Process of Developing the Online Certification Tests for Research Project Trainees and Assessing the Feasibility for Adaptation in Maternal and Child Health Projects.

An innovation launched by Datta Meghe Institute of Medical Sciences emphasized on promoting early child development through govt. Anganwadi centers under the project ‘Stepping Stones’. The innovation includes delivery of Enhanced Anganwadi Curriculum and Parenting Sessions through home visits by trained Anganwadi Workers with support from Community Health Workers. A system of computerized online and of training certification test was developed. This paper outlines the results of feasibility and acceptance of this system by Community Health Workers in maternal and child health programs.METHODSPre-tested questionnaire with questions on different aspects of certification test and responses with Likert-type scoring scale was provided to 30 randomly selected community health workers trained by DMIMS. Weighted means of total scores for agreement/disagreement for feasibility and acceptability questions was calculated.RESULTSAverage Weighted Mean of 4.07 demonstrated a strong agreement by all participants towards the feasibility and acceptability of this test. 47.67% candidates showed strong agreement.CONCLUSIONSSuch type of tests can be framed and utilized as, time saving screening, and certification test, for different types of community healthcare cadre.

Stimulating Home Environment for Early Childhood Development by Household Play Materials for Under 5 Rural Children in Forest Buffer Zone of Wardha District.

Home Environment of a child comprises of toys, books and stimulating play materials which are critical for promoting early development. Parents, family and atmosphere at home play a key role in stimulating child’s physical, cognitive and socio-emotional developments. This assessment was done in rural settings of forest buffer zone of Bor Tiger Sanctuary in Vidarbha to have a baseline picture about availability of play materials at households that promote child development and parent’s view about these play materials.METHODSThis was a cross-sectional survey which included assessment of 894 households in 45 villages from Seloo block of Wardha district. Survey tools included pretested questionnaire and home observation checklist which was administered at home visit and during interviews of parent-child dyads. Data was collected in android based ODK app and exported to server. Data imported from server was analysed using STATA-11.RESULTSAvailability of play materials as represented by Mean Item Availability Score (MIAS) was significantly associated with family structure, wealth index and parent’s education and occupation. Though 84.2% households had materials for moving around and outdoor play, only 26.9% households had materials for promoting coordinated gross-motor movements, 41.6% households had materials meant for stacking, constructing. Only 19.8% households had materials for learning shapes and colours, 29.8% households had picture books/charts, 32.4% households had materials for drawing and writing and only 11.3% children had materials promoting counting.CONCLUSIONSObvious gap can be seen in terms of paly materials available for under 5 children in rural and urban settings. Remote rural areas in this region need a well framed parenting program to sensitise parents about Early Child Development that can be blended with the existing ICDS program

Accessibility and Utilization of Emergency Obstetric Care in Rural Settings of Wardha District- Beneficiaries Perspective

In India, Emergency Obstetric Care services were started under RCH-II with the goal to reduce MMR to less than 100/lakh live births, and increase institutional deliveries to 80% by 2010. Strategy was to enhance availability and access to EmOC, for averting unpredictable death during pregnancy and childbirth. We wanted to determine the perception of beneficiary women about accessibility and utilization pattern of EmOC at peripheral health care facilities. METHODSThe present qualitative study was conducted in one of the eight blocks of Wardha (Maharashtra) from May to October-2017. Data was collected by in-depth interview of service users (21 beneficiaries). Notes were transcribed and then translated into English. Respondents’ verbatim that are significant and illustrative as per theme of study were used for analysis.RESULTSFacilitators for EmOC were found to be birth preparedness, promotion of institutional delivery, registration for JSY/JSSK through health workers along with provision of some EmOC services. Socio-cultural beliefs, leading to delay in recognition of danger signals to access care, transportation delay due to poor access of ambulance and identified vehicles along with insufficient coverage of JSSK program, were the main barriers. Beneficiaries who required EmOC were dissatisfied due to frequent referral & travelling, expenditure on transport & food, loss of daily wages, managing dependent family members and domestic work.

Prevalence Of Tobacco Consumption Among Adolescents From Rural Area Of Wardha District

Background-Globally adolescent population is around 1200 million and out of six person, every one person is in ado-lescence (aged10 to 19 years) period. Yet most of them are healthy, but premature death, illness and injury among them can hinder ability to grow and develop to their full potential. It is estimated that 1.2 million adolescents died in 2015 and mostly from preventable or treatable causes. Tobacco consumption is world’s leading cause of preventable morbidity and mortality. National Family Health Survey conducted in year 2016-17 reported tobacco consumption prevalence 38.9% in urban area and 48% in rural area of India. Method-It was a community based cross-sectional study conducted in eight villages of Wardha district adopted under Community Health Care program run by depart-ment of community medicine. Data was collected by interview from 485 adolescent in the age group of 10-19 years by domiciliary visits using pre-designed pre-tested questionnaire. Results:Prevalence of tobacco use (all forms), smoke-less tobacco use and smoking in rural adolescents were 20.82%, 20.41%, and 2.68%, respectively. Prevalence of to-bacco use in boys (30.29%) was more than girls (4.49%). Higher Prevalence was found in late adolescent period. Bidi was commonly used form of smoke tobacco while Kharra was the preferred smokeless tobacco. Almost all smokers were male but few exceptions were there. Conclusion: The prevalence of tobacco use among rural adolescents was very high (20.82%) as compared to national prevalence of 14.6% according to the global youth tobacco survey India 2009. There is a need of early intervention for tobacco cessation as overall mean age of 1st experienced to tobacco consumption was 12.02 years and in male and female users it was 12.25 years and 10.88 years respectively. 42.10 % adolescents 1st time experienced any type of tobacco products when they were in the 12-14 years age and only 0.66% adolescents experienced at the age of 17 -19 years. Maximum male (42.19%) and female (41.67%) ever user experi-enced their 1st tobacco consumption when they were 12-14 years old.

Ethical Issues In Epidemiological Studies

Epidemiology is the study of the distribution and determinants of health related states and events in populations, and its application to the control of health problems. An epidemiological studies involve the population and as such ethical issues are an important aspect of it which need to be properly understood and adhered to. These issues can relate to informed consent, appropriate sample size, selection of participants, confidentiality, conflict of interest etc. Studies like therapeutic trial have also a lot of ethical issues which differ from issues pertaining to non-therapeutic trials. The source of funding for the study can have implication. Fabrication of data, manipulation during analysis, intentional changes in the result to obtain a pre desired outcome are some grey areas which need to be addressed. Another ethical issue is publication in certain Journals with monetary involvement. Lastly but not the least, author-ship also have certain ethical issues. Attention to ethical issues can facilitate the effective planning, implementation, and growth of a variety of public health programs and research activities. Moreover with advancement in Epidemiol-ogylikemolecularepidemiology,geneticepidemiologyetc.theethicalissuesbecomemorecomplicated

Investigating diphtheria outbreak: A qualitative study in rural area.

Background: Even after three decades of implementation of the Universal Immunization Programme in India, cases of diphtheria continue to occur. It is pertinent to study the social and epidemiological determinants of diphtheria. Aims & Objective: The present study was undertaken to investigate epidemiological and social determinants of Diphtheria outbreak in a district in Central India and to understand response of health care system to this outbreak. Materials and Methods: Explanatory case study method, a qualitative method was employed involving interviews with stakeholders including family members of the affected children, specialists from tertiary care teaching hospital who treated these cases, health workers, public health functionaries at primary care and district level. Results: Both cases belonged to migratory community and non-immunization was identified as the chief proximal reason. Both, knowledge and utilisation of immunisation was poor in these communities and was limited to pulse polio immunization. Epidemiologically, the two cases were possibly linked. Vaccination drive to immunize all unimmunized children was conducted in the district where the cases were identified but not in the district where possibly the cases have originated. Conclusion: Social determinants including poverty, migration, poor access to health care all contributed in creating epidemiological situation where transmission of disease agent was easy, resulting in an outbreak. Migration creates vulnerability and our health systems should gear up themselves to address this vulnerability; appropriate strategies and micro-planning should be in place to cater to the needs of this underprivileged community. Strong surveillance system with adequate public health response addressing outbreaks is necessary.

Accreditation of public health education in India: Enhancing quality, competence and trust.

With an increase in the number of institutes offering public health education, there is a need for discussion on future directions and challenges. The World Health Report 2006 identified the need to improve the quality of public health education. There are various mechanisms and bodies that look after accreditation issues in several countries. The Council on Education for Public Health in the USA assists in the accreditation of schools of public health, as well as public health programmes. The Australian Network of Academic Public Health Institutions is actively engaged in discussions to improve the quality of its programme and institutions. In Europe, the European Agency for Accreditation in Public Health Education is responsible for accreditation. The South-East Asia Public Health Education Institutes Network facilitates accreditation of public health education in the region. In India, public health education varies across institutes. India needs an accreditation system to ensure that public health education is of the desired quality. Certain initiatives, such as conferences, consultation and the Calcutta Declaration, have been taken in the past two decades. However, the ideas mooted have yet to be translated into reality. The broad framework for accreditation may entail an institutional self-assessment against set standards, preparation of a database, cataloguing, and site visits by a peer team. There is a need for an apical body with all stakeholders participating in the process. Accreditation has specific benefits, but there are critical challenges as well. For example, the autonomy of the institutions needs to be protected, the accreditation bodies should exhibit professionalism and substantial financial resources are required. Before tackling specific criteria for accreditation, it is necessary to define a collective vision for schools of public health in India.

Role of Ghrelin in regulation of growth hormone secretion by Ghrelin-Pituitary-GH axis linkage.

Background: Ghrelin is the endogenous ligand of the growth hormone (GH) secretagogue receptor and is the first hormone linking gastrointestinal-pituitary axis. Actions of ghrelin on GH secretion provide a strong force for envisioning that one of the major role of ghrelin could be the regulation of secretion of GH. Aims & Objective: To explore the intriguing dimensions on the possible physiological role of the Ghrelin /GHRP system. Materials and Methods: The search was performed in electronic databases (Medline, Embase, Cochrane, Google scholar) and by hand searching by 2 reviewers. Clinical trials (Randomised and non-randomised trials), review articles, systematic reviews, conference proceedings and meta-analysis were included in the study. Results: Ghrelin stimulates strong increase in circulating GH levels both in vitro and in vivo in a dose-dependent manner. Human or animal ghrelin was found to be significantly more potent than a synthetic GHS, hexarelin. The regulation of GH by Ghrelin is influenced by various other factors like autonomic nervous system, GHRH, IGF-1, anterior pituitary hormones, obesity, etc. Conclusion: Ghrelin is a specific endogenous ligand for the GHS receptor and suggests the existence of a GHS–GHS receptor signaling system in the regulation of GH secretion. Stomach-ghrelin - pituitary-GH axis links nutritional intake to regulation of GH secretion. However, the mechanism underlying the feedback actions of GH on the regulation of ghrelin remains unanswered. Under physiological conditions, ghrelin administered either centrally or peripherally, exerts a potent, time-dependent stimulation of pulsatile secretion of GH by ghrelin-pituitary-GH axis.

Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India.

Background: Dental caries is one of the most common chronic diseases of early childhood. Dental problems in early childhood have been shown to be predictive of future dental problems, growth and development by interfering with comfort, nutrition, concentration, and school participation. Aim: To find out the prevalence of Early childhood caries (ECC) among the children attending the Anganwadis of Wardha district, to determine the feeding habits and their relationship to early childhood caries. Materials and Methods: Community-based cross-sectional study among the selected Anganwadis children of 2-5 years of Wardha district. Result: A total 330 subjects, 105 children were found to be having ECC, 47 (30.92%) males and 58 (32.58%) females. Total 215 children belonged to 43-60 months age group. Out of these, 72 (33.48%) children were having ECC. A significant association was found between the history of bottle-feeding and ECC (P = 0.0218). Prevalence of ECC was more among those who were bottle-fed than those who were not bottle-fed. Conclusion: Future health promotion and education programs in Anganwadis should include oral health issues and the risk factors for ECC, and its consequences should be addressed. Public-funded oral health program should be started and targeted at children from lower socioeconomic status. Effective strategies should be developed to promote use of brush and paste for cleaning teeth and discouraging inappropriate bottle-feeding, discouraging on demand consumption of chocolates and sugars.