Indian Journal of Public Health

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    Institutional Disrespect and Abuse during Health-Care Utilization in Public Health Facilities of Tamil Nadu: A Facility-Based Cross-Sectional Survey
    (Wolters Kluwer – Medknow, 2022-03) Krishnamoorthy, Y; Elangovan, V; Krishnan, M; Sinha, I; Samuel, G; Kanth, K.
    Background: Disrespect and abuse have a negative impact on the quality of care provided in the public health facilities, thereby impacting the public health‑care utilization of the patients. Objectives: This study aims to capture the burden and determinants of disrespect and abuse faced by the patients who seek care from public health facilities in Tamil Nadu. Methods: This study was conducted among 4917 participants at outpatient and inpatient levels in 18 public health facilities across six districts in Tamil Nadu. Institutional disrespect and abuse were reported as proportion with 95% confidence interval (CI). Logistic regression model was done to assess the determinants of institutional disrespect and abuse. Results: Overall, the proportion of participants facing some form of institutional disrespect and abuse was 9.8% (95% CI: 9.0%–10.6%). Elderly patients (≥60 years) (adjusted odds ratio [aOR] = 2.71; 95% CI: 1.27–5.76), widowed/separated/divorced (aOR = 1.99; 95% CI: 1.11–3.57), patients with higher educational qualification (aOR = 1.82; 95% CI: 1.25–2.64), patients belonging to the richest quintile in terms of socioeconomic status(aOR = 4.96; 95% CI: 3.59–6.84), and patients having some form of chronic disease (aOR = 1.37; 95% CI: 1.07–1.75) had significantly higher odds of facing institutional disrespect and abuse. Conclusion: Almost one in ten patients visiting secondary and tertiary care public health facilities in Tamil Nadu had faced some form of disrespect during their hospital visit/stay. The findings from our study should be taken up and further qualitative exploration to identify the reasons for such disrespectful care and corrective solutions should be suggested.
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    A Time and Motion Study of Community Health Workers in Rural Area of Ballabgarh, Haryana
    (Wolters Kluwer – Medknow, 2022-03) Mandal, S; Sathiyamoorthy, R; Salve, HR; Kumar, R; Kumar, R; CRHSP – Ballabgarh Study Group.
    Introduction: Health workforce is the important pillar of health system in India. Efficient utilization of scarce community‑level human resources in health care is critical to ensure optimum care in a community. Objective: To describe the time utilization pattern of health workers (HWs) during field activity at the primary healthcare level and to study the facilitators and barriers in efficient time utilization. Methods: A mixed‑method study with a time and motion approach was carried out in the rural areas of Ballabgarh block of Haryana. Time and motion approach was continuous, direct, synchronous and both active and passive method of time logging was adapted. Electronic Geo‑Positioning System based mobile, timestamp application and the digital stopwatch were used to capture time utilization. The quality of the data collected in the daily work plan during the household (HH) visits was assessed using semi‑structured interview schedule. In‑depth interview with the HWs was carried out to understand the facilitating factors and barriers in their efficient functioning. Results: Proportion of HH s covered in data collection for time and motion patterns was 36% out of the total number of HH s in the SCs. The completeness of work plan was 74.8%. The average number of HHs covered per day by an HW was 38. Mean (standard deviation [SD]) time duration spent in each HH in completing the work plan was 2.9 (0.8) minutes. Mean (SD) total distance travelled by HW per day was 1845.1 (974.2) metres. Mean (SD) time duration spent idle in the field was 22.7 (13.0) minutes. Proportion of effective time utilised in the field was 54.3%. Several enabling factors and barriers were identified at personal, community, and health system level. Conclusion: Only half of the allotted time was effectively utilized by the HWs for house visit in the community. Planning the beat schedule as per the feasibility and ensuring quality of HH visits using information technology is critical for providing primary healthcare at village level.
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    Is Maternal Anemia among Tribal Women being Neglected? A Study from Southern Rajasthan
    (Wolters Kluwer – Medknow, 2022-06) Dwivedi, R; Goel, AD; Vyas, V; Sharma, PP; Bhardwaj, P; Singh, K
    Poor birth outcomes have been linked to maternal anemia. Tribal women are at higher risk of malnutrition and disease due to sociocultural barriers and poor educational status. The data on the prevalence of maternal anemia and its associated factors among pregnant tribal women are limited. A community‑based cross‑sectional study was conducted among 429 pregnant tribal women for maternal anemia from August 2021 to June 2022. A structured questionnaire was employed to collect sociodemographic data. The prevalence of anemia was 85.7%, with a mean hemoglobin level of 9.21 ± 1.3 g/dL. On applying WHO 2011 anemia criteria for pregnant women, 25.0% had mild anemia, 73.4% had moderate anemia, and 1.6% had severe anemia. The significant factors associated with anemic condition were household condition, monthly income, and husband’s occupation. The higher prevalence of anemia among pregnant tribal women is alarming that necessitates a rethinking of health infrastructure and outreach in tribal dominant areas.
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    Incidence of Breakthrough Infections after COVID-19 Vaccination among the COVID-19 Vaccine Recipients at a Tertiary Care Hospital in Srinagar
    (Wolters Kluwer – Medknow, 2022-06) Fazili, A; Ain, SN; Shah, RJ; Raja, FN; Farhat, D; Nazir, I.
    COVID‑19 infections despite complete vaccination are called breakthrough infections. Breakthrough infections may decrease the vaccination confidence among people. This study was conducted soon after the Covishield vaccine was approved for use in J and K to find out the incidence of breakthrough infections among the recipients of the Covishield vaccine at SKIMS and to find out the associated factors. List of beneficiaries (between February 14, and May 15, 2021) was obtained from the records. Information was gathered telephonically. Incidence of breakthrough infections 6‑month postvaccination was determined. Among 919 participants, the incidence of breakthrough infections was 2.7% (25 cases). The medical profession was associated with a higher frequency of breakthrough infections. Most infections were mild to moderate (96%). One (4%) person required hospitalization. Thus, COVID‑19 infections can occur despite complete vaccination. Increased exposure places an individual at higher risk of breakthrough infections. Therefore, where exposure is high, COVID‑appropriate behavior should be followed despite being vaccinated.
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    The Impact of the COVID-19 Pandemic on Health-Care Delivery System for Other Diseases and Antimicrobial Resistance Threat in India
    (Wolters Kluwer – Medknow, 2022-06) Chakraborty, D; Majumdar, A; Debnath, F; Naskar, S; Dutta, S.
    India’s health‑care delivery is challenged with different inequalities and the dual burden of communicable and noncommunicable diseases. Lockdown posed negative effects on the growth and economy of the country; simultaneously, some positive effects, like increased health consciousness and adoption of hygienic practices, were also there. Health‑care delivery system faced tremendous challenges in diagnostics, therapeutics, infrastructure for inpatient care, and protection of health‑care manpower. During this period, people chose to self medicate which in turn increased the threat of emergence of antimicrobial resistance. Due to shifting priority to COVID from other diseases, resources were shifted to COVID, affecting the management of other acute and chronic diseases. The launching of COVID‑19 vaccination campaign showed some hope. However, despite the vaccination drive, strengthening infrastructure, and surveillance system, the devastating second wave could not be avoided due to the conglomeration of the crowd for pilgrimage, election campaign, and tourism in an unrestricted manner. It may be concluded that the fourth wave may be short lasting due to increased herd immunity.
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    Assessment of Infant and Young Child Feeding Practices among Mothers of Paniya Tribal Children Aged 0–23 Months in Gudalur Block, Nilgiris District
    (Wolters Kluwer – Medknow, 2022-06) Rithu, S; Vyas, N.
    Optimal infant and young child feeding practices(IYCFPs), despite being emphasized since 2003, are yet to be met in India. This study assessed these practices and their association with various factors among mothers of children aged 0–23 months in Paniya tribes in Nilgiris, Tamil Nadu. About 89.1% of the infants below six months were timely breastfed and 77.9% of them were exclusively breastfed, respectively. Complementary food was introduced to 25% of infants aged six to eight months. About 27.8% of them received a diverse diet. About 91.7% of them were fed egg and/or flesh food and 37% of them were fed vegetables and fruits. Illiterate mothers and mothers who had a vaginal delivery fed the infant optimally. The adherence to these practices was found to decrease gradually with an increase in the infant’s age. The prevalence of IYCFP is higher in the study population compared to the corresponding indicators for the district according to the National Family Health Survey‑5.
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    Influence of Lockdown during the COVID-19 Pandemic on Use of Pediatric Emergency Health Services: A Retrospective Observational Study from a Tertiary Care Hospital in New Delhi
    (Wolters Kluwer – Medknow, 2022-06) Sodani, R; Gupta, S; Sharma, AG.
    January 30, 2020, marked the beginning of the COVID‑19 pandemic in India. Various emergency measures were taken to contain the spread of COVID‑19 including extended periods of complete lockdown. The impact of these measures on routine and emergency health services was unforeseen. Hence, we conducted this study to critically analyze the effects of restrictions imposed during the COVID‑19 pandemic (including lockdown) on the utilization of health services, especially emergency services. We compared patient’s attendance in the outpatient department and pediatric emergency department (PED) and changes in clinicepidemiological profiles (before and during COVID‑19) in a tertiary care hospital. We observed a 43% decline in PED visits which decreased to 75% during the period of strict lockdown (P = 0.005). Reduction in emergency department visits was noticed uniformly in all disease categories. This study highlights the urgent need to plan for robust health‑care support system for the delivery of preventive and curative services to vulnerable age groups during any emergency.
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    Iodine Status of Pregnant Women in Iodine-Sufficient Regions: A Tertiary Care Unit Experience
    (Wolters Kluwer – Medknow, 2022-03) Bahadir, ÇT
    Background: The recommended urinary iodine concentration (UIC) levels in the overall adult population is 100–199 µg/L whereas 150–249 µg/L in pregnant women. Objectives: The objective is to determine the prevalence and severity of iodine deficiency in pregnant women in Amasya, which is located in the Western Black Sea region in Turkey, where sufficient iodine levels were achieved in the normal population. Methods: In this single‑center study, we retrospectively searched hospital patient records and identified pregnant women who were assessed for iodine levels between January 2019 and January 2021. A total of 408 pregnant women were found eligible for the study. Thyroid‑stimulating hormone (TSH), free triiodothyronine, free thyroxine, antithyroid peroxidase antibodies, and antithyroglobulin antibodies in serum samples and UIC were evaluated and compared between the trimesters. Insufficient iodine intake in pregnancy was defined as UIC <150 µg/L. Results: Median UIC and median TSH levels were 129 (range 45–452) µg/L and 2.98 (range 0.01–71.2) µIU/ml, respectively. 81.1% of pregnant women had UIC <150 µg/L. Iodine intake was adequate in 17.4% of pregnant whereas excessive in 1.5%. Prevalence of iodine deficiency during 1st, 2nd, and 3rd trimesters were 82.1%, 82.4%, and 74.5%, respectively. There was no significant difference in UIC levels between trimesters (P = 0.399). 72.9% of pregnant womens had TSH >2.5 mIU/L in the 1st trimester. Conclusion: Iodine deficiency in pregnancy may exist in an iodine‑sufficient population. Appropriate measures must be taken to ensure sufficient iodine levels in these individuals.
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    Outbreaks and Sporadic Cases of Japanese Encephalitis in the State of Odisha, India: Outcome of 7 Years of Laboratory Surveillance
    (Wolters Kluwer – Medknow, 2022-06) Sabat, J; Bhattacharya, D; Subhadra, S; Gurav, YK; Pati, SS; Dwibedi, B.
    Acute encephalitis syndrome (AES) is a major public health challenge in India. We report here the epidemiology of sporadics and outbreaks of Japanese Encephalitis (JE) in Odisha state during 2012–2018. A total of 4235 AES cases (sporadics – 3394, outbreak cases – 841) recorded including 42 outbreaks; majority (n = 18) of which were during 2016. Overall JE virus (JEV) positivity was 11.78% (outbreak cases – 24.5%, sporadic cases – 8.6%). Age ≤15 years were largely affected during outbreaks, while 16–60 years population was dominant among sporadics. The major outbreak (2016) involved 336 patients from a tribal dominated district, spread over 173 villages. JEV seropositivity was high (43.45%) with 28.57% mortality. Epidemiological linkage with pig rearing was documented through JEV neutralizing antibodies in 50% of pig serum samples. Although the postvaccination period (2017–18) showed increase in AES case reporting but low JE proportion. Ongoing surveillance and preparedness of the health system would be of importance, especially in tribal‑dominated districts.
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    A Cross-Sectional Study on Anxiety Due to COVID-19 and its Predictors among Undergraduate Medical Students in a Tertiary Care Teaching Hospital of Kolkata, West Bengal
    (Wolters Kluwer – Medknow, 2022-03) Chhakchhuak, V; Ray, K; Saha, SK; Basu, M.
    Background: Medical education is recognized as stressful globally. COVID‑19 pandemic is an additional source of anxiety to the medical students. Objectives: This study was conducted to assess the prevalence and to identify the factors associated with anxiety due to COVID‑19 among undergraduate medical students in a teaching hospital of Kolkata, West Bengal. Methods: An observational cross‑sectional study was conducted among 363 undergraduate medical students using the stratified random sampling of a medical college from June to July 2021. Data were collected using a predesigned, pretested, and structured online questionnaire, including “Coronavirus Anxiety Scale.” Descriptive statistics were used to estimate the prevalence of anxiety. Pearson’s Chi‑square test was performed to find out the factors associated with anxiety due to COVID‑19. Results: About 25.6% of the medical students were found to have anxiety due to COVID‑19. About 28.9% of them reported COVID‑19 infection in family in recent past and 11.0% had themselves tested positive. Nearly 20% reported loss of family members, relatives, and close friends due to COVID‑19. The factors associated with anxiety due to pandemic were socioeconomic status, social stigma, sleep disturbances, history of COVID‑19 in family, loss of job. and vaccination status of family members missing practical classes and exam‑related anxiety. Conclusion: The study found that one‑fourth of the medical students had anxiety due to COVID‑19. Social stigma due to COVID‑19 and loss of job of parents were the most significant predictors. It is recommended that targeted psychological and clinical interventions need to be taken to alleviate students’ anxiety due to COVID.
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    Leveraging Health Information Helpline to Sustain Health-Care Delivery during the COVID Pandemic: Experiences from a State in Eastern India
    (Wolters Kluwer – Medknow, 2022-03) Nawaz, AS; Singh, BP; Singh, AK; Mukherjee, C; Rathnam, N; Hegde, SK.
    Background: The unprecedented demands on health‑care systems due to the COVID‑19 pandemic made countries including India to switch toward alternative modes of health‑care delivery. Objectives: The aim of this study was to describe the various COVID‑related services delivered through 104 health information helpline (HIHL), located in Jharkhand during the pandemic. Methods: The de‑identified secondary data from February 2020 to December 2021 related to COVID services delivered through HIHL were analyzed. Results: There was a significant increase in the COVID call volume during the first as well as the second wave. The HIHL has been able to guide the callers on testing, home isolation and follow‑up, home‑based teleconsultation, vaccination, timely referral, and support with logistic‑related information. Conclusion: The 104 HIHL has played a critical role in sustaining health‑care delivery during the pandemic, combating the “infodemic” and guiding the general public by providing authentic information.
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    The Reference Values for Muscle Mass and Strength in Healthy Indian Adults Using Whole-Body Potassium Counter and Isokinetic Dynamometer
    (Wolters Kluwer – Medknow, 2022-06) Sucharita, S; Sreenath, N; Shinjini, B; Tony, DS; Rebecca, K; STEPS Study Team
    The study aims to define the sex‑based reference data for muscle mass and strength among healthy young Indians and to compare the data from the present study with available literature. Healthy Indian adults (n = 100) aged between 18 and 40 years were recruited. The assessment of muscle mass and strength was performed. The body cell mass (BCM), fat‑free mass, and muscle strength parameters were significantly higher among males compared to females (P < 0.001). A comparison of the current study data with the available literature showed that though BCM was comparable, Indians demonstrated a significantly lower isometric peak torque (P < 0.001 for both sexes). These findings suggest that Indians tend to have a lower muscle strength compared to the Western population, despite having a comparable BCM content.
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    Mortality Indicators with Clinical Profile of Multisystem Inflammatory Syndrome in Children during SARS-CoV-2 Second Wave in India: A Tertiary Referral Center Experience
    (Wolters Kluwer – Medknow, 2022-06) Gupta, S; Das, D; De, A; Bhattacharya, SK.
    Background: Domestic work being unrecognized as a formal form of occupation in India, workers are often deprived of basic social security, including access to proper health care. Self‑negligence coupled with societal neglect makes them vulnerable to injury and a variety of illnesses. Objectives: We aimed to study the morbidity pattern of women domestic workers residing in a slum area of Kolkata, West Bengal, India. Materials and Methods: An observational descriptive cross‑sectional study was carried out by interviewing and clinically examining 106 randomly selected women domestic workers. Results: The majority (82.08%) had health complaints: heart burn being most common (40.57%). Musculoskeletal and dermatological issues were common. Anemia (31.25%) was a common prediagnosed morbidity. Pallor (33.96%) and dental caries (31.13%) were common; 50.94% reported workplace injury. Of those having complaints, 77.36% sought health care, 59.43% of whom relied on health facilities. Lack of time (54.05%), felt need (35.14%) and money (21.62%) affected adequate care seeking. Participants with cardiorespiratory complaints tended to visit health facilities significantly more (P < 0.05). Conclusion: Health vulnerabilities and neglectful behavior among domestic workers are evident, making the need to sensitize them about their health risks and ways to overcome such issues very vital. Awareness should also be generated about government health schemes to encourage timely health checkup and necessary intervention.
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    The Impact of Coronavirus Disease 2019 Pandemic on Bronchiolitis (Lower Respiratory Tract Infection) Due to Respiratory Syncytial Virus: A Systematic Review and Meta-Analysis
    (Wolters Kluwer – Medknow, 2022-06) Sabeena, S; Ravishankar, N; Robin, S; Pillai, SS.
    The coronavirus disease 2019 (COVID‑19) pandemic has changed the epidemiology of respiratory syncytial virus (RSV) infection which accounts for most bronchiolitis and viral pneumonias in infants. This systematic review and meta‑analysis aimed to quantitatively assess the effect of the COVID‑19 pandemic on RSV‑associated bronchiolitis among hospitalized infants. The study protocol was registered in the PROSPERO database (CRD42022314000) and was designed based on Preferred Reporting Items for Systematic Reviews and Meta‑analyses guidelines updated in May 2020. The meta‑analysis component was modified appropriately to synthesize the pooled proportion of infants having RSV‑associated bronchiolitis before the COVID‑19 pandemic in 2019 and during the pandemic with 95% confidence interval (CI). We identified and screened 189 articles and systematically reviewed 50 full texts. Eight qualified studies from Europe and China, including 109,186 symptomatic cases of bronchiolitis before the pandemic in 2019 and 61,982 cases in 2020–2021 were pooled by random‑effects meta‑analysis. The quantitative analysis included laboratory‑confirmed RSV infection in 7691 infants with bronchiolitis reported before the pandemic in 2019. Meanwhile, during the pandemic, 4964 bronchiolitis cases were associated with RSV infection. The pooled proportion of RSV‑associated bronchiolitis cases before the pandemic in 2019 was 16.74% (95% CI 11.73, 22.43%, 95% prediction interval 0.032, 34.16). The pooled proportion of confirmed RSV cases during the pandemic in 2020/2021 was 19.20% (95% CI 12.01, 27.59%, 95% prediction interval 0.046, 42.35). There was an increase in RSV activity after the relaxation of stringent public health measures during the COVID‑19 pandemic.
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    Assessment of Effectiveness of Targeted Intervention Program Under National AIDS Control Program among Injecting Drug Users Across India
    (Wolters Kluwer – Medknow, 2022-06) Sahu, D; Ranjan, V; Thakur, N; Rai, SK; Rao, MV.
    Background: High HIV prevalence among injecting drug users (IDUs) remains a cause of concern and are considered key drivers of concentrated epidemic in India. The present paper aims to assess the effectiveness of the targeted intervention (TI) program on the risk behaviors among IDUs across regions of India. Materials and Methods: This paper used the data from the integrated biological and behavioral surveillance 2014–2015 among the IDUs in India. Descriptive statistics and propensity score matching analysis was carried out to understand the effectiveness of the TI program on the new needle/syringe used and needle/syringe shared in the last injecting episode by accounting for the covariates. Results: The matched samples estimate, i.e., average treatment effect on treated of new needles/syringe used and shared in the last injecting episode by those who received needles/syringes from peer educator or outreach workers (PE/ORWs) and those who did not receive was 2.8% (confidence interval [CI]: 0.05–5.6) increase in the use of new needles/syringes and 6.5% (CI: −9.7–−3.3) decrease in the needles/syringes shared in last injecting episode indicating that IDUs who received new needles/syringes from PE/ORWs are more likely to use new needle/syringe and less likely to share needle/syringes to those who did not receive needles/syringes. The results vary across the different regions of India. Conclusion: TI program proves to be an effective initiative in the behavior change among IDUs as substantiated by use of new needles/syringes and decreased sharing of needles/syringes. TI program coverage varies from region to region and may further be expanded to accelerate the program services to prevent HIV/AIDS.
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    COVID Vaccine Hesitancy among the Tribal Population and Its Determinants: A Community-Based Study at Berhampore Block of Murshidabad District, West Bengal
    (Wolters Kluwer – Medknow, 2022-03) Sarkar, A; Dalui, A; Sarkar, P; Das, M; Basu, R; Sardar, JC.
    Background: On January 16, 2021, India rolled out the COVID vaccination drive. A successful and effective vaccination campaign requires much more than the availability of a safe and effective vaccine. This includes identifying vulnerable populations with lower vaccine confidence and identifying the drivers of vaccine hesitancy. Objective: This study aims to find out vaccine hesitancy among the tribal population regarding COVID‑19 vaccination. Methods: It was an observational descriptive cross‑sectional study, conducted at Manindranagar and Hatinagar gram panchayat of Berhampore Block of Murshidabad district, West Bengal, from June 2021–November 2021, among tribal people aged >18 years. A total of 198 tribal people were selected by applying the probability proportional to size sampling method. Participants were interviewed using predesigned, pretested, and semi‑structured schedules. Potential predictors of hesitancy were investigated using the multivariate logistic regression model. Results: Vaccine hesitancy was present among 36.9% of the study participants. Fear of side effects (78.1%) was the most common reason of vaccine hesitancy. Only 30.8% of them received at least one dose of vaccine. Vaccine hesitancy was associated with decreased family income in the last 1 year (adjusted odds ratio [AOR] = 8.23), knowledge regarding vaccine (AOR = 0.41), adherence to COVID‑appropriate behavior (AOR = 0.45), and trust on the local health‑care worker (AOR = 0.32). Conclusion: Vaccine hesitancy among the tribal population is driven by a lack of knowledge and awareness. Their economic status, attitudes toward the health system, and accessibility factors may also play a major role in vaccine hesitancy. Extensive information, education, and communication activity, more involvement of health‑care workers in the awareness campaign, and establishment of vaccination centers in tribal villages may be helpful.
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    A Scoping Review of Persistent Symptoms after COVID Infection at Different Follow-Up Periods
    (Wolters Kluwer – Medknow, 2022-06) Sreelakshmi, PR; Tandale, BV; Jadhav, AV; Vaidya, RR; Walimbe, AM; Jadhav, S.
    The clinical entity termed as long COVID has gained importance in the recent past. As this phenomenon is still evolving, it is important to document the magnitude of the syndrome during different time periods. This scoping review attempts to synthesize evidence generated from longitudinal studies which have follow‑up periods beyond 3 months, up to 12 months. The review also documents the reported prevalence of long COVID for the different regions of the World Health Organization. Longitudinal studies published till March 2022 were systematically searched on PubMed, Google Scholar, and medRxiv. Among the identified 594 studies, 48 were included in this review. Data from selected studies were synthesized. The overall pooled prevalence of long COVID was 49% (40%–58%). The pooled estimates after 3 months, 4–6 months, 7–9 months, and 10–12 months were 44% (32%–57%), 50% (43%–57%), 49% (37%–62%), and 54% (46%–62%), respectively. Eastern Mediterranean Region (EMR) had the highest pooled prevalence of 63% (34%–92%] and the South East Asian Region (SEAR) had the least pooled estimate of 15% (10%–21%). The study brings out the high prevalence of long COVID even after 12 months of follow‑up. It also shows the regional differences in the reported prevalence of the syndrome. This review highlights the need for well‑planned follow‑up studies, especially in developing nations to understand the magnitude and the pattern of long COVID‑related symptoms as they emerge.
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    Time Elapsed from Onset of Symptoms to Antituberculosis Treatment in Children with Central Nervous System Tuberculosis in a Tertiary Hospital in South India: A Mixed-Methods Pilot Study
    (Wolters Kluwer – Medknow, 2022-06) Giridharan, P; Rebecca, P; Devaleenal, B; Chelladurai, E; Chinnaiyan, P; Malaisamy, M.
    A pilot study with a mixed-methods design was conducted to estimate the time for tuberculosis (TB) treatment initiation and associated factors among children with central nervous system-TB (CNS-TB). A total of 38 children were enrolled for the quantitative component, and 20 in-depth interviews were conducted. The median duration (interquartile range) from onset of symptoms to treatment initiation was 23 (11, 55) days. About 44% and 31% of the children presented with Stage II and Stage III of CNS-TB, respectively. The major reasons for delay were symptoms not taken seriously (50%) and too many referrals (21%). About 89% of the families went into catastrophic health expenditure due to the disease. The treatment delay may be due to both patient delay and health system delay. Tailoring approaches to target the pediatric population could further improve early detection and treatment initiation of CNS-TB.
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    The Impact of an Educational Program on Knowledge and Perception of Patient Safety Culture among Nurses in the Two Medical Colleges of Manipur: A Quasi-Experimental Study
    (Wolters Kluwer – Medknow, 2022-06) Akoijam, P; Konjengbam, S.
    Background: Nurses’ leaders are protracted as high‑leverage players who would be instrumental in initiating or bettering the culture of safety in the hospital, with no previous intervention done for the same in Manipur. Objectives: The aim of this study was to assess the effectiveness of an educational intervention program on patient safety culture among nurses in Manipur. Materials and Methods: A quasi‑experimental study was conducted from July 2019 to December 2021 among the 32 nurses of two tertiary‑level hospitals in Manipur. A structured questionnaire and Hospital Survey on  Patient Safety Culture version 2 were used (Hospital Survey on Patient Safety Culture (HSOPSC) version 2.O (AHRQ, Rockyville, Maryland, USA)). A 2‑day intervention based on the WHO’s Multi‑Professional Patient Safety Curriculum Guide was used. Data were collected before, immediately, and 3 months after the intervention. Data were summarized using descriptive using IBM SPSS 26. Paired t‑test, Chi‑square test, and t‑test were employed to check for differences within and between the groups, and P < 0.05 was taken as statistically significant. Results: The mean knowledge scores were comparable between the groups at baseline (7.13 ± 3.3, 8.44 ± 3.74; P= 0.142) but differed significantly at posttest and follow‑up tests(P < 0.0001). The dimensions of “staffing and work pace” and “reporting patient safety events” had the lowest positive responses from both the groups at baseline. There is a significant increase in the total safety score from baseline to posttest and follow‑up in the intervention group (P < 0.001). Conclusions: The study asseverated the effectiveness of an educational intervention in increasing the knowledge and perception of patient safety culture, but the results highlighted the need for training at regular intervals.
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    Effect of Tobacco Taxation on Smoking Prevalence and Smoking-Attributable Deaths in India
    (Wolters Kluwer – Medknow, 2022-06) Rana, K; Goel, S; Prinja, S.
    Background: Higher taxes are the single most effective way to encourage tobacco users to quit tobacco use and prevent youth from initiation. Objectives: The present study aims to estimate the effect of raising the tax on smoked tobacco products on its consumption and smoking‑attributable deaths in India. Materials and Methods: A mathematical model was developed which used the projected population of India, taxation rates on smoked tobacco products, smoking prevalence, and price elasticity of demand of cigarette and bidi from 2017 to 2025. Four scenarios of tax increment (0%, 25%, 50%, and 100%) on smoked tobacco products were created which were modeled to calculate smoking prevalence and smoking‑attributable deaths due to respiratory diseases, heart diseases, stroke tuberculosis, and cancer in country till 2025. Results: A relative decrease of 6.2% in the prevalence of smoking was observed between the existing tax rates and its increment to 100% over the last increment of 6%. Similarly, smoking‑attributable deaths (SAD) decreased by 6.04% on increasing the tax rates to 100% of the existing taxation rates. There has been a steady increase in SAD in scenario 1 which decreases effectively in scenario 4, which in turn leads to the saving of around 33,000 lives due to tobacco‑related diseases by 2025. Conclusion: The consumption of cigarettes and bidis can be reduced by raising the price of these products. The model will help policymakers in deciding to fix the tax and ultimately the price of cigarettes and bidi to reduce its consumption and smoking‑attributable mortality.