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.

Summary: Human papillomavirus (HPV) vaccination is the primary preventive strategy to reduce the burden of cervical cancer as well as other HPV-related malignancies. Today, at least 144 countries provide the HPV vaccine as part of the national immunization schedule for girls. The original WHO recommendation of three doses of the HPV vaccine has been recently updated to a one to two-dose schedule. This has been proven to be cost-effective and will be able to protect more girls and women with the limited resources in low- and middle-income countries.

Summary: Mumps infection, a public health problem caused by the mumps virus, presents with uni/bilateral swelling of the parotid gland(s) with meningitis and orchitis as complications. The COVID-19 pandemic disrupted successful mumps vaccination programs. A prospective study was conducted from January to March 2024 to diagnose suspected mumps patients attending hospitals in southern India. Samples analyzed for mumps using fast-track diagnostics reverse transcription polymerase chain reaction kits were categorized as per WHO clinical case definition. Of 200 samples screened, 26 (13%) were positive - 10 blood, 11 cerebrospinal fluid, and 5 Buccal swab samples. In developing countries like India, laboratories with advanced testing methodologies reduce mumps-related morbidity.

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: Raised blood pressure (BP) is an important risk factor for cardiovascular diseases. Research has shown a negative gradient of BP with socioeconomic status (SES) in developed countries. However, studies in India reveal conflicting results.

Objectives: To examine the association between SES and BP among older adults in India and to explore the mediating mechanisms.

Methods: Structural Equation Modeling was employed to investigate the association of SES indicators (monthly per-capita expenditure and education) with systolic and diastolic BP using the cross-sectional data from Longitudinal Aging Study of India- Wave-1 (2017-2019). Separate models were fitted for rural men, rural women, urban men, and urban women to capture the residence- and gender-based variations. Mediating effects of bio-behavioral risk factors and antihypertensive medication use were explored.

Results: The sample size under analysis was 59,333. After adjusting for age, SES was positively associated with systolic and diastolic BP in both rural men and women. A clear pattern was not observed in urban men, while a negative association was observed in urban women. The hypothesized mediators exhibited a harmful mediating effect in all associations, with Body Mass Index being the strongest. There existed a significant protective effect of raising SES on BP in urban women which was not explained by the mediators.

Conclusion: In a country like India undergoing rapid socioeconomic changes, BP complexly interacts with SES, varying between residence and genders. This underscores the need for further exploration to inform effective public health interventions.

Background: Women's hypertension (HTN) is often underestimated and goes untreated due to the perception that women have a lesser risk of cardiovascular disease compared to males.

Objectives: The purpose of this study was to assess the prevalence and major risk factors of HTN in adult women of Punjab.

Materials and methods: A community-based cross-sectional study with multistage sampling design was conducted among rural population of Punjab. The survey was designed in accordance with the WHO STEPwise approach for surveillance of noncommunicable disease to provide prevalence estimates of risk factors for three age groups for HTN. Village was considered a primary sampling unit (PSU). From each selected PSU in a rural area, households were selected. The ultimate sampling units were the households.

Results: A total of 2160 females were screened for HTN. Eight hundred and twenty-seven (38.27%) were found to be hypertensive, with 27.9% in stage 1 and 10.4% in stage 2 HTN. Body mass index and reproductive health factors ( P = 0.001) were substantially linked with HTN. Significant disparities emerged in nutritional habits: hypertensive subjects exhibited higher average sugar intake ( P = 0.006) and salt intake ( P = 0.007) and were more likely to add table salt during meals ( P = 0.013).

Conclusion: HTN prevalence is alarmingly high in Punjab, posing significant risks for chronic diseases and other health complications among its residents. The findings from this research could provide crucial insights that form the basis for developing tailored public health programs, policies, and awareness campaigns focused on HTN and its risk factors in rural communities.

Background: Scrub typhus is an acute febrile illness caused by the Gram-negative cocco-bacillus Orientiatsutsugamushi , accidentally transmitted to humans by the bite of mite chiggers. Its epidemiology in India remains obscure due to under-reporting of cases.

Objectives: This single-hospital study prospectively determined the seropositivity, clinical features and treatment response of scrub typhus over 5 years in the city of Jodhpur, Western Rajasthan, from where no formal seropositivity data were previously available.

Methods: All patients with acute febrile illness of more than 5 days were screened according to the Department of Health Research-Indian Council of Medical Research (DHR-ICMR) 2015 guidelines and enrolled after their signed informed consent. Serological test Orientiatsutsugamushi immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) was performed. All positives were reported to Integrated Diseases Surveillance Programme.

Results: Over the 5-year study (2019-2023), a total of 1497 patients met the DHR-ICMR criteria, and 83 (5.5%) tested Orientiatsutsugamushi IgM ELISA positive. The classical clinical features such as eschar, rash, and lymphadenopathy were less common; and others such as myalgia, headache, malaise, altered sensorium, LFT derangement, thrombocytopenia, and leukocytosis were more commonly reported. More cases occurred during winter and responded well to doxycycline or azithromycin clinically. Three died before initiation of therapy.

Discussion: This is the first study from Jodhpur to describe the occurrence of scrub typhus, by the DHR-ICMR guidelines. Despite being a reportable disease under the Integrated Disease Surveillance programme, the epidemiology of scrub typhus remains obscure in India due to low clinical suspicion, poor availability of diagnostic services and under-reporting of clinical cases.

Background: Noise-induced nonauditory effects and hearing loss are increasingly recognized as significant occupational health risks.

Objectives: The study investigates the nonauditory and auditory effects of daily noise exposure on traffic policemen in Chandigarh, focusing on their knowledge, perceptions, and attitudes toward noise pollution.

Methods: A cross-sectional design was employed, comparing 100 traffic policemen exposed to noise pollution with a control group of policemen working in quieter office settings.

Results: The Chi-square test showed a statistically significant association between stress and irritation among traffic policemen compared to their office-based counterparts ( P < 0.05). However, no significant differences were found in responses regarding disturbance, headache, loss of sleep, or hypertension ( P > 0.05). Self-assessment of auditory effects revealed that 56% of traffic policemen experienced symptoms of tinnitus, compared to 29% of general policemen. Diurnal noise levels at various traffic junctions in Chandigarh showed the highest (L eq ) near the airport light point junction (79.9-78.8 dB) and the lowest at the Sukhna Lake entry point (72.0-69.89 dB). Average noise levels across all locations ranged from 76.04 to 75.30 dB, both during peak and nonpeak hours, well above the World Health Organization's recommended limit of 65 dB for traffic areas. Most traffic policemen were unaware of the harmful effects of noise pollution and did not consider it an occupational hazard.

Conclusion: This study highlights the need for stricter enforcement of noise control policies and increased awareness of noise pollution to reduce its impact on public health, particularly regarding noncommunicable diseases.

Background: Over the past three decades, adolescents' caloric consumption from energy-dense foods (EDF) has increased dramatically, coinciding with rising overweight and obesity rates in this population.

Objectives: To investigate the relationship between consuming a variety of energy-dense foods (VEDFs) and body mass index (BMI) in adolescents.

Materials and methods: In this cross-sectional study, 373 adolescents (13-15 years) from private schools were assessed for food consumption and anthropometric measurements using surveys and food frequency questionnaires.

Results: Among participants (mean age 13.4 years), 39.7% were underweight, 46.1% had normal BMI, 9.6% had overweight, and 4.5% had obesity. Adolescents consumed an average of 4 varieties and 10.6 servings of EDF daily. While VEDF was not associated with BMI, it significantly correlated with increased total food consumption.

Conclusion: In this adolescent cohort, consumption of VEDF did not directly influence BMI. Longitudinal studies are needed to assess long-term impacts on body composition.