Excess Screen Time and its Associated Factors among Young Men in a Rural Community of North India

Screen-based media usage among young people is blooming rapidly due to technological and digital revolution. We conducted community-based cross-sectional study to determine the prevalence of excess screen time and its association with sociodemographic and behavioral patterns in a rural block of Haryana, India. Asemi-structured interview schedule was administered by trained physicians to ascertain screen time in a typical day and various socioeconomic and behavioral factors among a random sample of 860 young men aged 18–24 years. The prevalence of excess screen time was 61.8% (95% confidence interval [CI] 58.4–65.1). It was significantly associated with education (adjusted odds ratio [AOR] 1.7, 95% CI 1.1–2.6) and occupation (AOR 2.2, 95% CI 1.2–3.9) of the father and their sleep duration of ?8 h (AOR 1.6, 95% CI 1.2–2.3). Limiting the screen time as per international standards and behavioral interventions are needed for this young population.

Understanding the patterns of technology and internet use for academics by undergraduate medical students in a teaching hospital of North India

E-learning or computer-based learning has been incorporated into medical education in many countries. Readiness to utilize this medium merits exploration in the Indian context. Therefore, we aimed at assessing the current patterns of technology and internet use by undergraduate medical students in a tertiary care teaching hospital, focusing on their use for academics and their views on e-learning. Materials and Methods: This cross-sectional study was conducted using a self-administered questionnaire among undergraduate medical students in the first 4 years of the study. The data generated were entered into Microsoft Excel and analyzed using SPSS version 22. Descriptive analysis and comparison of proportions were done using Chi-square test. Results: A total of 212 students responded, with a mean (±standard deviation) age of 20 years (±1.54) and 70.3% of males. There was universal access to technological devices with complete internet access. Internet was used primarily for entertainment (99.1%) and WhatsApp (97.2%), with 86.8% use in academics. Most students accessed the internet multiple times each day. Majority of the students (90.6%) used social networking sites and were open to using it for academics. Reliability of the material found online was a concern (83.5%), and most (63.2%) were interested in further training. Only a quarter of the students had utilized medical e-learning material online, and a majority (77.4%) were willing to incorporate it into the curriculum feeling that it would benefit them (64.6%). Conclusions: Incorporating e-learning tools into the medical curriculum needs to be considered for undergraduate medical studies, owing to its availability and readiness for utilization.

Anemia among pregnant women attending antenatal clinic at a secondary health care facility in district Faridabad, Haryana

India confronts a high burden of anemia among pregnant women, that contributes to significant morbidity and mortality for mother and child. Anemia Mukt Bharat strategy launched by Government of India envisages provision of variety of facility-based interventions for management of anemia in pregnancy. Secondary care hospitals prescribe injectable iron treatment for moderate anemia and blood transfusion services for severe anemia. Objective: To estimate the magnitude and severity of anemia among pregnant women when they presented themselves for the first time at the antenatal care clinic of a secondary care hospital so as to forecast adequate supplies of medicines for managing anemia. Materials and Methods: This was a descriptive study using routinely maintained hospital clinical records during the years 2013–2015. It was conducted in a subdistrict hospital, Ballabhgarh in Faridabad district of Haryana state. Hemoglobin (Hb) level was routinely measured at first visit for all pregnant women using BC-3000 plus autohematology analyzer. Anemia in pregnancy was considered when Hb concentration was <11.0 g/dL. Results: The Hb level at first visit was available for 13,467 women during the study period. The mean Hb level (standard deviation) was 9.3 g/dL (1.3). The proportion of anemic pregnant women was 91.3% (95% confidence interval [CI]: 90.8, 91.7). The most common category of anemia was moderate anemia 62.5% (95% CI: 61.6, 63.2). Conclusion: We found a very high prevalence of anemia in pregnant women presenting to a secondary care setting of a North Indian hospital during their first visit to the facility during the antenatal period.

Prevalence of visual impairment due to uncorrected refractive error: Results from Delhi‑Rapid Assessment of Visual Impairment Study.

Aim: To estimate the prevalence of visual impairment (VI) due to uncorrected refractive error (URE) and to assess the barriers to utilization of services in the adult urban population of Delhi. Materials and Methods: A population‑based rapid assessment of VI was conducted among people aged 40 years and above in 24 randomly selected clusters of East Delhi district. Presenting visual acuity (PVA) was assessed in each eye using Snellen’s “E” chart. Pinhole examination was done if PVA was <20/60 in either eye and ocular examination to ascertain the cause of VI. Barriers to utilization of services for refractive error were recorded with questionnaires. Results: Of 2421 individuals enumerated, 2331 (96%) individuals were examined. Females were 50.7% among them. The mean age of all examined subjects was 51.32 ± 10.5 years (standard deviation). VI in either eye due to URE was present in 275 individuals (11.8%, 95% confidence interval [CI]: 10.5–13.1). URE was identified as the most common cause (53.4%) of VI. The overall prevalence of VI due to URE in the study population was 6.1% (95% CI: 5.1–7.0). The elder population as well as females were more likely to have VI due to URE (odds ratio [OR] = 12.3; P < 0.001 and OR = 1.5; P < 0.02). Lack of felt need was the most common reported barrier (31.5%). Conclusions: The prevalence of VI due to URE among the urban adult population of Delhi is still high despite the availability of abundant eye care facilities. The majority of reported barriers are related to human behavior and attitude toward the refractive error. Understanding these aspects will help in planning appropriate strategies to eliminate VI due to URE.

Challenges in scaling up successful public health interventions: Lessons learnt from resistance to a nationwide roll-out of the weekly iron–folic acid supplementation programme for adolescents in India.

Anaemia, a major public health problem globally, affects an estimated 1.6 billion people.1 It has effects on the physical and mental health, as well as the productivity of people, particularly those in the vulnerable groups.2,3 The National Family Health Survey (NFHS)-3, 2005–06 estimated that 56% of women and 30% of men in India in the age group of 15–19 years were anaemic.4 Anaemia among people in the age group of 15–24 years was reported to be more common in the rural than urban areas, and among families belonging to the lower socioeconomic strata (Table I). Iron deficiency anaemia is one of the most prevalent micronutrient deficiencies globally and in India.5 About 60% of adolescents in the age group of 10–17 years have been reported to consume less than 50% of the recommended dietary allowance of iron, according to the 2012 National Nutrition Monitoring Bureau (NNMB) multistate survey.6 The low iron content of a typical Indian diet, along with the high prevalence of worm infestation, is the cause of the high prevalence of anaemia in India.7 The various strategies for the

hould birth preparedness and complication readiness (BPCR) interventions be scaled up in developing countries.

This meta-analysis aimed to put together evidence on effectiveness of birth preparedness and complication readiness (BPCR) interventions on maternal and neonatal mortality. BPCR activities cover antenatal, intranatal, postnatal and neonatal periods with the strategy to inform mothers about location of emergency services, potential occurrence of obstetric complications and signs of complications, encourage the mother to take decisions before the onset of labour and to save money needed to pay for services and, finally, be able to take decisions during an emergency or complications.1 The intervention was BPCR, which could be any individual intervention or any of the above components combined, received by pregnant women residing in developing nations. In the comparator group were women who did not receive any BPCR interventions. The primary outcomes were maternal mortality ratio (MMR) and neonatal mortality rates (NMR) while the secondary outcomes were process indicators such as use of skilled services, and hygienic practices in the home. The review included randomized controlled trials; the level of randomization was either at the individual or at the cluster level. Articles published in French or English language were considered. Major search engines were used to look for relevant articles. Finally, 14 studies were selected and the quality ascertainment was done using McMaster Quality Assessment Tool. Meta-analysis was done to combine relative risks (RR), and a random effects model was used. Data were reanalysed on the basis of the intention-to-treat principle. Combinations

Assessment of Essential Newborn Care Services in Secondary-level Facilities from Two Districts of India.

India faces a formidable burden of neonatal deaths, and quality newborn care is essential for reducing the high neonatal mortality rate. We examined newborn care services, with a focus on essential newborn care (ENC) in two districts, one each from two states in India. Nagaur district in Rajasthan and Chhatarpur district in Madhya Pradesh were included. Six secondary-level facilities from the districts─two district hospitals (DHs) and four community health centres (CHCs) were evaluated, where maximum institutional births within districts were taking place. The assessment included record review, facility observation, and competency assessment of service providers, using structured checklists and sets of questionnaire. The domains assessed for competency were: resuscitation, provision of warmth, breastfeeding, kangaroo mother care, and infection prevention. Our assessments showed that no inpatient care was being rendered at the CHCs while, at DHs, neonates with sepsis, asphyxia, and prematurity/low birthweight were managed. Newborn care corners existed within or adjacent to the labour room in all the facilities and were largely unutilized spaces in most of the facilities. Resuscitation bags and masks were available in four out of six facilities, with a predominant lack of masks of both sizes. Two CHCs in Chhatarpur did not have suction device. The average knowledge score amongst service providers in resuscitation was 76% and, in the remaining ENC domains, was 78%. The corresponding average skill scores were 24% and 34%, highlighting a huge contrast in knowledge and skill scores. This disparity was observed for all levels of providers assessed. While knowledge domain scores were largely satisfactory (>75%) for the majority of providers in domains of kangaroo mother care and breastfeeding, the scores were only moderately satisfactory (50-75%) for all other knowledge domains. The skill scores for all domains were predominantly non-satisfactory (<50%). The findings underpin the need for improving the existing ENC services by making newborn care corners functional and enhancing skills of service providers to reduce neonatal mortality rate in India.

Courses in reproductive and child health in India: An overview.

Defining the human resource needs for providing quality maternal, newborn, and child health services across such a large and diverse population country like India is truly challenging. The effective response to significant challenges and increased requirements of evidence-based effectiveness of the public health projects on maternal and child health is putting pressure on existing program managers to acquire new advanced academic training and information. The data regarding the existing courses on reproductive and child health and related fields in the country were obtained by a predefined search made on the Internet through the Google search engine in December 2011. The collected data were the name and location of the institution offering the respective course, theme, course duration, course structure, eligibility criteria, and mode of learning. In India, around 15 institutes are offering certificate/postgraduate diploma courses on maternal and child health either as a regular program or through distance education program. The admission procedure for each institute is independent of others. The courses vary in terms of duration, eligibility criteria, and fee structure. Conceptualizing an educational initiative in response to national demands for increased workforce capacity to eliminate key medical and nonmedical educational barriers and financial and nonfinancial barriers to advanced academic preparation would enhance the quality of services available in the region.

Does Facility-Based Newborn Care Improve Neonatal Outcomes? A Review of Evidence.

Context: Facility based newborn care is gaining importance as an intervention aiming at reduction of neonatal mortality. Objective: To assess different factors that affect effectiveness of facility based newborn care on neonatal outcomes. Evidence acquisition: Electronic search using key search engines along with search of grey literature manually. Observational and interventional studies published between 1966- Aug 2010 in English having a change in neonatal mortality as an outcome measure were considered. Results: A total of 40 articles were fully reviewed for generating synthesized evidence. All were observational studies. The exposure variables that affected neonatal outcomes were grouped into three categories- regionalization of perinatal care (17 articles), strengthening of lower level neonatal facilities (12), and other miscellaneous factors (11). Regionalization played a key role in advancing newborn care practices. It increased in-utero transfer of high risk newborns and improved survival outcomes especially for very low birth weight neonates at level III facilities. It led to reduction in neonatal mortality owing primarily to enhanced survival of low birth weight infants. Strengthening of lower level units contributed significantly in reducing neonatal mortality. High patient volume (>2,000 deliveries/ year), inborn status, availability of referral system and inter-facility transfers, and adequate nursing care staff in neonatal units also demonstrated protective effect in averting neonatal deaths. Conclusions: Countries investing in facility based newborn care should give impetus to establishing regionalized systems of perinatal care. Strengthening of lower level units with high case loads, can yield optimal reduction in NMR.

Tracking Survival of Institutional Births for Neonatal Period- Feasibility at District Hospitals.

We assessed the feasibility of involving routine district health system personnel in tracking survival of institutional births for neonatal period in two district hospitals (Nagaur in Rajasthan and Chhatarpur in Madhya Pradesh) for the month of March 2010. A centralized district level tracking system was used in Nagaur, whereas in Chattarpur, block-wise tracking of births was performed. A total of 607 live births were tracked with 17 identified neonatal deaths. Prematurity and infections were commonest causes of deaths with majority occurring within first week of life. The block-wise approach resulted in identifying extra neonatal deaths.

Challenges in Scaling up of Special Care Newborn Units- Lessons from India.

Neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) are being set up to provide quality level II newborn care services in district hospitals of several districts to meet this challenge. The units are located in some of the remotest districts where the burden of neonatal deaths and accessibility to special care is a concern. A recently concluded evaluation of these units indicates that it is possible to provide quality level II newborn care in district hospitals. However, there are critical constraints such as availability and skills of human resources, maintenance of equipment and bed occupancy. It is not the SCNU alone but an active network of SCNU (level II care), neonatal stabilization units (level I care) and newborn care corners can impact neonatal mortality rate reduction higher. Number of beds is also not sufficient to cater to the increasing demand of such services. Available number of nurses is a problem in many such units. An effective and sustainable system to maintain and repair the equipment is essential. Scaling up these units would require squarely addressing these issues.

Assessment of Special Care Newborn Units in India.

The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) have been set up to provide quality level II newborn-care services in several district hospitals to meet this challenge. The units are located in some remotest districts where the burden of neonatal deaths is high, and access to special newborn care is poor. The study was conducted to assess the functioning of SCNUs in eight rural districts of India. The evaluation was based on an analysis of secondary data from the eight units that had been functioning for at least one year. A cross-sectional survey was also conducted to assess the availability of human resources, equipment, and quality care. Descriptive statistics were used for analyzing the inputs (resources) and outcomes (morbidity and mortality). The rate of mortality among admitted neonates was taken as the key outcome variable to assess the performance of the units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of 3-5 years considering the first year of operationalization as the base. Correlation coefficients were estimated to understand the possible association of case-fatality rate with factors, such as bed:doctor ratio, bed:nurse ratio, average duration of stay, and bed occupancy rate, and the asepsis score was determined. The rates of admission increased from a median of 16.7 per 100 deliveries in 2008 to 19.5 per 100 deliveries in 2009. The case-fatality rate reduced from 4% to 40% within one year of their functioning. Proportional mortality due to sepsis and low birthweight (LBW) declined significantly over two years (LBW <2.5 kg). The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. The units had a varying nurse:bed ratio (1:0.5-1:1.3). The bed occupancy rate ranged from 28% to 155% (median 103%), and the average duration of stay ranged from two days to 15 days (median 4.75 days). Repair and maintenance of equipment were a major concern. It is possible to set up and manage quality SCNUs and improve the survival of newborns with LBW and sepsis in developing countries, although several challenges relating to human resources, maintenance of equipment, and maintenance of asepsis remain.

Operations research in public health.

Operations Research (OR) is gaining importance in public health interventions and programmes increasingly both nationally and internationally. The focus of these research techniques is to constantly guide the programme implementation to achieve best results. It modulates inputs and processes involved in the programme cycle and strive to produce optimal gains in achieving targets and goals. Utilizing the vast range of qualitative and quantitative tools, this research has produced significant results worth applying and testing in the real field. It also identifies problems; often programme managers encompass in operations of public health goods and test the feasible solutions for them. This paper higlights the relevance, thems, and methodological approaches in context to OR in public health. Multiple research and training opportunities currently exist locally and globally, to carry out OR for bringing out timely improvements.

Hepatitis B and C Virus Infection in an Urban Slum of Northern India.

A community based cross sectional study was conducted in an urban slum amongst males to assess the magnitude of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections among males between 20-50 years of age. All of the 288 males who were contacted had agreed to participate in the study. However, the information could be collected from a total of 260 subjects, using a pretested, pre-coded schedule included socio-demographic characteristics. Serological tests were done for Hepatitis B and C. The data were analyzed using EPI-INFO 3.2.2. Proportion of persons tested serologically positive for Hepatitis B and C in the present study was observed to be 10.38% and 1.15%, respectively. Higher proportion for hepatitis Band C was observed amongst those Muslims, below 35 years of age, stay in the area for less than 5 years, Illiterates, unstable occupation, staying away from home and those with no history of blood transfusion or donation; however the difference was not statistically significant. There is a need to carry out more community based studies amongst such populations at risk in order to assess the true prevalence and risk factors for appropriate intervention.

Effectiveness of HIV Counseling Services on Knowledge, Attitude, Behavior and Practice (KABP) Among Pregnant Women Attending PPTCT Program.

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score =15.3) and post test (mean score=35.6) (P<0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individual. with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p<0.0001). The condom use among the study participant significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p<0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.

Deafness: Burden, prevention and control in India.

The high burden of deafness globally and in India is largely preventable and avoidable. According to the 2005 estimates of WHO, 278 million people have disabling hearing impairment. The prevalence of deafness in Southeast Asia ranges from 4.6% to 8.8%. In India, 63 million people (6.3%) suffer from significant auditory loss. Nationwide disability surveys have estimated hearing loss to be the second most common cause of disability. A lack of skilled manpower and human resources make this problem a huge challenge. The Government of India has launched the National Programme for Prevention and Control of Deafness. This article highlights the major components of the programme with a focus on manpower development and ear service provision including rehabilitation. Since the programme is also being implemented at the primary healthcare level, it envisages a reduction in the burden of deafness and prevention of future hearing loss in India.