Acceptability and effect of ShishuPoshan mHealth application on knowledge, attitudes and practice of breastfeeding among primi mothers availing postnatal care at a rural tertiary hospital.

Introduction: ShishuPoshan is a free Android application for mothers that provides scientific guidance on breastfeeding and baby care issues in the local language. We aimed to assess its effect and acceptability in primi mothers in a rural area of Maharashtra, India. Material and Methods: A before and after study was conducted in 50 primi mothers to study the acceptability and effect of ShishuPoshan mHealth application on knowledge, attitude and practice about breastfeeding in primi mothers in a rural tertiary care hospital. Results: Most participants (84%) downloaded the application, and 60% used it regularly. Major reason for not using the app was discomfort with mobile phone (7%) and not having anyone to read the content in the house (7%). The application was easy to use by 48%, and 10% did not find time to use it. Enablers were regional language, easy-to-understand content, simple interface, and frequently asked question (FAQ) format to give information. Barriers to adoption were that women preferred tips from family members, were uncomfortable with mobile phones, and did not have anyone to help them use them. Conclusion: It successfully delivered key messages like exclusive breastfeeding, colostrum use, proper maternal nutrition, and demand to feed, but it needs to further emphasise early initiation of feeding. Incorporation of feedback like adding videos, myth busters, and making app more interactive may further improve its effectiveness. mHealth interventions like ShishuPoshan are promising modalities for the dissemination of appropriate information.

Incidence, predictors, and outcome for post-operative atrial fibrillation in Indian patients undergoing off-pump coronary artery bypass grafting-a prospective observational study.

Purpose: Indian patients who undergo surgical revascularization are relatively younger than their Western counterparts and are predominantly revascularized using off-pump coronary artery bypass grafting (OPCAB) technique. They may therefore be at a reduced risk of developing post-operative atrial fibrillation (POAF). The aim of this study was to assess the incidence of POAF, measure its impact on outcomes, and identify the predictors for POAF in the Indian patients undergoing OPCAB. Besides, the ability of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons (STS) scores in predicting POAF was also assessed. Methods: In this prospective observational study, all patients undergoing isolated OPCAB in a single institution over a 12-month period were included. Patients undergoing re-operative surgery, emergency procedure, concomitant surgery, or those with history of previously diagnosed or treated atrial fibrillation were excluded. Logistic regression was performed to identify the predictors of POAF. The receiver operating characteristic (ROC) curve was used to determine the ability of EuroSCORE and STS scores to assess risk of developing POAF. Results: We recruited 1108 patients in the study of which 88 (7.94%) patients developed POAF. Age (OR = 1.082, p < 0.001, 95%CI: 1.050-1.114), unstable angina (OR = 16.32, p = 0.036, 95%CI: 1.2-221.4), presence of diabetes mellitus (OR 1.781, p = 0.025, 95%CI: 1.074-2.955), left atrial size (OR 2.506, p = 0.001, 95%CI: 1.478-4.251), and presence of chronic renal failure (OR 8.7, p = 0.001, 95%CI: 2.4-31.53) were significant predictors of POAF. Both the EuroSCORE (p = 0.035) and the STS score (p = 0.001) were significantly higher in patients developing POAF. The area under the ROC curve for the EuroSCORE II was 0.62 and for the STS score was 0.64 suggesting satisfactory and similar discriminatory power of both the scores to predict POAF in these patients. POAF was associated with significantly increased adverse outcomes like stroke and prolonged hospital stay. Conclusions: In our study, the incidence of POAF was much lower (7.94%) than that reported previously. POAF significantly increased adverse outcomes and length of hospital stay. Both EuroSCORE II and STS scores had similar discriminating power in predicting POAF.

Need-based training of community health officers for tuberculosis care in Ahmednagar district of Maharashtra, India: A before and after study.

BACKGROUND: Community health officers (CHOs) are a newly introduced cadre of mid-level health-care providers who will man the health and wellness centers under Ayushman Bharat Mission in India. Need-based training will help them fulfil their role in early diagnosis, treatment, and referral of tuberculosis (TB) patients. The present study identified the gaps in the awareness about TB in a heterogeneous group of trainees and addressed them through need-based training. MATERIALS AND METHODS: A before and after the study was carried out in 110 trainee CHOs at Rural Medical College, Loni. In-depth interviews were conducted with public health experts and focus group discussion was conducted with trainees to gain the quality inputs. Structured questionnaires based on training objectives specifically pertaining to TB were designed. Training was provided with an emphasis on addressing the gaps identified in the pretest. Posttest evaluation was done at the end of the training to assess its effectiveness. Data were analyzed using the SPSS software version. 17.0 (Inc., Chicago, IL, USA). RESULTS: The mean pretest score was 15.15 (standard deviation [SD] = 3.55) which improved after 6 months training to 24.01 (SD = 1.223), i.e., from 60% to 96%. There was highly significant improvement in overall knowledge score of trainees (t = 28.124, df = 109, P < 0.001). There was a statistically significant improvement in scores of all topics at the end of 6 months training in both Nursing and Ayurved graduates. Except for knowledge regarding the treatment of multidrug-resistant TB (P = 0.004), knowledge about all other topics was comparable in nursing and Ayurved graduates at the end. CONCLUSIONS: Needs assessment proved effective in identifying the gaps in knowledge and skills of interdisciplinary trainee CHOs. Medical colleges with expertise in teaching, training, and health service provision can work with the public health system to provide a model for rapid upgrading and capacity building to meet health-care challenges such as TB.

Assessment of community-based education in community health officers' training at a Rural Medical College in Northern Ahmednagar District of Maharashtra, India: A longitudinal study.

We evaluated the Community Health Officer (CHO) training program in northern Ahmednagar district of Maharashtra, India. A longitudinal study was conducted among 110 CHO trainees from August 2019 to January 2020. The trainees undertook field visits and survey with lectures and clinical postings. Evaluation was based on pre- and post-Multiple Choice Question tests, the WHO Education of Health Personnel Checklist, Journals, and Logbooks. MannWhitney U-test, Wilcoxon-rank test were used to compare nonnormal variables while t-test was used for comparison of age. Initially, nursing graduates performed better than Ayurveda graduates, especially in punctuality, grasp on problems, and problem-solving ability. Nursing graduates kept better journals and logbooks. Female trainees performed better than male trainees. Ayurveda and nursing graduates were comparable at the end of the training. Need-based training and upskilling of mid-level healthcare providers can be done at scale by roping in medical colleges.

Is the medical teacher's mental health neglected? Effects of perceived student attitudes and behaviors on mental health and lifestyle of teachers in a rural university of western Maharashtra in India.

BACKGROUND: A medical teacher is a practitioner, teacher, trainer, and researcher all at once. There are very few studies assessing stress among medical teachers. With landmark policy changes, disruption and ongoing pandemic, looking at the mental health of medical teachers assumes greater importance. METHODS: A cross-sectional study was carried out in the teaching faculty of medical, dental, nursing, and physiotherapy colleges affiliated within a rural medical university in western Maharashtra. A convenience sample of 100 teachers was taken and a self-report questionnaire was used to collect data from the teachers. Stress was measured by the Perceived Stress Scale. RESULTS: Low stress scores (0-13) were seen in 43% of teachers, 55% had moderate stress scores (14-26), and 2% had high stress scores (27-40). Teaching was reported as a stressor by only 8%, whereas administrative work, lifestyle, family responsibilities, finances, patient care, professional jealousy, competition, and frequently changing norms were more commonly reported stressors. The overt focus on entrance test preparation, over-reliance on mobile phones, short attention span, poor listening skills, lack of interpersonal skills, lack of initiative to acquire clinical skills, lack of punctuality, and transactional nature toward learning were some of the perceived faults in the attitude of medical students as reported by the teachers. CONCLUSION: Teachers are coping with changing trends in technology and attitude of students toward learning and shoulder a multitude of responsibilities while creating doctors and healthcare professionals of the future. Attention needs to be paid to their health.