Willingness of medical students to volunteer during the Covid-19 pandemic: Assessment at a tertiary care hospital in India

BACKGROUND The involvement of medical students in strategies to control Covid-19 might be considered to cope with the shortage of healthcare workers. We assessed the knowledge about Covid-19, willingness to volunteer, potential areas of involvement and reasons for hesitation among medical students towards volunteering. METHODS We did this cross-sectional study among undergraduate students at a tertiary care teaching hospital in New Delhi. We used a web-based questionnaire to elicit demographic information, knowledge of Covid-19, willingness to volunteer and reasons deterring them from working during the Covid-19 pandemic, and self-declared knowledge in six domains. RESULTS A total of 292 students participated in the study with a mean (SD) age of 19.9 (3.1) years. The mean (SD) knowledge score of Covid-19 was 6.9 (1.1) (maximum score 10). Knowledge score was significantly different among preclinical (6.5), paraclinical (7.18) and clinical groups (7.03). Almost three-fourth (75.3%) participants were willing to volunteer in the Covid-19 pandemic, though 67.8% had not received any training in emergency medicine or public health crisis management. Willingness to work was maximum in areas of social work and indirect patient care (62.3% each). Lack of personal protective equipment was cited as a highly deterring factor for volunteering (62.7%) followed by fear of transmitting the infection to family members (45.9%), fear of causing harm to the patient (34.2%) and the absence of available treatment (22.2%). CONCLUSIONS A majority of the students were willing to volunteer even though they had not received adequate training. Students may serve as an auxiliary force during the pandemic, especially in non-clinical settings.

Decoding mystery disease “litchi as idiopathic triggering cause of hypoglycemia-induced (LITCHI) encephalitic syndrome” – Are the evidence of association adequate?

There has been an increase in reports of outbreak of encephalopathy in children presenting with a syndrome of sudden onset of high fever and altered sensorium in and around the peak of Indian summer months in geographical regions that flourish in Litchi plantation. In the light of the increased mortality and morbidity due to the mystery disease and the speculations surrounding litchi consumptions, a study was conducted in the litchi production hub of Muzaffarpur district Bihar in India by the NCDC in technical collaboration with US CDC. The variables that were significantly associated were litchi consumption (OR: 9.6 [3.8-24.1]), visiting a fruit orchard (OR: 6 [2.7-13.4]), and absence of an evening meal (OR: 2.2 [1.2-4.3]) in the 24-h preceding illness onset. The recommendations that have been advocated are to avoid eating unripe litchi or its seed and always preferring fresh and ripe ones, children should not to go to sleep without a proper dinner meal during the litchi season and cases of altered sensorium should be always be checked for blood glucose levels and prompt correction should be done if levels suggest hypoglycemia in hospitals.

Estimating the burden of 'weighing less': A systematic review and meta-analysis of low birth-weight in India.

Background. The National Family Health Survey-3 (NFHS- 3; 2005–06) reports that the prevalence of low birth-weight babies is 22% in India. This old figure is probably an underestimate as this nationwide survey acquired information on birth-weight of only 34% of babies. We aimed to make a fresh estimate of the proportion of low birth-weight babies. Methods. A systematic search was done through PubMed, Google Scholar, Cochrane Library, Medline, IndMed, Embase, WHO and Biomed Central databases. Studies published from 2004 to 2014 were included. Study quality was assessed using the adapted Mirza and Jenkins checklist. An ‘adjustment’ of 24% was applied to the published estimates where data were collected through records or through a combination of records and anthropometry. The adjustment was done to account for the heaping of birth-weight data at 2500 g. Metaanalysis using both random and fixed effects model was done to derive an estimate. Results. Nineteen studies with 44 133 subjects were included in the review. The pooled estimate for the prevalence of low birth-weight was 27% (95% CI 24%–30%) and the ‘adjusted’ pooled prevalence was 31% (95% CI 28%–33%). The prevalence in urban and rural areas was 30% (95% CI 23%– 38%) and 26% (95% CI 22%–30%), respectively. Regionwise estimates revealed that the prevalence at 33% was comparatively higher in eastern regions (95% CI 29%–37%). Conclusion. The pooled prevalence of low birth-weight is higher than that reported by NFHS-3. Updated estimates should be used to guide future interventions and policies. Natl Med J India 2016;29:73–81

Prevalence of iodine deficiency among adult population residing in Rural Ballabgarh, district Faridabad, Haryana.

Community-based surveys are essential to monitor iodine deficiency disorders (IDD) program at both the state and national levels. There is paucity of information on population iodine nutrition status in Haryana state using standard methods. A cross-sectional study was conducted in villages of Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, Haryana, India. A total of 465 randomly selected individuals were assessed for urinary iodine concentration (UIC) by microplate method and household salt iodine content using iodometric titration. Of the interviewed households, 73% were using adequately iodized salt (≥15 ppm). Iodine nutrition was deficient in 17% respondents (UIC <100 μg/L); 20.2% among males and 13.9% among females. Iodine intake of the study population as measured by UIC was adequate but nearly one-fourth of households in the study population were consuming inadequately iodized salt. The availability and access to adequately iodized salt in the study population should be improved by strengthening regulatory monitoring.

Spot urine sample for estimating sodium intake of a population.

McLean R, Williams S, Mann J. (Department of Human Nutrition; Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago; Department of Preventive and Social Medicine; Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.) Monitoring population sodium intake using spot urine samples: Validation in a New Zealand population. J Hum Hypertens 2014;28:657–62.

A reliable and accurate portable device for rapid quantitative estimation of iodine content in different types of edible salt.

Background: Continuous monitoring of salt iodization to ensure the success of the Universal Salt Iodization (USI) program can be significantly strengthened by the use of a simple, safe, and rapid method of salt iodine estimation. This study assessed the validity of a new portable device, iCheck Iodine developed by the BioAnalyt GmbH to estimate the iodine content in salt. Materials and Methods: Validation of the device was conducted in the laboratory of the South Asia regional office of the International Council for Control of Iodine Deficiency Disorders (ICCIDD). The validity of the device was assessed using device specific indicators, comparison of iCheck Iodine device with the iodometric titration, and comparison between iodine estimation using 1 g and 10 g salt by iCheck Iodine using 116 salt samples procured from various small-, medium-, and large-scale salt processors across India. Results: The intra- and interassay imprecision for 10 parts per million (ppm), 30 ppm, and 50 ppm concentrations of iodized salt were 2.8%, 6.1%, and 3.1%, and 2.4%, 2.2%, and 2.1%, respectively. Interoperator imprecision was 6.2%, 6.3%, and 4.6% for the salt with iodine concentrations of 10 ppm, 30 ppm, and 50 ppm respectively. The correlation coefficient between measurements by the two methods was 0.934 and the correlation coefficient between measurements using 1 g of iodized salt and 10 g of iodized salt by the iCheck Iodine device was 0.983. Conclusions: The iCheck Iodine device is reliable and provides a valid method for the quantitative estimation of the iodine content of iodized salt fortified with potassium iodate in the field setting and in different types of salt.

Challenges in scaling up successful public health interventions: Lessons learnt from resistance to a nationwide roll-out of the weekly iron–folic acid supplementation programme for adolescents in India.

Anaemia, a major public health problem globally, affects an estimated 1.6 billion people.1 It has effects on the physical and mental health, as well as the productivity of people, particularly those in the vulnerable groups.2,3 The National Family Health Survey (NFHS)-3, 2005–06 estimated that 56% of women and 30% of men in India in the age group of 15–19 years were anaemic.4 Anaemia among people in the age group of 15–24 years was reported to be more common in the rural than urban areas, and among families belonging to the lower socioeconomic strata (Table I). Iron deficiency anaemia is one of the most prevalent micronutrient deficiencies globally and in India.5 About 60% of adolescents in the age group of 10–17 years have been reported to consume less than 50% of the recommended dietary allowance of iron, according to the 2012 National Nutrition Monitoring Bureau (NNMB) multistate survey.6 The low iron content of a typical Indian diet, along with the high prevalence of worm infestation, is the cause of the high prevalence of anaemia in India.7 The various strategies for the

Strengthening Production End Salt Iodization: Computerized Management Information System in Salt Department, India.

Objectives: This paper presents the implementation of computerized Management Information System (MIS) in Salt Department, the nodal agency in India for regulation and control of manufacturer, supply and distribution of iodized salt, to strengthen production end salt iodization. Methods: The MIS was launched in March 2012 with the joint action of Salt Department and the non-governmental development agencies GAIN, MI, UNICEF, and ICCIDD through the platform of National Coalition for Sustained Optimal Iodine Intake. Web based MIS was installed in all offices of the Salt Department with its data centre located in salt Department Headquarter in Jaipur. The Salt MIS has modules on distribution and supply of salt, salt quality management, salt testing laboratories, and other functionalities of Salt Department. In the second phase, trainings of personnel from Salt Department were conducted for mainstreaming the use of MIS. Results: 81% of the 203 identified personnel were trained in MIS. All 104 factory offices and 30 out of 91% of 33 laboratories started using MIS for monthly reports. Real time information is available on production figures, quality of iodized salt and movement of iodized salt. Linking information to decision making process facilitated regulatory actions in salt producing pockets. Conclusions: Successful implementation of MIS in the Salt Department through the coordinated efforts of partner agencies resulted in improved functioning of Salt Department. Effective monitoring of iodized salt production, movement and distribution resulted in strengthening of production end salt iodization and improved access to quality iodized salt to consumers.

Iodized Salt Coverage Study 2010: Household Consumption and Consumer Behavior about Iodized Salt in Rural Areas of Select States of India.

Objectives: This study assessed the household coverage with iodized salt and consumer behavior with regards to edible salt in rural areas of eight selected states of India. Methods: The study was conducted by ICCIDD in association with MI and the Salt Commissioner’s Office in 2010. Iodine content of household edible salt was measured and consumer behavior in terms of knowledge and perceptions regarding iodized salt and edible salt buying behavior was assessed in 9600 rural household in selected states. Results: 47.2% of the households were consuming adequately iodized salt; 47%, 35%, 45%, 59%, 50%, 42%, 35%, and 64% respectively in states of Andhra Pradesh, Karnataka, Madhya Pradesh, Orissa, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand. 58% of the respondents were aware about the iodized salt but only 13% of the respondents perceived ‘iodized salt’ to be an attribute of good quality salt. 54% of the households were using packaged crushed salt. Households with higher wealth index, awareness about iodized salt, using packaged crushed salt, and purchasing edible salt from general stores or Public Distribution System (PDS) were more likely to use adequately iodized salt. Conclusions: Despite an improvement of twenty percentage points from a previous survey in 2005-06, the coverage with adequately iodized salt in these states remains below the national average for rural areas. Increasing awareness and demand generation at the household level and introduction of good quality iodized salt in the Public Distribution System at affordable cost will help in improving the household coverage with adequately iodized salt in these states.

Academic Institutions Role in Ensuring Sustainability of IDD Control Program: A Case Study from India.

Objectives: This paper discusses the role of academic institutions in ensuring sustainability of Iodine Deficiency Disorders (IDD) control Programme. Methods: A case study of six decade long (1956-2013) contribution of All India Institute of Medical Sciences (AIIMS), New Delhi in IDD Control Programme in India is presented. Results: AIIMS, New Delhi, in association with other partners, launched seminal Kangra Valley Study in 1956 to assess the impact of iodized salt on IDD. Success of the study led to initiation of National Goitre Control Programme in 1962. Researchers from AIIMS provided evidence for extra- Himalayan existence of IDD, and impact of iodine on cognition leading to introduction of universal salt iodization in 1986 and subsequent renaming of programme as National Iodine Deficiency Disorders Control Programme (NIDDCP). In the year 2000,when ban on sale of non-iodized salt was lifted research and policy advocacy was carried out to to achieve re-imposition of ban on non-iodized salt. AIIMS took lead in bringing all agencies working on IDD on the same platform through formation of National Coalition in 2006, the Secretariat of which is located at AIIMS. AIIMS continues to influence policy through representation in expert committees and other government forum. Currently tenth generation of IDD researchers is active in research and policy advocacy on IDD in the country. Conclusions: The reason for success of academic institution in ensuring sustainability is continuity in efforts, presence of champion, a multi-disciplinary team, , mentorship, credibility, evidence based policy and programme research and a facilitating role in coalition building to achieve coordination.

Iodised Salt Consumption in Medical Colleges of India.

Objectives: To assess the knowledge regarding Iodine deficiency disorders and iodized salt among selected persons involved in providing cooked food to the doctors and students of the Medical colleges of India and to study the procurement and storage practices and iodine content of salt in kitchens of Hostels and Canteens of the Medical colleges of India Methods: Cross sectional study was conducted involving 24 medical colleges in 11 states. Knowledge assessment of 96 person responsible for purchase of salt in hostel/canteen kitchen and 97 supervisors were conducted. Salt samples from 135 hostel/canteen kitchen were tested for iodine content using titration. Results: Among the participants responsible for purchase of salt in the canteen, 80.2% have heard about iodine and 82.3% think that iodine is necessary for better health. Eighty five percent of the purchasing personnel think that it was necessary to take iodized salt. Out of the total, 85% of purchase in charge and 93% of supervisors said that they purchase only iodized salt for the hostel/canteen kitchen. Only 31.9% of the salt samples were stored in air tight containers. Eighty one percent of salt samples received were adequately iodized. Conclusions: The knowledge regarding the Iodine Deficiency Disorder and iodized salt was found to be adequate in the study and has resulted in emphasis on purchase of Iodized salt. But the existence of inadequately iodized salt in the samples collected shows the need for strict monitoring and enforcement of Prevention of Food Adulteration act.

Accelerating Progress to Universal Salt Iodization in India Achievements, Challenges, and Future Actions.

Objectives: India was one of the first countries to introduce salt iodization. This presentation reviews the national efforts towards universal salt iodization (USI) in India, documents achievements and progress, and highlights key challenges in programme implementation. Methods: The Salt Department of the Government of India and its development partners have made concerted efforts to improve availability, access and use of adequately iodized salt. Results: National and state level advocacy meetings were carried out to ensure high political commitment and prioritization of the USI programme. The National Coalition for Sustained Iodine Intake was launched to improve the overall programme management and coordination. The technical capacity of salt producers was enhanced and salt wholesalers and retailers were mapped, sensitized and equipped with tools and skills to procure only adequately iodized salt. A state-of-the-art management information system was launched to improve the efficiency in monitoring the flow of iodized salt. In addition, awareness and communication activities were scaled up to generate demand for iodized salt. As a result, the national household coverage of adequately iodized salt increased from 51% in 2005 to 71% in 2009. However, data indicate a clear urban-rural and rich-poor differential, leaving some of the most disadvantaged populations vulnerable to iodine deficiency. Conclusions: An evidence-based, well-defined strategy will be necessary to reach the last 30% of households, which are are likely to be least accessible and most socio-economically vulnerable. Both national and state level policies should mainstream the use of adequately iodized salt in feeding programmes for the benefit of all.

Prevalence of Household-level Food Insecurity and Its Determinants in an Urban Resettlement Colony in North India.

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world’s largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean familysize being 5.5 (SD±2.5) and the mean monthly household income being INR 9,784 (SD±631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p≤0.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p≤0.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem.

Iodine deficiency disorders (IDD) control in India.

Iodine deficiency disorders (IDD) constitute the single largest cause of preventable brain damage worldwide. Majority of consequences of IDD are invisible and irreversible but at the same time these are preventable. In India, the entire population is prone to IDD due to deficiency of iodine in the soil of the subcontinent and consequently the food derived from it. To combat the risk of IDD, salt is fortified with iodine. However, an estimated 350 million people do not consume adequately iodized salt and, therefore, are at risk for IDD. Of the 325 districts surveyed in India so far, 263 are IDD-endemic. The current household level iodized salt coverage in India is 91 per cent with 71 per cent households consuming adequately iodized salt. The IDD control goal in India was to reduce the prevalence of IDD below 10 per cent in the entire country by 2012. What is required is a “mission approach” with greater coordination amongst all stakeholders of IDD control efforts in India. Mainstreaming of IDD control in policy making, devising State specific action plans to control IDD, strict implementation of Food Safety and Standards (FSS) Act, 2006, addressing inequities in iodized salt coverage (rural-urban, socio-economic), providing iodized salt in Public Distribution System, strengthening monitoring and evaluation of IDD programme and ensuring sustainability of IDD control activities are essential to achieve sustainable elimination of IDD in India.

Causes of death in rural adult population of North India (2002-2007), using verbal autopsy tool.

Background: With the on-going epidemiological transition, information on the pattern of mortality is important for health planning. Verbal autopsy (VA) is an established tool to ascertain the cause of death in areas where routine registration systems are incomplete or inaccurate. We estimated cause-specific mortality rates in rural adult population of 28 villages of Ballabgarh in North India using VA. Materials and Methods: During 2002-2007, trained multi-purpose health workers conducted 2294 VA interviews and underlying cause of death was coded by physicians. Proportional mortality (%) was calculated by dividing the number of deaths attributed to a specific cause by the total number of deaths for which a VA was carried out. Findings: 61% of deaths occurred among males and 59% occurred among those aged ≥60 years. The leading causes of death were diseases of the respiratory system (18.7%) and the circulatory system (18.1%). Infectious causes and injuries and other external causes, each accounted for around 15% of total deaths followed by neoplasms (6.8%) and diseases of the digestive system (4%). Among those 45 years of age, more than half of deaths were attributed to non-communicable diseases (NCDs) alone. Accidents and injuries were responsible for one-fourth of deaths in 15-30 years age group. Conclusion: NCDs and injuries are emerging as major causes of death in this region thereby posing newer challenges to public health system.

Epidemiology to public health intervention for preventing cardiovascular diseases: The role of translational research.

Despite significant progress in medical research, cardiovascular diseases (CVDs) continue to be the largest contributors of morbidity and mortality both in developed and developing countries. The status of public health interventions related to CVDs prevention was reviewed to identify actions that are required to bridge the existing gap between the evidence and the policy. We used a framework comprising two steps - “bench to bedside” and from “bedside to community” to evaluate translational research. Available literature was reviewed to document the current status of CVD prevention and control at national level in India. Case studies of risk factor surveillance, tobacco control and blood pressure measurement were used to understand different aspects of translational research. National level initiatives in non-communicable diseases surveillance, prevention and control are a recent phenomena in India. The delay in translation of research to policy has occurred primarily at the second level, i.e., from ‘bedside to community’. The possible reasons for this were: inappropriate perception of the problem by policy makers and programme managers, lack of global public health guidelines and tools, and inadequate nationally relevant research related to operationalization and cost of public health interventions. Public health fraternity, both nationally and internationally, needs to establish institutional mechanisms to strengthen human resource capacity to initiate and monitor the process of translational research in India. Larger public interest demands that focus should shift to overcoming the barriers at community level translation. Only this will ensure that the extraordinary scientific advances of this century are rapidly translated for the benefit of more than one billion Indians.

Prevalence of knee osteoarthritis amongst perimenopausal women in urban resettlement colony in South Delhi.

A community-based cross-sectional study was carried out in an urban resettlement colony in South Delhi to study the prevalence of knee osteoarthritis in women aged ≥40 years and treatment seeking behavior of women suffering from osteoarthritis. Osteoarthritis was diagnosed by using clinical criteria given by American College of Rheumatology for diagnosis of Idiopathic Osteoarthritis of knee joints. A total 260 women were interviewed out of which 123 (47.3%) women were found to be suffering from knee osteoarthritis. Prevalence of osteoarthritis found to be increased with age. Less than half of those with osteoarthritis underwent treatment. With this high prevalence of osteoarthritis, there is need to spread awareness about the disease, its prevention, and rehabilitation in the community

A review of tracking progress towards elimination of Iodine deficiency disorders in Tamil Nadu, India.

Background : Iodine deficiency disorders (IDD) are significant health problem in India. But there is dearth of regional/state level information for the same. Objective: This study was designed to study the current status of IDD in Tamil Nadu. Materials and Methods: A cross-sectional community-based survey was conducted in the state of Tamil Nadu. The study population was children in the age group of 6-12 years and the probability proportional to size 30 cluster methodology was used for sample selection. The parameters studied were prevalence of goiter, urinary iodine excretion, and iodine content in salt at the household level. Results: A total of 1230 children aged between 6 and 12 years were studied. The total goiter rate was 13.5% (95% CI: 11.1-14.9). The median urinary iodine excretion was found to be 89.5 μg/L (range, 10.2-378 μg/L). The 56% of the urinary iodine excretion values were <100 μg/L. The proportion of households consuming adequately iodized salt (iodine content ≥ 15 parts per million) was 18.2% (95% CI: 16.1-20.5). Conclusion: The total goiter rate of 13.5% and median urinary iodine excretion of 89.5 μg/L is indicative of iodine deficiency in Tamil Nadu.