Operational research in health-care settings Rajesh Kunwar, VK Srivastava Indian Journal of Community Medicine 2019 44(4):295-298

Challenges and solutions in implementing hearing screening program in India Abhiruchi Galhotra, Preeti Sahu Indian Journal of Community Medicine 2019 44(4):299-302 Hearing is the key to learning spoken language, performing academically, and engaging socially for children. Degree of hearing loss quantifies the hearing ability from mild to profound, based on the audiometric findings for an individual across certain frequencies or pitches. Early identification and appropriate intervention is the prime need. A probable strategy is to ensure that every newborn is screened for possible hearing loss at the birth in the hospital. In India, hearing screening facility is mostly available to newborns brought into tertiary hospitals. Some of the key issues in the implementation of the program identified are lack of human resources, inadequate infrastructure, equipment-related shortcomings, and low priority for hearing impairment (HI) prevention. The Government of India initiated efforts toward prevention and control of HI, i.e., National Program for Prevention and Control of deafness and Rashtriya Bal Swasthya Karyakram which are significant milestones in the implementation of systematic nationwide hearing screening programs.

Controversies in cough management: An Indian perspective Dhanya Mohan Indian Journal of Community Medicine 2019 44(4):303-306 Chronic cough is one of the most common symptoms for patients-seeking consultation in an outpatient clinic. It is associated with substantial psychological, physical, and social burdens and impaired quality of life. This review highlights some of the major diagnostic and management challenges confronted in the field of cough with a special focus on the Indian perspective. Heterogeneity in definitions and classifications and challenges associated with over-the-counter drug use and irrational drug use are some of the major controversies. Streamlined diagnostic approach involving a combination of subjective and objective tools, evidence-based amendments in clinical practice, and stringent implementation of regulatory guidelines are mandatory to address controversies in cough management in developing countries.

Factors contributing to alcohol relapse in a rural population: Lessons from a camp-based de-addiction model from rural Karnataka Rahul Rampure, Leeberk Raja Inbaraj, Carolin George Elizabeth, Gift Norman Indian Journal of Community Medicine 2019 44(4):307-312 Context: Alcohol consumption is the third largest risk factor for disease and disability in developing countries. Globally, 4% of all deaths are related to alcohol consumption every year. De-addiction measures and rehabilitation strategies can sometimes be challenging in rural population as there is a potential for a higher rate of relapse due to socio-cultural barriers such as unemployment, limited entrainment activities, and peer pressure during social events. Methodology: A cross-sectional study was conducted to determine the factors contributing to relapse in Bengaluru rural district. A total of 112 participants were interviewed, after attending de-addiction camp, using a semi-structured questionnaire containing instruments such as Penn Alcohol Craving Scale, self-efficacy scale, interpersonal support evaluation list, and presumptive stressful life events scale. Bivariate and multivariate logistic regression was done to determine the factors associated with relapse. Results: The relapse rate was 55.4% among the study participants. Education, self-efficacy, social support, and craving were associated with relapse in the bivariate analysis (P < 0.05). In multiple logistic regression model, craving (odds ratio [OR] – 1.8, confidence interval [CI]: 1.2–2.5), good interpersonal tangible support (OR – 0.09, CI: 0.01–0.5), and desirable life events (OR – 0.03, CI: 0.02–0.6) in the past were associated with relapse. Conclusion: Relapse rate was 55.4% among the study participants which is comparable to the findings of the other long-term studies. Increased craving, low-self-efficacy, and poor social support were associated with relapse hence need to be addressed in follow-up counseling sessions.

A cross-sectional study to assess reproductive and child health profile of working women residing in urban slums of Rajkot city Ankit Prabhubhai Viramgami, Pramod B Verma, Mayur C Vala, Sandeep Sharma Indian Journal of Community Medicine 2019 44(4):313-316 Context: In India, people residing in slum are not able to get safe food, drinking water, and shelter. Special vulnerable group such as women and children are at higher risk for infectious- and nutritional-related problems. Because of the dual responsibility of working women for her family and job, chances are always higher that the reproductive and child health (RCH) of such families are compromised. Aims: The aim of this study is to assess RCH profile of working women residing in slums. Subjects and Methods: A community-based cross-sectional observational study was carried out among slums of Rajkot city. With the usage of simple random sampling technique and informed verbal consent for the study, a total of 480 working and nonworking women were enrolled in this study. Semi-closed prestandardized questionnaire was used to capture their sociodemographic, reproductive health, and child health parameters. The World Health Organization growth standard was used to categorize the nutritional status of their children. Results: Age of marriage and first conception were significantly delayed among working women. Only 37.8%working women had adequate birth spacing between two children. About 33.3% had received adequate antenatal care (ANC) services during pregnancy. Higher prevalence of malnutrition (65.2%) and lower prevalence of full immunization (39.4%) were found among children of working women. Conclusions: Low birth spacing, lower utilization of ANC care services, higher malnutrition, and poor immunization coverage among working women had indicated underutilization of RCH services by working women of slum.

Anxiety disorders among adolescents in a rural area of northern India using Screen for Child Anxiety-Related Emotional Disorders tool: A Community-based Study Swapna Madasu, Sumit Malhotra, Shashi Kant, Rajesh Sagar, Ashwani Kumar Mishra, Puneet Misra, Farhad Ahamed Indian Journal of Community Medicine 2019 44(4):317-321 Background: Anxiety disorders are the most frequent mental disorders encountered in childhood and adolescent years. The number of epidemiological studies done in this area within India is limited. Objectives: We determined the prevalence of anxiety disorders among adolescents in a rural community of Ballabgarh block, district Faridabad, Haryana. Secondarily, we also assessed sociodemographic and other factors associated with anxiety disorders among adolescents. Materials and Methods: This community-based cross-sectional study was conducted among 729 adolescents (10–19 years). Screen for Child Anxiety-Related Emotional Disorders tool was used for assessing prevalence and type of anxiety disorders. Sociodemographic and personal factors were included in the logistic regression multivariable model to establish associations. Adjusted odds ratios (AOR) along with 95% confidence intervals (CI) are computed. Results: The prevalence of anxiety disorders among adolescents was (22.7%; 95% CI: 19.7–26.0). Girls (27.6%) had higher prevalence than boys (18.3%) (P < 0.01). Social anxiety disorder (14.3%; 95% CI: 11.7–16.9) was the most common form of anxiety disorder. Female sex (AOR 1.8; 95% CI 1.2–2.6; P < 0.01), lower-middle socioeconomic status (AOR 1.96; 95% CI 1.2–3.1; P < 0.01), and presence of stressful event within the past 1-year (AOR 2.48; 95% CI: 1.12–5.06; P = 0.01) were found to be associated with the presence of anxiety disorders. Conclusions: Anxiety disorders are common among adolescents in rural settings of India. Tackling them will require appropriate health systems response. Adequate interventions should be incorporated at primary care level to address the mental health concerns of adolescents.

“My life is spoiled because of him…” A qualitative study of human immunodeficiency virus disclosure and male involvement in prevention of mother-to-child transmission program Anjali Modi, Jayendrakumar K Kosambiya, Sangita Trivedi, Vipul P Chaudhari, Alap Mehta, Kristen J Wells Indian Journal of Community Medicine 2019 44(4):322-327 Background: India has the third largest human immunodeficiency virus (HIV) epidemic in the world, with 15,000 newborns infected every year. Prevention of mother-to-child transmission (PMTCT) services can eliminate new HIV infections. Nondisclosure of positive HIV status and nonoptimal uptake of PMTCT are related. Therefore, understanding different aspects of HIV disclosure are necessary for program managers and careproviders for prevention and support. Objective: The present research explores HIV disclosure narratives, the family's perspective, and theoretical framework in the context of PMTCT. Methods: A qualitative study was conducted among 31 (16 mothers and 15 fathers) utilizers of PMTCT at an urban antiretroviral therapy center. A semi-structured in-depth interview guide based on disclosure process model (DPM) was used to explore HIV disclosure goals and outcomes by both members of parental dyad. The recorded interviews were transcribed verbatim, translated into English, and analyzed with Atlas.ti software. Directed content analysis was used to code data according to “a priori” and emerging themes. Demographic data were analyzed using descriptive statistics. Results: Limited disclosure is a necessity for pregnant women and their male partners for approach coping with HIV diagnosis and pursuing positive support for PMTCT adherence. Interpersonal, society, and community contextual outcomes affect the care uptake and future likelihood of disclosure. Conclusions: DPM suggestions from the present study can be used to facilitate a goal-directed process that allows parents/PLWHA to selectively disclose their HIV status to family members and acquaintances for obtaining maximum support to eliminate newborn HIV infections while minimizing distress, stigma, and discrimination.

Association of nutritional status with depression and cognitive function of older women residing in old-age homes of Kolkata, India Bidisha Maity, Debnath Chaudhuri, Indranil Saha, Minati Sen Indian Journal of Community Medicine 2019 44(4):328-331 Introduction: Depression and cognitive function are said to be the foes of the nutritional status of the older adults. Depression is the most common psychological problem in old age, while deterioration of cognitive function is also observed in this age group. Objectives: The main objective of the study is to find out the association of nutritional status with depression and cognitive function of older women. Materials and Methods: A cross-sectional study was done among 196 older women, residing in old-age homes of Kolkata. Nutritional status of the participants was assessed by the long version of Mini Nutritional Assessment tool (MNA®). Level of depression was assessed by Geriatric Depression Scale (GDS 30). Cognitive function was checked by using the Folstein Mini-Mental State Examination (MMSE). Chi-square, Kruskal–Wallis test, and Spearman's rho correlation coefficient was calculated using SPSS software. Results: About 38.3% and 14.8% participants were suffering from mild and severe depression. 13.2% and 9.2% older women were found with borderline impairment and impairment in cognitive function, respectively. Significant correlation of nutritional status was found with both depression and cognitive function (P < 0.05), and this was supported by multinominal logistic regression model. Conclusions: Both depression and impairment in cognitive function can cause malnutrition or vice versa among older women.

An epidemiological study on the assessment of cardiovascular health status among adults in an urban area of Teliamura municipality area, Khowai, Tripura Kaushik Nag, Nabarun Karmakar, Bivek Ghosh, Anjan Datta Indian Journal of Community Medicine 2019 44(4):332-336 Background: In India, cardiovascular disease (CVD) is the largest cause of mortality and morbidity in all regions of the country. Now, to reduce the burden of CVD in our country, we first need to assess cardiovascular health status of the adult population. Objective: The aim of this study is to assess cardiovascular health status among adults and to find the influence of sociodemographic factors on it. Methodology: In a cross-sectional study, cardiovascular health status of 100 sampled adult population of urban area of Teliamura Municipality area, Tripura, was assessed using a pre-designed and pre-tested semi-structured schedule from July 2017 to August 2017. Samples were taken from the adult population by simple random sampling. Collected data were compiled and analyzed using the Statistical Package for the Social Sciences (SPSS 16.0.). The Chi-square and Fisher's exact test were applied to find association. Results: The mean age of the study participants was 44.89 (±13.76) years, comprised 52.0% males and 48% females. Hypertension was seen among 58% of the study population and 77% had ideal (<100 mg/dl) level of fasting blood sugar (FBS). The present study showed obesity, hypertension, high level of total cholesterol, high level of FBS was mostly prevalent among 42–61 years age group. Married people were more obese, hypertensive compared to unmarried. Conclusion: Middle age group population were worst affected by high blood pressure, high blood sugar, poor body mass index, and poor level of cholesterol. Healthy lifestyle measures might reduce the burden of CVD which could be evaluated in future research.

Prevalence of primary infertility and its associated risk factors in urban population of central India: A community-based cross-sectional study Ashwini Katole, Ajeet V Saoji Indian Journal of Community Medicine 2019 44(4):337-341 Background: Primary infertility is a serious health issue that has profound socioeconomic and health implications on both the individual and society. Despite the important consequences of infertility, estimation of its prevalence is limited. Objective: The objective of the study is (1) to estimate the prevalence of primary infertility among women of reproductive age group in urban population of Central India and (2) to study its associated risk factors. Material and Methods: In a community-based cross-sectional study, all married women between 15 and 49 years of age in urban field practice area were included. The data were collected by face-to-face interview with the help of predesigned and pretested questionnaire. Results: The majority of the women (39.3%) belonged to 25–29 years of age group. The overall prevalence of primary infertility among reproductive age group women was 8.9% (51/570). Sociodemographic factors that had statistically significant association with infertility were age at marriage more than 25 years (P < 0.05), nuclear family (P < 0.05), higher education level (P = 0.04), employed women (P < 0.05), high socioeconomic status (P = 0.01), and family history of infertility (P < 0.05). Physiological factors that had statistically significant association with infertility were obesity (P = 0.03), age at menarche more than 14 years (P < 0.05) and irregular menstruation pattern (P < 0.05). Depression (P = 0.01) and stress (P < 0.05) were the psychological factors significantly associated with infertility. Conclusion: The prevalence rate of primary infertility in urban population of Central India was lower than reported trends of infertility from developing countries. Sound knowledge about various factors related to infertility can help health-care providers and policymakers to design and implement various policies.