Burden of Long COVID-19 in a Cohort of Recovered COVID-19 Patients in Delhi, India.

BACKGROUND: The long COVID phase is characterized by signs and symptoms persisting for at least three months after recovery from acute COVID-19 illness. There is limited data on comprehensive long-term clinical follow-up of COVID-19 patients. AIMS: This study aims to explore the burden and symptomatology of long COVID syndrome and its association with various health parameters. SETTINGS AND DESIGN: This prospective observational study was conducted in Delhi from May 2022 to March 2023. METHODS AND MATERIAL: A total of 553 adult patients who had recovered from COVID-19 were enrolled in the study. A sociodemographic and clinical profile was obtained using validated questionnaires, along with an evaluation of biochemical parameters to assess the associated factors. STATISTICAL ANALYSIS USED: Chi-square test, unpaired t-test, and bivariate regression analysis were applied using Statistical Product and Service Solutions (SPSS, version 28; IBM SPSS Statistics for Windows, Armonk, NY). A p value of <0.05 was considered significant. RESULTS: A total of 252 patients (45.6%) had long COVID syndrome, which was significantly associated with the presence of any pre-existing comorbidity (OR=1.46 (1.02-2.09); p=0.039), previous history of hypertension (OR=1.82 (1.07-3.09); p=0.027), and vaccination against COVID-19 (OR=1.392 (1.171-1.656); p=0.003). The most common symptoms reported were persistent fatigue (33.3%) and persistent dry cough (28.5%). Patients with long COVID syndrome are also reported to have poorer sleep quality. Biochemical findings showed abnormal T lymphocytes (9.3%) and raised HbA1c (11.9%). CONCLUSIONS: Multiple risk factors and symptoms associated with long COVID syndrome were identified in this study. Research efforts and knowledge regarding the pattern of illness will aid in long-term monitoring and development of interventional strategies and guidelines for the care of recovered COVID-19 patients.

COVID-19 Vaccine Acceptance and Its Determinants in the General Population of Delhi, India: A State Level Cross-Sectional Survey.

OBJECTIVE: To ascertain the COVID-19 vaccination acceptance and the factors contributing to vaccine hesitancy and vaccine confidence in the adult population, and the intention for vaccination of their children. METHODS: This cross-sectional analysis reports the ancillary results of a population-based SARS-CoV-2 serosurvey conducted in Delhi, India, from September 24 to October 14, 2021. Data were collected from 20312 adult participants through a multistage sampling method from all the 274 wards in the 11 districts of the national capital territory region. RESULTS:  We enrolled 12093 (59.3%) females and 8219 (40.5%) male participants with mean (SD) age of 40.3 (14.6) years. The vaccine acceptance rate in the participants was 67.7% (95% CI 67.1, 68.4), with 6031 (43.8%) having received one dose and 7727 (56.2%) having received two vaccine doses. On adjusted analysis, lack of vaccine acceptance was independently associated with female gender aOR 1.15 (95% CI 1.1, 1.23), younger age-group (18-49 years) aOR 1.85 (95% CI 1.71, 2.0), low educational status aOR 1.88 (95% CI 1.77, 2.0), in those with no history of COVID-19 aOR 1.81 (95% CI 1.69, 1.95), non-healthcare workers aOR 2.1 (95% CI 1.7, 2.53), and in the absence of hypertension comorbidity aOR 1.22 (1.1, 1.38). Lack of awareness of COVID-19 vaccines, including doubts on vaccine efficacy and long-term safety, were primary drivers of vaccine hesitancy in the unvaccinated subgroup. Only 35.6% participants reported a positive intention to vaccinate their children. CONCLUSIONS: One in three adults lacked vaccine acceptance. High prevalence of delay in second dose vaccination was also observed.

Calorie- and Protein-Deficient Diets Despite Adequate Dietary Diversity among Pregnant Women in a Low-Income Urban Area in Delhi, India.

We interviewed 221 antenatal women in the second or third trimester of pregnancy attending a primary care antenatal clinic at a low-income area in Delhi, India, during 2019-20. The Minimum Dietary Diversity-Women (MDD-W) score for 10 food groups was calculated using the open recall method during a 24-h recall period. The median MDD-W score was 6 (IQR 4-7). Low dietary diversity (MDD-W <5) was observed in 65 (29.4%) participants. Low SES and higher age (≥25 years) were statistically significant predictors of lower dietary diversity, but it was unrelated to parity. Furthermore, protein deficit was observed in 185 (83.7%) and calorie deficit in 210 (95%) participants.

Utilization of Nutritional Supplementation Services and Their Predictors in Pregnant and Lactating Women Living in an Urban Resettlement Colony of Delhi, India: A Cross-Sectional Study.

Introduction Maternal undernutrition during pregnancy and lactating has adverse health consequences for the mother and her child. The Integrated Child Development Services (ICDS) scheme by the Government of India provides supplementary nutrition services to all pregnant and lactating women but its utilization is suboptimal due to inefficient distribution through the health system and beneficiary concerns regarding its usefulness. This study was conducted with the objective of assessing the utilization of nutrition-related ICDS services by pregnant and lactating women in urban poor settlements of Delhi and the sociodemographic factors associated with non-utilization. Materials and methods This was a community-based cross-sectional survey in an urban resettlement colony and slum area located in the northeast district of Delhi. The data collection was conducted from January to May 2022. Eligible participants included pregnant women in their second or third trimester of pregnancy and lactating mothers in their first six months of the postpartum period who were residents of the study setting. Data were collected using face-to-face interviews using a pre-tested and self-designed questionnaire. The primary outcome was the proportion of women utilizing ICDS take-home rations (THR) in the previous month. Results A total of 365 participants were recruited in this study including 208 pregnant and 157 lactating women having a median (IQR) age of 25 (22-28) years. A total of 211 (57.8%) participants reported a history of utilization of ICDS supplementary nutrition services during their current pregnancy or postpartum with 154 (42.2%) having received THR in the previous month. Among the currently pregnant women, 84 (40.4%) had utilized ICDS THR while in the currently lactating women, 70 (44.6%) had utilized THR in the previous month. On adjusted analysis, multigravid women were less likely to have utilized ICDS compared to primigravida women. Reasons for non-utilization of the ICDS supplementary nutrition services by the mothers were temporary disruption due to cessation of ICDS services by protesting Anganwadi workers (over demand for increased honorarium), difficult access to Anganwadi center, the poor perceived taste of the food provided as THR, and perception by the mothers that they did not require THR. Most women reported sharing the THR with their family members. All pregnant and lactating women were found to be calorie and protein deficient in this study when applying the recommended intake values. No association was observed between the utilization of ICDS in the previous month and the presence of calorie deficiency in both pregnant (p=0.35) and lactating (p=0.24) women. Conclusions More than four in ten eligible pregnant and lactating women in an urban resettlement colony in Delhi did not utilize ICDS supplementary nutrition services with similar rates of utilization in both pregnant and lactating women. Women living in joint families and consequently larger households were less likely to utilize ICDS services. A majority of pregnant and lactating women were calorie and protein deficient even on applying non-pregnant cut-off requirements. The ICDS scheme needs to strengthen information, education, and communication (IEC) strategies and interventions to improve its acceptability and utilization by this vulnerable population.

Utilization of antenatal care services and its sociodemographic correlates in urban and rural areas in Delhi, India.

INTRODUCTION: Timely and quality antenatal care (ANC) is an essential element of universal health coverage and a key determinant for the prevention of maternal mortality. Nevertheless, evidence from large-scale health surveys in developing countries highlight a lack of access and utilization of antenatal care especially among socioeconomically disadvantaged populations. METHODS: A total of 200 women were recruited from urban and rural primary care service provision areas of a government medical college in Delhi during April 2016-2017. Women with infants were interviewed to assess the antenatal care received by them during their recently concluded pregnancy. RESULTS: The mean (SD) age of the participants was 25.6 (3.9) years. A total of 63 (31.5%) participants were primigravida, and 137 (68.5%) were multigravida. The knowledge of ANC was significantly higher in the participants that were more educated (p<0.001) but it was similar in both the urban and rural sites. Only 107 (53%) participants reported receiving comprehensive antenatal care defined as early registration of pregnancy (within 12 weeks), at least four ANC visits, two doses of tetanus toxoid, and at least 100 days of iron/folic acid supplementation (IFAS). The participants lacking knowledge of ANC had three times higher odds of suboptimal ANC utilization during their previous pregnancy (p=0.018). Furthermore, the ANC content was adequate in terms of medical service provision but deficient in terms of educational and counseling services. CONCLUSIONS: A high prevalence of suboptimal ANC utilization was observed despite the availability of government-funded primary care.

Awareness About Anti-Smoking Related Laws and Legislation Among General Population in Slums of Delhi, India.

Introduction: Almost 40% of Delhi's population lives in slums and is vulnerable to tobacco use. It is therefore important to assess their opinion and ensure compliance to antismoking legislation. The present study was undertaken to assess the awareness of the general public residing in slums in Delhi regarding the smoke-free initiative of 2009, 3 years after intensive implementation. Methods: It was a cross-sectional study conducted among participants selected by cluster sampling from the slums in six districts of Delhi using a pretested semistructured questionnaire. A total of 708 slum dwellers were interviewed. Results: Out of the total, only 16.1% (n = 114) of the participants had heard of The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA), though, they were aware about some of the provisions of the COTPA. Majority (n = 529; 74.7%) perceived the smoke-free zones as the places where smoking forms of tobacco are banned. Regarding the awareness about the places designated as smoke-free zones, 82.1% (n = 581) of the respondents named educational institutions. About 61% of the people interviewed reported to have seen people smoking at public places on the day of interview while only 21.5% reported to have seen any one getting punished for smoking. Conclusions: Awareness about COTPA was low. The study respondents perceived that no action was being taken against persons acting in violation of the law. Thus, there is a need for stricter implementation of COTPA and increased spreading of awareness among the general public. Implications: While awareness about antismoking legislation among general population (particularly slums) has been studied world over, this has not been the case in India. The study depicts opinion of one of the susceptible populations regarding tobacco control legislation, which has hitherto not been studied in the Indian context. This study has an important implication as it highlights the need for stringent enforcement of antismoking legislation for tobacco control.

Recurrent floods and prevalence of diarrhea among under five children: observations from Bahraich district, Uttar Pradesh, India.

BACKGROUND: Diarrhea is an important problem among the under-five children in India. OBJECTIVE: The paper examines long-term impacts of recurrent floods on diarrhea among under-five children in Uttar Pradesh, India. DESIGN: A two stage stratified cluster survey was conducted in flood affected (exposed) and non-flood affected areas (unexposed). RESULTS: The long-term impact of the floods was not clearly marked in the overall prevalence of diarrhea with the exposed group having prevalence of 55.1% as against 56.2% in the unexposed group of children under five. Economic condition of the household is associated with the prevalence of diarrhea in both exposed and unexposed strata. Anemia was found to be a significant risk factor for diarrhea among children in both the flood exposed and non-flood exposed populations. The recurrent floods did not have any significant effect on the prevalence of diarrhea in relation to gender, religion, caste, and household size. CONCLUSIONS: The study indicates that the long-term impacts of floods are very differently manifested than the immediate impacts.

Prevalence of bacterial vaginosis in a community setting and role of the pap smear in its detection.

OBJECTIVE: To study the revalence of bacterial vaginosis (BV) in symptomatic and asymptomatic women in a community setting, to assess the validiy of the Pap smear in the detection of BV and to determine the sensitivity and specificity of clinical criteria for the diagnosis of BV. STUDY DESIGN: Gram staining was performed on vaginal secretions collected from 301 women to determine the prevalence of BV. Each smear was assigned a score on the basis of the bacterial morphotypes identified. The bacterial pattern was also studied on 270 adequate, Pap-stained cervical smears and compared with the gold standard, the morphotypes on gram stain, to derive the validity of the Pap smear in diagnosing BV. Also each clinical criterion defined for diagnosis of BV was independently evaluated to determine their sensitivity and specificity. RESULTS: The overall prevalence of BV was 41.5% in the study subjects using Amsel's and Nugent's criteria. The Pap smear was 78.3% sensitive and 86.9% specific in detection of BV. Among the clinical criteria, the presence of clue cells on wet mounts was both highly sensitive (76.7%) and specific (92.4%) for diagnosing BV, while a positive whiff test had a specificity of 86.9% with sensitivity of 33.9%. Vaginal pH > 4.5 was sensitive (88.3%) but less specific (58.6%). The presence of a thin, homogeneous discharge clinging to vaginal mucosa had low sensitivity (56.3%) and specificity (48.9%). In this study, BV was prevalent in both symptomatic and asymptomatic women. The routine Pap smear was able to detect BV in the majority of women. Its utility can be greater in asymptomatic women, in whom this infection may go undetected otherwise, resulting in future complications related to reproductive health. Among Amsel's clinical criteria, the most sensitive and specific was the presence of clue cells in wet mounts. They can be detected easily by laboratory staff with little training in primary health care seting