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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 6 | Issue 1
Page Nos. 1-79

Online since Friday, June 5, 2020

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EDITORIAL  

COVID-19 pandemic: Saving lives and livelihoods and human existence Highly accessed article p. 1
Vikas Bhatia, Raviraj Uttamrao Kamble
DOI:10.4103/IJCFM.IJCFM_45_20  
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PERSPECTIVE Top

Socioeconomic status: A theoretical framework for the development and use of assessment tools p. 4
Pradeep R Deshmukh, Sujiv Akkilagunta
DOI:10.4103/IJCFM.IJCFM_32_20  
Decades of research have established the relationship between socioeconomic status (SES) and health. The tools for the assessment of SES have evolved ever since, growing in complexity over time. The purpose of measuring SES in health research is twofold – to causally link the exposure to poor SES with health state and to find out the causal mechanisms to devise programmatic interventions. In health research, SES should be viewed as a determinant of unequal distribution of health resources that further leads to health disparities. We refer to socioeconomic position as an umbrella term for social stratification that defines individuals/households based on the present circumstances. Socioeconomic position can be measured in three distinctly varied ways – socioeconomic disadvantage, social class, and SES (or position). Tools for the measurement of SES can be classified as indices based on income and expenditure, indices bases on occupation and education, wealth index combining education, and asset-based wealth index. Each tool has its own theoretical assumptions – Weberian, Marxist, or Functionalist perspectives. The choice of tool should depend on theoretical assumptions. The tool should be comprehensive, including all three dimensions – education, occupation, and income. Life-course perspective, linking the timing of exposure to poor SES over the life course is useful in the development of interventions. Study tools incorporating a life course perspective in the measurement of SES are the need of the hour.
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Time to win the war against COVID-19: How and where community medicine professionals can contribute? p. 9
Prajna Paramita Giri, Vikas Bhatia
DOI:10.4103/IJCFM.IJCFM_35_20  
A coordinated and multidisciplinary approach is needed to fight against coronavirus. In the absence of any proven therapy and vaccines, the nonpharmaceutical interventions or public health measures will play major role in containment coronavirus spread. The community medicine specialists can contribute to the public health as well as health-care services in combating the pandemic. Domains where community medicine professionals can contribute: The community medicine professionals can contribute at micro, meso, and macrolevel of framework of health system which refers to the patient/individual interaction level, the health care organization and community level, and the policy level, respectively. At micro level, faculty and residents of community medicine department can play a pivotal role in pandemic preparedness in the areas catered by Urban Health and Training Center and Rural Health and Training Centers of Medical Colleges. Considering district at the mesolevel, if the district has a medical college, then the department of community medicine can take the lead in preparing a District Pandemic Preparedness and Response plan in consultation with relevant stakeholders. At the macro level of framework, community medicine specialists can contribute in a larger way such as developing the guidelines and policies related to COVID-19. Where whole-society or the community is the key to control pandemic, the community medicine professionals can play the important role in the response mechanism for COVID-19 as well as for future pandemic.
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REVIEW ARTICLE Top

SARS COVID-19 crisis – Developing nations to emulate what? p. 13
Sonia Puri
DOI:10.4103/IJCFM.IJCFM_27_20  
A new public health crisis, SARS COVID 19/2019 novel coronavirus has engulfed the world in no time causing enormous affliction and mortality, collapsing health care, social devastation, and economic Wreck down. Developing nations are affected disproportionately more in contrast to developed nations. The purpose of this article is primarily to highlight the time tested strategies which must be emulated by developing nations in view of resource and time constraints.
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ORIGINAL ARTICLES Top

Assessment of mental health status using patient health questionnaire-9 in patients attending outpatient department at a block primary health center in Patna, Bihar p. 17
Pragya Kumar, Ditipriya Bhar, Geetika Singh, Shamshad Ahmad
DOI:10.4103/IJCFM.IJCFM_45_19  
Introduction: Identification of untreated depression could be a chance of opportunity in outdoor settings. Earlier findings show a high proportion of depression among patients visiting outdoor at the tertiary level of care. We want to estimate its burden in an outdoor setting at the primary level of care. Material and Methods: The current study was a facility-based cross-sectional study which was conducted for 3 months at a primary health center (PHC) in a rural area of Patna (Naubatpur), Bihar. Patient health questionnaire (PHQ)-9, along with sociodemographic variables, was included in the development of a semi-structured questionnaire. A trained data collector took one-to-one interview using this questionnaire. Results: The proportion of male and female were almost equal (49% vs. 51%). The mean age of the study subjects was 38.80 ± 13 years. Most study subjects were suffering from depression (59.60%). One-third of them had mild, one-fourth had moderate, and rest had a moderately severe and severe category of depression. The mean score was 6.67 ± 5.08. In mild to the moderate category of depression, higher age group of the study subjects was more affected. In the severe category of depression, younger age group was affected worse. The prevalence of depression was almost doubled in females as compared to males in all category of depression, and this was statistically significant. The prevalence of moderately severe depression was highest in the study subjects who were illiterate. Conclusion: PHQ-9 can be used at PHC to screen the patients with depression.
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Effect of information, education, and communication activity on health literacy of obesity and physical activity among school-going adolescents in Delhi p. 22
Srishti Yadav, Anita Khokhar
DOI:10.4103/IJCFM.IJCFM_21_19  
Introduction: Awareness about risk factors of lifestyle diseases such as obesity and lack of physical activity is present among adolescents but to some extent only. Furthermore, younger ones tend to maintain the unhealthy habits as they age. Thus, intervention should start at an early age. Aim: This study was conducted to assess the health literacy of school-going adolescents regarding obesity and lack of physical activity as risk factors for lifestyle diseases and assess the improvement in their knowledge after different information, education and communication (IEC) activities in two schools. Settings and Design: It was a school-based interventional study conducted in two schools. Material and Methods: Pretested questionnaire for baseline and post-IEC activity assessment of health literacy of risk factors like obesity and physical inactivity in lifestyle diseases was administered among students of Class 6, 7, and 8. Postintervention data were collected at 2 weeks after the first intervention and 3 months after the last intervention. Responses were scored and categorized as satisfactory and unsatisfactory. Statistical Analysis: Chi square test was applied to compare the proportion of scores (satisfactory and unsatisfactory) at baseline, 2 weeks and 3 months. Results: About 64% students in school 1 and 69% students in school 2 knew what obesity was. Moreover, about 79% of students in school 1 and 69% students in school 2 knew the minimum duration of physical activity required to prevent lifestyle diseases. There were a higher proportion of students with a satisfactory level of knowledge in both the schools after 2 weeks and 3 months of IEC activity, and the differences were statistically significant (P < 0.05). Conclusion: The proportion of students having satisfactory knowledge satisfactory knowledge of obesity and physical activity increased after educational interventions among school-going adolescents of both the schools.
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Overweight and obesity among school-going adolescents in Bengaluru, South India p. 28
Anangamanjari D Pedapudi, Ryan A Davis, Priya Rosenberg, Priya Koilpillai, Bhavya Balasubramanya, Avita Rose Johnson, Ambuj Kumar, Lynette Menezes
DOI:10.4103/IJCFM.IJCFM_70_19  
Introduction: Adolescent obesity is an emerging public health problem in urban India. This study assessed the prevalence of overweight and obesity and its associated factors among school-going adolescents in Bengaluru, India. Material and Methods: Cross-sectional study of 734 male and female students aged 10 years and older from two private schools in Bengaluru city, India. Students were administered a questionnaire that recorded socioeconomic, and family-related factors and lifestyle behaviors. Anthropometric measurements done to determine overweight and obesity using the WHO body mass index for age charts. Nominal variables were described in terms of frequency and proportion, and odd's ratio (OR) (with 95% confidence interval) as test of association. Results: The prevalence of overweight and obesity among adolescents was 21.7% and 6.1% respectively. Age, gender, religion, education level of parents, mother working outside the home, participation in vigorous physical activities, vegetarian diet, and consumption of junk foods as snacks were not found to be significantly associated with overweight/obesity. Conclusion: The prevalence of overweight/obesity among school-going adolescents in Bengaluru, India was 27.8%. Adolescents from the higher income families, OR = 2.35 (1.43–3.85) as well as students who indicated a family history of obesity, OR = 2.4 (1.72–3.33) were more likely to be overweight or obese. Since young adolescents spend a significant portion of their day in school, a comprehensive school health service including growth monitoring, nutrition education, and exercise programs remains one of the most cost-effective public health measures.
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A study on epidemiological determinants of malnutrition and health status of under-5 children in the field practice area of rural health training center p. 34
Kailas S Ninama, Parul Manish Hathila, DV Bala
DOI:10.4103/IJCFM.IJCFM_17_19  
Introduction: Malnutrition is the condition that results from eating a diet in which certain nutrients are lacking, in excess, or in the wrong proportions. Child is the victim of interplay of nutrition, socioeconomic (SE), and health factors that cause malnutrition. Aim: The aim is to study the epidemiological determinants of malnutrition and health status of under-5 children. Material and Methods: The present cross-sectional study was carried out in 600 under-5 (0–59 months) children from March 1, 2012 to July 31, 2013, in Rural Health Training Center field practice area by house-to-house survey till the desired sample was achieved. Sociodemographic information, mother's obstetric history, clinical examination, and anthropometry measurement of under-5 children and immunization status (either by history or by available medical records) was obtained. Results: Majority (534 [89%]) of children were Hindus, from lower SE Class III and IV, 337 (56.2%) and 193 (32.2%), respectively. Sex ratio was 980 females/1000 males. Quarter (122) of the children belonged to age group 0–11 months followed by 138 (23%) and 123 (20.5%) from 12 to 23 months and 48–59 months, respectively. The prevalence of wasting, stunting, and underweight was 151 (25.2%), 237 (39.5%), and 223 (37.2%), respectively. Acute morbidity rate was observed to be 47 (7.8%). Full immunization appropriate for age was 537 (89.5%). Under-5 mortality rate was 30/1000 under-5 years children per year (n = 18). Conclusion: Prevalence of malnutrition was high in males and lower SE Class (III and IV). Acute morbidity was higher in males than females.
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A study to assess the magnitude of exposure to secondhand smoke among antenatal mothers in an urban slum of central Karnataka p. 41
Rachana R Annadani, Smruti Krishna Bhat, Malatesh Undi
DOI:10.4103/IJCFM.IJCFM_57_19  
Introduction: Secondhand smoke (SHS) exposure in reproductive-age women can cause adverse reproductive health outcomes similar to active tobacco smoking such as pregnancy complications, fetal growth restriction, preterm delivery, stillbirths, and infant death. Nearly 56% of the reproductive-age women in the World Health Organization South-East Asian region are exposed to SHS. However, no data is available on exposure to SHS among pregnant mothers, especially in urban slums. Objectives: The objective was to assess the magnitude of exposure to SHS among antenatal mothers in an urban slum and their knowledge regarding hazards of exposure to SHS on them and fetus. Material and Methods: After obtaining ethical clearance, 418 antenatal mothers who visited the antenatal clinic in an urban slum were included. Data regarding exposure to SHS were collected. Their knowledge on hazards of exposure to SHS on both mother and fetus was also collected. Results: Majority were in the age group of 21–25 years (55.5%), studied up to high school (40.7%), and were homemakers (72.1%). Among the 418 antenatal mothers, 277 (66.27%) were exposed to secondhand smoke; 199 (47.61%) at public places, 53 (12.68%) at their homes, and 25 (5.98%) at their workplaces. Only half of the study participants were aware that SHS is injurious to health of the individual, and only 24.4% of the study participants were aware that SHS is also injurious to fetal health. Conclusion: Exposure to SHS among the study participants was high (66.27%), and the awareness regarding the harmful effects of SHS on the health of the mother and fetus among the participants was poor.
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Selection of Urban Health Equity Assessment and Response Tool indicators using item response theory analysis to assess a city health profile in India p. 47
M Siva Durga Prasad Nayak, KA Narayan
DOI:10.4103/IJCFM.IJCFM_72_19  
Introduction: City health profile is a useful tool for understanding the health gap and to plan to close the health gap. Of the different tools available to draft a city health profile, the Urban Health Equity Assessment and Response Tool (HEART) developed by the WHO Kobe Centre is one of the best among them. A list of core indicators of the Urban HEART varies from country to country. Aim: In this scenario, an attempt was made with an aim to choose feasible indicators in the Urban HEART to assess a city health profile in Indian setting. Material and Methods: The current study is a cross-sectional observational study conducted among different public health experts in India using an online survey technique. An online survey form was created to collect the public health expert's opinion and sent to public health experts. A total of 105 responses were collected. Statistical Analysis: The average opinion score for each indicator was measured. Item response theory analysis technique was used to calculate the feasibility score to categorize the indicators. Results: The average score of the 60 indicators ranged from 4.54 to 2.77. The feasibility score ranged from 4.13 to − 0.49. Of 60 indicators, 16 indicators were strongly recommended, 41 were recommended, and 3 indicators were optional indicators. Nineteen were highly feasible, 28 feasible, and 13 were less feasible indicators. Conclusion: The Urban HEART can be applied in Indian setting. Data collection can be started with feasible indicators and later can be extended to other indicators.
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Stress, its determinants and its association with academic performance among the students of a medical college in Kerala p. 56
M Madhusudan, Sudarshan B Puttaswamy, K M Anjali Krishna, PK Farsana, AS Angela, I Muneer, Tessy Thomas
DOI:10.4103/IJCFM.IJCFM_62_19  
Introduction: Medical education is one of the most stressful academic curricula worldwide, negatively affecting the health of medical students. Stress in medical students if not tackled in time, can have professional ramifications, as well as personal consequences. Hence, in this background, this study was undertaken to find out the prevalence of stress among medical students, its determinants and its association with academic performance. Material and Methods: This was a cross-sectional study done at a medical college, Wayanad district, between January and June 2019. All the undergraduate medical students of the college were the study subjects. Data were collected using a predesigned and pretested self-administered questionnaire, the first part of which had questions pertaining to basic sociodemographic details, factors affecting stress, and their academic performance, and the second part was the Medical Student Stress Questionnaire. Completed responses were obtained from a total of 605 students. Results: About 29.8%, 53.6%, 16.7% and 0% were found to have no/mild stress, moderate stress, high stress and severe stress respectively. The prevalence of moderate/high stress was more among 25–26 years, males, married, Phase I MBBS, government quota, Muslim, urban origin, and day scholar students. However, only religion and place of origin were found to have a significant association (P = <0.01 and 0.048 respectively). The median stress score was highest for the academic domain 1.5 and least for drive and desire related and group activities related domain (1 for both). There was a very weak positive correlation (r = 0.007) between the percentage of marks obtained and total stress scores, and the correlation was found to be statistically insignificant (P = 0.868). Conclusion: The prevalence of stress among the participants was low. Muslim religion and urban origin were found to have a significant association with the prevalence of moderate/high stress. There was a very weak positive correlation between the percentage of marks obtained and total stress scores.
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A cross-sectional descriptive study to assess the awareness of breast cancer and practice of breast self-examination among rural women in Kancheepuram district p. 61
Saurabh RamBihariLal Shrivastava, C Sowbha, Prateek Saurabh Shrivastava
DOI:10.4103/IJCFM.IJCFM_69_19  
Introduction: Breast cancer has been ranked as leading cancer across the world among women. The current study was done to assess the awareness about breast cancer and the practice of breast self-examination (BSE) among rural women in Kancheepuram district. Material and Methods: A cross-sectional community-based descriptive study in the rural field practice area of a medical college was conducted for 2 months. The sample size for the study was estimated to be 120 and systematic random sampling was employed. All women aged between 30 and 70 years of age were included in the study, and they were interviewed using a pretested semi-structured schedule. The knowledge responses were arbitrarily categorized as poor, fair, and good knowledge. Utmost care was taken to maintain privacy and confidentiality. Data entry was done in Microsoft Excel, and statistical analysis was performed using SPSS version 23.0. Results: The mean age of the study participants were 47.2 ± 7.8 years, with the majority of women from 50 to 60 years age-group. Most of the study participants 102 (85%) have heard about breast cancer, and positive family history and inadequate breastfeeding were identified as the most common risk factors. Only 4 (3.3%) women were practicing BSE and even among them none of them were doing it regularly. Factors like women being not aware of what to look for or how to perform it were the main barriers preventing them from doing BSE. Conclusion: In conclusion, 51 (42.5%) women had good to fair knowledge about breast cancer, whereas only 20% of the study participants were aware about BSE and its role in early detection of breast cancer. These findings clearly indicate that intensive efforts have to be taken for the advocacy, communication, and social mobilization to enable early detection of breast cancer among these underprivileged women.
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SHORT COMMUNICATION Top

Understanding the trends of public spending on health sector: World Health Organization p. 66
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/IJCFM.IJCFM_15_19  
Since the global leaders have adopted the Sustainable Development Goals, major steps have been taken by different nations to attain the goal of universal health coverage. Apart from the various measures which have been tried upon, due emphasis has been given to augment the financial allocation to the health sector and thus expand the reach of health care services. The findings of a recently released report have indicated a hike in the total health spending both in low- & middle-income nations and high-income nations. In the nutshell, it was reported that in excess of 50% and 35% expenditure on health has been through government sector and through out of pocket expenditure respectively. In conclusion, there is an immense need for an augmentation in the government spending on the health sector to minimize the health inequalities and the strengthening of the primary health care.
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CASE REPORTS Top

Reactive arthritis due to asymptomatic Escherichia coli bacteriuria in a young tuberculosis patient p. 68
Hameed Aboobackar Shahul, Mohan K Manu, Aswini Kumar Mohapatra
DOI:10.4103/IJCFM.IJCFM_77_19  
Reactive arthritis (ReA) is commonly associated with gastroenteritis by Yersinia, Salmonella, Shigella, Campylobacter, and Clostridium difficile and genitourinary infections by Chlamydia trachomatis and Neisseria gonorrhea. Urinary tract infection (UTI) with Escherichia coli is rarely associated with ReA. Failure to screen for UTI, especially in patients with asymptomatic bacteriuria, can lead to delayed diagnosis and inappropriate treatment. A 31-year-old homemaker, who had been diagnosed with pulmonary TB 1 month back and had completed 1 month of successful anti-TB therapy, presented with pain and swelling of the right knee and fever of 1-week duration. She had healing erythema nodosum on both her thighs. Her right knee had pain and swelling that lead to restriction of movements. X-ray of the right knee showed joint effusion with no joint destruction. Work up for autoimmune arthritis was negative. Synovial fluid studies ruled out septic arthritis, crystal arthropathies, and tuberculous arthritis. Urinalysis suggested UTI and urine culture isolated E. coli. Hence, we made the diagnosis of ReA due to UTI with E. coli. She received oral nonsteroidal anti-inflammatory drugs and a course of ciprofloxacin. She had a complete recovery.
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Extensive subcutaneous emphysema masquerading as anaphylaxis p. 71
Upendra Hansda, Prajna Paramita Giri, Sangeeta Sahoo
DOI:10.4103/IJCFM.IJCFM_18_20  
Road traffic accident is not uncommon in India. Though the chest injury is less common after road traffic accident it may present atypically. Delay in diagnosis of a life threatening chest injury may lead to death. We are reporting a case of extensive subcutaneous emphysema after road traffic accident. The subcutaneous emphysema was due to tension pneumothorax, which was managed in time to save the patient.
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RESIDENT CORNER Top

Public health updates from October 2019 to April 2020 p. 74
Annu Antony, R Akshaya, Jyolsna Nair
DOI:10.4103/IJCFM.IJCFM_28_20  
Public health is a very dynamic area, were the policies, guidelines, management is continuously monitored and amended to the current situation. Epidemics and pandemics are now frequent and more widespread due to globalization. In this scenario, being updated in public health related news and changes are must for an effective community medicine practice. Our article concisely presents all the relevant updates from the month of October 2019 to April 2020. This article discusses the timeline of COVID-19 pandemic in this period, Ebola epidemic, new changes in national programs, new amendments in National Policies or Acts, new schemes implemented, and also discusses the yearly themes of international and national days related to public health celebrated during the time frame.
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LETTER TO EDITOR Top

“Elixir of life:” Palliative care p. 78
Pratibha Vyas, Pankaj Bhardwaj
DOI:10.4103/IJCFM.IJCFM_78_19  
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