ABSTRACT
Background & objectives: The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district. Methods: A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed. Results: Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement. Interpretation & conclusions: The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.
ABSTRACT
Introduction: 2019 novel coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first reported in Wuhan, in China, rapidly spread to other parts of the world forming a global pandemic. Secondary fungal or bacterial infections or coinfections are important challenges increasing the patients’ morbidity and mortality in COVID infection patients. The coronavirus disease-2019 (COVID-19) pandemic has led to increases in the cases of mucormycosis in India; rhino-orbito-cerebral mucormycosis is considered the most common type of mucormycosis, which is acquired by inhaling fungal spores in the paranasal sinuses. Objectives: The aims of this study were to assess the clinical and demographic profile of the patient with mucormycosis admitted to Government Medical College, Jalgaon and to identify the risk factors observed in the admitted patient with mucormycosis. Materials and Methods: The cross-sectional descriptive study was conducted among the patients admitted for the treatment of mucormycosis in Government Medical College and Hospital, Jalgaon, Maharashtra. A total of 91 patients admitted from April 15, 2021 to June 15, 2021 were enrolled as study participants. Result: More than half of the study participants were having complaints of swelling and pain over the cheek and face at the time of admission, whereas 20% were having pain in the nose, growth/swelling, and discharge from nose followed by toothache and loss of teeth in 13% of the study participants. More than 50% of patients were diabetic and 91% have a history of steroid use for the treatment of COVID-19. 57% of the study participants were having a history of diabetes. Conclusion: The physician should be more attentive for mucormycosis among the post-COVID-19 patients with diabetes patients and/or presenting with pain in the facial or orbital region or blackish or bloody nasal discharge.