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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 4 | Issue 2
Page Nos. 2-79

Online since Monday, February 4, 2019

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EDITORIAL  

Developing the underdeveloped: Aspirational districts program from public health point of view p. 2
Vikas Bhatia, Rama Shankar Rath, Arvind Kumar Singh
DOI:10.4103/2395-2113.251433  
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REVIEW ARTICLE Top

Adapting the stepped care approach for providing comprehensive mental health services in rural India: Tapping the untapped potential p. 5
Priyamadhaba Behera, R Senthil Amudhan, Rishab Gupta, Anindo Majumdar, Arun M Kokane, Mohan Bairwa
DOI:10.4103/2395-2113.251440  
Recent National Mental Health Survey (2015-16) reported a prevalence of 13.7% for any mental disorders excluding tobacco use disorders in India. Translating it into real numbers, nearly 150 million people need active mental health interventions, disproportionately more in rural areas. Major challenges in delivering comprehensive mental health services in rural India are: a) lack of a well-defined strategy; and b) lack of trained mental health manpower. To fill this gap, the global mental health community has increasingly realized the importance of Community Health Workers (CHWs) and role of stepped care approach in mental health service delivery. We propose a model of stepped care approach to fulfil the need of rural India, utilizing the existing health system components for improving mental health knowledge, reducing social stigma for mental disorders, screening for priority mental disorders at community level, ensuring compliance to treatment, timely follow-up, and community-based rehabilitation by mobilising community support for diagnosed cases. This stepped care approach will integrate mental health into Ayushman Bharat’s Health and Wellness Centres (HWCs) for the provision of comprehensive primary health care. Integration of new age technologies such as telepsychiatry, e-health, and mHealth into the proposed model will make it feasible and cost-efficient for inaccessible parts of the country.
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CME Top

Acute osteomyelitis p. 11
RB Kalia
DOI:10.4103/2395-2113.251431  
Acute osteomyelitis requires careful clinical evaluation, a high index of suspicion as it is an uncommon but devastating disease that affects largely previously healthy children. Management of osteomyelitis is a formidable challenge as success of antibiotics in soft tissues has not been replicated in bony tissue due to peculiar anatomy and physiology of the bone. Illness, malnutrition and decreased immunity predispose children to develop acute osteomyelitis. Absence of phagocytic cells in the metaphysis may explain predilection in children. Recently the trend in treatment strategy includes a rapid transition from intravenous to oral antimicrobial therapy and a shortened overall course of therapy. Many new therapeutic options are on the horizon that will likely impact the management of this and other childhood bacterial infections. This review will focus on recent advances in the management of acute hematogenous osteomyelitis in children.
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COMMENTARY Top

Microplastics- All we know till now and the way out p. 19
Utsav Raj, Puneet Kumar, Abhiruchi Galhotra
DOI:10.4103/2395-2113.251432  
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ORIGINAL ARTICLES Top

Levels and determinants of glycosylated hemoglobin (HbA1c) status among reproductive age women of Tripura, North East India p. 22
Subrata Baidya, Rituparna Das
DOI:10.4103/2395-2113.251434  
Introduction: Glycosylated hemoglobin (HbA1c), a marker of chronic hyperglycemia, has been recommended for use, in the diagnosis of diabetes. Objective: To assess the mean HbA1c level among reproductive age women in Tripura and to study the factors associated with high HbA1c level (≥ 6.5 %). Material & Methods: This cross-sectional study was conducted in Tripura among 2000 reproductive age women selected by Cluster sampling using PPS technique. Results: The present study revealed that the mean HbA1c level was 5.29 + 0.83% among the reproductive age women with 3.95% participants having HbA1c level of ≥ 6.5%). Multiple logistic regression analysis revealed that the age group and income of the family had a significant effect on the HbA1c status. Scheduled tribe women had 0.43 odds (0.22-0.81) of having high HbA1cstatus compared to women from general caste. Conclusion: The present study provided the reference values for HbA1c distribution among reproductive age women in Tripura and may be useful in the early identification of at-risk individuals.
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Neck circumference as a marker of malnutrition among children attending the under five clinic of a tertiary care hospital in Nagpur, Maharashtra p. 27
Chaitanya R Patil, Ketan R Dagdiya, Prithvi B Petkar, Abhijit Kherde
DOI:10.4103/2395-2113.251435  
Introduction: India is facing a dual burden of overweight/obesity and under nutrition among children less than 5 years of age. Neck circumference is recently studied marker for malnutrition among adults and older children. Objective: To correlate neck circumference with body mass index and to associate it with wasting and underweight status. Material & Methods: A cross sectional study was conducted among children less than 5 years of age attending the outpatient setup of a tertiary care setup in Nagpur, Maharashtra. Demographic details and anthropometric measurements were done for the children with necessary permission before the start of the study. Anthropometry was done using standard guidelines and WHO charts were used for classification of wasting and underweight Results: We included 260 study subjects in our study. The mean age of the children was 21.55 ± 17.31 months and majority of them were females, belonged to Hindu religion (58.07%), belonged to Class 4 (33.08%) and the mothers were educated up to senior secondary (34.62%). Neck circumference had significant positive correlation with birth weight (r=0.138) and body mass index (r=0.211). The average neck circumference was significantly lower in case of wasted (p<0.05) and underweight children (p<0.05). Conclusion: Neck circumference correlated significantly with body mass index and was significantly lower in wasted and underweight in children less than 5 years of age.
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Vaccine hesitancy and attitude towards vaccination among parents of children between 1-5 years of age attending a tertiary care hospital in Chennai, India p. 31
Sahana Sankara Narayanan, Aparna Jayaraman, Vijayaprasad Gopichandran
DOI:10.4103/2395-2113.251436  
Introduction: Vaccination is an effective public health intervention; however, coverage of vaccination is declining in states like Tamil Nadu which have good health indicators. Objective: To evaluate the presence of vaccine hesitancy among parents of children between 1 and 5 years of age attending the paediatric out patient department of a tertiary care hospital in Chennai and to assess its relationship with attitudes towards vaccines. Material & Methods: A cross sectional questionnaire-based survey was conducted among 100 consecutively sampled parents of children between 1 and 5 years of age attending a tertiary care paediatric out-patient department. The Parental Attitude towards Childhood Vaccines scale of vaccine hesitancy and the Beliefs and Attitudes towards Childhood Vaccines scale were used to measure vaccine hesitancy and beliefs and attitudes towards vaccination respectively. The data were analysed descriptively and statistical correlation between vaccination attitudes and vaccination hesitancy were studied. Results: In the predominantly urban, educated, working class population, the prevalence of vaccine hesitancy was 21%. But all the children had received complete vaccination appropriate for age. The major drivers for vaccine hesitancy were suspicions about newer vaccines, concerns about adverse effects of vaccines and the perception that there is no need for vaccines against uncommon diseases. The vaccine hesitancy scores were negatively correlated with the vaccine attitude scores (R = -0.266; p = 0.007). Conclusion: Vaccine hesitancy is present among the sampled mothers and is influenced mainly by concerns regarding safety of newer vaccines. Vaccine hesitancy needs to be clearly addressed for strengthening the Universal Immunization Program.
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Epidemiology of ovarian tumours in Northern India - A tertiary hospital based study p. 37
Sonia Puri, Veenal Chadha, AK Pandey
DOI:10.4103/2395-2113.251437  
Introduction: Ovarian cancer is the leading cause of mortality of female gynaecological cancers and ranks seventh as the most common cancer worldwide. The increasing life expectancy has led to increase in its burden exponentially now even in developing countries but limited knowledge is there about the pattern of ovarian tumours. Objective: To determine the burden and describe the pattern of ovarian tumours in patients visiting GMCH. Material and methods: This epidemiological study is retrospective, descriptive hospital based study over five years. The data so collected was analysed using SPSS software. Results: Maximum number i.e 74(24.4%) of cases were in the age group of 50 to 59 years followed by 40 to 49 years. It is also seen that maximum number of cases i.e total of 65 registries were in the year 2013. Maximum number of cases were from the state of Haryana contributing to nearly 41% of total cases. Most of the cases could not be classified into four stages i.e they were categorized as unknown. Chemotherapy is the most commonly used treatment modality. Epithelial adenocarcinoma was the commonest histology subtype. Conclusion: Research should be aimed to find tools for screening and early diagnosis so that better therapeutic approaches can be designed to decrease the burden.
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Shared risk factors of non-communicable diseases: A community based study among adults in an urban resettlement colony of Delhi p. 42
Anshu Singh, Anita Shankar Acharya, Balraj Dhiman
DOI:10.4103/2395-2113.251438  
Introduction: As urbanisation is increasing, the problem of communicable as well as non-communicable diseases (NCDs) is also increasing. Hypertension, diabetes, obesity, cardiovascular diseases constitute most of the NCDs whose risk factors are almost similar. They could be modifiable like physical activity, waist circumference, diet, smoking, alcohol intake . Objective: To study the magnitude of shared risk factors for Non-communicable diseases in adults of an urban resettlement colony of Delhi. Material and Methods: A cross sectional survey was conducted on adults >30 years (n=580) in both genders in an urban resettlement colony of Delhi in 2014. A Semi-structured interview schedule consisting of Socio-demographic characteristics, risk factor profile was used. Data was entered and analyzed in SPSS 12 Results: Out of the total 580 subjects (313)53.96% were women and 267(46.03%) were men. Majority 405(69.8%) of the study subjects were taking inadequate fruits and vegetables (<5 times/day) and 212 (36.6%) were taking >5 gm salt per day. About 181(31.2%) of the study subjects were sedentary workers, the proportion was more among women 99(31.6%). 223(83.5%) men had waist circumference within normal limits whereas 178 (56.9%) women had waist circumference more than 88 cm. One in four men were smokers. Nearly 49(18.4 %) of the men were current tobacco chewers as compared to 17(1.6%) of women. Only 33 (12.4%) men were currently consuming alcohol. Results of multiple logistic regression showed increasing age, education and marital status as significant socio demographic factors for increased prevalence of risk factors for NCDs. Conclusion: Promotion of lifestyle change to address these risk factors that can be modified including weight reduction, increased physical activity and healthy eating should be encouraged along with changing of behavioural factors like quitting smoking and alcohol.
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Depression and its correlates among geriatric people: A community based study from Southern Haryana, India p. 49
Suraj Chawla, Neeraj Gour, Pawan Kumar Goel, Ravi Rohilla
DOI:10.4103/2395-2113.251439  
Introduction: On account of improved life expectancy, better education and health facilities in India, the proportion of the geriatric population has gone up. In India, prevalence of depression estimated to be 4.5% in the year 2015, which affects about 57 million people. Objective: To determine the prevalence of depression and its epidemiological correlates among geriatric people residing in southern Haryana, India. Material and Methods: This community based study with cross-sectional design was conducted in rural and urban field practice areas of department of Community Medicine. Geriatric people were contacted by investigators through house to house visit. Study subjects were screened for depression by using standard shorter version Geriatric Depression Scale (GDS-15). Pearson’s Chi-square test was used for categorical variables. Stepwise multiple logistic regression was used to find out an independent factors associated with depression. Result: A total of 308 elderly persons belonging to rural and urban areas participated in our study. Prevalence of depression (GDS score >5) among the elderly population in the present study was found to be 22.72% (95% CI: 18.2-27.8). Conclusion: Present study depicted that every fourth elderly person was suffering with depression. Nuclear family, sleep problems, not consulting elderly in decisions, chronic morbidity, lack of physical activities, and death of close relatives were identified as risk factors of depression.
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PERSPECTIVE Top

Concept of primary eye care & school health in India p. 55
Anjan Kumar Giri, Sunita Behera, Abhiruchi Galhotra
DOI:10.4103/2395-2113.251441  
Primary eye care consists of promotive, preventive and curative actions by trained personnel or other interested people. Teachers are the best manpower to be trained for this purpose since they are more close to the students always. Poor visual function during early childhood may have several adverse outcomes. Through the school children, health messages can be propagated to their families, friends and peer groups. Training school teachers and empowering students and other staff of the school on simple and safe eye care practices through organized activities may come out as a cost effective way of improving general health and academic performance.
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Role of artificial intelligence (AI) in public health p. 60
Prem Sagar Panda, Vikas Bhatia
DOI:10.4103/2395-2113.251442  
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SHORT COMMUNICATION Top

Study of morbidity pattern in readymade denim factory workers in suburban slum of Maharashtra: A cross-sectional overview p. 63
Sunil Kumar Panigrahi, Parmeshwar Satpathy, Vineeta Singh, Sulabha V Akarte
DOI:10.4103/2395-2113.251443  
Introduction: Clothes form indispensible trade in modern society & jeans clothes are among the clothes with highest demand among youth. Most of the times the jeans fabrics are made in some industries and then they are transported to different small scale industries to make readymade clothes. Mostly these small scale industries consist of small labour force mostly involved in cutting & making of readymade jeans clothes. Most of these industries are unorganised sectors. This study intends to assess morbidity patterns workers in one of such industries invoved in cutting & making of readymade jeans clothes. Objective: To assess the morbidity pattern among the workers. Material & Methods: It is a crossectional study conducted in one of the small factory producing readymade jeans clothes. The total number of workers included was 256. The objective of the study was to assess the morbidity among the workers. The study tool used was a pre validated &pretested questionnaire, which included their demographic characteristics, general & systemic examination. Results: Among all the 256 workers in the factories, highest number i.e. 136 (53.13%) were in 20-30 year age group followed by 68(26.56%) in 30-40 year age group, 24(9.38%) each in 10-20 years & 40-50 years age group and only 4(1.56%) were in 50-60 years of age group. All of them were males. Conclusion: The health needs of the people working in these industries are high due to significant co morbidities, long working hours, lack of health awareness regarding substance abuse and safe sexual practice.
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DIAGNOSTICS IN CLINICAL SETTING Top

Sickle cell anemia: An update on diagnosis, management and prevention strategies p. 67
Shruti Mishra, Gaurav Chhabra
DOI:10.4103/2395-2113.251444  
Sickle cell anemia is the most common disease entity of all the monogenic disorders. This is an autosomal recessive disorder. HbS polymerization, vaso-occlusion, and hemolytic anemia are central to the pathophysiology of sickle cell disease, they precipitate a cascade of pathologic events, which in turn lead to a wide range of complications. The disease is particularly more prevalent in certain regions of the country like Odisha, Madhya Pradesh, Tamilnadu and has a significant impact on morbidity. Community based approach by providing availability of screening tests, & pre-marital and pre-pregnancy counselling should be initiated to reduce the disease burden in the society.
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CASE REPORT Top

Foot gangrene following dorsalis pedis artery cannulation: Risk versus benefit of arterial cannulation in polytrauma patient p. 72
Ritesh Panda, Chitta Ranjan Mohanty
DOI:10.4103/2395-2113.251445  
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PUBLIC HEALTH UPDATE Top

Public health updates (July-November 2018) p. 74
Dinesh P Sahu, Susmita Dora, Madhushree Acharya, DR Kavi Nila, Pradnya Chandanshive, R Akshaya
DOI:10.4103/2395-2113.251446  
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STUDENT CORNER Top

Lepromatous leprosy with erythematous nodosum leprosum: A public health challenge p. 77
Dinesh Prasad Sahu, Prajna Paramita Giri, Debjyoti Mohapatra, Binod Kumar Behera, Sonu H Subba
DOI:10.4103/2395-2113.251447  
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