Indian journal of public health最新文献

Background: Growth faltering among children is a global public health concern. Timely identification of growth faltering is crucial for appropriate interventions.

Objectives: We aimed to estimate the magnitude of growth faltering and its correlates in terms of sociodemographic characteristics, feeding status, and morbidity pattern among under-five children in a rural area of West Bengal.

Materials and methods: A community-based longitudinal descriptive study was conducted during May 2021 to July 2022 in a subcenter area of Bhatar block of Purba Bardhaman district, West Bengal. A calculated sample of 112 children aged 0-47 months selected randomly was followed up for 12 months at 2-month interval. Growth parameters were measured, and mothers/caregivers were interviewed for relevant data using a predesigned, pretested schedule. Bivariate and multivariable logistic regression was done for correlates and predictors of growth faltering. Analysis was done with SPSS-22.

Results: Incidence of at least one episode of growth faltering was 56.3/100 children, and incidence rate of growth faltering was 8.9 episodes/100 children-months. Unemployed father (adjusted odds ratio [aOR] = 35.3; 95% confidence interval [CI] = 2.3-543), children having ≥1 siblings (aOR = 11.4; CI = 3-43.4), and children whose mothers were married before 18 years (aOR = 0.3; CI = 0.1-0.9) were significant predictors of growth faltering. Growth faltering was significantly more among children with more episodes of morbidity ( P < 0.001) and fewer episodes of age-appropriate feeding ( P < 0.001).

Conclusion: Growth faltering among under-five children is quite high in the area, significantly associated with inappropriate feeding and episodes of morbidity. This can be properly addressed approaching through the high-risk attributes as identified by our study.

Background: "Indian Biomedical Journals" (IBMJs), despite a long-standing, lack the metrics and global visibility that a researcher would assume. Lately, there is a growing awareness regarding the issues faced by the IBMJs.

Objectives: To inform actionable solutions for intended consequences (pragmatism), a situation assessment was conducted by engaging the IBMJs publishing in English. Toward engaging a sustainable debate to help increase their global impact was the primary objective of this study.

Materials and methods: In March 2024, editors of IBMJs on varied subjects were invited to participate in a qualitative inquiry. Following journal landscaping (through a self-administered questionnaire), the editor-participants identified the broad domains of inquiry based on their lived experiences. These domains, among many, captured the quality of submitted research manuscripts, time to decision (TTD), financing challenges, etc. Finally, a group discussion with reflections on strengths, weaknesses, and opportunities helped triangulate the study findings.

Results: A total of 357 IBMJs were screened from the Journal Citation Reports 2023 list. Of these, 20 Science Citation Index Expanded Journals with ≥1000 citations and consistently attaining an impact factor of ≥1 over the five preceding years were invited. Of them, Editors of 13 Journals (three monthly, five bimonthly, and five quarterly) consented and participated. The oldest Journal of this cohort was over 110 years old, and the youngest was 16 years old. All Journals were published in hybrid mode, and only three levied article processing charges. The major strengths of the IBMJs were free access to published content irrespective of subscription status, low-cost publishing, and the ability to cater to research from a wide pool of non-native English-speaking investigators, mainly from the South Asian region. The weaknesses comprised receiving poor-quality manuscripts, lack of novelty, longer TTD, and voluntarism of editors and reviewers. Predominantly published in English, it was observed that IBMJs can promote multiregional collaborations in the Global South and beyond. Other identified opportunities were translating Indian research into multiple local languages (which could help increase visibility), enhancing capacity on "how to write and publish quality manuscripts," "promoting journals through social media and discussions in Journal consortia," and "walking science to the common mass."

Conclusion: This qualitative inquiry identified a few elements to build a future roadmap and revealed some opportunities to increase IBMJs' global footprint. Quality rather than quantity of research publications and innovative dissemination of regional research outputs appear critical in this direction.

Summary: Modern medicine often prizes technical mastery over the human element, yet the true essence of public health lies in the relationships between healers and the community. This oration explores the transition from a technically competent doctor to a "total quality individual" by integrating the World Health Organization's ten core life skills. In an era defined by rapid technological shifts and rising medicolegal pressure, soft skills such as empathy, communication, and emotional intelligence are no longer just "nice-to-have" traits; they are fundamental competencies. By adopting the Attitude Behavior Creativity Discipline - Effective Communication Goal Honesty Framework framework - covering attitude, behavior, discipline, and honesty - medical professionals can move beyond clinical success to achieve lasting professional satisfaction and institutional excellence.

Background: The changing patterns in the incidence of diseases have highlighted the importance of increasing government intervention toward noncommunicable diseases, but a detailed analysis is needed at the specific disease level.

Objectives: This study attempts to look in some detail at the burden of disease and the share of private and public sectors in providing health facilities across some selected ailments.

Materials and methods: Some specific ailments in both communicable and noncommunicable disease segments including infections, respiratory, cardiovascular, diabetes, and gastrointestinal are identified based on high disability index and medical costs. The unit-level data by the National Sample Surveys on Social Consumption related to Health carried out in the 71 st and 75 th Rounds along with Global Burden of Disease data provided by the Institute for Health Metrics and Evaluation formed the database.

Results: The number of ailments per 1000 persons in the last 15 days of the survey held for the out-patient cases reveal that infections stood at the highest level of 32% followed by cardiovascular at 16.7%. Despite low average annual expenditure on communicable diseases, the high number of hospitalized cases increase the total expenditure on this segment multifold.

Conclusions: In this ailments-based analysis, the rising incidence of non-communicable diseases like cardiovascular diseases, diabetes and neoplasms is observed along with the high incidence of the upper and the lower respiratory tract diseases and other infections which have afflicted Indian population for decades. Both in terms of deaths and disability index, two ailments in the communicable disease segment, namely, chronic respiratory diseases and infections need to be addressed along with rising incidence of cardiovascular diseases and cancer. The disproportionately higher burden of medical expenses on the low-income strata and stark differences between public and private sectors in the costs of providing health facilities needs to be addressed by target allocation of government budget.

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.

Introduction: With epidemiological transition, the prevalence of diabetes and hypertension has significantly increased. Adherence to self-care is crucial to achieve blood glucose and blood pressure (BP) control.

Objectives: The study aimed to understand the impact of a structured community engagement program on blood glucose and BP levels among patients with diabetes and hypertension, respectively.

Methods: Patients receiving treatment at two primary care clinics at Karnataka and Telangana were enrolled after obtaining consent. Peer groups were created and weekly sessions on self-care conducted for 12 weeks. BP, body mass index, and glycosylated hemoglobin were recorded pre- and postintervention.

Results: Out of 284 patients enrolled, 202 underwent baseline investigations, and 142 (70%) completed all sessions. A median 3 mmHg reduction in systolic BP (SBP) was observed among hypertensive patients post intervention.

Conclusion: Community-based engagement sessions contributed to reduction in SBP. Similar model can be considered under the National Programme for Prevention and Control of Noncommunicable Diseases to improve self-care among noncommunicable disease patients by training health workers.

Background: Vision impairment and blindness are major public health challenges, especially in low- and middle-income countries. Although the prevalence of blindness in India has reduced considerably, untreated cataract still remains a public health challenge. The World Report on Vision (2019) emphasizes the need to make eye care an integral aspect of universal health coverage and incorporate integrated people-centred eye care in health systems.

Objective: (1) To describe the setup of an Integrated Primary Eye Care model. (2) To describe the pattern of ocular morbidity among patients attending the primary healthcare clinics across four states in India.

Methods: Retrospective observational study describing the primary eye care services delivered across four states in India between August 2019 and March 2020. The de-identified secondary data were analyzed for the pattern of ocular morbidity.

Results: Seven thousand and twenty-four patients availed the eye care services across the four primary care clinics. Majority of the patients were female (54.7%), most patients belonged to the age groups of 45-60 years (33.2%) and 30-45 years (32.3%). Elderly patients of both genders had equal access to the eye care services. The common presenting complaints were diminished vision (83.1%), redness (9.5%), and pain (6.4%).

Conclusion: Uncorrected presbyopia (35%), refractive error (32.8%), and cataract (12.8%) were the commonly observed ocular morbidities. Integration of primary eye care into primary health care can improve access to eye care services, especially for vulnerable population such as elderly and women, who otherwise face several challenges to access eye care services.

Background: The hijra and transgender (H/TG) persons have enhanced risk of HIV infection.

Objectives: We aimed to explore whether there were any associations between stigma, HIV risk behaviors, and HIV seropositivity among H/TG persons in India.

Materials and methods: We analyzed 4966 H/TG participants, from the national integrated biological and behavioral surveillance survey conducted in 2014-2015 focusing on experiences of stigma from family, friends, and healthcare settings. Univariate, bivariate, and multivariate logistic regression were used to calculate the unadjusted and adjusted odds ratios with a 95% confidence interval, to assess the association if any, between stigma, HIV risk behaviors, and HIV seropositivity among H/TG persons in India.

Results: Nearly half of the participants reported experiencing stigma from social circles, whereas a significant proportion faced stigma in healthcare setting. The stigma was associated with HIV risk behaviors such as inconsistent condom use, substance use, and lower HIV knowledge. We did not find a direct association between stigma and HIV seropositivity, suggesting that while stigma influences behaviors, its impact on actual HIV infection rates may be more nuanced.

Conclusions: There was a need for targeted interventions to address stigma faced by H/TG from their social circle and also in healthcare setting.

Background: The global prison population exceeds 11.5 million, with a 3% Human immunodeficiency virus (HIV) infection rate, significant burden of Hepatitis C, and risk of undiagnosed infectious diseases due to limited prior healthcare access. On release, prisoners may reintegrate into society, contributing to the spread of infections.

Objectives: To estimate the burden and correlates of HIV, coinfections, and risk behaviors among prison inmates in three Indian states.

Materials and methods: This study utilizes data from the 17 th round of HIV Sentinel Surveillance Plus 2021, among prison inmates in Chhattisgarh, West Bengal, and Nagaland. Participants were interviewed using a structured questionnaire, and blood specimens were tested for HIV, Syphilis, Hepatitis B virus (HBV), and Hepatitis C virus (HCV). Data were analyzed using STATA version 17. Stratified data analysis was done employing Pearson Chi-square testing. Factors associated with HIV and any infection were assessed with multivariable logistic regression analysis controlling sociodemographic factors as potential confounders.

Results: Nagaland records the highest HIV (4.6%), Syphilis (3.6%), and HCV (1.0%), and West Bengal has the highest HBV burden (1.5%). Logistic regression revealed higher odds of HIV infection among those with a history of imprisonment, undertrial status, and good HIV knowledge. The burden of any infection was higher in the 30-39 age group and those with a prior history of imprisonment.

Conclusion: This study highlighted the interplay between sociodemographics and high-risk behaviors within prison settings and the concentrated HIV epidemic. The findings should drive actionable strategies, guiding strategic planning, intervention prioritization, and resource allocation to enhance overall public health outcomes beyond prison confines.

Summary: Supervisory monitoring visits play a vital role in strengthening surveillance systems in India's healthcare sector, particularly in sexually transmitted infection/RTI programs under the National AIDS Control Organization. This article focuses on the Apex Regional STD Centre at Vardhman Mahavir Medical College, Safdarjung Hospital, highlighting the impact of these visits on program implementation, data accuracy, and equitable healthcare services. Key recommendations include improving personnel training, optimizing supply chain management, and refining procurement processes. By empowering healthcare staff and ensuring robust operational procedures, supervisory visits contribute to enhanced health outcomes and the overall success of public health initiatives.