Indian journal of public health最新文献

Background: Bedridden patients heavily rely on caregivers for daily living activities and accessing care. They have the issues not only with physical health but also psychosocial and spiritual health.

Objectives: This study implemented a home-based supportive care model based on primary healthcare approach for bedridden patients and assessed its feasibility and effect.

Materials and methods: This model was implemented at a primary health center in rural Ballabgarh, Haryana. Health workers identified the bedridden patients, and medical interns assessed their concerns across physical, mental, social, and spiritual domains. Individual care plans were developed after family meetings, including caregiver training. Health workers conducted monthly home visits for medication refills and supportive care. Baseline and 3-month follow-up assessments used Edmonton symptom assessment scale-revised (ESAS-r) and distress thermometer to assess effect. Feedback was collected from patients, caregivers, and health workers.

Results: Of the 74 identified bedridden patients, 71 were enrolled. The mean age was 52.8 years, with a median bedridden duration of 6.1 years. The common symptoms included pain (91.7%), sleep-related issues (60.4%), and tiredness (56.3%). Postintervention, significant reductions were observed in distress scores (median score reduced from 6 to 4.5, P <0.05), pain (median score 5 to 4, P -value<0.05), tiredness (median score 2 to 0.5, P -value < 0.05), and depression (median score 1.5 to 0, P -value <0.05) on ESAS-r. Feedback from health workers and interns highlighted increased self-confidence, compassion for others, and gained respect in the community.

Conclusion: This model of home-based supportive care was feasible and effective in reducing the symptoms and distress among bedridden patients.

Background: Escherichia coli are the reservoirs of antimicrobial resistance (AMR) genes. Shiga toxin-producing E. coli of animal origin can cause severe life-threatening infections in man.

Objectives: The present study investigated the susceptibility of poultry-origin E. coli isolates to Clinical and Laboratory Standard Institute (CLSI)-recommended antibiotics and their Shiga toxin profiles.

Materials and methods: A total of 141 samples comprising cloacal swabs and water and litter samples were investigated. Antimicrobial susceptibility profiles of the recovered isolates were determined for 15 antibiotics as recommended by CLSI. Shiga toxin-encoding genes (Shiga toxin 1 [ stx1 ] and Shiga toxin 2 [ stx2 ]) and plasmid-mediated AMR determinants were ascertained by the polymerase chain reaction.

Results: E. coli isolation rates were 90.1% with a higher incidence in organized (93.8%) compared to backyard rearing systems (87%). AMR (21.3%) was limited to only three antibiotic classes, i.e., penicillins (9.4%), fluoroquinolones (11.0%), and phenicols (0.8%). All the isolates were susceptible to aminoglycosides, carbapenems, monobactams, and polymyxins with the absence of multidrug resistance. The incidence of resistant E. coli was significantly higher in organized rearing systems (30.0%) compared to backyard units (13.4%). All penicillin-resistant isolates were positive for bla SHV and two isolates co-expressed bla OXA-1 with bla SHV . 21.4% of fluoroquinolone-resistant isolates were positive for plasmid-mediated aac (6')-Ib resistance. 96.3% of resistant isolates carried isolates stx2 and none had stx1 .

Conclusion: Low AMR incidence was recorded in E. coli isolates of poultry origin for CLSI-recommended old and newer classes of antibiotics. Higher levels of stx2 detections in antimicrobial-resistant E. coli isolates pose a significant public health threat.

Background: In August 2023, a scrub typhus "outbreak-alert" was generated by the Integrated Disease Surveillance Program from Sagalee block, Arunachal Pradesh, India.

Objectives: We investigated to characterize the outbreak and identify possible exposures.

Materials and methods: A case was defined as immunoglobulin M antibody positive for scrub typhus by rapid diagnostic or enzyme-linked immunosorbent assay in resident (>6 months stay) of Sagalee block between January and September 2023 and identified from surveillance line-list and facility record review. We interviewed cases using a semi-structured questionnaire for demographics, clinical presentations, and possible exposures. We surveyed the case environment for shrubs, water bodies, domestic animals, and rodent infestation. We collected rodent pinna for mite isolation and serology samples for the Weil-Felix test and calculated entomological indices.

Results: Of 42 cases identified (67% females, median age 40 years, interquartile range 28-50), 83% were farmers and 62% had forest-dependent livelihoods. Eschar was present in 12% cases; 98% recovered, and one died. All cases resided either within 100 m of forest, fields, and water bodies or 10 m from bushes, 95% reported domestic or peridomestic rodent activity, and none used insect repellent or insecticide/rodenticide. Rodent infestation rate was 78% (18/23), chigger-index nine (207/23) (critical value 0.69), and 44% (7/16) of rodent samples had significant (>1:40) OXK titres in Weil-Felix test.

Conclusions: We demonstrated that conducive ecology, favorable human host behavior, and high density of vector infestation completed the epidemiological triad of scrub typhus. We recommended that the district heath unit to coordinate with the agricultural and allied departments for rodent control activities and community awareness for personal protection measures.

Background: End TB Strategy seeks to eliminate catastrophic costs for TB-affected households. Objectives: The study was done to address the knowledge gap with regards to catastrophic & out of pocket expenses (OOPE) incurred by TB patients and to identify its determinants.

Methods and material: A cross-sectional study was carried out at 2 randomly selected Tuberculosis Units in Lucknow district. Three hundred and seventy one drug sensitive TB patients were interviewed using a semi structured schedule to assess direct, indirect & coping cost and its determinants over the course of treatment. Chi square and Mann Whitney U test was applied to measure association of categorical and continuous data variable respectively, with incurring catastrophic cost. Multivariate regression analysis was used to identify predictors for catastrophic cost.

Results: About 18% of patients had catastrophic expenses, with a median of INR 28,670 (INR 6000-215,375) and a total median OOPE of INR 10,150 (INR 0-215,375). A higher proportion of households with TB patients aged 15-59 years, female, non-Hindu, rural inhabitants, and educational levels below high school experienced catastrophic and OOPE. Multivariate regression analysis revealed "Recurrent TB episodes," "place of first consultation," and "socioeconomic class-SEC" as significant predictors. TB patients with recurrent TB, First consultation at a private facility and belonging to lower SEC were more likely to incur catastrophic expenses.

Conclusions: Strengthening early case detection and enrollment of TB patients under National TB Elimination Programme in vulnerable population and addressing determinants like recurrent TB through tailored IEC can cut down on catastrophic and OOPE.

Background: The Ayushman Bharat-Health and Wellness Centers (HWCs) program envisages collective action for health through the formation of facility-level committees- Jan Arogya Samitis (JAS), at the HWCs.

Objectives: The study aimed to appraise the constitution and functioning of the JAS, identify the enablers and barriers in carrying out its functions, and explore the perceived level of decentralization among elected and nonelected community members in Punjab state of India.

Materials and methods: A sequential mixed methods study was conducted in a block of Punjab. The first phase consisted of quantitative assessment of the constitution and functioning of JAS, which was followed by in-depth interviews with the JAS members to understand the enablers and barriers for the functioning of the committee. The final phase comprised interviews with the elected local body representatives and community members to understand their perceived extent of decision space, capacities, and accountability for a series of healthcare functions.

Results: It was noted that JAS performed the functions of leading health promotional activities and enabling quality service delivery. However, the committees played a passive role in supporting village-level committees, monitoring services, and facilitating social accountability, majorly due to awareness gaps. The perceived extent of decision space, capacity, and accountability was found to be low to moderate with significantly higher decision space and accountability reported by elected representatives, in comparison to service recipients.

Conclusion: The study emphasizes the need of consistent support for strengthening local health governance through the structured capacity-building program for all the members of health committees and regular supportive supervision.

Introduction: Auxiliary nurse midwife (ANM) health workers are pivotal in providing preventive and promotive healthcare services, including vaccinations, disease screening, antenatal checkups, and health education at the primary healthcare level. Their tireless efforts in strengthening primary healthcare and combating recent pandemics are evident. This study aimed to assess the extent, associated factors, and reasons for burnout in a district of West Bengal.

Methods: This mixed methods research (explanatory-sequential approach: Quan-Qual) was conducted from May 2022 to January 2023, involving randomly selected 226 ANMs from 13 rural blocks (cross-sectional design). ANMs with maximum burnout were purposively selected for the qualitative follow-up. A self-administered, modified Copenhagen Burnout Inventory questionnaire captured three domains of burnout. Responses from an open-ended free-listing guide identified reasons for burnout. Adjusted multinomial logistic regression analysis determined factors associated with burnout. Findings were integrated and presented in a joint display.

Results: Out of 214 complete responses, 44.9% reported burnout, over single (20.1%), double (18.7%), and triple (6.1%) domains, namely personal (32.2%), work-related (28.5%), and patient-related (14.9%) burnouts. Chronic morbidity, lack of physical activity, and recent negative incidents were associated with higher burnouts, whereas <5 km home to work-site distance and more support from supervisor were protective factors. Qualitative exploration revealed logistics problems, workload, distance, lack of support, etc., as reasons for burnout. After data triangulation, burnouts were identified with individual, interpersonal, community, and institutional level socioecological attributes.

Conclusion: Almost 45% ANM suffered burnout. Addressing the interrelated factors at different socioecological levels could enhance productivity and job satisfaction, fostering a positive work environment.

Background: The initiative for managing severe acute malnutrition at the community level was officially launched statewide in Madhya Pradesh in 2020 as the part of the Poshan Abhiyan.

Objectives: The current study was carried out to examine the clinical outcome of the dietary interventions given to Severely Acute Malnourished (SAM) children receiving community-based rehabilitation named as C-SAM and determining its association with sociodemographic and feeding practices.

Materials and methods: An observational and prospective study was conducted on 400 children aged 6 months to 59 months. Interview of mother/caretaker was done to elicit the information regarding sociodemographic details and feeding practice of child using a structured and pretested questionnaire. Anthropometric assessment was done during home visit and documentation of the weight and height/length of the child was done. The outcome was assessed as cured/recovered, not recovered, defaulter, and death as per the recommended guidelines.

Results: The age group of 13-24 months had the highest percentage of SAM children (37.1%). After 12-week duration in C-SAM, 44.8% of study participants were found to be recovered and 7% required Nutrition Rehabilitation Center referral. The age of the child, mother's age at childbirth, father's education, exclusive breast feeding, and optimum feeding practices are found to be significantly associated with the outcome. On the follow-up, appreciably, no weight loss was observed in discharged children and 26 children among nonrecovered also gained recovery.

Conclusion: The clinical outcome observed therein shows the recovery with the 12-week protocol in less than half of the participants thus the strategy may be extended till the time child is gaining recovery.

Background: A study was conducted to examine variations in latent tuberculosis infection (LTBI) risk factors among household contacts (HHCs) of tuberculosis (TB) patients.

Objectives: The objective of this study was to assess LTBI prevalence among first-degree relatives (FDRs) and spouses of TB patients and identify associated risk factors.

Methods: A cohort study at JIPMER under Regional Prospective Observational Research for TB India included HHCs of newly diagnosed pulmonary TB patients. Prevalence ratios with 95% confidence intervals (CIs) were calculated using generalized linear modeling.

Results: Among 1318 HHCs of 548 TB patients, the mean ages were 45.2 (13.7) and 29.5 (16.1) years, respectively. LTBI prevalence was 58.1%, with 0.5% progressing to active TB. Spouses had a higher LTBI prevalence (64.2%) than FDR (55.8%), with a significantly elevated risk (PRR: 1.42, 95% CI: 1.11-1.83). Older age (40-59 and ≥60 years), bed-sharing, female gender, prolonged exposure, undernutrition, overweight/obesity, and alcohol use were linked to higher LTBI prevalence. Female spouses spent more time caring for index cases than male spouses.

Conclusion: Spouses had a higher LTBI prevalence than FDR. Screening programs should prioritize female spouses, undernourished individuals, overweight/obese individuals, and alcohol users to reduce TB transmission.