Indian Journal of Community Medicine最新文献

Children with developmental disabilities require medical care, rehabilitation therapies, and social welfare support. While district early intervention centers offer some services, the private sector remains unorganized. The study aimed to qualitatively assess caregivers' needs, identify gaps in referral linkages, and suggest health systems interventions to assure smooth transition from medical to rehabilitation services. In-depth interviews of 28 caregivers of children with cerebral palsy, intellectual disability and autism spectrum disorder were conducted. Interviews were analyzed from the perspective of health systems interventions, using content analysis. Study revealed three themes. The first theme related to inadequate information at diagnosis including insufficient information about complications among high-risk babies, and inadequate guidance when delayed milestones were observed. The second theme related to interaction with the doctor, highlighting perceived lack of knowledge among doctors about developmental disabilities, ineffective communication, and limited knowledge about rehabilitation services. The third theme was regarding challenges with rehabilitation such as caregivers' inadequate knowledge about therapies benefits and need for coordination between doctors and therapists. Findings indicate the need for strengthening knowledge about early childhood development, the benefits of early intervention, and strengthening referral pathways to assure coordination between available services and continuity of care.

Background: The global burden of malnutrition affects millions of children. Stunting, known as the chronic form of malnutrition, attacks the overall growth and development of the child. A child who is stunted is most likely to suffer from irreversible physical and mental damage. The study aims at formative research to identify and document various determinants of stunting in rural India.

Methods: The study was conducted in Kherol village of Sabarkantha district. Through an ethnographic approach, eight children (four stunted and four non-stunted) under the age of 2 years were enrolled in the study. For identifying the determinants of stunting, the children were observed for three consecutive days (approx. 12 hours a day) by researchers after obtaining consent from the parents. The observations were then analyzed based on the broad themes that emerged from the study.

Results: The observations were classified in to themes and analysis was conducted. The themes identified for analysis were feeding practices, food hygiene, animal exposure and sanitation and hygiene. Consumption of packet and junk food was found to be more among, stunted children. Families of children from non-stunted group maintained a better personal hygiene. Frequency of breastfeeding was found more among children of non-stunted group. Practice of handwashing after animal exposure was found poor among members of children who were stunted.

Conclusion: Improper feeding and poor hygiene and sanitation practices have a potential to jeopardize the nutritional status of young children and can be the mainspring for children to suffer from malnutrition and its lifelong consequences.

Background: Worldwide, there is a growing concern of Internet Gaming Disorder (IGD). IGD is an emerging problem in India, the top ranked country in gaming app downloads and the second largest Internet-using country in the world. Especially post pandemic, young adults spend longer hours on Internet and online gaming. This study was done to estimate the prevalence of IGD and to find out the association of IGD with sociodemographic and Internet gaming pattern characteristics.

Materials and methods: This cross-sectional study investigated the prevalence and predictors of IGD among 353 young adults aged 18-25 years in Tamil Nadu using an online self-reported questionnaire. Internet Gaming Disorder Questionnaire-Short Form (IGDQ-SF) assessing all nine DSM-5 criteria for IGD was used. Data were analyzed using the SPSS version 21. Categorical data are presented as frequency and proportions. Bivariate analysis and multiple logistic regression were done to identify the predictor variables of IGD. P value < 0.05 is considered statistically significant.

Results: Out of 353 young adult participants, 3.4% had IGD. Multiple logistic regression analysis revealed that age of starting gaming, money spent on Internet, buying and playing online games, amount of time spent online on weekends, and type of game played were strongly associated with IGD (P < 0.05).

Conclusion: Understanding the prevalence of IGD and its causes and associated factors remains limited, underscoring the need for additional research and the implementation of preventive measures.

Introduction: Mumps is an acute viral infection characterized by swelling of parotid or other salivary glands. In November, 2023, a clinical case of mumps was detected during a household visit in Ajwan village, Naubatpur block, Patna, which led to the investigation to determine a possible outbreak of mumps along with its epidemiology and to implement control measures.

Methodology: House-to-house survey was conducted in localities with clustering of probable cases to gather necessary data using a structured questionnaire. The team provided medications to detected cases and conducted health awareness activities. The Integrated Disease Surveillance Programme unit, Patna, was alerted, and the line list of cases was shared. Specimens collected from eight active cases were "Reactive" for Mumps IgM antibody.

Results: A total of 109 houses were surveyed, and 51 cases of mumps were detected with the majority (45.0%) between 6 and 10 years of age and a higher proportion of males (51.0%). The majority (56.9%) reported bilateral parotid gland swelling. None were immunized against mumps, and isolation was practiced by only 1 (2.0%). The majority visited local pharmacy for medication (68.6%), followed by unregistered practitioner/quack (11.8%). The overall attack rate of the outbreak was 6.36%, and the highest attack rate was observed in the 6-10 years age group (23.95%).

Conclusion: The outbreak investigation findings emphasize the need for health awareness drives regarding mumps and the importance of isolation. With sporadic cases and cyclical outbreaks occurring regularly in India, introduction of the two-dose schedule of Measles-Mumps-Rubella in the national immunization schedule needs to be considered along with inclusion of mumps in the list of diseases under surveillance.

Background: The fear of falling among older adults poses significant health and psychosocial challenges. The current research aimed to assess the prevalence of fear of falling among older adults in selected villages of Tamil Nadu, India, and to explore the factors associated with it.

Materials and methods: A community-based cross-sectional study was conducted among older adults aged 60 years and above in Vellore District, Tamil Nadu. Four villages have been randomly chosen for the study, namely Venkatapuram, Vasanthanadai, Mothakkal, and Pillayar Kuppam. Also, a systematic random sampling was employed to select households from the line list. Data were collected using the BG Prasad socioeconomic scale, Falls Efficacy Scale International (FES-I), and Geriatric Depression Scale (GDS). Descriptive statistics and Chi-square tests were utilized for data analysis.

Results: A high proportion of older adults (82%) self-reported experiencing fear of falling (n = 187). The prevalence of fear of falling (FOF) increased with advancing age, with the highest prevalence observed in individuals aged 80 years and above (97%), followed by those aged 70-79 years (84%) and 60-69 years (78%). Female participants reported a higher prevalence of FOF (86%) compared to their male counterparts (71%). Additionally, FOF was more common among individuals with a history of falls, existing comorbidities, depressive symptoms, and limited social support.

Conclusion: This study highlights fear of falling as a significant concern among older adults, driven by a range of demographic, physical, and psychosocial factors. Implementing targeted interventions to address modifiable risk factors is essential for reducing the fear of falling in this population.

Background: Unintended pregnancies, whether mistimed or unwanted, are a major public health concern. These pregnancies can negatively impact maternal and child health, as well as the social and economic well-being of families. A community-based cross-sectional study was conducted in Aligarh, North India, to estimate its prevalence and sociodemographic and women-specific correlates.

Materials and methods: The sample size for this study was calculated using a 14% prevalence rate of unintended pregnancies, with the formula N = [(1.96)²* P(1-P)]/L², where P represents the prevalence rate (14%) and L is the margin of error (3.5%). After adjusting for the nonresponse rate, the final sample size was determined to be 435 participants, all of whom were included in the analysis. Pregnancy intentions were assessed using the London Measures of Unintended Pregnancy (LMUP) scale, and data analysis was conducted using SPSS version 20.0.

Results: The overall prevalence of unintended pregnancies among the study population was 34%. Several determinants were found to be significantly associated with unintended pregnancies, including women aged over 30 years (AOR: 2.09), rural residence (AOR: 2.32), lower educational levels, having a spouse engaged in unskilled labour, pregnancy before the age of 18 (AOR: 7.42), and high birth order.

Conclusion: The study identified key factors associated with unintended pregnancies, including younger maternal age, rural residence, low education, and low socioeconomic status. Women-specific factors included early marriage and first pregnancy, high birth order, and lack of autonomy.

Background: Childhood, a crucial phase in one's development, is vulnerable to many vaccine-preventable diseases. COVID-19 pandemic disrupted routine immunization services in the state. Process evaluation of routine immunization service delivery in Assam.

Methods: A total of 2312 session sites in 33 districts of Assam were monitored using a supportive supervision tool developed by MOHFW. Descriptive and analytical statistics were used and analyzed using SPSS v. 25.

Results: The head count record was present in 88.9% of session sites; 93.5% had an updated due list. A blank MCP card was present in 75.1% of session sites, while in 70.1% of sites, the ANMs did not have the counterfoils. Hand washing facility was available in 81.6% of session sites. There was display of communication materials like posters on routine immunization (61%), posters on intensified Mission Indra Dhanush (IMI) (5.5%), banners (3.4%), and wall painting (on RI; 2.3%, IMI: 0.2%), while no IEC materials were displayed in 12.2% sessions. The availability of immunization logistics ranges from 70% to 94%.

Conclusion: Uninterrupted supply chain and sessions as per micro plan with quality maintenance are necessary to further strengthen routine immunization.

Background: India is endemic for rabies, the most dreaded complication of animal bites which accounts for 35-40% of the world's rabies cases. The Anti-Rabies Vaccine (ARV) is the only proven way to prevent deaths due to rabies; however, its compliance is still a matter of concern. This study was conducted with objectives to (1) generate the epidemiological profile of dog bite cases and (2) assess the determinants of ARV compliance.

Methodology: A prospective study was conducted at a Primary Health Centre (PHC), also the RHTC of a medical college in Ahmedabad, Gujarat. All consecutive incident cases of animal bite registered at RHTC between May-Dec 2023 were included and followed for 60 days (post-bite). All cases, whether ARV compliant or not were approached by home visits or telephonic meetings. Data were collected using a pre-designed semi-structured questionnaire.

Results: There were 221 cases of dog bites. Most involved were stray dogs 175 (79.2%). Bites occurred more in public places (75.1%), during the evening and early night hours, accounting for 42.5% of cases with a peak during September-November (45.2%). As for the treatment-seeking pattern, 40.7% did not do anything at home. Maximum cases were from category II 58.4%, followed by 30.3% and 11.3% cases from categories I and III. ARV was indicated in 196 cases; 121 (61.7%) of them fully complied with ARV. Reasons for non/poor compliance were feeling cured, being out of the station, and a lack of specific reasons. Important compliance determinants were the occupation of the case and the status of the animal vaccination.

Conclusion: Only 61.7% of cases had complete ARV compliance, highlighting compliance issues and the necessity of community-based awareness campaigns that emphasize wound care and ARV schedule completion.

Background: 'Delhi Triage and Treat Tuberculosis (D-TAT)' is a statewide differentiated tuberculosis care initiative to reduce tuberculosis deaths involving triaging for severe illness at diagnosis, followed by inpatient care. This operational research aimed to assess the feasibility in settings like Delhi (high transfers out of state, tuberculosis burden, and population density) and provide therapeutic nutrition (oral liquid Formula75) with a focus on inpatient care for very severely undernourished (one of the conditions identified during triaging) adults with tuberculosis.

Methods: This was a longitudinal descriptive study among public notified adults (≥15 y) with tuberculosis. Secondary data from Ni-kshay (case-based information management system of tuberculosis program), D-TAT severe tuberculosis web application, and paper-based therapeutic nutrition clinical tracking tool were used.

Results: Of 48 407 notified during January to September 2024, 22 326 (46%) were triaged, 899 (4% of triaged) were triage-positive, and 335 (38%) were admitted for a median of 8 days. Of 216 triage-positive in the January to June 2024 cohort, 75 had very severe undernutrition along with the provision of Formula 75, with a mean of 1085 mL consumption per day. Of these 75, 44 (59%) were unable to stand without support at admission, and this reduced to 11 (15%) on day 7. A total of 52 (69%) were stabilized and shifted to a high protein diet after a mean of 4 days (standard deviation: 2). Three died during admission.

Conclusion: There is a need to improve the quality and coverage of triaging and earmark isolation beds with therapeutic nutrition in additional hospitals. The first-ever findings of therapeutic nutrition are encouraging and should be scaled up.

Background: Tuberculosis (TB) remains a global health challenge, with India being severely affected. Despite efforts like the End TB Strategy and the National Strategic Plan for TB Control, the burden persists, necessitating innovative approaches such as the Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA). This study aims to assess the implementation and reach of PMTBMBA nutritional support, examining factors that influence its uptake among persons with TB (PwTB) and Ni-kshay Mitra: a voluntary donor to PwTB.

Materials and methods: Aggregated data variables from the records and registers of Ni-kshay Portal were analyzed for the duration of September 2022 to May 2023. It examined the nutritional support coverage under PMTBMBA initiative and outcomes of PwTB and uptake of scheme among Ni-kshay Mitra.

Results: The PMTBMBA showed 51% Ni-kshay Mitra supported, with varying levels of support provision across the states. Notably, 9.6% of PwTB documented with receipt of benefits during initial months, with better coverage in certain states. Most of the Ni-kshay Mitra distributed nutritional support, and analysis demonstrated a significant association between Ni-kshay Mitra support and improved treatment outcomes. This finding was confirmed through Chi-square analysis (P < 0.001, OR = 2.2) and regression analysis, showing that PwTB without support are significantly more likely to have unfavorable outcomes (Exp (B) =1.671).

Conclusion: The PMTBMBA represents a crucial initiative in India's TB control efforts, integrating comprehensive support for PwTB. However, challenges in volunteer engagement and geographical disparities highlight the need for targeted strategies and equitable nutritional support allocation. The study underscores the importance of community involvement and nutritional support in enhancing TB treatment outcomes, emphasizing the program's potential to drive progress toward TB elimination.