Mortality surveillance in India: Past, present, and future Anand Krishnan, Dilip Kumar Das Indian Journal of Public Health 2019 63(3):163-164

Do we have a magic bullet to treat moderate and severe anemia in pregnant women? Shashi Kant Indian Journal of Public Health 2019 63(3):165-170 A desperate situation may evoke a fundamental question or suggestion of a radical solution. Hence, let us first examine whether the current situation of maternal anemia in India is really desperate and therefore merits a search for a “magic bullet” as a cure.

Effect of dietary habit and physical activity on overnutrition of schoolgoing adolescents: A longitudinal assessment in a rural block of West Bengal Arista Lahiri, Arup Chakraborty, Urmila Dasgupta, Amal Kumar Sinha Roy, Krishnadas Bhattacharyya Indian Journal of Public Health 2019 63(3):171-177 Background: Overweight among adolescents has high prevalence on the eastern part of India, especially West Bengal. Objectives: The current study was conducted to estimate and compare the effects of different dietary habits and habits related to physical activity in the development of overweight and obesity among rural schoolgoing adolescents. Methods: A prospective repeated measures study was conducted on 645 schoolgoing adolescents from selected rural government-aided schools from June 2017 to December 2017. Dietary habits of the students and physical activity-related factors were the major predictors. Adjusting for the age and sex of the participants, effect of these factors on the development of overweight and obesity was analyzed by generalized estimating equations for 2 repeated measures, taken 6 months apart. Results: Most of the respondents were aged ≥16 years (56.90%), female (52.87%), Hindu (76.74%), from a nuclear family (76.74%), and studying in the secondary level (57.68%). There was a stark rise in proportion of overweight from 0.93% to 7.44%. The prevalence of unhealthy dietary habits was 68.99% at the baseline, and 66.82% on follow-up. The overall prevalence of inadequate physical activity increased to 48.68% from 47.91%. Female gender and older age group were at higher risk of being overweight or obesity. Overall fast food showed highest risk (3.04, 95% confidence interval [CI]: 1.86–4.95), while among the boys, it was with less vegetable consumption (4.64, 95% CI: 1.84–11.69). Conclusions: Strong evidence was generated of dietary practices being more rigidly related to overweight among the adolescents. Healthy dietary practices coupled with physical activity should be promoted to mitigate the risk of obesity.

Community perception and risk reduction practices toward malaria and dengue: A mixed-method study in slums of Chetla, Kolkata Debayan Podder, Bobby Paul, Aparajita Dasgupta, Lina Bandyopadhyay, Arkaprovo Pal, Soumit Roy Indian Journal of Public Health 2019 63(3):178-185 Background: Globally, vector-borne diseases account for 17% of infectious disease burden. In India, despite accelerated efforts, both malaria and dengue are major public health concern. Understanding local community perspectives is essential to strengthen ongoing program activities. Objectives: The study aimed to assess the community perceptions and risk reduction practices toward prevention and control of malaria and dengue at slums of Chetla in South Kolkata and to explore the perspectives of relevant local stakeholders in this regard. Methods: This cross-sectional study with mixed-method design was conducted from June to September 2018. Quantitative data were collected in 288 sampled households through face-to-face interview of respondents and environmental checklist, whereas, qualitative exploration was done with five key informant interviews. Quantitative data were analyzed using SPSS version 16 Software. Qualitative data were analyzed thematically using “cut and sort” processing technique. Results: In household survey, majority had unsatisfactory knowledge (68.4%), attitude (64.2%), and practices (62.8%) regarding diseases prevention/control, which was further substantiated by qualitative findings. The use of electric fans (79.5%), mosquito repellents (53.8%) were predominant practices; however, only a few used bed nets regularly (26.0%). Reportedly, “heat” and “poor ventilation” were key reasons behind reluctance to use bed nets. Multivariable regression analysis revealed that increasing age, proximity to a nearby canal, and unsatisfactory knowledge significantly predicted unfavorable attitude, whereas, respondents' gender and unfavorable attitude significantly predicted poor practices. Conclusions: Intensified social behavior change communication with active community participation is the need of the hour to prevent malaria and dengue occurrence and future outbreaks.

Clustering of cardiovascular disease risk factors – Syndemic approach: Is sit a time to shift toward integrated noncommunicable disease clinic? Kalaiselvi Selvaraj, Sitanshu Sekahr Kar, Gomathi Ramaswamy, KC Premarajan, Ganesh Kumar Saya, Vinodhkumar Kalidoss Indian Journal of Public Health 2019 63(3):186-193 Background: The concurrent occurrence of many noncommunicable disease (NCD) risk factors is common, and it can play a synergistic role in occurrence of NCDs. Objectives: This study aimed to identify the magnitude of clustering of NCD risk factors, patterns of risk factors emerged in clustering, and variations in clustering of risk factors based on socioeconomic factors. Methods: A cross-sectional survey was undertaken in an urban area of Puducherry among 2399 adults during 2014–2015. Sociodemographic and behavioral risk factors were assessed through a validated STEPS survey tool. Individuals with three or more risk factors were classified to have clustering of NCD risk factors. Socioeconomic positions in relation to clustering were identified through Chi-square analysis followed by multiple logistic regression where clustering at family and area was adjusted through multilevel modeling techniques. Results: Of the 2399 adults, 1741 (73%) had clustering of NCD risk factors. Inadequate consumption of fruits and vegetables, high salt intake, and high waist circumference are the three predominant risk factors across all subgroups. Adults belonging to Christian religion (adjusted odds ratio [adjOR]: 2.8, 95% confidence interval [CI]: 1.5–5.2), aged 35 years and over (adjOR: 2.0, 95% CI: 1.4–6.0), and illiterates (adjOR: 1.8, 95% CI: 1.1–5.5) are more likely to have clustered NCD risk factors compared to others. Conclusions: Clustering of NCD risk factors is highly prevalent in this region and mainly driven by dietary practices and obesity measures. There is an urgent need to reorient the health system toward integrated approach with mandated inclusion of nutritionist in NCD health service delivery.

ABC, VED and lead time analysis in the surgical store of a public sector tertiary care hospital in Delhi Mansoor Hussain, Vijaydeep Siddharth, Sanjay Arya Indian Journal of Public Health 2019 63(3):194-198 Background: An efficient inventory control system would help optimize the use of resources and eventually help improve patient care. Objectives: The study aimed to find out the surgical consumables using always, better, and control (ABC) and vital, essential, and desirable (VED) technique as well as calculating the lead time of specific category A and vital surgical consumables. Methods: This was a descriptive, record-based study conducted from January to March 2016 in the surgical stores of the All India Institute of Medical Sciences, New Delhi. The study comprised all the surgical consumables which were procured during the financial year 2014–2015. Stores ledger containing details of the consumption of the items, supply orders, and procurement files of the items were studied for performing ABC analysis and calculating the lead time. A list of surgical consumables was distributed to the doctors, nursing staff, technical staff, and hospital stores personnel to categorize them into VED categories after explaining them the basis for the classification. Results: ABC analysis revealed that 35 items (14%), 52 items (21%), and 171 items (69%) were categorized into A (70% annual consumption value [ACV]), B (20% ACV), and C (10% ACV) category, respectively. In the current study, vital items comprised the majority of the items, i.e., 73% of the total items and essential (E) category of items comprised 26% of all the items. The average internal, external, and total lead time was 17 days (range 3–30 days), 25 days (range 5–38) and 44 days (range 18–98 days), respectively. Conclusions: Hospitals stores need to implement inventory management techniques to reduce the number of stock-outs and internal lead time.

Prevalence of goiter and its association with iodine status among the women of reproductive age group in coastal villages of Udupi Taluk, Karnataka, India T Sravan Kumar Reddy, Veena G Kamath, George P Jacob, Asha Kamath, Cleeta Rebeiro Indian Journal of Public Health 2019 63(3):199-202 Background: Iodine deficiency is one of the most prevalent micronutrient deficiencies globally. Women in reproductive age group are vulnerable to develop iodine deficiency as there is an increase in demand for iodine, especially during pregnancy. Objectives: The objective is to assess the prevalence of goiter and its association with iodine status and salt usage practices among the women of reproductive age group. Methods: A community-based cross-sectional study was conducted from August 2015 to July 2017 among 1500 women of reproductive age group in five villages of Udupi Taluk. Stratified sampling design and proportion to population size of the reproductive age women in the study area was used to select the study participants. A pretested semi-structured questionnaire was used for data collection. Goiter was assessed clinically and graded as per the recommended criteria of the WHO. Salt samples from every household were collected for iodine estimation. Blood and urine samples were collected from subsample to estimate thyroid-stimulating hormone levels and urinary iodine excretion levels, respectively. Results: The overall prevalence of goiter was 13% with 11.5% being Grade 1 and 1.5% being Grade 2. No significant association of goiter with urinary iodine, salt iodine levels, and salt usage practices was found. Conclusions: Median urinary iodine among the women with goiter indicates iodine sufficiency and no significant difference observed in urinary iodine levels between women with and without goiter.

Are household food security, nutrient adequacy, and childhood nutrition clustered together? A cross-sectional study in Bankura, West Bengal Satabdi Mitra, Dipta Kanti Mukhopadhyay, Aditya Prasad Sarkar, Indrajit Saha Indian Journal of Public Health 2019 63(3):203-208 Background: Research on different measures of food security and their interrelation in order to identify vulnerable households are scarce in India. Objectives: The objective was to assess household food security (HHFS), nutrient adequacy, dietary diversity, and nutritional status of under-five children along with their interrelation in the slums of Bankura Municipality, West Bengal. Methods: A cross-sectional study was conducted during 2016–2017 among 240 households using two-stage 30-cluster random sampling. Information regarding socioeconomic characteristics, availability, and utilization of different poverty alleviation schemes was collected. HHFS was assessed by a validated HHFS scale-short form in Bengali and nutrient adequacy with 24-h recall method. The eldest under-five child in the family was measured for anthropometry using standard procedure and for dietary diversity with the Individual Dietary Diversity Score. Results: Overall, 74 (29.1%) households had “food security,” whereas 102 (44.3%) and 64 (26.6%) had, respectively, low and very low food security. Among 190 under-five children, 63 (35.3%) had single and 50 (25.5%) had multiple anthropometric failures. Overall, 89 (36.1%) households were deficient for both energy and protein and 111 (47.6%) had deficiency of either of these two. Indicators on the utilization of different poverty alleviation schemes were associated with low/very low food security. A “Composite Index of Food Scarcity” comprising of HHFS, nutrient adequacy, and dietary diversity was proposed which was found to have dose–response relationship with grades of anthropometric failure of under-five children. Conclusions: An index comprising of three indicators might help identify the vulnerable households in relation to food security more effectively than a single indicator.

Development of perceived prenatal maternal stress scale P Sreeja Gangadharan, S P K. Jena Indian Journal of Public Health 2019 63(3):209-214 Background: Pregnancy is a state, which is often associated with extreme joy and happiness. Women undergo a number of physiological and psychological changes during pregnancy, which are often stressful if aligned with other adverse life events, compromising their health and well-being. However, there exists no comprehensive psychological instruments for measuring this stress. Objectives: The study was conducted to develop a multidimensional scale to assess prenatal maternal stress (PNMS) comprehensively. Methods: The initial phase of the study focuses on developing items and assessing the content validity of these items. The second phase focuses on pilot-testing and field-testing the newly developed perceived PNMS scale (PPNMSS) among 356 pregnant women belonging to different parity and trimester from November 2015 to October 2016. Results: The underlying factor structure of the 28-item PPNMSS had explored using exploratory factor analysis. The final scale is retained with 15 items having considerable item loading under four major factors as follows: perceived social support, pregnancy-specific concerns, intimate partner relations, and financial concerns. Reliability of each of these dimensions was assessed using Cronbach's alpha. Convergent and divergent validity of the scale was assessed by correlating the scores with perceived stress scale and the World Health Organization (five) well-being index (1998 version). Conclusions: As a comprehensive scale, PPNMSS is efficient to measure PNMS, which facilitates an early detection of stress and depression among pregnant women and timely intervention by health care professionals.

Internet and doctor–patient relationship: Cross-sectional study of patients' perceptions and practices Sukanya Singh, Amitav Banerjee Indian Journal of Public Health 2019 63(3):215-219 Background: With the rapid rolling out of the information highway, an increasing number of patients are accessing the Internet for medical information. Against this background, the present study was undertaken. Objectives: To ascertain patients' use and opinion on impact of Internet on doctor–patient relationship. Methods: A cross-sectional study was done. A total of 709 patients was interviewed, 307 from urban and 402 from rural field practice areas. Institutional ethical approval was obtained before data collection. Categorical data were summarized by percentages with 95% confidence intervals (CIs). Quantitative data were summarized by mean and standard deviation. Associations were explored using odds ratio (OR) with 95% CI for categorical data and two sample t-test for quantitative data. Results: Internet for medical information was used by 50.35% of the patients (95% CI = 46.68, 54.02). More urban patients, i.e., 79.48% used Internet compared to rural patients, i.e., 28.11%. This difference was significant, OR = 9.9 (95% CI = 6.9, 14.0; P < 0.0001). Users of Internet had about 4 years more schooling than nonusers. This was significant, P < 0.0001. More users believed that this trend will improve the doctor–patient relations (51.26%), compared to nonusers (17.05%). This difference was significant, OR = 5.11, 95% CI = 3.61, 7.22, P < 0.0001. Conclusions: A large proportion of patients used Internet to get medical information, significantly more urban patients compared to rural patients. The implication of this is that doctors in times to come will be dealing with patients empowered by online health information.