Distribution of Infectious Disease Outbreaks in India before and after the COVID-19 Pandemic: Analysis of National Weekly Surveillance Data.

ABSTRACT: National surveillance data were collected to study the outbreak trends of infectious diseases/syndromes before and during the COVID-19 pandemic period, spanning from 2018 to 2022. The study found that out of 4208 outbreaks, 2972 occurred before the COVID-19 period, affecting 147,425 people, while 1236 outbreaks affected 52,324 people during the pandemic. The number of outbreaks for diseases such as acute flaccid paralysis, fever with rashes, leptospirosis, rabies, and scrub typhus increased during the pandemic. The geographic distribution of outbreaks remained similar for some reemerging diseases in both periods. The trends for dengue, Japanese encephalitis, and cholera remained consistent with peaks mostly from July to September in both periods. We observed a considerable reduction in morbidity and mortality due to outbreaks in India during the pandemic. Despite similar distributional patterns, the study indicates a strong suspicion of persistent outbreak-initiating factors, necessitating an efficient and vigilant surveillance system in the country.

Occupational health hazards and morbidity among nurserymen in a rural area of West Bengal.

Background: Horticulture or working in plant nursery is one of the main occupations in few areas of the southern part of West Bengal. It is considered as a hazardous health sector worldwide as it possesses several physical, chemical, and biological risks. Objectives: The present study aimed to estimate the occupational health hazards and morbidity profile among the nurserymen living in a rural area of West Bengal and to determine the factors associated with occupational health hazards and morbidity of the participants. Materials and Methods: An observational descriptive, cross-sectional study was conducted from September 2021 to November 2021among 132 nurserymen in a subcenter of South 24 Parganas district of West Bengal through interview using a predesigned, pretested, and structured schedule. Data were analyzed using the SPSS version 25.0. Bivariate and multivariate logistic regression was used to determine the factors associated with health hazards and morbidity. Results: Different types of occupational hazards experienced by the participants were physical (100%), biological (91.6%), ergonomical (91%), chemical (85.6%), and psychological (31.8%). Most common occupation-related morbidity reported was skin rash (82.6%) followed by headache (78%), neck pain (78%), and low back pain (59.8%). Multivariate logistic regression revealed that age ≥60 years, daily working hours of ≥7 h and presence of chronic disease were statistically significant covariates of hazards. Female gender and working span of >10 years were significant covariates of "high morbidity" (P < 0.05). Conclusion: One or more types of occupational hazards were experienced by the respondents. Future interventions to address hazards and morbidities of the workers along with the development of preventive measures are the need of the hour.

The impact of the COVID-19 pandemic on health-care delivery system for other diseases and antimicrobial resistance threat in India.

India's health-care delivery is challenged with different inequalities and theelivery is challenged with different inequalities and the dual burden of communicable and noncommunicable diseases. Lockdown posed negative effects on the growth and economy of the country; simultaneously, some positive effects, like increased health consciousness and adoption of hygienic practices, were also there. Health-care delivery system faced tremendous challenges in diagnostics, therapeutics, infrastructure for inpatient care, and protection of health-care manpower. During this period, people chose to self medicate which in turn increased the threat of emergence of antimicrobial resistance. Due to shifting priority to COVID from other diseases, resources were shifted to COVID, affecting the management of other acute and chronic diseases. The launching of COVID-19 vaccination campaign showed some hope. However, despite the vaccination drive, strengthening infrastructure, and surveillance system, the devastating second wave could not be avoided due to the conglomeration of the crowd for pilgrimage, election campaign, and tourism in an unrestricted manner. It may be concluded that the fourth wave may be short lasting due to increased herd immunity.

Exploring challenges of teenage pregnancy and motherhood from beneficiaries and providers' perspectives: A qualitative study in a rural area of Purba Bardhaman District, West Bengal.

Context: Teenage pregnancy and motherhood are globally important public health concerns. In India, 6.8% women between 15 and 19 years were already mothers or pregnant, whereas in Purba-Bardhaman district of West Bengal it was 21.9% (National-Family-Health-Survey-5). Challenges of teenage pregnancy and motherhood needs to be understood from beneficiaries' and providers' perspectives. Aims: This study aimed at exploring the various challenges faced by teenagers during their pregnancies and motherhood and understanding the barriers of service delivery to them in a block of West Bengal. Settings and Design: A qualitative study with phenomenological approach was conducted between January and June 2021 in Bhatar community development block of Purba-Bardhaman district, West Bengal. Methods and Material: In-depth interview (IDI) of 12 purposively selected teenage mothers and two sessions of Focus Group Discussions (FGDs) among 17 Auxiliary Nurse Midwives (ANMs) were conducted. Data was collected by audio recording the IDI and FGD sessions as well as by taking notes. Analysis Used: Inductive thematic analysis was done by using NVIVO software (Release 1.0, QSR International). Results: Throughout teenage pregnancy and motherhood, subjects were found to face various types of medical problems, lack of awareness, and non-supportive family environment. Various social constraints and psychosocial stressors emerged as significant challenges. Communication gaps, behavioural barriers, socio-cultural issues, and administrative issues were major themes emerged as barriers of service delivery. Conclusions: Lack of awareness and medical problems were important challenges faced by the teenage mothers whereas behavioural barriers were the most important service level barriers perceived by the grass root level service providers.

Contraceptive behavior and unmet need among the tribal married women aged 15-49 years: A cross-sectional study in a community development block of paschim Bardhaman District, West Bengal.

BACKGROUND: Contraceptive behavior and unmet need for family planning, particularly among the tribal women of reproductive age in India, still remains a public health concern. This needs to be explored in different geographical regions. OBJECTIVES: : This study aimed to ascertain the contraceptive behavior of tribal married women of 15-49 years and to assess the unmet need for family planning and its determinants. METHODS: : A descriptive, cross-sectional study was conducted during May 2019 to April 2020 in Barabani Block of Paschim Bardhaman District, West Bengal. A calculated sample of 530 study participants was selected from the study area by the simple random sampling. Required data on contraceptive behavior characteristics, unmet need, and correlates were collected by interviewing them with a predesigned schedule. Bivariate analysis and multivariable logistic regression were done. Data were analyzed using the SPSS software v. 20. RESULTS: : All study participants were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate; 51.7% had early marriage, and 52.4% had adolescent pregnancy. Only 41.1% women were found currently using any contraceptives, another 14.5% ever used and 44.4% never used any methods. Apprehension of side effects and spouse disapproval were reported as two common reasons for never using contraceptives. The age of the women appeared as a significant predictor of current contraceptive use. Overall, unmet need for family planning was 19.4% and age of the women, socioeconomic status, and type of the family were found as significant predictors. CONCLUSION: Issues contributing to unsatisfactory contraceptive behavior and high unmet need for family planning need to be addressed appropriately.

Status of salt iodization, related awareness and practice at the household level in slums of Burdwan Municipality, West Bengal.

BACKGROUND: Monitoring adequacy of salt iodization at consumption level and exploring the reasons for inadequacy, especially in marginalized communities, is crucial to achieve the target coverage of universal salt iodization. AIMS: To assess the iodine content of salt used at household level, related awareness and practice of respondents and their socio demographic correlates. SETTINGS AND DESIGNS: This cross-sectional descriptive study was conducted in the slums of Burdwan Municipality in 2019. METHODS AND MATERIAL: A total of 330 households were selected by cluster sampling. Salt iodine content was estimated at household level semi-quantitatively by Iodine testing kit, following recommended guidelines. One respondent from each household was interviewed to assess their awareness and practice regarding iodized salt. Kruskal Wallis test, Mann Whitney U test and Multivariable logistic regression was used. RESULTS: All 330 households were using iodized salt; 77.6% were consuming adequately iodized and 22.4% were consuming inadequately iodized salts. Only 30.9% of the respondents were aware about the importance of iodized salt, few had correct practice despite inadequate knowledge and none, except one, practiced adding salt at the end of cooking. Awareness and practice were associated with caste and age of the respondents, respectively. Keeping salt container near the oven, adjusting for keeping salt in uncovered container, significantly predicted inadequate level of iodization [AOR 6.17 (95% CI: 2.68-14.26)]. CONCLUSION: Inadequate iodization, lack of awareness regarding iodized salt and faulty storing practices amounting to increased risk of inadequate iodization are still prevalent emphasizing the need, in policy, for health education.

Care-seeking behaviour of suspected snakebite cases admitted in a medical college of West Bengal: A pathway analysis.

BACKGROUND: Snakebite is a time decisive medical emergency requiring contact with health facility at the earliest. Many snakebite victims yet seek care from traditional healers (THs) or village quacks (VQs) before reaching an appropriate facility, which leads to adverse consequences. This study was conducted to assess care-seeking behaviour and pathways followed in reaching appropriate facilities among suspected snakebite cases and to identify associated factors. METHODS: A hospital-based cross-sectional study was conducted at a medical college in West Bengal. All suspected snakebite cases admitted during a reference period of two months were studied. Study subjects and/or accompanying persons were interviewed for care-seeking behaviours and pathways followed. RESULTS: Among the 393 study participants, most were ≤30 years of age, men, agricultural workers, of lower middle and lower socioeconomic class and only 69.5% had formal schooling. The commonest place of occurrence was the agricultural field (40.7%), and the commonest biting site was the lower extremity (77.6%). Only half of participants (55.2%) used immediate correct measures at the biting site. Incorrect practices included tourniquet application (29.5%), use of herbal preparation (7.1%), blade shaving at site (2.8%) etc. As first care-seeking points, 15% and 24.9% of cases visited THs and VQs, respectively. Pathway analysis revealed that unfavourable pathway was followed by 39.9% participants. Two unfavourable points were consulted by 3.8% of participants. The care-seeking pathway was significantly associated with religion, caste, education and socioeconomic class. CONCLUSIONS: Findings of this study highlight the urgent need for behaviour change interventions addressing the myths and misconceptions of people regarding snakebite.

Respiratory Morbidity among Rice Mill Workers in an Urban Area of Burdwan District, West Bengal: A Cross-sectional Study.

BACKGROUND: Rice mill workers constitute a special group from the perspective of occupational health. Unprotected dust exposure among them adversely affects their respiratory health, which needs to be evaluated. Adequate evidence is still lacking in many parts of India including West Bengal. Burdwan is one of the main rice-producing districts in the state with abundant rice mills. AIM: The aim of the study was to find out the prevalence and pattern of respiratory morbidity and associated background characteristics of rice mill workers. SETTINGS AND DESIGN: A descriptive cross-sectional study was conducted at Burdwan municipality area during July-December 2016. MATERIALS AND METHODS: Considering 44.2% prevalence, 95% confidence interval, 15% allowable error, 10% non-response, a sample of 252 directly engaged rice mill workers were selected through multistage random sampling. With prior consent, the subjects were interviewed, clinically examined, and underwent spirometry; relevant records were also reviewed using a pre-designed schedule. Any abnormal spirometry finding was considered as respiratory morbidity. Ethical approval was obtained from institutional ethics committee. STATISTICAL ANALYSIS: Data were analyzed using SPSS version 20. Chi-square test and multiple logistic regression were applied. RESULTS: Prevalence of respiratory morbidity was 40.73% with obstructive and restrictive respiratory morbidity being 24.60% and 16.13%, respectively. Non-use of any protective measure, duration (years) of working in rice mill and average daily working hours were significant predictors of respiratory morbidity. CONCLUSION: Respiratory morbidity is quite high in the area. Proper health education and provision of personal protective equipments need to be provided.

Perceived psychological stress among undergraduate medical students: Role of academic factors.

Recently, there is a growing concern about stress during undergraduate medical training. The objectives of our study were to assess perceived stress among undergraduate medical students and to find out academic factors as determinants. A cross-sectional, questionnaire-based survey was carried out among undergraduate medical students of R. G. Kar Medical College, India, during July 2011-June 2012. Perceived stress was assessed using the Perceived Stress Scale-14. A 10-item questionnaire was used to assess academic sources of stress and their severity. The overall mean perceived stress score was 29.58 (standard deviation [SD] = 6.60), and 46.3% of the participants were in the group of more stressed (perceived stress score ≥28). The academic stressor factors predicted 78% of variability of perceived stress. A higher level of perceived stress was reported by the students. The students should be taught different stress management techniques to improve their ability to cope with a demanding professional course.