ABSTRACT
Background The Integrated Child Development Services (ICDS), a flagship program of the Government of India, is addressing the malnutrition, health, and development needs of young children, pregnant and lactating women, and adolescent girls for more than four decades. Although the program has been implemented for the past four decades, it could not bring the expected outcomes in terms of reducing malnutrition. The program's limited success can be attributed, among others, to insufficient skills of the program staff and inadequate convergence with the existing nutrition programs implemented through the health department. For the success of any program, advanced knowledge, improved skills, motivation, and the right attitude of the program staff are essential and can be instilled through the need-based training of the staff. The present study aimed at identifying gaps in existing training for health and ICDS program staff in the district and developing a capacity-building strategy to strengthen the implementation of the nutrition program in the district, including "Project Tushti," which aimed at combating malnutrition in Devbhumi Dwarka district of the Gujarat state. Methods The training needs assessment (TNA) was conducted using a descriptive cross-sectional study design. TNA is a method to determine program gaps and training required to fill in programmatic gaps. Appropriate use of TNA can promote designing effective training and nurture program staff productivity, thereby ensuring efficient use of resources for achieving desired program outcomes within the prescribed timeline. Considering the coronavirus disease 2019 (COVID-19)-led lockdown, convenient sampling was used to reach out to potential study participants. A total of 150 program staff from both health departments (particularly medical officers, taluka health officer, National Adolescent Health Program - Rashtriya Bal Swasthya Karyakram (RBSK) medical officer, community health officer from health and wellness center, female health workers, and Accredited Social Health Activists (ASHAs)) and ICDS team (chief district program officer, supervisor, Anganwadi workers, and helpers at Anganwadi center) were interviewed telephonically using a semi-structured interview guide. Interviews were conducted between May 10 and 16, 2020. Results Results reveal that about 49% of the health team and ICDS staff had not received nutrition-specific training in the last year. In terms of coverage, the training coverage was partial, and training content on nutrition was limited. Training contents were divided based on supervisory and implementing cadre feedback. Participants expressed the need for in-depth nutritional refresher training, including topics such as community-based management of acute malnutrition, identification of malnutrition, use of ICDS common application software, and soft skills such as communication skills and supportive supervision. Although 62% of participants preferred the face-to-face medium of training, they agreed with the online mode of training. Conclusion Findings indicate an urgent need for training, particularly in the district's nutrition domain for the staff involved in the implementation, and soft skills for supervisory level staff. Innovative training approaches using the digital platform can be explored for training delivery. The paper discusses innovative capacity-building strategies to address training needs effectively.
ABSTRACT
Protecting vulnerable populations from the COVID-19 pandemic is a strategic imperative, especially when considering the potential vulnerability it has on a wide range of marginalized communities. Transgender women and hijra individuals who struggle to cope financially, mentally, or physically are vulnerable groups that require attention during the COVD-19 pandemic. Using a qualitative descriptive research design, 12 transgender women and hijra persons participated in semi-structured telephone interviews during India's lockdown phases (1.0 and 2.0) of the COVID-19 pandemic. A snowball sampling technique was used to recruit study participants. Authors identified five themes: knowledge and practice; psychological domain; health conditions; individual and community experiences; and support. Findings offer broad insights into bolstering health concerns and access to healthcare services from public health and human rights perspective. An access to adequate healthcare services is a fundamental human right. The COVID-19 pandemic response without a human rights framework will have a major impact on the progress of the Sustainable Development Goals. Future studies of this population will illuminate unique considerations for healthcare workers while providing care to this neglected group.
ABSTRACT
Severe acute respiratory syndrome coronavirus - SARS CoV 2 (COVID 19) has posed a dire threat, not only to physical health but also to mental health, impacting our overall lifestyles. In addition to these threats, there have been unique challenges for different subsets of the population. Likewise, college students including research scholars are facing a variety of challenges in response to the COVID-19 outbreak. The scoping review maps existing literature on the mental health of college students in the times of COVID-19, approaches adopted by universities and academic institutions to help students cope with challenges posed by COVID-19 and draws lessons learnt and potential opportunities for integrating mental health promotion as part of routine services, particularly in low-and-middle-income countries context such as India. Four electronic databases (PubMed, PsycINFO, Scopus and Google Scholar) were searched following Arksey and O'Malley's scoping review process. Out of the total 1038 screened records, thirty-six studies were included in the review. Data characteristics such as the type of document, intervention and outcome were extracted. Data were synthesized using thematic content analysis. The fact that the COVID-19 pandemic has impacted the mental health of students, accentuates the urgent need to understand these concerns to inform the action and public mental health interventions that can better support college students to cope with the crisis.
ABSTRACT
Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-lead portable ECG devices across all primary health centers (PHC) in the district to screen cardiac abnormalities among high-risk and symptomatic adults for providing primary management and proper timely referral. The prime purpose of the study was to assess the cost-effectiveness of portable ECG for the screening of cardiovascular diseases (CVD) among high-risk and symptomatic adults at the PHC in Ahmedabad, Gujarat. Methods: Cost-effective analysis was conducted using a societal perspective. An incremental costing approach was adapted, and cost-effectiveness analysis was done using a decision-analytic model. We surveyed 73 patients who screened positive for cardiac abnormality, documented the type of ECG abnormalities, and diagnosed CVD. The program cost was obtained from the implementers. Transition probabilities were derived from primary data supported by expert opinion for the intervention arm, while a systematic search of the literature was undertaken to derive transition probabilities for the control arm. Results: The ECG screening at PHC saves 2.90 life years at an incremental cost of 89.97 USD (6657.47 INR), yielding a cost-effectiveness ratio of 31.07 USD (2,299.06 INR) per life-year saved, which is below the willingness to pay threshold. The budget impact analysis was also performed. Results are sensitive to the relative risk reduction associated with the non-participation and the cost of initial screening. Conclusion: Cost-effectiveness analysis clearly shows that the facility to screen cardiac abnormality at the PHC level is highly recommended for high-risk adults and symptomatic cases.