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   Table of Contents - Current issue
July-December 2020
Volume 6 | Issue 2
Page Nos. 81-176

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Living with COVID-19: Herd immunity to appropriate behavior to vaccine p. 81
Vikas Bhatia, Kishore Yadav Jothula
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Psychological impact of COVID-19 pandemic on healthcare workers and strategies to mitigate them p. 84
MD. Abu Bashar, Nazia Begam
The outbreak of a novel coronavirus starting from December 2019 and reaching pandemic proportions has raised concerns as to the ability of current protective measures and the health-care system to handle such a threat. Health-care workers may experience considerable psychological distress as a result of the COVID-19 pandemic due to providing direct patient care, vicarious trauma, quarantine, or self-isolation.
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Determinants of COVID-19 transmission in India: Issues and challenges p. 88
Ganesh Kumar Saya, Palanivel Chinnakali, KC Premarajan
The recent increase in trend of COVID-19 cases in India is an important public health issue. Cases reported vary in calendar time in different states and regions. Case presentations, its determinants and mediators such as behavioral and social factors may be different across and within countries. Although agent, host and environmental factors play a major role, there are other influencing factors for transmission of infection. Appropriate cost-effective prevention strategies such as social distancing, use of face mask and its implementation in the Indian context is a big challenge. Recent data available on the public domain was reviewed on various issues and challenges related to determinants of COVID-19 and its transmission in the Indian context. This review emphasizes to further strengthen prevention of infection transmission strategies at regional and state level by a combination of multiple strategies and robust surveillance system.
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Role of ayurvedic intervention in the management of anemia p. 93
Ishita Agarwal, Kapil Yadav, Gomathi Ramaswami, Tripti Rai
Anemia is an important public health problem in India. Complementary and alternative systems/traditional medicines can also be explored for the control of anemia apart from the existing platforms. Interventions with various herbal and iron formulations have been reported in Ayurveda. Hence, this review was aimed to explore the effect of various ayurvedic drugs on anemia from the existing literature. Literature was searched in PubMed, Google Scholar, Cochrane Library, Medline (Ovid), IndMed and by cross-referencing the articles. Key words used included “Pandu Roga,” “Anemia” and “Ayurveda.” The search was restricted to original research articles published in the English language from January 2005 to June 2018 among human subjects. Randomized and nonrandomized control trials were included in this review, which assessed the effectiveness of ayurvedic drugs on improvement in hemoglobin as well as subjective parameters such as weakness, anorexia, and pallor. Effectiveness of 17 different Ayurvedic preparations was assessed in the studies. The maximum increase in hemoglobin was observed by the drug Sarva-juara-hara-lauha in a dose of 500 mg (145.55 mg elemental iron), when administered daily for 30 days using honey as a vehicle. Increase in hemoglobin from 7.3 ± 1.9 to 12.1 ± 1.6 g/dL was observed. All studies that assessed the effect of the drugs on the basis of subjective parameters reported a decreased percentage of complaints by the patients. No adverse reactions were reported. In conclusion, administration of ayurvedic drugs is an effective and safe approach for prevention and management of anemia in various population groups. However, larger multicentric studies are required to assess the exact potential of these drugs in the control of anemia.
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Inventory management of drugs at a secondary level health-care center in Odisha p. 104
Susmita Dora, Arvind Kumar Singh, Prem Sagar Panda, Jitendra Kumar Sahoo
Introduction: Planning the recurring purchases in the pharmacy results in efficient functioning of a health-care facility. Limited studies have explored the inventory management at secondary-care settings. The objective of this study was to analyze the annual drug expenditure of Community Health Centre (CHC), Tangi during the year 2017-2018. Material and Methods: The annual procurement of, and expenditure incurred on drugs for financial year 2017-2018 drugs was analyzed at the secondary level CHC always, better, control (ABC) analysis, vital, essential, desirable (VED) analysis and combination matrix of ABC-VED which are inventory management techniques based on expenditure, criticality, and combination of both. Results: Total expenditure for the year 2017–2018 on 232 drugs was 4,606,487 rupees. According to ABC analysis, Category A, B and C constituted 8.6%, 19.4%, and 72% accounting for 70%, 20%, and 10% of the total expenditure. VED analysis showed 21%, 66%, 13% items as Vital, Essential, and Desirable, accounting for 14%, 67%, and 19% of annual expenditure. On ABC-VED matrix analysis, 24.1%, 66.8%, and 9.1% drugs were found to be Category A, B and C, accounting for 74.7%, 24.6%, and 0.7% of annual expenditure. Conclusion: ABC-VED matrix analysis can be used for effective management of inventory at a secondary level healthcare centre.
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External rapid convenience monitoring of measles–rubella campaign 2017 and lessons learned: Study from a hilly district of North India p. 108
Devender Kumar, Vijay Kumar Barwal, Amit Sachdeva, Anmol Gupta
Introduction: The most recent vaccine incorporated in the Universal Immunization Program of India is measles-rubella vaccine, introduced as a catch-up campaign to eliminate measles and control rubella by the year 2020. The success of any immunization campaign lies on its meticulous planning for areas such as trainings, cold chain management, advocacy, and social mobilizations. Rapid convenience monitoring (RCM) was done in nine health blocks of a hilly district of Himachal Pradesh, pertaining to various campaign activities, for determining vaccine coverage and side effects. Material and Methods: Standardized formats developed by the World Health Organization for RCM of the quality of activity at session sites which included information regarding vaccinating teams, immunization sites, logistics used, cold chain and aseptic condition management, waste disposal, and record maintenance were used. School and house-to-house visits were conducted randomly to check the indelible ink mark/vaccination cards to find out any missed child. Results: A total of 107 immunization sessions were observed for compliance. We assessed 1182 children between the age group of 9 months and 15 years for determining vaccine coverage during the measles–rubella campaign in September–October 2017. Compliance to various aspects of the campaign was found very good, exceeding 90% in almost all the domains. The total vaccination coverage was 98.1%. Schools and health-care providers were the major source of information for this campaign. No severe adverse events following immunization were reported during the survey. Conclusion: Activity compliance and vaccination coverage were found high. Adequate supply of indelible ink pens and functional hub cutters needs to be ensured. There should be revision of incentives to team members with increased involvement of accredited social health activist workers in such campaigns.
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A discrepancy in logistics and supply chain management: Findings from national iron plus initiative process documentation in Odisha p. 114
Vikas Bhatia, Swayam Pragyan Parida, Preetam B Mahajan, Sarika Palepu, Sourabh Paul
Introduction: Anemia is highly prevalent in India affecting all age groups. In 2016, process documentation program was done in Odisha by Department of Health and family Welfare, Government of Odisha with the aid of UNICEF and All India Institute of Medical Sciences, Bhubaneswar to assess National Iron Plus Initiative program. The objectives were to assess facilitating factors and hindrances in implementation of program. In the present study, hurdles in logistics and supply chain management are discussed. Material and Methods: A mixed-methods study was done among four districts (3 poor performing and one good performing) based on Iron folic acid tablets consumption. Two blocks from Keonjhar and Jagatsinghpur and one block from Bhadrak and Kalahandi were selected. In depth interviews and Focus group discussion were done among 170 respondents (officials and beneficiaries). By probability proportion to size, 50 sub-centres were chosen and front line workers interviewed. Data was collected by survey team and analysis was done using Nvivo qualitative research software program for qualitative surveys and Microsoft Excel for quantitative surveys. Results: It was seen that there were discrepancies in the method (bypassing officials), frequency of indenting (quarterly, bi-annual and annual), supply chain, stock out management (informal methods) and flow of supply (prolonged quarantine period). It was also seen that only 41% of sub-centres had IFA tablets at the time of survey. Conclusion: Logistics and supply chain management play a crucial role in the success of any program. Timely and orderly management, centralised method and formal approach need to be incorporated.
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Adherence to iron with folic acid supplementation in women attending an antenatal clinic at a low-income urban area in Delhi, India p. 120
Saurav Basu, Ekta Arora, M Meghachandra Singh, Suneela Garg, Nidhi Budh
Introduction: Adherence to Iron-Folic Acid Supplementation (IFAS) in pregnant women can safeguard them against nutritional anemia and the related adverse pregnancy outcomes. The objective of this study was to assess the adherence to oral IFAS in women attending an antenatal clinic in an urban resettlement colony of Delhi, India. Material and Methods: We conducted a cross-sectional study and enrolled 211 antenatal women through consecutive sampling during a 4-month period from December 2018 to April 2019. IFAS adherent status was defined as women taking ≥80% of their prescribed IFAS in the previous 7 days, equivalent to IFAS intake for at least 6 days in the previous week. We also estimated adequacy of IFAS drug stocks with the patient during the past 30 days. The data were analyzed using IBM SPSS Version 25. A P < 0.05 was considered statistically significant. Results: The mean (± standard deviation) age of the women was 24.6 (±3.4) years, ranging from 19 to 35 years. Median years of education was 11, and all the women were currently married. A total of 54 (25.6) women reported being non-adherent to their prescribed IFA medication. Only 175 (82.9%) women had adequate IFAS stocks during the past 30 days. On adjusted analysis, running out of IFAS stocks was a significant predictor of IFAS non-adherence (P = 0.004). Conclusion: The present study indicates that adherence to IFAS among pregnant women is suboptimal. Non-adherence was usually because of running out of drug-stocks but rarely due to drug side-effects.
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Quality of life among people living with HIV/AIDS receiving highly active anti-retroviral therapy: A domain-based analysis p. 125
Yasir Alvi, Najam Khalique, Anees Ahmad, Mohammad Salman Shah, Nafis Faizi
Introduction: With the highly effective antiretroviral treatment, HIV is transforming into a chronic condition, whose management is now experiencing problems of other chronic diseases, where quality of life (QoL) plays a central role. This study was conducted with the objective of determining the QoL among people living with HIV/AIDS (PLHA) taking Anti-Retroviral Therapy (ART) and examine the factors affecting it. Material and Methods: A cross-sectional study was conducted at ART center, Aligarh. 434 PLHA on antiretroviral therapy, were interviewed using a pretested questionnaire, assessing QoL with the World Health Organization (WHOQoL) HIV-BREF. For domain-based analysis, we examined the association of various factors with the individual domain. The P < 0.05 was considered statistically significant. Results: The mean score in all the domains of WHOQoL was maximum for the level of independence (15.7 ± 2.6) followed by the physical domain (15.5 ± 3.0), while environment domain (11.7 ± 1.8) had the least mean. All the domains, including overall QoL scored above average QoL. This study also showed that a strong relationship exists between QoL with lower socioeconomic status, presence of side effects from ART and depression. Conclusion: The QoL of HIV patients taking ART from Aligarh was adequate, reflecting the efforts of NACO and other agencies in managing the disease. With respect to its determinants, providing good family support, better employment opportunities, reducing stigma, and proper and timely management of side effects and depression could further increase levels of QoL.
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A cross-sectional study on parental awareness for newborn screening and assessment of the burden of congenital hypothyroidism and glucose 6-phosphate dehydrogenase deficiency p. 132
Suprava Patel, Phalguni Padhi, Ritu Priya, Tripty Naik, Rachita Nanda, Eli Mohapatra
Introduction: Newborn Screening (NBS) has been one of the most successful health programs and of most paramount importance worldwide but not so in India. Due to the lack of awareness and paucity of laboratory facilities, the disease burden in our population has not yet been established. Aim and Objective: The aim and objective of the study was to assess the burden of Congenital Hypothyroidism (CH) and Glucose 6-Phosphate Dehydrogenase (G6PD) deficiency in this area by NBS tests and to assess the impact of awareness sessions on the response rate of parents for NBS. Material and Methods: The screening was conducted in 474 babies of age 48 h up to 8 weeks. The dried blood spots collected were subjected to the following analytical protocol. Thyroid-stimulating hormone (TSH) level and G6PD enzyme activity were analyzed by immunofluorescence method-based neonatal kits. All babies with a positive screening test for G6PD deficiency and CH were asked for venous confirmatory testing after 7 days. Results: The efficiency of the program for all live birth babies delivered in the institute was 92% (n = 410/445). It was 82% in the first phase of the study period and 98.5% in the second phase. Repeated training of nursing professional reduced the sampling errors from 14.7% in the first phase to 6.1% in the second phase. A total of 11 samples reflected high TSH values, of which one baby confirmed for CH. Of the 24 babies who screened positive for G6PD, four were confirmed for the same. The prevalence for CH and G6PD deficiency was, respectively, 1 in 462 (2/1000) and 4 in 462 (8.7/1000). Conclusion: Development of expansion of NBS program in the state should be made mandatory for all newborns. The recommendations include awareness among parents, during antenatal and postnatal period and also to health professionals and provision for laboratory facilities for NBS testing at low cost.
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A study of factors influencing academic performance of undergraduate medical students p. 137
Priyanka, Manish Kumar Goel, Sanjeev Kumar Rasania
Introduction: An important indicator of quality of medical education is students' academic performance and the study of factors which influence the academic performance of medical students is important as it can provide information to improve educational programs. Material and Methods: This was a cross-sectional study involving medical students who passed their final professional examinations and were about to start their internship training. They were asked to complete an anonymously administered feedback form which contained questions regarding the academic performance of students in all the professional examinations of MBBS along with background characteristics of students. Data entry and statistical analysis was carried out using statistical software SPSS version 12. The primary outcome was the proportion of students in different levels of academic achievement. The secondary outcome was the factors associated with different levels of academic achievement. Descriptive statistics were used to describe the distribution of all variables. For finding out the association, an analysis using Chi-square test was done for qualitative data. Results: The mean age of participants was 22.7 ± 0.67 years (range 21–25). About 43.6% of the students had scored <60% marks, while 56.4% had scored more than that. High-performing students were found to spend more time on hobbies as well as on physical activities and less time on social networking sites as compared to the average-performing students. Study and sleep habits of high performers were significantly different from average performers. Conclusion: Many factors were found to have a significant association with academic performance of students such as residence, having a doctor parent, spending time on personal hobbies and social networking sites, time spent on study, and duration of sleep a day before examination.
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Determinants of injectable depot medroxyprogesterone acetate contraception among women of reproductive age: A study from Southern Haryana, India p. 144
Vikas Gupta, Suraj Chawla, Neeraj Gour, Pawan Kumar Goel
Introduction: The safety and effectiveness of Depot Medroxyprogesterone Acetate (DMPA) (available by the name of “Antara” in Government of India supply) has resulted in inclusion of this injectable contraceptive in the basket of family planning choices and thus has opened the way for clients to avail of a safe, effective, and hassle-free method with full confidentiality, which is also free of cost in public health facilities all over India. Material and Methods: This community-based study with cross-sectional design was conducted during April 2019–October 2019. During first 3 months of the study, all the females who adopted the DMPA contraception were included in the study and the factors for opting DMPA were assessed. Results: Among those who had previously used contraceptives, oral pills were the most prevalent method. Most of the clients who opted to DMPA agreed that they switched because of privacy and confidentiality attached to DMPA. The side effects were reported by more than four-fifth of subjects, and the most common side effects were irregular spotting per vaginally, amenorrhea, and weight gain. Conclusion: The present study has shown some light regarding the factors responsible for injectable DMPA uptake as a family planning method and the facilitators and barriers to consistent injectable DMPA use. The study findings are expected to be utilized for framing policies to improve compliance of DMPA and making it more acceptable, client-friendly initiative.
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Assessment of the relation between obesity, serum lipids, and dietary intake of vegetable oils p. 150
Viral R Dave, Rujul P Shukla, Sudip Bhavsar, Nirmika Patel, Kantibhai N Sonaliya
Introduction: The study was conducted to assess the association between consumption of particular variety of cooking oil and its effect on serum lipid profile and also on body mass index (BMI). Material and Methods: The study was conducted at one of the tertiary care hospitals, Ahmedabad city, India. Patients with ≥18 years age who were undergoing “lipid profile” test at central laboratory department of selected hospital and giving consent were the study participants. Details of serum lipid profile were taken from report along with which anthropometric measurements were done and details of diet were taken. Data were entered into MS Excel and were analyzed by frequency, contingency coefficient, and Fisher's exact test. Results: Total 1000 participants were included in the study, among which 274 (27.4%) had raised lipid levels and 729 (72.9%) were preobese or obese. Association between variety of cooking oil used and cholesterol-high-density lipoprotein ratio revealed contingency coefficient value of 0.042 with P value of 0.416. Association between BMI and variety of cooking oil used revealed Fisher's exact value as 83.015 with P < 0.001. Conclusion: Statistical association was not found between serum lipid profile and type of oil used for cooking. Obesity indices revealed significant statistical association with both variety of cooking oil used and serum lipid profile. Dyslipidemia was found to have statistical significant association with raised blood pressure and raised blood glucose.
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Self-esteem and body-image dissatisfaction among adolescents: A cross-sectional study p. 157
Meera George, Neethu George, S Ajmal, Aga Paul, MS Aathira, AK Amruthavani
Introduction: Adolescence is the time period in which the values about themselves will be created. Hence, self-esteem and correct perception about own body are an important context in their life. Objectives: The objective of this study is to find out the degree of dissatisfaction with their body size (DDBS) among adolescents and to analyze the influence of it on self-esteem. Material and Methods: This study was cross-sectional done among the undergraduate students in a private medical college and students of high-school section of the government school. A questionnaire was used to document the sociodemographic details, subjective assessment of body image, and self-esteem. Results: In this study, majority of the students had high (93; 50.8%) self-esteem and moderate self-esteem (62; 33.9%). Out of 183 samples, 53 (29%) were satisfied with body contour based on DDBS. In those who were underweight, it is shown that 48 (54.5%) wanted to increase their body weight, and in normal body mass index (BMI) category, 50% of participants wanted to lose their body weight. Age and BMI were significantly associated with self-esteem and body-image perception. Conclusion: The concept of body image has to be modified to reduce the risk of overweight, obesity, and eating disorders. This, in turn, can increase and sustain the self-esteem of adolescence.
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Primary health care “approach” and medical education: New opportunities for revitalizing the bond p. 163
Mohit P Gandhi
The importance of primary health care (PHC) has once again been reiterated in the Astana Declaration of 2018. PHC is an approach to health systems development rather than just a level of health-care service delivery. Understanding the PHC “approach” is crucial for doctors, across specializations and levels, as they are one of the prominent players in the country's health system. Undergraduate medical education offers an ideal window of opportunity to do so. The medical education policy, time and again, has acknowledged this need and has created mechanisms to fulfill it. The role of departments of community medicine has been kept central in these policy prescriptions. This, in practice, has led other departments to play only a weak role in the teaching and application of PHC. The Medical Council of India's new competency-based medical curriculum, with a renewed focus on integrated teaching, offers fresh opportunities to change this situation.
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Coronavirus disease 2019 pandemic: Strengthening health sector response amidst the background of global economic crisis p. 168
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The Coronavirus Disease-2019 (COVID-19) pandemic should be looked upon as much more than a public health emergency, as it has significantly impacted the global economy. Owing to the fact that the disease spreads by close contact, many of the nations imposed social restrictions, with an aim to reduce the spread of the disease. However, the bitter truth is that such measures enormously affects the income opportunities of individuals & families, and the financial status of the community and the nation at large. During these difficult times, each nation should start their response by funding all the components of the emergency response plan, strengthen the foundations of the health system and remove the possibility of financial constraints, which can prevent people to access health care. In conclusion, the COVID-19 pandemic has made us to come to a scenario where we have to not only save lives, but even ensure that livelihoods of people are sustained. Thus, the need of the hour is to strengthen the health sector through financial assistance, and simultaneously plan for the release of the lockdown to try to bring our economy back on track.
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Acute fatty liver of pregnancy: A clinical dilemma p. 171
Anita Yadav, Charu Sharma, Sukesh Kumar Kathpalia, Shiv Shankar Singh
Acute Fatty Liver of Pregnancy (AFLP) is a rare and life-threatening obstetric emergency. Although the exact pathogenesis is unknown, the cases of AFLP are believed to be associated with abnormal fatty acid oxidation. The diagnosis of AFLP is a challenging task for the clinicians because of the nonspecific clinical presentation which may mimic conditions such as acute viral hepatitis, preeclampsia or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) syndrome. Early diagnosis, prompt obstetric management, intensive supportive care, and a multidisciplinary approach are the key to a good outcome. We here present two similar cases of AFLP with two different outcomes managed in a tertiary care center of the Andaman and Nicobar Islands.
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Disinfection of environment in health-care settings: In COVID era p. 175
Raja Danasekaran, Vedapriya Dande Rajasekar
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