Rural community health workers’ readiness for mobile-phone based telemedicine uptake in India / Journal of Rural Medicine

Objective: Healthcare services using mobile-phone based telemedicine provide simple technology that does not require sophisticated equipment. This study assessed community health workers’ knowledge, attitude, and practice (i.e., their readiness) at the village level for uptake of mobile-phone based telemedicine.Materials and Methods: This cross-sectional study was conducted among 80 community health workers, including Auxiliary Nurse Midwives, Multipurpose Health Workers and Accredited Social Health Activists working in a rural health block of India. A pre-tested, semi-structured, interviewer-assisted, self-administered questionnaire was used to assess their mobile-phone based telemedicine readiness.Results: Sixty (75.0%) health workers owned mobile phones. The median readiness score for mobile-phone based telemedicine was 109.0. The Accredited Social Health Activists showed a better attitude toward mobile-phone based telemedicine than others. There was a significant moderate positive correlation (r=0.67) between knowledge and practice domains. Community health workers who had smartphones showed a significantly better attitude than those who did not.Conclusion: Training programs on telemedicine service delivery, focused on Auxiliary Nurse Midwives/ Multipurpose Health Workers, can improve their attitudes towards telemedicine. A better attitude of the Accredited Social Health Activists must be leveraged to initiate mobile-phone based telemedicine services on a pilot basis initially and later scaled up in other settings.

Effect of COVID-19 lockdown on the pathway of care and treatment outcome among patients with tuberculosis in a rural part of northern India: a community-based study / Journal of Rural Medicine

Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected routine healthcare services across all spectra, and tuberculosis (TB) care under the National Tuberculosis Elimination Program have been affected the most. However, evidence available at the community level is minimal. The clinical features, care cascade pathway, and treatment outcomes of TB patients pre- and during/post-COVID-19 pandemic lockdown in a rural community health block in northern India were assessed and compared.Materials and Methods: This was a retrospective cohort study that included all patients diagnosed with TB and initiated treatment under programmatic settings between January 1 and June 30, 2020, in a rural TB unit in northern India. The periods from January 1 to March 23 and March 24 to June 30 were marked as pre-lockdown and during/post-lockdown, respectively.Results: A total of 103 patients were diagnosed and treated for TB during the study period. A significantly higher proportion of pulmonary TB cases were reported during/post-lockdown (43, 82.7%) compared to that pre-lockdown (32, 62.7%), and a higher diagnostic delay was noted during/post-lockdown (35, 81.4%). Through adjusted analysis, patients diagnosed during/post-lockdown period (adjusted risk ratio [aRR], 0.85; 95% confidence interval [CI], 0.73–0.98) and previously treated (aRR, 0.77; 95% CI, 0.60–0.995) had significantly lower favorable treatment outcomes.Conclusions: The symptom and disease (pulmonary/extrapulmonary) pattern have changed during/post-lockdown. The care cascade delays are still high among TB patients, irrespective of the lockdown status. Lockdown had a significant adverse impact on the outcomes of TB treatment.

Google Search Trends Predicting Disease Outbreaks: An Analysis from India / 대한의료정보학회지

OBJECTIVES: Prompt detection is a cornerstone in the control and prevention of infectious diseases. The Integrated Disease Surveillance Project of India identifies outbreaks, but it does not exactly predict outbreaks. This study was conducted to assess temporal correlation between Google Trends and Integrated Disease Surveillance Programme (IDSP) data and to determine the feasibility of using Google Trends for the prediction of outbreaks or epidemics. METHODS: The Google search queries related to malaria, dengue fever, chikungunya, and enteric fever for Chandigarh union territory and Haryana state of India in 2016 were extracted and compared with presumptive form data of the IDSP. Spearman correlation and scatter plots were used to depict the statistical relationship between the two datasets. Time trend plots were constructed to assess the correlation between Google search trends and disease notification under the IDSP RESULTS: Temporal correlation was observed between the IDSP reporting and Google search trends. Time series analysis of the Google Trends showed strong correlation with the IDSP data with a lag of −2 to −3 weeks for chikungunya and dengue fever in Chandigarh (r > 0.80) and Haryana (r > 0.70). Malaria and enteric fever showed a lag period of −2 to −3 weeks with moderate correlation. CONCLUSIONS: Similar results were obtained when applying the results of previous studies to specific diseases, and it is considered that many other diseases should be studied at the national and sub-national levels.

Development and psychometric testing of an abridged version of Dundee Ready Educational Environment Measure (DREEM)

BACKGROUND@#Dundee Ready Educational Environment Measure (DREEM) is a 50-item tool to assess the educational environment of medical institutions as perceived by the students. This cross-sectional study developed and validated an abridged version of the DREEM-50 with an aim to have a less resource-intensive (time, manpower), yet valid and reliable, version of DREEM-50 while also avoiding respondent fatigue.@*METHODS@#A methodology similar to that used in the development of WHO-BREF was adopted to develop the abridged version of DREEM. Medical students (n = 418) from a private teaching hospital in Madurai, India, were divided into two groups. Group I (n = 277) participated in the development of the abridged version. This was performed by domain-wise selection of items that had the highest item-total correlation. Group II (n = 141) participated in the testing of the abridged version for construct validity, internal consistency and test-retest reliability. Confirmatory factor analysis was performed to assess the construct validity of DREEM-12.@*RESULTS@#The abridged version had 12 items (DREEM-12) spread over all five domains in DREEM-50. DREEM-12 explained 77.4% of the variance in DREEM-50 scores. Correlation between total scores of DREEM-50 and DREEM-12 was 0.88 (p < 0.001). Confirmatory factor analysis of DREEM-12 construct was statistically significant (LR test of model vs. saturated p = 0.0006). The internal consistency of DREEM-12 was 0.83. The test-retest reliability of DREEM-12 was 0.595, p < 0.001.@*CONCLUSION@#DREEM-12 is a valid and reliable tool for use in educational research. Future research using DREEM-12 will establish its validity and reliability across different settings.