ABSTRACT
Background: The current situation of Comprehensive Primary Healthcare (CPHC) in India with reference to its characteristics is lesser known. Objectives: 1. To explore various characteristics of research based on CPHC in India. 2. To identify gaps in research on CPHC. Materials and Methods: A broad search strategy was developed to obtain articles on CPHC from PubMed and Google scholar. Out of 218 articles, 17 were explored for objectives, key findings. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) was used. Results: Most were on reproductive and child health, non-communicable diseases, and utilization & gaps in services. Only 1 study was Randomized controlled trial, followed by mixed method (n=2). Fourteen studies focussed on current situation of CPHC and none on service delivery of CPHC. Conclusion: Limited studies have been conducted on CPHC in India. Significant number of research are needed for strengthening primary health care.
ABSTRACT
The purpose of the present review is to examine the new competency-based undergraduate curriculum in community medicine against the established frameworks and criteria and suggest the way forward for achieving competencies expected of the Indian Medical Graduate (IMG). The new Graduate Medical Education Regulations, 2018, is based on Harden's concept of the curriculum. Hence, we reviewed the components of new curriculum against Harden's conceptualization of various components of the curriculum, and since it claims it is competency-based, we used Tyler's Goal/Objective-Based Evaluation. The new undergraduate curriculum has shown a move toward integration of course content and defined the competencies in more measurable terms. However, it appears that the earlier information-based curriculum corresponding to book chapters (”topics”) has been modified to specify higher cognitive domains with no explicit link between the IMG level curriculum outcomes to subject level intended learning outcomes (ILOs). The mechanism to link ILOs to assessment is also not clear and so needs more clarity. The assessment system hinted at in the current document is mostly based on the existing conventional system of 50% as pass cutoff, etc., against criterion-referenced assessment applicable to competencies that need to be performed. Furthermore, there is no guidance on the creation of educational opportunities and environment for students and faculty – perhaps it is left to “Curriculum Implementation Support Programme (CISP) Workshops.” Hence, the need for preparing a roadmap/blueprint to learning experiences and assessment methods and levels and milestones to be reached at various phases of MBBS and during internship is required.
ABSTRACT
Background: Non-communicable diseases are among the leading causes of death in India, the rapid epidemiological transition as a consequence of economic and social changes is a major factor in the rise of patients suffering from non-communicable diseases (NCDs). Objectives: The objectives of the study were (1) to find out the prevalence of common risk factors among adults for NCDs, (2) to study the determinants of NCDs, and (3) to assess health-care seeking behavior and treatment adherence to NCDs. Material and Methods: The present study was undertaken in the field practice area of the Rural Health Training Center of the Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry. It was a community-based cross-sectional study. A representative sample of 590 respondents was selected by two-stage cluster sampling. Chi-square tests were applied to find proportions. Confidence intervals values were constructed around the prevalence ratio values. Multivariate analysis (negative binomial regression) was done to get the adjusted prevalence ratio and to select the variables that best predict the risk of development of at least one NCD among the study sample. Results: The prevalence of at least one NCD (hypertension and or diabetes) among respondents was 18.1%. Most of the patients with hypertension and or diabetes received treatment from a public health facility (68.2%) followed by private health-care services (31.8%) at village/ town level. The major perceived reasons for non-compliance to treatment among patients were related to the high cost of treatment (28%) from private services and sense of wellbeing without medication (28%). In multivariate analysis, two variables emerged as significant predictors for developing at least one NCD were alcohol consumption and obesity. Conclusions: Obesity was found be an independent risk factor for developing NCD. Hence, preventive measures should be applied to reducing BMI in obese individuals. Special efforts must be made to improve physical activity and dietary habits of these individuals from an early age so that the occurrence of NCD can be prevented. Awareness regarding physical activity and a healthy diet can be given in schools and colleges as it may have a better impact on the community. Opportunistic screening for NCD should be done for all adults in the outpatient department irrespective of their symptoms for early diagnosis of NCD.
ABSTRACT
OBJECTIVES: The objectives of the present study were to study the pattern of tobacco use among rural adolescents (15-19 years) and to find out reasons for use and non use of tobacco products. MATERIALS AND METHODS: In the present community-based research, triangulation of qualitative (free list, focus group discussions) and quantitative methods (survey) was undertaken. The study was carried out in surrounding 11 villages of the Kasturba Rural Health Training Centre, Anji during January 2008 where 385 adolescents were selected by simple random sampling and interviewed by house to house visits. After survey, six focus group discussions were undertaken with adolescent boys. RESULTS: About 68.3% boys and 12.4% girls had consumed any tobacco products in last 30 days. Out of boys who had consumed tobacco, 79.2% consumed kharra, and 46.4% consumed gutka. Among boys, 51.2% consumed it due to peer pressure, 35.2% consumed tobacco as they felt better, and five percent consumed tobacco to ease abdominal complaints and dental problem. Among girls, 72% used dry snuff for teeth cleaning, 32% and 20% consumed tobacco in the form of gutka and tobacco & lime respectively. The reasons for non use of tobacco among girls were fear of cancer (59%), poor oral health (37.9%). Among non consuming boys it was fear of cancer (58.6%), poor oral health (44.8%) and fear of getting addiction (29.3%). According to FGD respondents, few adolescent boys taste tobacco by 8-10 years of age, while girls do it by 12-13 years. Peer pressure acts as a pro tobacco influence among boys who are outgoing and spend more time with their friends. They prefer to consume freshly prepared kharra which was supposed to be less strong (tej) than gutka. Tobacco is being used in treatment of some health problems. Tobacco is chewed after meals for better digestion, given to ease toothache, pain in abdomen and to induce vomiting in suicidal insecticide poisoning. CONCLUSION: The current consumption of any tobacco products among rural adolescents was found very high. Hence, the multi-pronged intervention strategy is needed to tackle the problem.