Why investing in public health is so critical Jai Prakash Narain Indian Journal of Community Medicine 2019 44(3):185-187

Strengthening public health partnerships in India: Envisioning the role of law enforcement during public health emergencies Rachit Sharma, Md Mahbub Hossain Indian Journal of Community Medicine 2019 44(3):188-192 Unique challenges posed by complex public health emergencies have often called for institutions, responsible for restoring health, well-being, and order among affected populations, to realign their operating procedures and work in concordance with each other. To ensure optimal health, the growth of the individuals and societies, and development in a greater sense, it is essential to understand the scope of collaboration between law enforcement agencies and public health institutions during emergencies and their aftermath. To foster such partnerships, policy-level advocacy to overcome challenges posed by existing policies and legislation that limit the autonomy of the law enforcement and public health institutions for making informed decisions would be necessary. Human resources working at different levels should be sensitized about the nature and significance of the kind of collaboration, and they should be allowed to express and clarify their doubts about the same. Evidence-based standard operating procedures should be developed for different cadres of professionals, keeping harmony with the operational diversities. Critical issues such as financing the ventures, coordinating and implementing the protocols and projects, following up the cases and suspects, and examining every scenario using evidence-based scientific and legal methodologies would be crucial for the success of such collaborations.

Unmet need of antenatal screening for asymptomatic bacteriuria: A risk factor for adverse outcomes of pregnancy Manish Gehani, Suman Kapur, Pankaj Bhardwaj, Vijayalakshmi Nag, Sudharsanam Manni Balasubramaniam, Nagamani Kammili, Sudha D Madhuri Indian Journal of Community Medicine 2019 44(3):193-198 Recommended urine culture is unsuitable for screening pregnant women for asymptomatic bacteriuria due to long turn-around time, unaffordability, and user-unfriendliness. The objective of this review was to evaluate the suitability of various tests for this purpose. A PubMed-based systematic review of published articles irrespective of year and language was done. Search terms included asymptomatic bacteriuria, screening test, urinary tract infection, and diagnostic test. Diagnostic accuracy studies conducted on human populations comparing tests with urine culture were included. One author extracted predefined data fields, including quality indicators, another validated it. Of 78 records, 25 studies describing 15 tests were included. All tests were rapid, seven were valid and two of them were affordable and easy-to-use. No test provided comprehensive identification with antibiotic susceptibility. Despite publication bias, no test was found suitable for screening asymptomatic bacteriuria antenatally and providing evidence-based prescription. Further research is needed to develop tests which suit this purpose.

The catch-up growth in stunted children: Analysis of first and second India human development survey data Rajeev Jayalakshmi, Srinivasan Kannan Indian Journal of Community Medicine 2019 44(3):199-204 Context: Change in stunting as the children grow older is rarely found in published literature. Aims: The present paper compares the change in the prevalence of stunting among children as they grow from 0–4 years to 7–11 years. Settings and Design: The present paper is a secondary analysis of India Human Development Survey-I (IHDS-I) (2005) and IHDS-II (2012) data for Kerala. Methods and Materials: In total, 411 children of age 0–4 years and 390 children of age 7–11 years with anthropometric measurements were included in the present study, respectively, from IHDS-I and IHDS-II. Statistical Analysis Used: The statistical analyses were done using SPSS 21.0. The prevalence of stunting was estimated. Bivariate and multivariate analyses were performed using the Pearson Chi-square test. Results: The prevalence of stunting among children has been drastically reduced (50.4% to 20.3%) while growing older from 0–4 years to 7–11 years. Conclusions: More than half of the stunted children below 5 years regained normal growth, as they grow older.

Bone health after fifth decade in rural ambulatory South Indian postmenopausal women Aditya John Binu, Kripa Elizabeth Cherian, Nitin Kapoor, Felix K Jebasingh, Hesarghatta Shyamasunder Asha, Thomas Vizhalil Paul Indian Journal of Community Medicine 2019 44(3):205-208 Background: The incidence of postmenopausal osteoporosis continues to rise, as population ages. The morbidity and mortality associated with osteoporotic fractures have a significant negative impact on the economy and quality of life of the affected individual and the community, at large. Objectives: We aimed to study the prevalence of osteoporosis in ambulant rural postmenopausal women, and to look at their dietary calcium intake (DCI) and Vitamin D status. Subjects and Methods: This was a cross-sectional study conducted in 1565 ambulant South Indian rural postmenopausal women. Bone mineral density was estimated by a dual-energy X-ray absorptiometry scan at the femoral neck (FN) and lumbar spine (LS). DCI was calculated by recall for the previous week, and the blood bone biochemical profile was measured. Results: The mean standard deviation (SD) age and body mass index of this population were 60.7 (7.2) years and 26.2 (4.8) kg/m2, respectively. The prevalence of osteoporosis was 22% at the FN and 39% at the LS. An increase in the prevalence of osteoporosis was noted at both sites, in successive age categories. Mean (SD) DCI was 420 (282) mg/24 h. Fifty-four percent had Vitamin D deficiency (VDD) (<20 ng/ml) and 6% had severe VDD (<10 ng/ml). Conclusion: A significant proportion of this large cohort of south Indian healthy rural postmenopausal women had osteoporosis at either site with advancing age. Most of them had a suboptimal DCI, and over half of them had VDD.

Influence of sociodemographic factors in measles-rubella campaign compared with routine immunization at Mysore City Prathyusha Joe, Sumanth Mallikarjuna Majgi, N Vadiraja, Mudassir Azeez Khan Indian Journal of Community Medicine 2019 44(3):209-212 Background: Vaccines are mostly delivered through routine immunization and catch-up campaigns. Measles-rubella (MR) campaign, one of the largest vaccination campaigns, was launched on February 8, 2017, in five states of India including Karnataka. Objectives: The objective of this study was to compare the association of various sociodemographic factors influencing routine immunization and MR campaign and to identify the reasons for nonvaccination. Materials and Methods: A cross-sectional study was done after the end of MR campaign, by interviewing parents of 147 children aged 9 months to 5 years in urban areas of Mysore. Sociodemographic factors and measles vaccination status by routine immunization and MR campaign were studied. Results: The coverage of measles vaccination by routine immunization and the MR campaign was 93.9% (138/147) and 86.4% (127/147), respectively. While communication with field workers was significantly associated with both routine immunization and the MR campaign, religion and mother's educational status were associated with MR campaign (P < 0.05). The most common reason for not being vaccinated was lack of unawareness about the campaign and the location for vaccination which could have been curbed by health education. Conclusions: The study has shown that there are many factors which can be prevented by the health system that might help in improving immunization coverage.

Educational intervention on human papillomavirus in university students Meryene C Barrios, Liliana Stella Rodríguez, Claudia M Pachón, Emily A Lugo Indian Journal of Community Medicine 2019 44(3):213-216 Introduction: In recent years, there has been an increase in the number of cases of women and men suffering from a sexually transmitted disease. Objective: The objective of this study was to implement an educational intervention on the human papillomavirus (HPV) to increase knowledge about the disease among university students. Materials and Methods: In a preexperimental study with 385 students of both genders, the strategy was designed under the parameters of the PAHO and the Theory of Beliefs in Health. The problem was identified through biological samples of the genitals, and the impact was measured through a questionnaire. The presence of HPV DNA was made with molecular polymerase chain reaction tests; and the answers, through coefficients of variation. Results: Of the participants, 60 were positive: 49 women and 11 men. At the beginning of the application, the knowledge level was medium, between 9.0 and 9.6. After the application, it was between 12.5 and 13, being the level of knowledge average, but very close to the threshold of high. Conclusions: With the results of the tests, it was found that HPV is a real problem among university students. The level of knowledge remained medium, despite the educational intervention.

Analysis of maternal near miss at tertiary level hospitals, Ahmedabad: A valuable indicator for maternal health care Farzana Mansuri, Anjali Mall Indian Journal of Community Medicine 2019 44(3):217-221 Background: Complications during pregnancy and childbirth remain a leading cause of illness and death among women of reproductive age in India. In the recent years, the concept of the WHO maternal near miss (MNM) has been adopted by the tertiary level hospitals as it has an added advantage of offering a large number of cases for intervention and for the evaluation of the maternal healthcare being provided by the health-care system. Materials and Methods: In the present study, near miss criterion-based audit of MNM cases and maternal death (MD) cases, based on the WHO near miss approach and MD, was conducted from the record section of the four tertiary level hospitals. In the present study, the WHO MNM approach was adopted to assess the quality of maternal healthcare in tertiary level hospitals. Retrospective secondary data analysis from the records of record section and maternity wards pertaining to June 2015–May 2016, of the hospitals of Ahmedabad city, was conducted from January 2016 to November 2017. Results: The total number of live births of all the four hospitals under surveillance was 21,491. Severe maternal outcome cases were 326, of which 247 (75.8%) were of MNM cases and 79 (24.2%) were of MD. MNM mortality ratio was found to be 3.13:1. Eclampsia (29.45%) followed by preeclampsia (25.46%) and severe postpartum hemorrhage (22.39%) were the leading causes of potentially life-threatening conditions. Conclusion: Above finding suggests the development of a comprehensive framework for the assessment of MNM and further improvement in the quality of maternal health care.

A performance audit of first 30 months of manochaitanya programme at secondary care level of Karnataka, India Preeti Pansari Agarwal, Narayana Manjunatha, Rajani Parthasarathy, Channaveerachari Naveen Kumar, Rathan Kelkar, Suresh Bada Math, Jagadisha Thirthalli Indian Journal of Community Medicine 2019 44(3):222-224 Introduction: Lifetime prevalence of psychiatric disorders in India is about 14%, and the treatment gap is huge necessitating large-scale public health efforts. Manochaitanya programme (MCP), one such innovative program, was launched by the Government of Karnataka in October 2014. MCP entails provision of outpatient psychiatric care in subdistrict (Taluk) hospitals and primary health centers under a public–private (Indian Psychiatric Society-Karnataka chapter) partnership model, at least one Tuesday of every month. Aim: The aim was to do a secondary care level performance audit of MCP of initial 2½ years at all Taluka general hospitals of Karnataka. Methodology: Data on MCP were collected and tabulated from all 31 districts using a specially designed semistructured pro forma. This includes the number of self-reported psychiatric consultations in each Tuesday's clinic, number of psychiatrists, and their visit details. Prospective data were obtained from monthly reports. Results: The district coverage was 100% during initial 2½ years over this period, i.e., MCPs were successfully covered in at least one Taluka hospital in all 31 districts. A total number of estimated consultations under this initiative were 73,663 with an average of 24.1 patients per psychiatrist consultation. One hundred and eleven psychiatrists participated in a total of 3,056 visits across the state. Patient footfall increased consistently over this time period. Conclusions: Psychiatrist-based Manochaitanya programme at secondary care level at Taluk hospitals has noticed substantial benefits to patient care. There is a need for psychiatrist-based secondary care at Talukas (subdistrict) level across the country.

Study of noncommunicable diseases among the street sweepers of Muster Station, Ahmedabad municipal corporation Sonal Parikh, Anand Shah, Bansi Davda, DV Bala Indian Journal of Community Medicine 2019 44(3):225-227 Introduction: Today we all are talking for “Swatch Bharat”, but street workers are the real fighters who are working for this. Street working environment exposes to lot of organic and inorganic dust and chronic inhalation of dust during street sweeping which may increases respiratory health symptoms among them. This study was planned to study the effect of work on health of street workers primarily respiration function. Materials and Methods: A cross sectional study was carried out among muster station of Ahmedabad Municipal corporation area during a period of April 2013 to November 2014. For the study total 762 Safai Kamdar (street sweepers) and 41 administrative staff were included after taking consent. The participants were examined for hypertension, Peak expiratory flow rate (PEFR), lab investigations like hemoglobin and blood glucose. Results: Mean age of Street Sweeper was 39.2 + 10.02 years and admin staff was 38.2 + 6.92 years. Street Sweeper were found to be significantly underweight as compared to admin staff. Hypertension in administrative group (51.1%) was higher but not significant than Street Sweeper (45.03%). only 12.3 % of Safai Kamdar were using any kind of personal protective equipment (PPE). 52.1% of Street Sweeper had low PEFR was as compared to 20% of Administrative group. Conclusion: Street sweeping had a significant impact on health of street sweepers. They should be made aware about use of PPE.