kappa statistic showed excellent agreement. Conclusion: Community-based multiphasic screening programs is needed for early diagnosis of geriatric depression. ICD-10 having lesser number of questions can be used in the 1st phase of screening and those found positive can then be tested by GDS.
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Assessment of preventable risk factors of cardiovascular diseases among junior college students: A cross-sectional study p. 450
Rujuta Sachin Hadaye, Ruhi Dass
DOI:10.4103/ijcm.IJCM_682_20  
Context: Lifestyle-associated risk factors may begin during childhood and result into cardiovascular diseases in adult life. Thus, a study was conducted among junior college students to assess these preventable risk factors among them. Aims: To estimate (1) Prevalence of risk factors namely physical inactivity, unhealthy dietary habits, tobacco, and alcohol use among them and (2) The proportion of hypertension. Settings and Design: A cross-sectional study was done among 416 11th and 12th standard students from a school of a metropolitan city. Subjects and Methods: Two steps were conducted. Step 1 included an interview schedule and Step 2 involved anthropometry, pulse, and blood pressure of all the participants. Statistical analysis was done using SPSS 21. Chi-square test was applied. Results: The prevalence of tobacco and alcohol consumption, physical inactivity, and unhealthy dietary habits were 5.5%, 5%, 74.5%, and 52.1%, respectively. The prevalence of overweight students was 13.9%. The prevalence of prehypertension and hypertension was 26.9% and 12.7%, respectively. Conclusions: It was concluded that these risk factors namely, physical inactivity, unhealthy dietary habits, tobacco, and alcohol consumption commence during adolescence.
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Provision of care following road traffic injuries in a district in South India: A qualitative analysis of stakeholder perspective p. 454
Shreyaswi M Sathyanath, Rashmi Kundapur, Sudhir H Prabhu, Anusha Rashmi
DOI:10.4103/ijcm.IJCM_704_20  
Introduction: It is essential to explore ways to prevent and reduce the severity of injuries in road crashes. This study attempts at getting a ground-level understanding of perspectives surrounding road traffic injury among various stakeholders. Materials and Methods: In-depth interviews and focused group discussions were conducted over a period of 6 months among traffic police, toll booth operators, road transport officers, nurses, and intensive care specialists. The transcribed data were coded and analyzed, and a percentage of final themes as well as codes were drawn. Results: The common reasons cited for delay in transport of accident victims were fear regarding medicolegal issues among the first responders (36.9%) and delay in ambulance (41.5%). 26.1% agreed that time delay in transport can be reduced by generating awareness. Teaching first aid to the general public is essential as opined by 75% of nursing staff and 66.7% of emergency physicians. Documentation procedures (15.4%), long waiting hours (10.2%), and out-of-pocket expenditure and financial constraints (10.2%) were the commonly cited reasons for problems faced by patient bystanders. Conclusions: Creating awareness and improving access to ambulance were the two essential recommendations to prevent delay in prehospital care. Majority of the care providers and patient bystanders agreed that improving insurance coverage is essential to reduce financial constraints.
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Cardiovascular morbidity, quality of life, and cost of care among diabetic patients: A comparative study from a Tertiary Care Hospital of Uttarakhand, India p. 459
Bhola Nath, Shiv Dutt Gupta, Ankita Kankaria, Ranjeeta Kumari
DOI:10.4103/ijcm.IJCM_739_20  
Objectives: Diabetes is commonly observed to be associated with several comorbidities, out of which cardiovascular comorbidities are most frequently observed. The present study has been done to estimate the proportion of cardiovascular comorbidities among patients of diabetes and to compare it with that of matched nondiabetics. It also aimed to compare the quality of life (QOL) scores and the cost of treatment between diabetics and nondiabetics with cardiovascular comorbidities. Methodology: A hospital-based comparative analytical study was conducted in a tertiary care hospital of Uttarakhand, India. One hundred and ninety-five diabetic were compared with an equal number of age- and gender-matched nondiabetics. We compared the two groups for the presence of comorbidities by Chi-square test and for QOL and cost of care by independent t-test. Regression was done to study factors associated with direct cost incurred for treatment among diabetics with cardiovascular comorbidity. Results: The present study reported about four-time higher risk (odds ratio: 3.9; confidence interval: 2.5–6.1) of comorbidities of cardiovascular system (CVS) among diabetics as compared to nondiabetics. QOL scores were reported to be significantly lower among diabetics with comorbidities of CVS in comparison to nondiabetics. Significant predictors of direct cost among diabetics were religion, marital status, income, and use of alcohol. Conclusion: Cardiovascular comorbidities have been reported to be four times higher among diabetics in comparison to nondiabetics, leading to an adverse effect on QOL and increased expenditure on treatment.
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Strengths, weaknesses, and suggestions for improvement in postgraduate assessment in community medicine in India: A Delphi study p. 464
Amol R Dongre, John Norcini
DOI:10.4103/ijcm.IJCM_776_20  
Objectives: It was to understand the strengths and weaknesses of the current postgraduate assessment system in community medicine in India, to identify recommendations for change, and to build a consensus around them. Materials and Methods: A conventional Delphi technique was preferred for consensus building among experts. We completed three Delphi rounds over a period of 4 weeks, and 16 experts participated in the study. Content analysis was done for open-ended responses, and consensus analysis was done for Likert-type scale questionnaire. In round three, we obtained their top five preferences for change in assessment. Results: The experts agreed to have an assessment system based on ongoing formative and one end-of-year summative assessment. Apart from this, they agreed on the various occasions for carrying out the formative assessment. Furthermore, they clearly agreed on measures such as blueprinting, improving test formats, and adequate briefing of test-taking students. Conclusion and Recommendations: Most of the consensus items were found to be in alignment with the modern assessment theory. Regulating body and policymakers should revise the current postgraduate assessment system in community medicine to enhance its validity and reliability.
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Prevalence of asymptomatic bacteriuria and antimicrobial resistance profile among pregnant females in a Tertiary Care Hospital p. 469
Anjali Agarwal, Shreya Pandey, Ujjwal Maheshwari, MP Singh, Jyoti Srivastava, Seema Bose
DOI:10.4103/ijcm.IJCM_792_20  
Background and Objectives: Urinary tract infection (UTI) is the most common clinical finding during pregnancy, and if it is asymptomatic bacteriuria (ASB), it can progress to pyelonephritis, leading to further complications. The present study aims to know the prevalence of ASB in pregnant females and the antimicrobial resistance pattern in our hospital setup. Materials and Methods: A total of 552 urine samples were collected from pregnant females (with no symptoms of UTI) both attending outpatient department and admitted in the wards of obstetrics and gynecology department. Urine culture was performed on blood agar, MacConkey agar, and UTI chromogenic agar. Antibiotic sensitivity test was done using Kirby-Bauer disc diffusion method, and the results were interpreted. Results: The prevalence rate of ASB in pregnant females was 17.4%. It was common in the age group of 25–33 years (60.4%). The infection rate was higher in the second trimester (43.7%) compared to the third (29.2%) and first (27.1%) trimester. Multiparity (60.4%) was a common finding in ASB during pregnancy. There was a significant finding of previous history of UTI (22.9%) and anemia (58.3%) associated with ASB in pregnant females. Escherichia coli (39.2%) was the most common microorganism isolated followed by Staphylococcus aureus (34.3%), Enterococcus faecalis (14.7%), Klebsiella (4.9%), coagulase-negative Staphylococcus spp. (2.9%), and Citrobacter and Acinetobacter (1.9%). Most sensitive drugs to be given in ASB during pregnancy were nitrofurantoin and fosfomycin. Conclusion: It was emphasized that urine culture should be done in early antenatal visit as routine screening to identify ASB in pregnant females as it can prevent fetal and maternal complications.
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Risk factors for colorectal cancer in Goa, India: A Hospital-based Case–Control study p. 474
Agnelo Menino Ferreira, Shradha U Chodankar, Frederick Satiro Vaz, Delia Basil D'souza, Manojkumar S Kulkarni
DOI:10.4103/ijcm.IJCM_848_20  
Introduction: Colorectal cancer is the third most common cancer in men and the second in women worldwide. The objective of the present study was to determine and quantify important modifiable risk factors attributable to colorectal cancer, in order to explore the ways to reduce the incidence of colorectal cancer in this region. Materials and Methods: A case–control study was conducted at a tertiary care hospital in Goa, India. The study subjects were group matched for age and sex so as to include 110 cases and 110 controls. Only incident cases of colorectal cancer were recruited in the study. Predesigned structured questionnaire was utilized for data collection, while anthropometric measurements and laboratory investigations were conducted. Statistical analysis was conducted using SPSS software package. The study was approved by the Institutional Ethics Committee of the institute. Informed written consent was obtained from the study participants. Results: Smoking, smokeless tobacco use, alcohol consumption, red meat consumption, high body mass index (BMI), and the presence of Type 2 diabetes mellitus were found to be the risk factors for colorectal cancer on univariate analysis, while fruit and vegetable consumption were found to be the protective factors. Multiple logistic regression analysis identified Type 2 diabetes mellitus and high BMI as risk factors for colorectal cancer and consumption of fruits and vegetables as protective factors. Conclusion: Identification of risk factors for colorectal cancer would help in setting of colorectal cancer screening guidelines as well as for creating awareness regarding prevention of colorectal cancer among the general population.
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The barrier to contraceptive use among multiparous women in Indonesia p. 479
Ratna Dwi Wulandari, Agung Dwi Laksono, Ratu Matahari
DOI:10.4103/ijcm.IJCM_902_20  
Background: The lack of perception related to the risk of pregnancy and contraceptive use's side effects is the main reason for not using contraceptives. Objective: This study aimed to analyze barriers to contraceptive use among multiparous women in Indonesia. Methods: This study employed the 2017 Indonesia Demographic and Health Survey. The analysis unit was multiparous women aged 15–49 years old, and the sample was 25,543 women. The contraceptive use was the dependent variable, while the independent variables analyzed were residence, age, education, employment, wealth, and insurance. The study used a binary logistic regression to determine the barriers. Results: Women in urban areas were 1.100 times more likely not to use contraceptives than women in rural areas. All categories of age group are more likely to use contraception than the 45–49 age group. Multiparous women who had low education had a higher possibility of not using contraceptives. Unemployed multiparous women were 1.008 times more likely not to use contraceptives than employed multiparous women. In terms of wealth status, women with all wealth status tended not to use contraceptives than the richest. Conclusions: Multiparous women in Indonesia had five barriers to not using contraceptives. These included living in urban, being at younger ages, having no education, being unemployed, and having low wealth status.
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Hypovitaminosis D, dyslipidemia, and thyroid dysfunction among adolescents and their associations with blood pressure in a Northeastern City of India p. 484
Bidhan Goswami, Himadri Bhattacharjya, Shauli Sengupta, Bhaskar Bhattacharjee
DOI:10.4103/ijcm.IJCM_907_20  
Background: Blood pressure (BP) is associated with serum levels of Vitamin D3, lipid profile, and thyroid hormones among adults. However, limited information is available regarding such associations in adolescents. Objectives: The objectives of this study were to estimate the prevalence of Vitamin D3 deficiency, dyslipidemia, and thyroid dysfunction among secondary school students of Agartala and to determine their associations with BP. Methodology: This cross-sectional study was conducted from April 1, 2018, to December 31, 2018, among 1000 secondary-level school students of Agartala municipal corporation area, chosen by multistage sampling ensuring proportionate representation. Results: The prevalence of Vitamin D3 deficiency, thyroid dysfunction, and dyslipidemia was found to be 79.4%, 62.8%, and 37.5%, respectively. Among the respondents, 58.1% had raised BP, 16.7% were overweight, 5.3% were obese, and 48.3% had high waist–hip ratio (WHR). Among them, 70.97% of the fatty participants, 82.27% with high body mass index (BMI), and 69.05% with either low or normal WHR had significantly raised BP (P < 0.05). Out of total, 58.26% of the participants with normal serum D3 level, 59.95% with either euthyroid or hyperthyroid status, and 62.13% with dyslipidemia had raised BP, though these were not significant (P > 0.05). Binary logistic regression model has identified higher BMI, higher body fat content, high WHR, habit of consuming extra salt, and fast food on a regular basis as significant determinants of raised BP in this population (P < 0.05). Conclusion: Hypovitaminosis D, thyroid dysfunction, and dyslipidemia are prevalent among adolescents of Northeast India, but they did not emerge as significant determinants of BP in this population.
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Coherence between existing system of defining urban poor with kuppuswamy and Hashim's system; Which is more relevant? p. 489
Sanjivani Vishwanath Patil, Sudhanshu Ashok Mahajan, Prakash Prabhakarrao Doke, Jayashree Sachin Gothankar
DOI:10.4103/ijcm.IJCM_912_20  
Background: Identification of below poverty line (BPL) households is of paramount importance to provide benefits under poverty alleviation and other programs. Objectives: (1) To assess households in urban slums in terms of housing, assets, and amenities. (2) To compare three different systems of socioeconomic status (SES) – ration card holders, Modified Kuppuswamy Scale, and Hashim's system. Materials and Methods: A cross-sectional, community-based study was conducted in urban slums of field practice area of a medical college, Pune. Considering 35% of urban households in India qualify as poor, sample size of 593 households was calculated. A predesigned, validated, pretested questionnaire was used, covering sociodemographic domains including indicators of three systems. Agreement between these scales was calculated by kappa statistics. Results: Total 639 households were surveyed covering 3078 slum population. Percentage of BPL families according to possession of yellow ration card, Modified Kuppuswamy Scale, and Hashim's system were 35.99%, 48.67%, and 48.51%, respectively. The proportion of agreement between Kuppuswamy scale and ration card was 55.71% and for Hashim system and ration card was 51.79%. Conclusions: The present study revealed no agreement between these three systems. Hashim system gives more accurate and realistic picture of SES of the urban slums households owing to its holistic approach.
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Constructing practical and realistic asset-based socioeconomic status assessment scale using principal component analysis for urban population of Puducherry, India p. 494
Vinayagamoorthy Venugopal, Amol R Dongre, Poomathy Ponnusamy
DOI:10.4103/ijcm.IJCM_925_20  
Background: Socioeconomic status (SES) is a key determinant of health. However, ascertaining the SES in developing countries is really challenging. Hence, we decided to develop an asset-based simple and rational SES tool for urban population of Puducherry and compare it with Modified Kuppuswamy's (MK) scale. Materials and Methods: Sequential mixed methods design was used. The list of local household assets to determine SES was created based on group interviews with stakeholders and review of literature. Then, survey was carried out among 500 urban households by trained medical interns after obtaining informed consent. EpiCollect-5, mobile-based software, was used to capture data. Principal component analysis (PCA) was carried out to construct a wealth index using SPSS version 24. The assets included in the final PCA were ranked based on their contribution to the index by linear regression. Results: The eigenvalue for the first principal component was 6.7 accounting for 33.6% of the variance in the original data. Finally, reduced 10-item-based SES scale was created and scoring system was formulated based on regression coefficient. The weighted kappa statistics and correlation coefficient measure of reliability between household quintiles on 20-item and 10-item reduced SES tool were 0.77 and 0.95, respectively. There was a moderate correlation between SES obtained from MK scale and newly constructed scale. Conclusions: The newly devised SES scale is context specific, reliable, easy to administer, and quick to ascertain the SES and thus can be used for a similar context in future health research.
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A study on the emotional intelligence among teaching faculty of a medical college in South Karnataka p. 499
Raman Hulinaykar, Kusuma Achalkar, Ningangouda Parvatagouda, MM Angadi
DOI:10.4103/ijcm.IJCM_931_20  
Introduction: Doctors have multiple roles to play in the society. The emotional intelligence (EI) of medical college teachers plays a decisive role on the outcome of medical students. Teachers with good EI will create a learning environment that encourages positive social interaction, active encouragement, and motivation to learn among students. Objectives: The objective of the study is to assess the level of EI and the influence of sociodemographic variables on it among teaching faculties of a medical college. Materials and Methods: A cross-sectional study was conducted using self-report EI questionnaire scale. The data were analyzed and expressed in percentages and proportions. Mean, standard deviation, and statistical significance were calculated, wherever necessary. Results: More than half of the teaching faculty showed average EI (66.67%) and 8.33% had poor EI. The social skills of teaching faculty showed positive correlation and statistical significance with teaching experience. Conclusion: There is a need to take appropriate steps to improve the EI of teaching faculties by the institutions as it has an impact on the outcome of learner doctors.
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Medication adherence to oral hypoglycemic drugs among individuals with Type 2 diabetes mellitus – A community study p. 503
Rajeev Aravindakshan, Sherin Billy Abraham, Rajalakshmy Aiyappan
DOI:10.4103/ijcm.IJCM_985_20  
Context: Control of diabetes mellitus is a global challenge and nonadherence to diabetic medications is a public health concern. Factors related to patients, medications, and system can contribute to nonadherence. Aims: We aimed to determine self-reported adherence to oral hypoglycemics and to understand the determinants of medication adherence in a group of adult diabetics in South Kerala. Methods: A cross-sectional survey was conducted among 218 diabetic individuals. An eight-item questionnaire to assess the level of adherence and a structured interview schedule were administered to meet the objectives. Adherence was categorized as poor, moderate and high, based on k-means cluster analysis. Results: The proportion of good adherence was 60.09%. Higher age, male gender, nonalcoholic, higher family income, higher frequency of blood glucose monitoring, and controlled blood sugar level were independent predictors of good adherence. Conclusion: The proportion of individuals with poor medication adherence is low. Focus must be on determining factors influencing medication nonadherence.
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Effect of long-term regular Yoga on physical health of Yoga practitioners p. 508
Manisha Kalpesh Gohel, Ajay G Phatak, Utpala N Kharod, Bhanuprasad A Pandya, Balvantkumar L Prajapati, Utkarsh M Shah
DOI:10.4103/ijcm.IJCM_554_20  
Background: Yoga is a physical, mental, and spiritual discipline. The effect of yoga on mental health has been studied extensively in India but less in the context of physical health. Objective: The objective was to explore the effect of long-term regular yoga on physical health of yoga practitioners. Materials and Methods: It was an interventional study. Inclusion criteria were students who enrolled for 1-year diploma course at the yoga center. Exclusion criteria were nonregular yoga practitioners during the course. Physical health parameters considered for assessment before and after the yoga course were pulmonary function tests, maximum oxygen consumption (VO2 max) using Bruce treadmill test, flexibility, body composition analysis, and hemoglobin level. Paired sample t-test and Chi-square test were used for statistical analysis. Results: The aerobic capacity improved significantly in terms of mean (standard deviation [SD]) forced vital capacity (P < 0.001), forced expiration volume at the end of the first second (P < 0.001) as well as peak expiratory flow rate (P = 0.04). The mean (SD) flexibility score improved significantly (P < 0.001). Similarly, the endurance improved significantly in terms of mean (SD) Vo2 max (< 0.001) and treadmill time (P < 0.001). There was no significant change in body composition and hemoglobin level. Conclusions: Regular yoga practitioners demonstrated the improvement in pulmonary functions, cardiorespiratory fitness, endurance, and flexibility.
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Underweight, overweight, and anemia among elderly persons in a rural area of Ballabgarh, Haryana p. 511
Sunanda Gupta, Rakesh Kumar, Mani Kalaivani, Baridalyne Nongkynrih, Shashi Kant, Sanjeev Kumar Gupta
DOI:10.4103/ijcm.IJCM_688_20  
Background: Underweight, overweight, and anemia are common public health problems among elderly individuals. Objectives: The current study was conducted in a rural area of Ballabgarh, Haryana, to estimate the prevalence of underweight, overweight, and anemia among elderly persons and to find their association with sociodemographic variables. Materials and Methods: A total of 420 elderly persons aged ≥60 years were selected by simple random sampling. Information on variables was collected by an interview schedule. Body mass index (BMI) was calculated from height and arm-span of elderly persons. Hemoglobin was estimated with HemoCue® Hb 201+ system. Results: Of the total participants, 33.6% were underweight, 13.8% were overweight, 15.6% were obese, and 37.0% had normal BMI. None of the sociodemographic variables was found to be significantly associated with being underweight. Being female was significantly associated with being overweight/obese. The prevalence of anemia was 36.4%. None of the sociodemographic variables was associated with anemia. Conclusions: Underweight and anemia are common among elderly persons in rural areas. These need to be addressed through community-based interventions.
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Merits and demerits of selective isolation of superspreaders: A mathematical modeling study based upon West Bengal (India) SARS-COV 2 data Highly accessed article p. 515
Sourodip Ghoshdastidar, Kamalesh Sarkar, Biswajit Ghoshdastidar
DOI:10.4103/ijcm.IJCM_817_20  
Context: All COVID cases and their contacts are considered highly infectious requiring isolation, which blocks the COVID isolation beds and disrupts life in the community. Aim: To find out the effect of selective isolation and contact tracing of superspreaders as compared with the conventional ongoing protocol. Settings and Design: A mathematical model was designed to look at the effect of isolation and contact tracing of only those with high viral loads (superspreaders) on COVID-19 bed occupancy and overall mortality, in comparison with conventional protocol of isolation and contact tracing of all cases. Materials and Methods: An agent-based model, calibrated to the ongoing West Bengal COVID-19 data, was run for a total of 178 days to find out the effect of the interventions on COVID-19 bed occupancy and mortality. Results: There is an impressive reduction in the occupancy of COVID isolation beds, even with the preintervention testing rate with no negative impact on mortality. Conclusions: Strict isolation of superspreaders only, maybe highly effective in reducing the burden on health care and solving the COVID isolation bed crises if the testing rate is significantly increased.
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Impact of COVID-19 pandemic on childhood immunization in a Tertiary Health-Care Center p. 520
Afreen Khan, Aparna Chakravarty, Jagannath Mahapatra
DOI:10.4103/ijcm.IJCM_847_20  
Background: After the emergence of COVID-19 pandemic, health facilities nationwide became the battleground for COVID-19. Many hospitals are designated as COVID-19 hospitals and various measures taken by the government to contain the spread of infection have disrupted the provision of routine health-care services including immunization. The aim of this study is to describe the impact of COVID-19 pandemic on immunization in a tertiary level health-care facility. Materials and Methodology: Data of children vaccinated as per the Universal immunization program (UIP) schedule were retrieved from immunizations records for a 7 month (January to July) period for the years 2019 and 2020. The trends of vaccination during COVID-19 pandemic are studied and are compared with the date matched data of the previous year. Results: There was a significant drop in the vaccine counts after emergence of COVID-19 pandemic. Maximum drop (−87%) was seen during the month of April (76.52% ± 43.62% vs. 16.95% ± 42.55%; P < 0.001) followed by May and June when it was −67% and −33%, respectively. Conclusion: COVID-19 pandemic has created the gaps in immunization which requires immediate attention. Further failure in sustaining the vaccination services and weak catch-up plans can lead to the emergence of vaccine-preventable diseases which may result in increased childhood morbidity and mortality.
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A quality improvement study on improving communication between health-care provider and laboring woman: A step toward respectful maternity care p. 524
Bharti Sharma, Pooja Sikka, Aashima Arora, Guneet Singh Assi, Vanita Suri
DOI:10.4103/ijcm.IJCM_1034_20  
Background: Effective communication between health-care providers (HCP) and women during labor is a key component for providing dignified and consented maternity care. The quality improvement (QI) study was planned to improve the communication skills of HCP to provide dignified and consented care in the labor ward. Methodology: This study was conducted at the labor ward of a tertiary care hospital. To assess the magnitude of nondignified and nonconsented care, baseline data were collected from the women who had normal vaginal delivery through interviews using a prestructured questionnaire. The HCPs were also interviewed about the reasons for nondignified and nonconsented care. Various change ideas were tested through the plan-do-study-act cycle to sensitize the HCP with World Health Organization recommendations on intrapartum communication. Results: There was a marked improvement in communication between HCP and women in labor, i.e., addressing the woman by her name (100%), consent before each clinical examination (93%), and providing information about the progress of labor after each examination (50%). Conclusion: A QI approach is feasible and effective as a behavior change intervention to provide dignified and consented care in the existing settings.
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Complementary feeding practices and nutritional status of children (6–23 months) in an urban resettlement colony of East Delhi p. 528
Pragti Chhabra, Anita Gupta, Neelima Thakur
DOI:10.4103/ijcm.IJCM_1046_20  
Background: Even with optimum breastfeeding, children are at risk of being stunted if they do not receive timely adequate and appropriate complementary feeding. Objectives: The objective is to determine the prevailing complementary feeding practices, and nutritional status of children aged 6–23 months. Materials and Methods: Mothers of 350 children of age 6-–23 months of an urban resettlement colony of East Delhi were interviewed using a pre-tested questionnaire based on the WHO indicators to record their complementary feeding practices. Weight and height was taken to assess the nutritional status. Results: The minimum meal frequency was adequate in 60.6%, minimum dietary diversity in 15.1%, and minimum acceptable diet in 9% children. The prevalence of wasting was 43.7%, underweight 43.4%, and stunting 29.1%, as per Z-score. Statistically significant association of wasting with low birth weight, bottle feeding, and consumption of market food was observed (P < 0.05). Conclusions: Complementary feeding indicators were unsatisfactory in most children. A high prevalence of wasting and under-nutrition was observed.
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Extent, pattern and correlates of depression in urban geriatric subjects: Findings from community based study p. 533
Priya Keshari, Hari Shankar
DOI:10.4103/ijcm.IJCM_1052_20  
Background: Depression decreases an individual's quality of life and increases dependence on others. The declining physical potential familiar infrastructure and loss of peer may cause anxiety, stress, depression, etc., in geriatric population. Objectives: The objectives of this study were as follows: (A) to assess the extent and pattern of depression in study subjects and (B) to find out the correlates of depression in subjects. Materials and Methods: This cross-sectional study was conducted on 616 geriatric subjects selected by multistage sampling procedure from urban Varanasi, India. A predesigned, pretested proforma was used for collecting socioeconomic information. Depression status was assessed using the Geriatric Depression Scale. For analysis of data, SPSS version 22.0 was used. Chi-square and logistic regression were used for inferential purpose. Results: The overall prevalence of depression in geriatric subjects was 29.7%; 15.7% of subjects were not satisfied with life and 30% often felt helpless. The adjusted odds ratio (95% confidence interval) for depression was 4.54 (2.99–6.09) in subjects >70 years, 4.00 (2.45–6.54) for widowed, 1.95 (1.13–3.35) for widowers, 4.95 (2.02–12.07) for lower, and 3.17 (1.79–5.64) for upper-lower socioeconomic status. Conclusion: Nearly one-third of urban geriatric subjects had depression which was significantly enhanced by advancing age, loss of partner, and socioeconomic adversities.
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Maternity leave access and breastfeeding practices among working mothers in an urban residential area of East Delhi p. 537
Naudibya Majhi, Khan Amir Maroof, Arun Kumar Sharma, Dheeraj Shah
DOI:10.4103/ijcm.IJCM_1056_20  
Background: Despite the provision of maternity leave benefits under the maternity benefit amendment act, its access by working mothers in the community is unknown. Objectives: The objective is to find out access to maternity leave among working mothers and its association with breastfeeding practices. Materials and Methods: A cross-sectional, community-based study was conducted among 150 working mothers with children 6 months to 3 years of age. Chi-square tests and logistic regression were applied to find the association of breastfeeding practices with maternity leave and independent predictors of exclusive breastfeeding (EBF), respectively. Results: Paid maternity leave was accessed by majority (103, 68.7%) of the working mothers. EBF among mothers working in government organizations was more (Adjusted odds ratio: 2.3, 95% confidence interval: 1.0–5.1) than in private organizations. Conclusion: Lower proportion of mothers in private organizations had availed paid maternity leave as compared to government organizations. Increase in coverage of maternity benefits in the private sector is needed.
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Disclosure of sexual orientation and its predictors among HIV-positive men who have sex with men in a contemporary African setting p. 541
Tolulope Olumide Afolaranmi, Zuwaira I Hassan, Kainechukwu G Ugwu, Obinna J Ugwu, Akinyemi O D. Ofakunrin, Tinuade A Oyebode, Moses P Chingle, Ali I Shugaba
DOI:10.4103/ijcm.IJCM_35_21  
Background: Sexual orientation disclosure has been reported to promote good peer support, improve psychological health, as well as access to STIs and HIV prevention services. Hence, this study sought to assess the level of disclosure sexual orientation and its predictors among HIV-positive men who have sex with men (MSM) in Plateau state Nigeria. Methods: This was a cross-sectional study design conducted between October 2018 and December 2019 among 114 HIV-infected MSM through respondent driven sampling technique. Epi Info version 7 was used for the data analysis with adjusted odds ratio and 95% confidence interval (CI) used as point and interval estimates on the logistic regression model and P < 0.05 considered statistically significant. Results: The mean age of the respondents was 26.0 ± 5.4 years with disclosure of sexual orientation to nonpartner being reported by 45 (39.5%). Positive family history of same sex practice was found to significantly predict self disclosure of sexual orientation (adjusted odds ratio: 3.30; 95% CI: 1.2356–8.8038; P = 0.017). Conclusions: This study has revealed a low level of disclosure of sexual orientation among HIV-positive MSM in Plateau state with a positive family history of same sex involvement as its predictor.
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Comparative yield of pulmonary tuberculosis by different symptoms among Saharia tribe of Madhya Pradesh, India p. 546
Ravendra Sharma, VG Rao, Rajiv Yadav, Prashant Mishra, Mercy Aparna Lingla, Samridhi Nigam, Jyothi Bhat
DOI:10.4103/ijcm.IJCM_42_21  
Background: Symptom elicitation is a simple and inexpensive screening tool used for population screening in tuberculosis (TB) prevalence surveys. However, the information on the yield of TB cases by symptoms is sparsely available. Methods: A cross-sectional pulmonary TB (PTB) prevalence survey was conducted. All available eligible individuals were interviewed for symptoms of PTB. Sputum samples were collected and tested for PTB by smear microscopy and culture. Results: Among 2890 individuals tested for PTB, 77% had cough for 2 weeks or more and one-third reported chest pain for 1 month or more. About 31% were having a history of anti-TB treatment. Cough contributed to 82% PTB cases and the history of anti-TB treatment contributed to another 8.4% confirmed cases. Fever recorded lowest yield among the symptoms of PTB. Conclusion: The study suggests that fever alone may be ignored from symptomatic elicitation, and history of previous anti-TB treatment should be treated as an important indication for PTB symptomatic elicitation.
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Is there any relationship between poor menstrual hygiene management and anemia? – A quantitative study among adolescent girls of the urban slum of Madhya Pradesh p. 550
Surya Bali, Sembagamuthu Sembiah, Akanksha Jain, Yash Alok, Jayeeta Burman, Darshan Parida
DOI:10.4103/ijcm.IJCM_73_21  
Background: Anemia and poor menstrual hygiene practices have a considerable impact on all aspects of an adolescent girl's life. There is a dire need for evidence on the burden and its association to provide actionable preventive measures. Objective: The objective of this study is to explore the magnitude and association between poor Menstrual Hygiene Management (MHM) practices and anemia. Materials and Methods: A cross-sectional study conducted among 393 adolescent girls of the urban slum of Bhopal (June 2017–July 2018). Hemoglobin (Hb) was determined by a portable Hb meter (HemoCue). Logistic regression analysis was done to find out if there is any association between poor MHM practices and anemia. Results: The present study found the prevalence of anemia as 38.7% among which 65.1%, 31.5%, and 3.2% were suffering from mild, moderate, and severe forms of anemia, respectively, and 87.3% were practicing poor MHM. Logistic regression found that the MHM, bleeding during menstruation, religion, educational status, and nutritional status of adolescents were significant factors associated with anemia. Conclusion: The study concluded that there is a significant association between poor MHM and anemia. Concerted convergent actions focusing on the provision of awareness regarding MHM and sanitary facilities to maintain proper menstrual hygiene are needed to reduce the burden of anemia.
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Determinants of nutritional status among under-five children in the tribal population of The Nilgiris, Southern India: A cross-sectional study p. 554
Roshina Sunny, Jiji Elamana, Jeby Jose Olickal
DOI:10.4103/ijcm.IJCM_118_21  
Background: The tribal populations in The Nilgiris of Tamil Nadu are identified as particularly vulnerable tribal groups (PVTGs) and are “high risk” in terms of health and nutrition. Objectives: The objective of the study is, among the under-five tribal children, to determine the prevalence of undernutrition and the factors associated with it. Materials and Methods: This community-based cross-sectional study was conducted between March and June 2019 among 605 under-five tribal children. The prevalence of underweight, stunting, and wasting was expressed as proportion; the association with determinants was assessed using log-binomial regression model. Results: The prevalence of underweight, stunting, and wasting was 63% (95% confidence interval [CI] 57–70), 62% (95% CI 54–70), and 31% (95% CI 24–38), respectively. Among them, 29%, 35%, and 10% were severely underweight, stunted, and wasted, respectively. Among 605 participants, 80% utilized supplementary nutrition program of the Integrated Child Development Services; only 21% of whom utilized it as per the ICDS recommended quantities prescribed for different category of beneficiaries. Male child, age >2 years, and illiteracy of father were significantly associated with underweight. Age >2 years and illiteracy of mother were significantly associated with stunting. Male child and low family income were significantly associated with wasting. Conclusion: Nearly three out of four children in the community were undernourished. Poverty alleviation programs are required to combat undernutrition among backward communities.
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High prevalence of Vitamin D deficiency among North Indian athletes p. 559
Ravi Gupta, Vaibhav Bohat, Anil Kapoor, Akash Singhal, Ashwani Soni, Gladson David Masih
DOI:10.4103/ijcm.IJCM_170_21  
Background: Vitamin D deficiency is high in athletes and has an impact on athletes' performance. Introduction: Assessment of serum Vitamin D levels in healthy North Indian sportspersons and its correlation with serum parathyroid hormone (PTH) levels and bone mineral density (BMD). Materials and Methods: Three-hundred and sixty-nine healthy athletes' aged 18–45 years were enrolled. Depending upon Vitamin D levels athletes were categorized into three groups: deficient (<20 ng/ml), insufficient (20–30 ng/ml), and sufficient (>30 ng/ml). BMD and serum PTH levels were assessed in all athletes and correlation was seen with Vitamin D levels. Results: Two-hundred and fifty-eight (69.9%) athletes were Vitamin D deficient, 51/369 (13.8%) were Vitamin D insufficient, and 60/369 (16.3%) athletes were Vitamin D sufficient. There was a direct correlation between low serum Vitamin D levels and low BMD (r = 0.473; P < 0.05). Overall, 114/369 (30%) athletes had low BMD and out of these 114 athletes, 108 (95%) were Vitamin D deficient. Serum PTH levels were found to have inverse relations with both Vitamin D (r= −0.629) and BMD (r=-0.267). Conclusions: Vitamin D deficiency is highly prevalent among the North Indian athletes and the presence of low Vitamin D (<20 ng/ml) levels is associated with low BMD and high PTH levels.
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LETTERS TO EDITOR Top

Study on the effectiveness of structured teaching program regarding knowledge of swine flu among nursing students p. 562
Kanika Guleria, Amandeep Kaur, Vipasha Kaistha
DOI:10.4103/ijcm.IJCM_645_20  
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A study on the sleep–Wake behavior during COVID-19 lockdown and its effect on menstrual cycle p. 564
Goutam Dutta, Karthiga Murugesan
DOI:10.4103/ijcm.IJCM_767_20  
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Screening and health education services by accredited social health activists regarding impact of psychoactive substance use and self-medication during pregnancy and lactation, at Government Health Centres in Bangalore, India p. 566
Prasanthi Nattala, KS Meena, Pratima Murthy, Girish N Rao, Parthasarathy Rajani, Padmavathy Doraiswamy
DOI:10.4103/ijcm.IJCM_800_20  
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Mitigating symptoms and enhancing quality of life among women with stress urinary incontinence p. 568
BS Suchithra, Fatima Dsilva, TP Rajeev, Neevan Dsouza
DOI:10.4103/ijcm.IJCM_859_20  
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Determinants of access to low-cost ultrasound services among pregnant women in rural areas of Keffi, Nigeria Highly accessed article p. 570
Idris Muhammad Yakubu, Srikanta Banerjee, Nwi-Ue Letam
DOI:10.4103/ijcm.IJCM_971_20  
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Oral health literacy and its relationship with oral hygiene status among school teachers in Davangere City p. 572
GK Divyapriya, DJ Veeresh, Puja C Yavagal, Nadaf Nousheen, Denzy Lawrence
DOI:10.4103/ijcm.IJCM_1022_20  
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Prevalence of mental health problems among high school students p. 574
Abirami Sakthivel, Suvetha Kannappan, Anuja S Panicker
DOI:10.4103/ijcm.IJCM_1041_20  
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Graduates of MD Community Medicine to specialize in infectious diseases: A long-term public health prospect p. 576
Manju Dubey, M Mohan Kumar, Yachana Choudhary, Manju Toppo
DOI:10.4103/ijcm.IJCM_1058_20  
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OBITUARY Top

Obituary p. 578

DOI:10.4103/0970-0218.328209  
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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007