Showing papers in "Indian Journal of Public Health in 2017"

Nomophobic behaviors among smartphone using medical and engineering students in two colleges of West Bengal.

Abstract: Background: Growing smartphone usage among global and Indian college students has resulted in considerable issues of “nomophobia” (NMP) or feelings of discomfort or anxiety experienced by individuals whenever unable to use their smartphones. This significantly impacts their health, work, and study. Objective: The objective of this study is to find out the prevalence of NMP among smartphone using medical and engineering undergraduates of West Bengal and to compare the nomophobic behaviors, its predictors, and smartphone usage among them. Methods: A cross-sectional study was conducted among 303 medical and 305 engineering undergraduates in West Bengal using a validated NMP questionnaire consisting of four factors. Comparison of means of individual questions and factor scores was done. Nomophobic clusters among the two groups were identified using two-stage cluster analysis. Binary logistic regression was used for comparison of predictors of NMP. Results: Engineering students showed a higher proportion of nomophobics (44.6%) than medical students (42.6%). Significant higher means was observed among engineering students for the factor “giving upconvenience” and individual variables like “scared due to running out of battery,” “nervous due to disconnection from online identity,” “uncomfortable when unable stay up-to-date with social media” and “anxious when unable to check E-mails.” A Higher proportion of nomophobics among both groups were females, those owning smartphone beyond 2 years, having monthly mobile bill above Rs. 200 and spending over 4 h daily on smartphone. Conclusion: NMP has emerged as a significant cause of concern among both the groups. Standardized measures for identification and appropriate psychobehavioral therapy for those seeking help might alleviate the problem.

Multisectoral approach for promoting public health

Abstract: Multisectoral approach (MSA) refers to deliberate collaboration among various stakeholder groups (e.g., government, civil society, and private sector) and sectors (e.g., health, environment, and economy) to jointly achieve a policy outcome. By engaging multiple sectors, partners can leverage knowledge, expertise, reach, and resources, benefiting from their combined and varied strengths as they work toward the shared goal of producing better health outcomes. Improving public health (PH) is challenging because of the size of its population and wide variation in geography. MSA help in addressing identified health issues in focused way as it helps in pooling the resources and formulating the common objectives. One of the major advantages is optimization of usage of resources by avoiding duplication of inputs and activities which tremendously improve program effectiveness and efficiency. Willingness at the leadership and mandate at the policy level are necessary to plan and execute the successful multisectoral coordination. All the major stakeholders require to share the common vision and perspective. Developing institutional mechanism is utmost requirement as it will standardize the processes of intersectoral coordination (ISC). Creation of PH cadre is strategic move to meet the major health challenges being faced by the health system, and it would be anchor of establishing systematic ISC. There are many national and international examples of MSA applications such as for malaria elimination, tobacco control, HIV/AIDS prevention, Finland's community-based cardiovascular disease prevention project (North Karelia Project), and Singapore's Health Promotion Board. Promotion of MSA within the health system and with other ministries is seen as an important measure for effective implementation and improving efficiency.

A study of falls among elderly persons in a rural area of Haryana.

Abstract: Background: Falls are a common, disabling, and frequently fatal health concern among elderly persons. Assessment of the prevalence of falls and associated factors can lead to the identification of corrective measures, which can help in preventing falls and their consequent effects on health and well-being of the elderly. Objectives: The objective is to determine the prevalence of falls among elderly persons in a rural area and to study the association of falls with sociodemographic variables and selected health conditions. Methods: In a community-based, cross-sectional study conducted among 456 elderly persons in a rural area, information regarding sociodemographic details, selected health conditions, and history of falls in the past 12 months was recorded. Univariate analysis followed by stepwise multivariate logistic regression analysis was carried out. The effect of sociodemographic and various health conditions on falls was analyzed using logistic regression analysis. Results: Among the 456 study participants, the prevalence of falls in the past 12 months was 36.6% (95% confidence interval [CI] =32.1–40.0). The prevalence among women was 40.6% (95% CI = 34.5–46.7) and among men was 31.5% (95% CI = 25.0–37.9). Low socioeconomic status, urgency of micturition, knee pain, visual impairment, hearing impairment, functional disability, and depression were significantly associated with falls. Conclusions: Falls are common among elderly persons. Health programs for the elderly must include prevention of falls and rehabilitation of fall-related injuries.

Smokeless tobacco and public health in Bangladesh.

Abstract: Despite the high prevalence of smokeless tobacco (SLT) use among adults in Bangladesh, SLT was not included in the Tobacco Control Law till 2013. Information on SLT use among Bangladeshi people is inadequate for policymaking and implementing effective control measures. With the aim to identify the prevalence and trends of different SLT products, health and economic impacts, manufacture, and sale of and policies related to SLT in Bangladesh, we carried out a literature review, which involved literature search, data extraction, and synthesis. Evidence suggests that in Bangladesh, SLTs range from unprocessed to processed or manufactured products including Sada Pata, Zarda, Gul, and Khoinee. Over 27% of Bangladeshi adults aged 15 years and older use SLT in one form or other. SLT use is associated with age, sex, education, and socioeconomic status. SLT consumption has reportedly been associated with increased prevalence of heart diseases, stroke, and oral cancer and led to around 320,000 disability adjusted life years lost in Bangladesh in 2010. No cessation service is available for SLT users in public facilities. Compared to cigarettes, taxation on SLT remains low in Bangladesh. The amendment made in Tobacco Control Law in 2013 requires graphic health warnings to cover 50% of SLT packaging, ban on advertisement of SLT products, and restriction to sale to minors. However, implementation of the law is weak. As the use of SLT is culturally accepted in Bangladesh, culturally appropriate public awareness program is required to curb SLT use along with increased tax and cessation services.

Youth tobacco use in South-East Asia: Implications for tobacco epidemic and options for its control in the region

Abstract: Nearly half of all male population and two in every five females in the WHO South-East Asia Region (SEAR) consume some form of tobacco. Preventing initiation among adolescents is critical for overall tobacco control. We assessed the trends in youth tobacco use and policies in SEAR. Data are used from school-based youth (Global Youth Tobacco Survey and global school student-based health survey) and adult (Global Adult Tobacco Survey, STEPS) tobacco surveys and the WHO Framework of Convention of Tobacco Control (FCTC) implementation database. More than 10% of 13-15-year-old adolescent students reported tobacco use in 8 out of 11 countries. The prevalence of smokeless tobacco exceeded that of cigarettes except in Indonesia, Thailand, and Timor-Leste. No consistent declining trends in tobacco use were observed in any of the countries with 3 or more data points. More than half of all daily smokers aged 20-34 years initiated "daily" smoking before 20 years of age. 19% (Bangladesh) to 55% (Timor-Leste) of 13-17-year old students tried their first cigarette before their 14th birthday. Majority of adolescent students in most of the SEAR countries reported purchasing their cigarettes from store/shop/vendor and as single sticks, with few exceptions and purchased them as "single" cigarette. There is a limited change in affordability of cigarettes in SEAR over time. Tobacco use remains high among youth in SEAR. Efforts should be strengthened to fully implement/enforce recommended policy measures (legal minimum age, fiscal measures to reduce tobacco affordability; prohibiting sale of single cigarettes, etc.) and to explore new measures (e.g., tobacco-free generation).

Tobacco use among thai students: Results from the 2015 global youth tobacco survey.

Abstract: Background: Tobacco use often starts in adolescence and is a leading cause of premature mortality. Two previous rounds of the global youth tobacco survey (GYTS) found that a significant proportion of Thai youth currently smoke. Objectives: We conducted the third round of GYTS in Thailand in 2015 to monitor trends in tobacco use. Methods: We selected 31 public and private secondary schools using random sampling based on probability proportional to school enrolment. In each school, we selected 1–3 classes (Grades 7–9) by random sampling. All students in these classes from 30 schools (one school declined) completed a self-administered standard questionnaire in the Thai language. The association between tobacco use and independent variables was examined using univariate and multivariable logistic regression analysis. Results: Of 1876 students, 1721 were aged 13–15 years. Overall, 15% of students currently used tobacco; boys 21.8% and girls 8.1%. The prevalence of current cigarette smoking was 11.3%; 3.3% students currently used electronic cigarettes. Exposure to secondhand smoke (SHS) at home, school, and in enclosed public places was reported by 33.8%, 47.9%, and 38.6%, respectively. Among current smokers, 44% were not stopped from purchasing cigarettes despite being underage. Higher tobacco use was associated with being older, male, exposed to SHS, in possession of an object with a tobacco logo, and being offered a free tobacco product by a tobacco company. Conclusion: Tobacco and cigarette use among Thai students remains high. Underage current smokers have easy access to cigarettes. Urgent steps are needed to curb the access of youth to tobacco.

Aggregate availability of doctors in India: 2014–2030

Abstract: Background: The current belief of availability of doctors in India is based on the registration stock of doctors accumulated since the early 20th century. This has not been adjusted to attrition of the strength occurring due to retirement, emigration, etc. Objectives: To estimate the number of practicing doctors currently available in India and will be available in 2030 after adjustments made for attrition of the stock. Methods: The paper used Medical Council of India's historical data (1960–2015) on registration stock of doctors obtained from the Indian medical registers available on its website and other data on emigration of doctors accessed from Organization for Economic Cooperation and Development and destination country sources. Results: The paper found that there were only 4.8 practicing doctors per 10,000 population available in India in 2014, in contrast to the belief of having 7 doctors per 10,000 people. Rest of the registered doctors have either retired or emigrated from the country to practice abroad. It is estimated that the country would be able to achieve a ratio of about 6.9 practicing doctors per 10,000 people only by 2030. Conclusion: Given these findings of the current availability of doctors per 10,000 people and their growth prospects over the next 15-year period, it looks like an impossible task to achieve even a moderate doctor-population ratio of 1:1000 by 2030. Therefore, a genuine commitment to provide equitable healthcare to the rural population must innovate and experiment a special cadre of practitioners for rural areas on a pan-India basis.

Perceived psychological stress among undergraduate medical students: Role of academic factors

Abstract: Recently, there is a growing concern about stress during undergraduate medical training. The objectives of our study were to assess perceived stress among undergraduate medical students and to find out academic factors as determinants. A cross-sectional, questionnaire-based survey was carried out among undergraduate medical students of R. G. Kar Medical College, India, during July 2011-June 2012. Perceived stress was assessed using the Perceived Stress Scale-14. A 10-item questionnaire was used to assess academic sources of stress and their severity. The overall mean perceived stress score was 29.58 (standard deviation [SD] = 6.60), and 46.3% of the participants were in the group of more stressed (perceived stress score ≥28). The academic stressor factors predicted 78% of variability of perceived stress. A higher level of perceived stress was reported by the students. The students should be taught different stress management techniques to improve their ability to cope with a demanding professional course.

Urinary tract infection among pregnant women at a secondary level hospital in Northern India.

Abstract: Background: Urinary tract infection (UTI) during pregnancy is frequently associated with complications. Currently, in India, there is no regular screening for UTI, and facility for diagnosis of UTI is not available at peripheral government health centers. Objective: To estimate the proportion of pregnant women with UTI among antenatal clinic attendees in rural Haryana. Methods: Eligible participants were pregnant women attending antenatal clinic of secondary care center of rural Haryana from March to May 2015. Consecutive sampling was done to select pregnant women. Interview schedule was administered to the selected women, and midstream urine sample was collected. Urine sample was plated on MacConkey agar, and colony count was done using standard methods. Results: A total of 1253 pregnant women were included in the study. The proportion of women with symptoms of UTI on the basis of history was 33.3% (95% confidence interval [CI] - 30.7, 35.9), and UTI by colony count was 3.3% (95% CI - 2.4, 4.5). The presence of UTI was found to be significantly associated with the presence of any symptom of UTI on multivariate analysis (odds ratio [95% CI] - 7.35 [1.95, 27.77]). Conclusions: The burden of UTI among pregnant women attending antenatal clinic of a sub-district hospital was considerable, more so among the women that presented with symptoms suggestive of UTI. The study suggested that considering the burden of UTI and its complications, diagnosis of UTI at a resource-constrained setting like a secondary care hospital can be done after screening women for symptoms suggestive of UTI.

Depression in cancer patients undergoing chemotherapy in a tertiary care hospital of North Bengal, India.

Abstract: Background: Detection of cancer and subsequent chemotherapy can lead to clinical depression in many cancer patients. Objectives: The study was conducted to find out the extent of depression in cancer patients undergoing chemotherapy and determine the factors associated with depression. Methods: A cross-sectional descriptive study was conducted at the Chemotherapy Day Care Centre of North Bengal Medical College and Hospital from May to June 2013. A total of 174 cancer patients were selected and interviewed after obtaining informed consent and Institutional Ethics Committee Clearance. Brief Edinburgh Depression Scale was used to find out depression with a score of 6 and above indicating depression. Data obtained was analyzed using SPSS software version 20. Logistic regression was used to see the relative importance of multiple contributing factors toward depression. Results: Out of 174 cancer patients, 97 (55.7%) were found to be depressed. Depression was comparatively higher in patients ≥50 years; in males; those belonging to religion other than Hindus; who received higher education; had monthly family income ≥5000 rupees and were involved in moderate or heavy work. Nearly 70.6% of blood cancer patients; 64.3% of those who had been receiving chemotherapy for ≥6 months and 56.9% of those in their 4th or less cycle of chemotherapy were found to be depressed. Conclusion: The study revealed depression is substantially high among cancer patients undergoing chemotherapy in this area. Diagnosis and treatment of cancer patients need to be complemented by psychological support for the cancer patients.

Pediatric HIV in India: Current scenario and the way forward

Abstract: In India, the prevention of parent-to-child transmission and antiretroviral therapy services for HIV-infected mothers and children have been rapidly scaled up over the recent years. Despite these advances, a large number of HIV-infected children are born in every year. A thorough literature review has been done by retrieving related studies (published from the year 2000 onward); using a Medline search and by extracting recent findings from the official websites of the National AIDS Control Organization, UNAIDS, UNICEF, and World Health Organization. The efforts that are made to control pediatric HIV are challenged by a large range of factors such as low health service utilization, poor drug adherence, delayed infant diagnosis, discriminatory attitude of health providers, loss to follow-up, and poor coordination in managing continuum of care. These challenges may be addressed by adopting innovative and effective strategies and strengthening the existing health system. This would bring about a significant reduction in pediatric HIV incidence and improve the outcomes in children who are HIV infected.

The rise of global health diplomacy: An interdisciplinary concept linking health and international relations

Abstract: Global health diplomacy (GHD) is relatively a very new field that has yet to be clearly defined and developed though there are various definitions given by different experts from foreign policy, global health, diplomacy, international relations, governance, and law. With the intensification of globalization and increasing gaps between countries, new and reemerging health threats such as HIV/AIDS, tuberculosis, influenza, severe acute respiratory syndrome, Ebola, and Zika and a gradual rethinking on security concepts framed a new political context. The health problems addressed diplomatically have also become diverse ranging from neglected tropical diseases, infectious diseases, sale of unsafe, counterfeit drugs to brain drain crisis. We see that global health has become more diverse as the actors widened and also the interests appealing not only to the traditional humanitarian ideals associated with health but also to the principles grounded in national and global security. Recently, we are witnessing the increased priority given to the GHD because the issue of health is discussed by various actors outside the WHO to shape the global policy for health determinants. In fact, the area of health has become the part of UN Summit Diplomacy involving the G8, G20, BRICS, and the EU. The recent WHO Pandemic Influenza Framework, UN High Level Framework on Prevention and Control of Noncommunicable Diseases, and the WHO Framework Convention on Tobacco Control are some of the examples of long-term negotiation processes for agreements that took place.

Organ donation in India: Scarcity in abundance

Abstract: In modern era, India witnessed its first successful corneal, kidney and cardiac transplant in the year 1960, 1967 and 1994 though the reverberations for organ donation and transplantation (ODT) existed since time-memorial with roots existing in Hindu mythology along with vivid example of Guru Dadheech and lord Ganesha. No country in the world is able to meets its organ requirement. Government of India promulgated Transplantation of Human Organ and Tissues Act in 1994 and with the view to enlarge its scope and promote organ donation government has brought new amendments as of year 2014 and 2017. In the background of this journey many new developmental milestones have been achieved in the country however organ donation which has assumed public health significance has been consistently lower than expectations. This manuscript highlights the current status of ODT in the country; legislative environment, limitations, challenges, health education activities, and newer initiatives.

Out-of-Pocket health expenditure and sources of financing for delivery, postpartum, and neonatal health in urban slums of Bhubaneswar, Odisha, India.

Abstract: Background: Out-of-pocket expenditure (OOPE) is an obstacle in the path of getting universal health coverage in India. Objective: This study aimed to explore the OOPE, sources of funding, and experience of catastrophic expenditure (CE) for healthcare related to delivery, postpartum, and neonatal morbidity. Methods: A community-based, cross-sectional survey was conducted among a sample of 240 recently delivered women from the slums of Bhubaneswar, Odisha. Information on background, details of delivery, expenditure on delivery and on morbidities, and sources of funding was collected using a structured interview schedule. Results: Only 29.6% of the households incurred OOPE, and the others incurred either nil OOPE or had a net income because of benefits received from Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojana (JSY), and “Mamata” schemes of the government. The median total OOPE was found to be 2100 INR (100–38,620). Multivariate analysis found parity, place of delivery, type of delivery, and presence of morbidity to be significantly associated with incurring any OOPE. Nearly 15% of the households incurred OOPE exceeding 40% of the reported monthly household income including 9%, whose OOPE was 100% or more of the reported household monthly income. Conclusion: While mechanisms such as JSSK, JSY, and Mamata had benefitted the vast majority, around half of those who did incur OOPE experienced CE. Additional insurance facility for cesarean section delivery might reduce the excessive financial burden on households.

Caregiver burden on wives of substance-dependent husbands and its correlates at a Tertiary Care Centre in Northern India.

Abstract: Background: Substance dependence is well recognized as a complex biopsychosocial phenomenon. Complications arising out of it not only impairs life of substance-dependent patient but also causes enormous burden on their caregivers. Little attention has been paid to the relationship between caregiver burden and substance use. Objectives: The study was conducted to assess and compare the quantum of burden on wives of alcohol and heroin-dependent patients and also to determine the correlation between sociodemographic factors and caregiver burden. Methods: A cross-sectional study was conducted at a tertiary care center of North India to compare burden on wives of alcohol and heroin dependent husbands. Burden was assessed using burden assessment schedule (Sell et al.). Data obtained were analyzed using SPSS software. Results: Wives of both alcohol and heroin dependent patients had moderate-to-high burden of caregiving (Score of 38.1 out of maximum 60), those of heroin dependent patients perceived more burden in the factors of “impact on marital relationship,” “appreciation of caregiving,” “impact on relation with others,” and overall burden as compared to wives of alcohol-dependent patients. Significant negative correlation was found between “impact on marital relationship,” “appreciation of caregiving,” and “impact on relation with others” scores and patients' education status as well as between “appreciation of caregiving” score and wives' age where higher score denotes more burden. Conclusion: Significant burden exists on wives of substance-dependent patients; thus management plans must be devised aiming not only patients but also wives so as to reduce burden.

Vitamin D status of adult females residing in Ballabgarh health and demographic surveillance system: A community-based study.

Abstract: Background: Vitamin D deficiency (VDD) is widespread, yet it is the most underdiagnosed and undertreated nutritional deficiency in the world. The prevalence of VDD is estimated to affect over 1 billion people worldwide. Objectives: The present study was conducted to estimate the prevalence of VDD among adult females aged 20–60 years residing in a rural community of North India, and to find its association with various sociobehavioral risk factors. Methods: The present study is an analytical cross-sectional study conducted among females aged 20–60 years in rural Ballabgarh. Four hundred women were randomly selected from one of the villages of the Health and Demographic Surveillance System. Semi-structured, pretested interview schedule was administered to the study participants. Fasting venous blood sample was collected for the measurement of plasma sugar level and Vitamin D (25-hydroxyvitamin D). Results: The prevalence of VDD was 90.8% (95% confidence interval [CI] – 87.5–93.3), while that of Vitamin D insufficiency was 8.9% (95% CI – 6.4–12.2). On logistic regression analysis, 24 h calorie intake, protein intake, and prediabetes status of the participants were significantly associated with VDD. Conclusion: Very high prevalence of VDD was observed among the females (20–60 years) residing in rural Ballabgarh.

Effect of a brief smoking cessation intervention on adult tobacco smokers with pulmonary tuberculosis: A cluster randomized controlled trial from North India.

Abstract: Background: An association between smoking and poor tuberculosis (TB) treatment outcomes has been globally established. Various smoking cessation interventions (SCIs) have been proven worldwide to curb smoking behavior. There is a need for evidence to assess if SCI increases the chance of successful treatment outcome among TB patients. Objectives: To assess the effectiveness of a brief SCI; The Ask, Brief, Cessation support (ABC) package, on treatment outcomes and smoking cessation in smear-positive adult pulmonary TB patients. Methods: A cluster, randomized controlled trial was conducted wherein 17 designated microscopic centers of Chandigarh, India were randomly assigned using a computer-generated randomization sequence to receive SCI within directly observed treatment, short (DOTS) services, or existing standard of care. Eligible and consenting smokers (15 + years) registered as smear-positive pulmonary TB for DOTS (n = 156) between January and June 2013 were enrolled. Smoking cessation (self-reported) was assessed at intervals till the end of treatment. End TB treatment outcomes were extracted from patient records. Results: Treatment success was lower in intervention arm (83.6%) as compared control arm (88.2%), but the difference was statistically insignificant (P = 0.427). Smoking cessation was higher in intervention arm (80.2%) compared to comparison arm (57.5%) (adjusted incidence risk ratio = 1.56; 95% confidence interval = 1.24–1.93; P < 0.0001). Conclusions: SCI is effective in inducing smoking cessation among TB patients. No association of SCI with TB treatment outcomes could be detected.

Dietary patterns with special reference to calcium intake in 2-16-year-old Urban Western Indian children.

Abstract: Background: It is important to establish good dietary practices in childhood that promote adequate calcium intake throughout life and reduce the risk of osteoporotic fractures in later life. Objectives: To assess dietary patterns of 2–16-year-old children with special reference to calcium and suggest strategies and develop recipes suitable to identified patterns to increase dietary calcium intake. Methods: We studied 220 schoolchildren (2–16 years) around Pune city, India. The study duration was June 2013–July 2014. Height and weight were measured using standard protocols. Dietary intake was assessed by 24-h diet recall on 3 nonconsecutive days. Dietary patterns were derived by cluster analysis in two age groups; children (2–9 years) and adolescents (10–16 years). As per the dietary patterns, calcium-rich recipes were developed. Results: Among children, “rice-pulse” (RP) and “wheat, milk, and milk products” (WM) patterns were observed. Among adolescents, RP, “wheat, milk, and bakery” (WMB), and “mixed food” patterns were observed. Children who consumed “WM” and “WMB” patterns had greater intake of calcium (P < 0.05) than children consuming other dietary patterns. The daily calcium intake of whole group was 53% of the recommended dietary allowance. From this, 30% calcium came from milk. Each serve of the developed recipe provided an average of 254 mg of calcium. Conclusion: Majority of children had cereal-pulse-based dietary patterns. By replacing foods from existing dietary patterns with calcium-rich foods, the dietary calcium content may be increased in a sustainable manner.

Dengue fever in a municipality of West Bengal, India, 2015: An outbreak investigation.

Abstract: Background: In November 2015, death due to fever and increased number of fever cases were reported from Baranagar Municipality of North 24 Parganas district of West Bengal. Objectives: The episode was investigated with the objective to (1) confirm the existence of an outbreak, (2) describe it in terms of time, place, and person, (3) determine the cause of outbreak, and (4) recommend control measures. Methods: Monthly incidence of dengue from 2012 to 2014 was calculated and compared with 2015 to confirm the outbreak. We used Integrated Disease Surveillance Programme definition and searched for suspect dengue cases going door-to-door in ward number one of Baranagar Municipality. Active case search was done in health facilities also. Information on date of onset, symptoms, sociodemographic, serological reports, and clinical outcome for suspected and confirmed dengue cases was collected. Blood specimens were collected for NS1 ELISA/monoclonal IgM antibody capture-ELISA test. Environmental and entomological surveys were done. Results: Six hundred and seventy-one dengue cases (Overall attack rate = 3/1000), two deaths (Case fatality = 3/1000) were reported during September 14, 2015, till December 12, 2015. Out of 34 wards, attack rate was highest in ward number 1 (0.7%) and was 3 per 1000 among females. All age groups were affected. Thirty-two percent required hospitalization. NS1 ELISA was positive for 612 cases. Out of interviewed 31 dengue cases, 94% had headache, 90% had myalgia, followed by arthralgia, rash, and retro-orbital pain. Only in ward number 1, house index was >5%. Conclusion: We confirmed dengue outbreak. All age groups got affected. Deaths occurred in this outbreak. Potential breeding sources were present in ward number 1.

Malnutrition-free India: Dream or reality

Abstract: In spite of great efforts done by the Government of India to tackle the problem of malnutrition, proportion of population normal on nutrition scale has been stationary; nearly half of them have been a victim of under- and over-nutrition. Over a period, undernutrition has declined but this has been compensated by overnutrition. Hidden hunger is a still an unfinished agendum. The achievement of food grain security at the national level did not percolate down, and households' food insecurity and level of chronic food insecurity are still high. High economic growth rates have failed to improve food security in India. There is a need and scope for organizational, financial, and managerial reforms in this direction. The repercussion of malnutrition is not limited to physical deterioration, but it also affects the psychological level of victims. The legislative, service, and educational approaches should be optimized to fulfill the dream of malnutrition-free India.

Tobacco use among young adolescents in Myanmar: Findings from global youth tobacco survey

Abstract: Background: Tobacco consumption among youths poses significant public health problem in developing countries. This study utilized the available data of Global Youth Tobacco Survey (GYTS) to assess the prevalence of tobacco use among Myanmar adolescents. Objectives: We have conducted the fourth round of the GYTS in Myanmar during 2016 to monitor trends in tobacco use. Methods: We have selected 51 schools using random sampling based on probability proportional to school enrollment. In each school, we selected grades 9–11 by random sampling. All students in these classes completed a self-administered standard questionnaire. Results: A total of 3633 students who were participated in the survey 2621 students were 13–15 year. Overall 13.6% of students currently used tobacco; boys 26.3% and girls 3.7%. The prevalence of current cigarette smoking was 8.3%; boys 17.0%, girls 1.5%, whereas 5.7% of students currently smokeless tobacco users; boys 11.0%, girls 1.5%. Exposure to secondhand smoke (SHS) at home, in enclosed public places, and school was reported by 33.2%, 28.4%, and 64.5%, respectively. More than four out of 5 (83.4%) students had noticed someone using tobacco on television, videos or movies, and 42.3% had noticed tobacco advertising at points of sale. Among current smokers, 62.9% were not refused by purchasing cigarettes because of their minor age. Conclusion: Myanmar has higher prevalence of tobacco use among students, especially among boys. The study provides evidence-based information for developing comprehensive tobacco control programs – both education and policy interventions to reduce smoking rate among young people in Myanmar.

Directly observed iron supplementation for control of iron deficiency anemia.

Abstract: Anemia is major public health problem affecting 1.6 billion people worldwide. The poor compliance of iron supplementation remains main contributor for high prevalence of anemia. The current paper reviewed the effectiveness of direct observation of oral iron supplementation on anemia. A systematic search was performed through electronic databases and local libraries. Search strategies used subject headings and key words "directly observed" and "iron supplementation." Searches were sought through April 2014. A total of 14 articles were included in the study. Findings were presented in three categories. First, all of those reported an improvement in compliance of iron supplementation. Second, reduction in the prevalence of anemia was reported by all and third, all except one reported increased blood hemoglobin level. Directly observed an iron supplementation is an effective approach for prevention and management of anemia in vulnerable groups. However, larger trials are needed before concluding that scaling up directly observed iron supplementation through community health volunteers would be beneficial.

Research misconduct: A neglected plague.

Abstract: Truthfulness and honesty are absolute essentials of research. But to sustain in the not-so-pleasant "publish-or-perish" environment and "cut-throat" competition to increase the credibility associated with one's name, many individual researchers as well as research groups are turning towards research misconduct and this plague is gradually reaching epidemic and pandemic proportions. This overview highlights the various types and means of research misconduct and gives suggestions aiming to curb this academic menace so that research sanctity and integrity can be preserved and scientific research does not get polluted by the dirt of misreported or fabricated data.

Impact of nutritious meals on the nutritional status of the tribal students: A comparison between centralized kitchens (Annapurna) and regular kitchens in government tribal residential schools from two Districts of Maharashtra, India.

Abstract: Background: Tackling undernutrition is a global priority. It is the single largest risk factor influencing the burden of disease estimates at the global level. The Annapurna Project was undertaken by Government of Maharashtra to provide nutritious meals to Ashram/residential tribal school students through a centralized kitchen for achieving optimal growth and development and to prevent morbidity. Objectives: The primary objective of our work was to ascertain whether the provision of nutritious meals through centralized kitchens improves the proportion of underweight and stunted children. Methods: We used a cluster trial with parallel intervention and control arms. The allocation ratio was 1:1 for participants in the intervention and control areas. The pilot was undertaken between 2015 and 2017. Tribal dominant Nashik and Palghar districts in Maharashtra were selected by the state government to implement the centralized kitchen plan. Results: At the baseline, the percentage of underweight children in the intervention group was 36.9% and 31.9% in the control groups. The percentage of stunting in the intervention group was 30.0% and 38.2% in the control group. At the endline, 21.9% and 26.3% of the children were underweight. Both groups showed an improvement as compared to the baseline. However, the difference in reduction between the intervention and the control group was insignificant. Similarly, stunting also reduced to 12.9% and 14.6% in the intervention and control groups, respectively. Conclusion: The provision of regular nutritious meals, through centralized and local kitchen in government tribal residential schools of Maharashtra is effective and important in tackling undernutrition in Tribal children.

Economic burden of managing Type 2 diabetes mellitus: Analysis from a Teaching Hospital in Malaysia

Abstract: Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that consumes a large amount of health-care resources. It is essential to estimate the cost of managing T2DM to the society, especially in developing countries. Economic studies of T2DM as a primary diagnosis would assist efficient health-care resource allocation for disease management. Objective: This study aims to measure the economic burden of T2DM as the primary diagnosis for hospitalization from provider's perspective. Methods: A retrospective prevalence-based costing study was conducted in a teaching hospital. Financial administrative data and inpatient medical records of patients with primary diagnosis (International Classification Disease-10 coding) E11 in the year 2013 were included in costing analysis. Average cost per episode of care and average cost per outpatient visit were calculated using gross direct costing allocation approach. Results: Total admissions for T2DM as primary diagnosis in 2013 were 217 with total outpatient visits of 3214. Average cost per episode of care was RM 901.51 (US$ 286.20) and the average cost per outpatient visit was RM 641.02 (US$ 203.50) from provider's perspective. The annual economic burden of T2DM for hospitalized patients was RM 195,627.67 (US$ 62,104) and RM 2,061,520.32 (US$ 654,450) for those being treated in the outpatient setting.Conclusions: Economic burden to provide T2DM care was higher in the outpatient setting due to the higher utilization of the health-care service in this setting. Thus, more focus toward improving T2DM outpatient service could mitigate further increase in health-care cost from this chronic disease.

Alcohol consumption, hazardous drinking, and alcohol dependency among the population of Andaman and Nicobar Islands, India.

Abstract: Background: Harmful use of alcohol is one of the globally recognized causes of health hazards. There are no data on alcohol consumption from Andaman and Nicobar Islands. Objective: The objective of the study was to assess the prevalence and pattern of alcohol use among the population of Andaman and Nicobar Islands, India. Methods: A representative sample of 18,018 individuals aged ≥14 years were chosen by multistage random sampling and administered a structured instrument, a modified version of the Gender, Alcohol, and Culture: An International Study (GENACIS) which included sociodemographic details and Alcohol Use Disorders Identification Test (AUDIT). Results: The overall prevalence of alcohol consumption was 35% among males and over 6.0% in females, aged 14 and above. Two out of every five alcohol users fit into a category of hazardous drinkers. One-fourth of the total users (23%) are alcohol dependents. Both the hazardous drinking and dependent use are high among males compared to females. Almost 18.0% of male drinkers and 12.0% of female drinkers reported heavy drinking on typical drinking occasions. The predominant beverages consumed were in the category of homebrews such as toddy and handia. Conclusion: The present study highlights the magnitude of hazardous drinking and alcohol dependence in Andaman and Nicobar Islands, India and the complex sociocultural differences in the pattern of alcohol use. Based on the AUDIT data, among the population of Andaman and Nicobar Islands (aged 14 and above), one out of ten requires active interventions to manage the harmful impact of alcohol misuse.

“Near-Miss” Obstetric events and maternal mortality in a Tertiary Care Hospital

Abstract: Obstetric near-miss or severe acute maternal morbidity is gaining interest internationally as a new indicator of the quality of obstetric care. This is a retrospective study conducted using "The WHO Near-Miss Approach" to provide insight into obstetric emergencies, near-miss cases, and maternal deaths in our hospital. The maternal near-miss ratio was 8.4/1000 live births, maternal near-miss to mortality ratio was 5.3:1. Hemorrhage was the leading cause (43.7%) of morbidity in near-miss cases while hypertensive disorders were the leading cause in maternal deaths (66.6%). Among women with potentially life-threatening conditions, severe preeclampsia was the most common complication (50.54%). The near-miss approach helps to evaluate and improve the quality of care provided by health system by identifying the pattern of severe maternal morbidity and mortality, strengths and weakness in the referral system and the clinical interventions available and the ways in which improvements can be made.

Integrated brief tobacco and alcohol cessation intervention in a primary health-care setting in Karnataka.

Abstract: Background: Tobacco and alcohol use are important preventable risk factors for noncommunicable diseases and need to be addressed in primary health care. Objectives: To find the effectiveness of Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)-based brief intervention for alcohol and tobacco in a primary health-care setting in Karnataka. Methods: This study was conducted in 2012 where one primary health center (PHC) in Karnataka was an intervention site and other the control site. One hundred patients each in both control and intervention PHCs took part in the study. In the control PHC, patients were administered the ASSIST questionnaire and given an information pamphlet on tobacco- and alcohol-related harm. In the intervention PHC, ASSIST-based brief intervention was provided for both tobacco and alcohol cessation. At the 3rd month, ASSIST questionnaire was re-administered to record their follow-up score. Chi-square test, paired t-test, and independent sample t-test were used for statistical analysis. Results: Following the initial assessment and intervention, there was statistically significant reduction in mean ASSIST scores for tobacco in both the PHCs. For alcohol, though there was reduction in scores in both PHCs, it was statistically significant only in intervention PHC. There was also a significant reduction in the number of heavy alcohol users in the intervention PHC following assessment and intervention. Conclusions: This study shows that with minimal intervention, there is reduction in the degree of both tobacco and alcohol use and calls for wider and stringent research on the same topic.

Regulating smokeless tobacco and processed areca nut in South-East Asia region: The journey so far and the road ahead.

Abstract: South-East Asia Region (SEAR) has more smokeless tobacco users as compared to smokers. The growing prevalence and cultural acceptance of consumption of flavored areca nut and related products, for example, supari and pan masala in many countries are confounding the scenario. The prevalence of a variety of tobacco products makes regulation a challenge which gets more complicated in view of weak enforcement of regulatory policies aggressive marketing of such products by the tobacco industry. Some countries have attempted to regulate smokeless tobacco and related products by enforcing bans. However, limited evidence base along with lack of technical and regulatory capacities have restricted the SEAR countries to effectively implement product regulation in respect of smokeless tobacco and related products. This paper lays out specific priorities for research and need to enhance regulatory capacity for smokeless tobacco and processed areca nut in the SEAR countries. A systematic and comprehensive search was conducted to identify all original published literature related to regulating smokeless tobacco and processed areca nut. Studies reporting on the same were obtained through searches in relevant academic databases. Relevant World Health Organization (WHO) documents and reports on tobacco products regulation were consulted. Generating the right evidence along with the need to build the capacity of the countries to test the smokeless tobacco and processed areca nut products by establishing testing facilities and providing practical guidelines is of paramount importance. The countries of the SEAR need to prioritize the implementation of Articles 9 and 10 of the WHO Framework Convention on Tobacco Control to strengthen the regulation of smokeless tobacco and processed areca nut products.

Prevalence of obesity and overweight and their comparison by three growth standards among affluent school students aged 8-18 years in Rajkot.

Abstract: Obesity and overweight emerged as an important public health problem in India. The present study was conducted to estimate the prevalence of obesity and overweight and compare it using three different standards among affluent school students aged 8-18 years from Rajkot, Gujarat. Anthropometric measurements of students of four schools from 3rd to 12th standards were taken. The prevalence of overweight and obesity was assessed using three standards - revised Indian Association of Pediatrics (IAP) 2015, WHO 2007, and International Obesity Task Force (IOTF) standards. A total of 1496 children including 79.1% boys and 20.9% girls participated in the study. The prevalence of obesity was reported 14% by IAP standards, 11.1% by WHO standards, and 5.1% by IOTF standards. Overweight children prevalence was reported more (19.1%) with IAP standards, followed by 15.8% with IOTF standards and 15.3% by WHO standards. High prevalence of obesity and overweight was reported with IAP 2015 standards and WHO 2007 standards.