Challenges of Second-hand Smoke: Are We Asking the Right Questions?

Second-hand tobacco smoke as defined by WHO is the smoke emitted by a smoker or released from a burnt cigarette or any tobacco product. It is highly prevalent all over the globe but its serious health implications are often neglected by the public and the scientific community alike. Second-hand smoke has everlasting impact on all the body’s major organs, especially among the vulnerable population of children, pregnant ladies, people with chronic diseases and senior citizens. Although India started its war against this menace earlier than other counties, all its efforts remain bootless as its approach and implementation have a wide range of lacunae. This review aims to give a big picture of second-hand smoke, highlighting its pathophysiological changes in the body, socioeconomic impact, various strategies, and the gap that prevents these strategies from finding a favorable result in India. It becomes all the more important to reduce its impact owing to the increase in prevalence among youth reducing their vitality, derailing the society and the nation. It is recommended that the health authorities approach this health problem with utmost seriousness as a laid-back approach could welcome this silent killer’s known and unknown repercussions

Text messaging improves diabetes-related knowledge of patients in India: A quasi-experimental study

Background. Diabetes-related health education promotes patient efficacy for diabetes self-management. However, sub-optimal knowledge of diabetes in people with diabetes is recognized as a challenge in overcrowded public health facilities in India. We aimed to determine the effect of health education through mobile phone text messages (short messaging service [SMS]) on diabetes-related knowledge of patients with diabetes. Methods. From February 2016 to February 2017, we recruited adult patients with diabetes for this quasi-experimental study done in the outpatient setting of a major tertiary care government hospital in Delhi, India. Participants in the intervention group received a text message on diabetes self-care practices every alternate day for 90 days. We evaluated the patients’ knowledge of diabetes using the Spoken Knowledge in Low Literacy in Diabetes (SKILL-D) questionnaire and a self-designed diabetes knowledge questionnaire. Results. We enrolled 190 men and 160 women, of whom 52 (13.7%) were lost to follow-up. At baseline, mean diabetes knowledge scores were higher in the intervention group compared to the control group. After the intervention period of 3 months, the diabetes knowledge scores for SKILL-D and the patient diabetes knowledge questionnaire showed a statistically significant increase in the intervention group (mean difference 0.7 and 0.5, respectively; p<0.001, but there was no increase in the control group). Conclusion. The use of mobile phone technology for diabetes-related health education through mobile text-message (SMS) technology is an effective method for health promotion.

Three-parent baby: Is it ethical?

The UK was the first country to legalise mitochondrial donation in October 2015. In 2016, the first three-parent baby was born in Mexico and the US Food and Drug Administration declared that further research on mitochondrial donation is ethically permissible. It has now become an important issue, raising as it does, the spectre of “genetically modified designer babies”.

Need for integration of gender equity in family planning services.

The family planning programme of India has shown many significant changes since its inception five decades back. The programme has made the contraceptives easily accessible and affordable to the people. Devices with very low failure rate are provided free of cost to those who need it. Despite these significant improvements in service delivery related to family planning the programme cannot be said to achieve success at all levels. There are many issues with the family planning services available through the public health facilities in India. Failure to adopt the latest technology is one of these. But the most serious drawback of the programme is that it has never been able to bridge the gap between the two genders related to contraceptives. The programme gave emphasis to women-centric contraceptive and thus women were seen as their clients. The choice to adopt a contraceptive though is ‘cafeteria approach’ in family planning lexicon; it is the choice of the husband that is ultimately practiced. There is not enough dialogue between husband and wife and husband and health worker to discuss the use of one contraceptive over another. The male gender needs to be taken in confidence while promoting the family planning practice. The integration of gender equity is to be done carefully so as not to make dominant gender more powerful. Only when there is equity between genders while using family planning services the programme will achieve success.

Gender-violence and health care: How health system can step in.

Gender-violence also known as domestic violence, domestic abuse, spousal abuse or intimate partner violence, can be broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, friends or cohabitation. It can manifest as physical aggression, sexual abuse, emotional abuse, intimidation, stalking and economic and food deprivation. In most countries gender violence is a crime; though scope of the domestic or gender violence act and severity of punishment varies considerably between the countries.

Non-health determinants of health and healthcare in Delhi.

With only 0.05% of the total area of the country, Delhi is home to 1.34% of India’s population. This creates enormous pressure on natural and man-made resources, and generates situations in which non-health determinants may take precedence over the conventional determinants directly associated with health and healthcare. With the rising advocacy on social determinants of health, several of these factors may rightly seem to be part of the broader territory of healthrelated variables, and in that context, they may be designated as conventional non-medical determinants. We discuss some more visible domains, such as demography, migration and floating population; the physical and biological environment; economic determinants; social determinants; legislation and enforcement, and underscore some less explored yet critical domains of the determinants related to culture, governance and politics. What emerges as a compelling reality is a wide differential in physical environment, urban planning and access to infrastructural inputs between the privileged and marginalized areas of Delhi. Inequities in physical quality of life are so gross that even a value-neutral, official narrative betrays them helplessly. We propose actionable areas to address some of the pressing non-health determinants of health and healthcare.

Cochlear implantation in India: A public health perspective.

Around 7% of the population of India suffers from profound deafness. More than a million children needs either hearing aid or cochlear implant surgery to restore their hearing power. Many of them had never heard a single word since their birth. Still only 5000 cochlear implant surgery has been conducted in the country, the first being nearly 20 years ago, and most of them in private health facilities where the patient paid out of their pocket. The main reason of such poor penetration of the surgery in masses is the inhibitory cost associated with cochlear implant surgery and the lack of trained man-power to conduct such surgeries. The other reason is being the government engagement with other pressing health needs of the society resulting in the shout of ear care falling on deaf ears. With the advent of National Program for Prevention and Control of Deafness (NPPCD) in 2006, there is renewed interest in tackling this public health disaster.

Measles elimination goal: Is it feasible for India.

Objective : To assess whether measles elimination goal would be feasible for India or not. Methodology: Secondary review of data from WHO Regional Consultative Meet on Measles and Workshop on Rubella. Discussion with stakeholders such as UNICEF experts, PATH, and Government officials. Results: The National Technical Advisory Group of India (NTAGI) has chalked out two broad strategies depending on the routine measles coverage of first dose (MCV1). In 18 states with sustained MCV1 coverage ≥80%, a second routine dose of measles would be given, whereas those states with <80% coverage, supplementary immunization will be introduced in a phased manner. There are many challenges at this juncture-unfinished agenda polio eradication, lack of VPD surveillance system, financial and manpower constraints. However, solutions are possible. Conclusion: Before setting an elimination goal in India, a thorough understanding of the regional situation is required. India should opt for the Measles Mortality Reduction before proceeding to the Elimination Goal by 2020.

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.

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.

Adolescent friendly health services in India: A need of the hour.

Adolescents account for almost one third of India's population. They are prone to suffer from reproductive and sexual health, nutritional, mental and behavioral problems. Health services which cater exclusively to the needs of adolescents are scanty and concentrated in urban areas. Adolescent Friendly Health Services (AFHS) which provide a broad range of preventive, promotive and curative services under one roof can help to ensure improved availability, accessibility and utilization of health services. AFHS is being initiated by governmental, private and non-governmental organizations. Lessons to improve the quality of AFHS could be further learnt from evaluation of pilot projects and success stories of similar initiatives in other countries.

Prevalence and awareness about sexually transmitted infections among males in urban slums of Delhi.

BACKGROUND: India is at present facing an emergence of sexually transmitted infections (STIs) and human immunodeficiency virus. Community-based studies on the prevalence of STIs among males are scanty. AIM:(i) To study the prevalence of STIs and (ii) to assess the level of awareness about STIs among males belonging to the reproductive age group residing in an urban slum. SETTING AND DESIGN: This is a cross-sectional study conducted in selected areas of Delhi, using a camp approach. MATERIALS AND METHODS: One hundred ninety-six males in the reproductive age group were interviewed regarding their awareness about STIs, past history and present complaints of any symptoms suggestive of an STI. This was followed by a clinical examination. Required samples were also collected for microbiological tests. STATISTICAL TESTS: Simple proportions and Chi-square test. RESULTS AND CONCLUSIONS: As many as 70% of the study participants were unable to mention even one symptom of an STI. About 73.4% of the study participants stated that staying in a monogamous relationship could help prevent STI, while only 39.2% were aware that condoms could afford protection against an STI. As many as 8.7% complained of urethral discharge, while 5.6% complained of itching, 2.5% reported presence of genital ulcer and 1.0% complained of groin swelling. We found a seroprevalence rate of 1.5% for trichomoniasis and 3.6% for syphilis. Thus the overall awareness level about STIs and their prevention was rather low. Poor treatment-seeking behavior was also observed. The actual prevalence rate in the general population might be higher due to the likelihood of presence of an asymptomatic infection. The present study calls for a multipronged approach which also includes targeted interventions and strategies to be adopted in the reproductive health programs for males who have been neglected by the program managers so far.

Socio-demographic co-relates of psychiatric disorders.

OBJECTIVE: To find out the magnitude of probable psychopathology in children and study association of psychopathology with demographic, developmental and social factors. METHODS: Childhood Psychopathology Measurement Schedule (CPMS) was used to measure the magnitude of probable psychopathology in 620 children from an urban slum of Miraj (Maharashtra). A second schedule recorded demographic, developmental and social factors. RESULTS: CPMS score > 10 was observed in 102 children (16.5%). It was significantly higher in children aged 7-10 years, in males, belonging to lower socioeconomic status, large families, being first born, having low birth weight (LBW); body mass index (BMI) less than 18.5. Low maternal education and alcohol abuse in father also had significant association with CPMS score > 10. CONCLUSION: Findings suggest a need to educate the community about psychological implications of LBW, large family size and overcrowding in children. Improving maternal education and controlling alcoholism could help in reducing childhood psychopathology.