Postmenopausal Experiences and Constraints in Seeking Health Care in A Rural Area of West Bengal, India

Introduction: During menopause, women experience various psychological or physical changes which need adequate attention. Moreover, women don’t seek help for these problems due to their hesitancy, lack of awareness, socio-cultural, financial constraints or as they feel this is a natural-phenomenon. The study aims to explore the postmenopausal experiences faced by women during menopause and to elicit the constraints faced by them in seeking health-care services. Methodology: This was a qualitative study with phenomenological approach conducted among post-menopausal women (≥45 years) from Oct 2022-Jan 2023 with the help of In-Depth-Interview guide in four villages of Bhatar Block, Purba-Bardhaman District. Considering the availability of the study participants, they were selected purposively from the list prepared by ASHA of each village and recruitment done till the point of data-saturation. Inductive thematic-analysis was used to identify codes and themes. Results: During menopause, women experienced physical and psychological changes in the body, changes in social life and for these changes they had to adjust to cope-up. They felt various needs like empathy from hus-bands, children, peers. On the other hand, they did not seek help from health-care services due to their knowledge gap, dissatisfaction from previous-visit, cost-issue and unavailability of resources in health-care delivery system. Conclusion: Majority of the post-menopausal women faced various problems associated with menopause, but very few had sought help. So, health care providers have an important role to generate awareness among post-menopausal women regarding physical and mental changes during this phase.

COVID Vaccine Hesitancy among the Tribal Population and Its Determinants: A Community-Based Study at Berhampore Block of Murshidabad District, West Bengal

Background: On January 16, 2021, India rolled out the COVID vaccination drive. A successful and effective vaccination campaign requires much more than the availability of a safe and effective vaccine. This includes identifying vulnerable populations with lower vaccine confidence and identifying the drivers of vaccine hesitancy. Objective: This study aims to find out vaccine hesitancy among the tribal population regarding COVID‑19 vaccination. Methods: It was an observational descriptive cross‑sectional study, conducted at Manindranagar and Hatinagar gram panchayat of Berhampore Block of Murshidabad district, West Bengal, from June 2021–November 2021, among tribal people aged >18 years. A total of 198 tribal people were selected by applying the probability proportional to size sampling method. Participants were interviewed using predesigned, pretested, and semi‑structured schedules. Potential predictors of hesitancy were investigated using the multivariate logistic regression model. Results: Vaccine hesitancy was present among 36.9% of the study participants. Fear of side effects (78.1%) was the most common reason of vaccine hesitancy. Only 30.8% of them received at least one dose of vaccine. Vaccine hesitancy was associated with decreased family income in the last 1 year (adjusted odds ratio [AOR] = 8.23), knowledge regarding vaccine (AOR = 0.41), adherence to COVID‑appropriate behavior (AOR = 0.45), and trust on the local health‑care worker (AOR = 0.32). Conclusion: Vaccine hesitancy among the tribal population is driven by a lack of knowledge and awareness. Their economic status, attitudes toward the health system, and accessibility factors may also play a major role in vaccine hesitancy. Extensive information, education, and communication activity, more involvement of health‑care workers in the awareness campaign, and establishment of vaccination centers in tribal villages may be helpful.

Factors Influencing Contribution of Geriatric Persons in the Society: A Glance from a Rural Area of West Bengal

Background: To facilitate healthy aging in India, it is important not only to acknowledge older people’s contribution but also to understand their perception regarding their impact in the society along with society’s attitude toward them. Objectives: This study aims to assess their self‑perceived contribution in the society and the factors related with their contribution. Methods: It was an observational, descriptive, cross‑sectional study, conducted at Amdanga block of North 24 Parganas district, West Bengal, during July 2021–June 2022. A total 0f 384 geriatrics were interviewed by the house‑to‑house survey with the help of a predesigned, pretested and semi‑structured schedule. Potential predictors of contribution were investigated using the multivariate logistic regression model. Results: 78.9% of participants had contribution in the society. 85.9% were taking care of family members when they were sick. 93.2% were sharing their opinion with the family members. 86.5% were participating in various social works. 79.1% were suffering from at least one physical health problem. With increase in the number of health problems, chances of good contribution decreases. In case of self‑perceived contribution in the society family type, employment, physical health and social participation are influencing the most. Conclusion: Elderly people are taking care of not only family members, but even relatives and neighbors also. They are sharing their knowledge and experience with family members and in the society. They are also contributing financially. Employment and proper health‑care infrastructure for geriatric may be helpful to maximize their contribution.

Comparison Of In-Hospital Mortality Of COVID-19 Patients Between Those Who Were Vaccinated And Who Were Not

Background:We compared the mortality rate of patients with moderate to severe COVID-19 who were vaccinated and who were not. Material And Methods:In this retrospective observational study, we collected data of patients who were admitted with moderate to severe COVID-19.The vaccination status and co morbidities of the patients were documented. The incidence and in-hospital mortality of COVID-19 patients was assessed.Univariate analysis was performed to determine the risk factors of in-hospital mortality.Result:Of 294 patients, 5.1% (n=15) received Covaxin™and 26.5% (n=78) received Covishield™;68.4%(n=201) patientswere unvaccinated.Of patientswho were vaccinated and contracted COVID-19, 24.8%(n=73) had taken the first dose and 6.8%(n=20) had taken the second dose of either vaccine.The in-hospital mortality rate was 13.6% (n=40). No significant association was found with the type of vaccine and the in-hospital mortality (p=0.23). Significant associations with in-hospital mortality were found with the interval before COVID-19 disease andvaccination (OR, 3.02; p=0.01); and the presence ofdiabetes mellitus (OR, 2.13; p=0.02), cardiovascular diseases (OR, 2.11; p<0.001), and malignancy (OR: 2.33; p=0.0325).Conclusion:The mortality rate of unvaccinated patients with moderate to severe COVID-19 was high. There was no significant difference in the effectiveness of Covaxin™ and Covishield™ in terms of the incidence of COVID-19 and in-hospital mortality. Diabetes mellitus, cardiovascular diseases, and malignancies had a significant association with in-hospital mortality in patients with moderate to severe COVID-19.

articleEarly diagnosis of neonatal sepsis in primary health care unit.

Aim: The aim of the study is to find out the role of common haematological parameters along with micro-ESR, I/T ratio in diagnosis of neonatal sepsis for initiating early management. Methods: This is a descriptive study consisting of 35 neonates admitted at a sophisticated institute with clinical suspicion of septicaemia along with 40 neonates as the comparison group. The neonatal haematological parameters including total leucocytes count, absolute neutrophil count, immature neutrophil count, I/T ratio, platelet count were measured in all the neonates. Micro-ESR was measured as a bed side test. CRP was also measured using slide agglutination method and the results were compared with turbidimetric method. Blood culture was done as a gold standard test for sepsis. Micro-ESR more than age of the patient in days +3 mm in 1st hour was considered significant for sepsis. I/T ratio more than or equal to 0.2 was considered positive for sepsis. Results: The study revealed that micro-ESR and I/T ratio were significantly higher (p<0.001) in suspected cases of septicaemia as compared to the neonates in the comparison group. Sensitivity and specificity of micro-ESR were 87.09% and 75.0% respectively. Sensitivity and specificity of I/T ratio were 93.54% and 95% respectively. Conclusion: Micro-ESR and I/T ratio can be used effectively as cheap and simple tests to screen for septicaemia in neonate which is possible even in a primary health care centre.

Comments on Evaluation of Endoscopic Findings and Detection of H. pylori Antibody by Serum IgG ELISA.

Bangladesh is a developing country with high prevalence of peptic ulcer disease and H. pylori infection. During the period of January 2007 to December 2007, a cross sectional study was conducted. In this study, serum samples were collected from 86 dyspeptic patients undergoing upper GIT endoscopy to determine anti-H. pylori IgG antibody by serum ELISA and was evaluated with endoscopic findings. Out of 86 study patients, gastro-duodenal mucosa was found normal in 58.14%, gastritis in 11.63%, duodenitis 2.33%, reflux oesophagitis 4.65%, peptic ulcer 17.44% and carcinoma of stomach 5.81%. Among 86 study population, 68 were serum IgG ELISA positive and 20 were negative.

A Comparative Study Among Different Invasive Methods For The Diagnosis Of Helicobacter Pylori.

H. pylori infection occurs worldwide. Approximately 50% of the world population is infected with this organism. A cross-sectional study was conducted on 81 dyspeptic patients attending at Dhaka Medical College Hospital, for diagnostic endoscopy. H. pylori infection was measured by three invasive methods: culture, rapid urease test & histopathology. Among study patients maximum (34.57%) H. pylori infected were in 21-30 years age group, bearing male female ratio 1: 92.86. Forty four (54.32%) out of 81 were culture positive, 61 (75.31%) were rapid urease test positive and 62 (76.54%) were histopathology positive. By using ‘gold standard’ definition, 64 (79.02%) were H. pylori infected, 17 were un-infected. Finally comparing among three invasive methods, all are highly sensitive and specific to diagnose H. pylori infection.

A study on drug use in a district hospital of West Bengal.

A cross-sectional study at Howrah General Hospital, West Bengal for prescription analysis and assessment of drug dispensing in 341 patients revealed that the average number of drugs prescribed per encounter was 2.98 +/- 1.69, 38.2% drugs were in generic name and majority were from essential drugs list. 18.6% and 5.2% encounters used antibiotics and injections respectively. Average consultation and dispensing time were short. Majority of drugs were dispensed but unlabeled. 46.8% patients knew correct dosage of drugs. Only 4.7% patients were treated without drugs. Average drug cost per encounter was Rs. 31.32+30.89 where antibiotics and injections shared 36.5% and 4.6% respectively.

Syndromic approach for determination of reproductive tract infections among adolescent girls.

The present study shows overall prevalence (64%) of reproductive tract infection among adolescent girls, based on self-perceived symptoms. Mean age of respondents were found to be 17.8 +/- 0.82 years and mean age at marriage and mean age at first pregnancy were 17.2 years and 17.5 years respectively; 35.35% of girls in the present study were married. In addition, no significant difference was observed between unmarried (60.10%) and married (71.17%) reproductive tract infection groups. Moreover, no significant association was present in prevalence of reproductive tract infection between the Muslim (67%) and the Hindu (60%). Highest prevalence (84.06%) of reproductive tract infection was observed among illiterate girls and with improvement of educational status there was decrease in the prevalence and the association was found highly significant. Significantly, higher prevalence (72%) was observed among members of family size 7 and above.

Development of a training programme for school teachers on school health service.

A training programme was developed and implemented for 56 primary school teachers of Barasat II block in North 24 Parganas district as per their recommended roles and responsibilities in School health service. The methodology consisted of development of learning objectives, evaluation parameters (questionnaire and check list) and teaching-learning materials. This was followed by pre-training assessment, implementation of training and re-training and evaluation of the outcome 7 days and 3 months after initial training and re-training. One way analysis of variance revealed significant overall improvement of the cognitive, affective and psychomotor domain of learning of school teachers. The need of periodic re-inforcement training with adequate scope of practice under supervision were emphasized.

Evaluation of in vitro and in vivo antibacterial activity of dobutamine hydrochloride.

PURPOSE: To determine the in vitro and in vivo antibacterial activity of a cardiovascular drug dobutamine hydrochloride. METHODS: The minimum inhibitory concentration (MIC) of dobutamine was determined both by agar and broth dilution methods against 331 strains of bacteria from three gram positive and 13 gram negative genera. The antibacterial action of dobutamine was further tested in animal models. RESULTS: Dobutamine was seen to possess powerful inhibitory action (5-200mg/mL) against most test bacteria in in vitro studies. It was bacteriostatic in nature. In vivo studies showed that the drug offered significant protection (p< 0.001) to mice challenged with a virulent bacterium. CONCLUSION: Dobutamine showed remarkable antibacterial property against several pathogenic bacteria. Its potential as an antibacterial agent may be confirmed after further pharmacological studies.

Breast-feeding counselling and its effect on the prevalence of exclusive breast-feeding.

This prospective intervention study was undertaken to assess the impact of repeated breast-feeding counselling on the rate of exclusive breast-feeding up to five months. The study was carried out in two breast-feeding counselling sub-centres, established at the community level in the vicinity of two maternity facilities and one main centre established in an urban children hospital. Eighty-four pregnant mothers who attended the maternity facilities for delivery of babies were randomly selected and repeatedly counselled regarding breast-feeding--once just before delivery and subsequently at the completion of 1, 2, 3, 4, 5, 6, 9, and 12 month(s) of age of the child. These child-mother pairs comprised the intervention group. Another group of 90 child-mother pairs was selected from the maternity facilities. Mothers in this group (comparison group) received a single session of breast-feeding counselling just before delivery of babies. Fifty-nine and 55 child-mother pairs in the intervention and the comparison groups respectively completed the one-year follow-up. In the intervention group, 54.2% and in the comparison group 36.4% of the babies were exclusively breastfed up to five months of age. Forty-two (88%) children in the intervention group and 29 (53%) in the comparison group were given complementary foods at the optimum time, e.g. after completion of five months, and 81% of the children in the intervention group and 100% of the children in the comparison group were given complementary foods in the first year of life. It was observed that repeated organized breast-feeding counselling significantly improved the prevalence of exclusive breast-feeding to 54% which is much above the existing national prevalence (12.7%) in Bangladesh.

Comparison of ELISA for antibody detection and biopsy urease test against H. pylori in cases of gastoduodenal disorders.

Out of 156 cases of various gastro duodenal disorders studied H. pylori was diagnosed in 119 (76.28%) as indicated by Biopsy urease test and IgG ELISA. Biopsy urease test detected higher number of cases 119 when compared to IgG ELISA 107 cases. ELISA being a non invasive technique can be used successfully for the diagnosis of H. pylori infections.

Detergent-mediated destaining of coomassie brilliant blue-stained SDS polyacrylamide gels.

A simple and one-step detergent-mediated destaining procedure for SDS Polyacrylamide gels for proteins is described. Suspension (5%, w/v) of a commercially available household detergent, Vim Ultra, has been found to be very efficient in destaining polyacrylamide gels without interfering with the resolution of proteins. As compared to the routinely used solvent (methanol-acetic acid-water)-mediated destaining procedure, the present method is economical and user-friendly.

Changes of gastroduodenal peroxidase activity of rats by cerebellar modulation.

The effect of vestibulo-cerebellar lesion and its stimulation by rotation on gastric and duodenal peroxidase activity of rats was studied. Vestibulocerebellar lesion by kainic acid produced gastroduodenal ulceration and peroxidase activity of these tissues were decreased. Mucosal thickness of gastric and duodenal tissue were also decreased. It was observed that when vestibulo-cerebellar lesioned rats were subjected to vestibular stimulation, the peroxidase activity was increased together with increased mucosal thickness of gastric and duodenal tissue. At the same time, it was noted that the severity of ulceration was decreased. We conclude that the study of peroxidase activity is a sensitive and potentially useful estimate of gastric and duodenal injury produced by cerebellar lesion that can be valuable in assessing ulcerogenesis and healing.

Effect of cerebellar modulation on rat gastric secretion and enterochromaffin-like cell.

Effect of cerebellar lesion and vestibular stimulation (VS) on the activity and alternation of ECL-cells along with changes in gastric volume and acid secretion was studied. The results suggest that cerebellar lesion caused increased gastric volume and acid secretion and tended to decrease ECL-cell density. On the other hand VS of nodular lesioned rats resulted in decrease of above parameter which became marked only after 21 days of nodular lesion.

Study of impact of nutrition & health day strategy on the coverage rates of supplementary nutrition and health interventions among the ICDS beneficiaries in a rural block of Madhya Pradesh.

To study the trends of beneficiary coverage (pregnant and lactating women and children less than two years of age) for utilization of supplementary nutrition and health services in a rural block before and after the launch of a strategy to converge Health & Integrated Child Development Services (ICDS) on a single day christened "Nutrition and Health Day" (NHD). It is a before and after intervention design in rural ICDS block Amarwada in district Chhindwada. As a part of intervention, NHD were organised on which convergent services of Health & ICDS were made available to the beneficiaries. On the weekly NHDs, uncooked supplementary nutrition for the week was distributed to pregnant and lactating mothers and children under two. The Health worker visited the Anganwadi Centre (AWC) and immunized children and pregnant women, distributed IFA, Vitamin A and provided health and nutrition education. The study assessed the impact of these interventions on the coverage rates of the services. Study was conducted between May 97 and March 98. The routine monitoring reports of the ICDS and Health System of the state government were used as study tools. The study sample comprised of AWC beneficiaries in the project area. The total population of the block was 89,476. Participation in the supplementary nutrition program (SNP) increased two to three folds in all categories of the target population. Immunization and Vitamin A coverage levels for children also showed an increase of about 3 and 5-8 times from baseline status respectively in a year's time. Among pregnant women, Tetanus Toxoid (TT) and Iron and Folic Acid (IFA) utilization rates have also shown two and five fold increase respectively.

Comparison between two different modes of oxygen therapy during immediate postoperative period following mitral commisurotomy.

Hypoxaemia is a common postoperative problem after thoracotomy. Oxygen therapy with continuous monitoring by pulse oximetry should be a routine practice. This study was conducted to compare the efficacy between nasal cannula and ventimask for post-thoracotomy oxygen supplementation on 20 patients divided into 2 groups of 10 each undergoing closed mitral commisurotomy. The study period was of 5 months duration from March to July, 1996. The mean oxygen saturation remained above 98% in both the groups receiving oxygen either by nasal cannula or ventimask. As there was adequate oxygenation, the cost benefit ratio favours the use of nasal cannula for routine postoperative oxygen supplementation in the closed mitral commisurotomy patients.