Stigma among healthcare workers towards hepatitis B infection in Bangalore, India: a qualitative study.

BACKGROUND: With about 50 million people infected with hepatitis B (HBV) in India the burden of disease is high. Stigma has been identified to have a major negative impact on screening, diagnosis and treatment of hepatitis B patients. The aim of this study was to assess the stigma in nurses and physicians in Bangalore, India; studies on stigma in HBV have only been published outside of India. METHODS: Semi-structured in-depth-interviews were conducted in the period of March 20th and April 16th 2018 to study stigma and other problems in the care of hepatitis B patients. Stigma was pragmatically defined as a mark of disgrace associated with having a hepatitis B infection. Thirty physicians and nurses in different clinics and hospitals across the city of Bangalore were selected by purposeful sampling and snowball effect until theoretical saturation was reached. RESULTS: The following themes were identified during the interviews: feelings when treating a patient; pregnancy and marriage; confidentiality; morality; improvement in care and the difference with HIV. The most stigma was discovered in the theme morality. The majority of our participants mentioned lack of awareness as biggest obstacle in health care of hepatitis B patients. CONCLUSIONS: This is the first qualitative study in India exploring hepatitis B stigma among health care workers. Stigma was found in certain themes, such as morality. Though, no unwillingness to treat was found. There was a general lack of awareness amongst patients according to our participants and could jeopardize proper treatment. These results will further help in developing strategies to tackle hepatitis B in India.

Community-based nutrition education for improving infant growth in rural Karnataka.

OBJECTIVE: To evaluate a nutrition education intervention designed to improve infant growth and feeding practices. DESIGN: An intervention study using monthly nutrition education delivered by locally trained counsellors targeted at caregivers of infants aged 5-11 months. Comparison of outcomes for 2 groups--one non-intervention group of infants enrolled in 1997 that did not receive the intervention in the first year of life, and an intervention group of infants enrolled 1998-1999 that received the nutrition education. SETTING: 11 randomly selected and 2 purposively selected villages of south Karnataka. SUBJECTS: 138 Infants (n = 69 intervention) aged 5-11 months. METHODS: Families were administered a monthly questionnaire on feeding and child care behavior, and study infants were weighed at this time, using the SECA solar scales, developed for UNICEF. Logistic regression was used to examine differences between intervention and non-intervention infants in infant feeding behavior outcomes. RESULTS: Statistically significant improvement was found in weight velocity for female infants in the intervention group. These infants were also more likely to exhibit at least four positive feeding behaviors--intervention infants had a higher mean daily feeding frequency (more likely to be fed solids at least four times a day (OR = 4.35, 95% CI = 1.96, 10.00), higher dietary diversity (more likely to receive a more diverse diet OR = 3.23, 95% CI = 1.28, 7.69), and were more likely to be fed foods suggested by the counsellors such as bananas (OR = 10.00, 95% = 2.78, 33.3) compared to non-intervention infants. CONCLUSION: Nutrition education and counselling was significantly associated with increased weight velocity among girls and improved feeding behavior among both boys and girls. These results provide further evidence that community-based nutrition programs that emphasise appropriate feeding and care behavior can be used to prevent and address early childhood malnutrition in poor households.