Effect of COVID-19 Lockdown on Maternal and Infant Healthcare Services in an Urban Resettlement Area of East Delhi.

INTRODUCTION:  The coronavirus disease 2019 (COVID-19) pandemic has substantially disrupted essential maternal and infant healthcare services due to the diversion of resources. The imposition of lockdown was one of the critical strategies to flatten the curve in several countries, including India. This led to restricted access to pregnancy-related care, immunization services, and had an impact on home-based newborn care. We aimed to determine the effect of the COVID-19 lockdown on institutional deliveries and child healthcare services in a residential community of East Delhi. METHODS: This community-based, comparative study was conducted between January 2021 and August 2022. Seventy-seven families experiencing childbirth during the COVID-19 lockdown period (24th March 2020 to 30th November 2020) were compared with an equivalent number of families having childbirth during the corresponding period preceding the lockdown (24th March 2019 to 30th November 2019). The study involved face-to-face interviews conducted using a pretested and pre-validated interviewer-administered schedule. RESULTS: We found that non-institutional deliveries were substantially higher in the during-lockdown group (n=11, 14.3%) compared to the before-lockdown group (n=1, 1.3%) (OR=12.67 [1.59, 100.73]). Additionally, a significantly lower proportion of pregnant women received a minimum of four antenatal checkups (OR=8.26 [2.71, 25.23]), as well as iron and calcium supplementation during the lockdown. Reasons for non-institutional deliveries primarily included unavailability and denial of delivery services, as well as the fear of exposure to COVID-19 infection, as highlighted in our study. A significantly lower proportion [OR=6.07 (2.56, 14.42)] of children were found to be immunized-for-age, along with a substantial delay in vaccination among those born during the lockdown period. There was a significant decrease in home visits by community health workers during both the antenatal and postnatal periods amidst the lockdown. Moreover, the proportion of children exclusively breastfed for six months was notably lower [OR=2.32 (1.17, 4.63)], and the age until which exclusive breastfeeding was continued was lower in the during-lockdown group. Regarding healthcare-seeking behavior, services were sought by the families of 95.5% of children who fell sick during the lockdown period. Approximately 45.2% of families procured medicines from private health facilities, while about one-third acquired them from non-registered medical practitioners (NRMPs). CONCLUSION: The COVID-19 lockdown significantly affected maternal and child healthcare services, leading to adverse outcomes across various crucial aspects. Institutional deliveries, antenatal care, community health worker visits, child immunization, and healthcare-seeking behavior were all adversely affected. In times of natural disasters like pandemics, it is crucial to establish specific provisions ensuring uninterrupted maternal and child healthcare throughout the lockdown. Integrating health education into essential services becomes imperative within the pandemic preparedness plan.

Development and implementation of a sustainable COVID-19 training package for healthcare workers: Experience from a teaching hospital of North India.

Background: With the impending threat of future COVID-19 waves, it is imperative that teaching hospitals develop, implement, and evaluate a systematic training program to render HCW elastic in delivering COVID-19 related services. We present our experience in developing, implementing, and evaluating a sustainable and scalable COVID-19 patient management training package for healthcare workers. Materials and Methods: A mixed-methods study design was used. Rapid assessment to understand the need of the trainees and identify the available resources was done followed by planning of the training module and its implementation. The program was evaluated for effectiveness and sustainability. Data analysis was done using descriptive statistics and qualitative data generated from open-ended questions in the feedback forms and the discussions were analyzed using rapid content analysis. Results: A total of 66.8% of the doctors and 18.9% of the nurses were trained by online synchronous mode while 55.0% of the nursing officers and 47.1% of the nursing orderlies and paramedical staff were trained in onsite skill development sessions. Need assessment identified that healthcare workers were ill-prepared to use medical devices such as Bipap machines, ventilators, and oxygen delivery devices. The participants mentioned that the multidisciplinary approach and video-based demonstrations facilitated their online learning while the incremental learning approach, easy-to-understand terminology and hands-on experience facilitated their onsite skill development sessions. Conclusion: The COVID-19 training package developed was multidisciplinary, effective, sustainable, and scalable in a resource-limited setting. We suggest that this model can be adapted by healthcare organizations to develop and implement such training packages for their healthcare workers.

Health care services: Utilization and perception among elderly in an urban resettlement colony of Delhi.

Context: Health care utilization informs us about the utility of services which are available. We have a paucity of studies related to health care utilization among elderly in India. Aims: The aim of this study is to find out utilization of health care services by elderly (≥60 years), pattern, factors associated with, and perception of the elderly population regarding facilitators and barriers for the same. Settings and Design: A community based cross-sectional, observational study was conducted in a resettlement colony of East Delhi. Materials and Methods: A pretested, semi-structured, and interviewer-administered questionnaire was used. Duration of data collection was November 2018 to January 2020. Statistical Analysis Used: For quantitative variables, mean, median, proportion, Chi-square test, binary logistic regression using Statistical Package for the Social Sciences (SPSS), and for qualitative variables thematic analysis were done. Results: The study included 288 study participants. Although utilization of health care services in last 15 days among elderly is 90%, it was also found that 69% of the elderly consulted a licensed medical practitioner. A private facility was visited by 58% of the study participants. Female gender (OR: 1.97; P = 0.02), religion as Hindu (OR, 2.09; P = 0.04), and marital status "single" (OR, 1.8; P = 0.04) were observed to be significant predictors of health care utilization. The participants expressed less waiting time, cashless facility for visits, availability of an accompanying person, behavior of staffs work as facilitators for utilization of services. Conclusions: Considering the unique characteristics of this age group, a shift from facility to community-based approach may be considered. Efforts may be made to create elderly friendly health facilities.

Rapid transition to online teaching program during COVID-19 lockdown: Experience from a medical college of India.

BACKGROUND: COVID-19 pandemic has forced medical colleges around the world to shift to online teaching. There is hardly any evidence regarding such rapid transitions to online teaching, especially from resource-poor settings. We share our experience of developing an online teaching program based on teachers' and students' feedback. MATERIALS AND METHODS: A mixed methods study was conducted during the COVID-19 lockdown period in a public-funded medical institute of India. Online feedback was obtained 3 weeks after the beginning of emergency remote teaching. The responses by the students and teachers shaped the final online teaching program which reinforced the perceived strengths and addressed the weaknesses. Observations were made for the proportion of scheduled lectures delivered through digital platform and students' attendance in the 1st week and last week of the study period. RESULTS: Feedback was obtained from 367 students and 56 teachers. Around three-fourths of the students (76.7%) and teachers (73.2%) were satisfied with online teaching. The themes generated for benefits of online teaching were similar for both students and teachers, but the perceived challenges differed. Students found online teaching more stressful, and teachers were apprehensive of the new technology and lack of a controlled environment. CONCLUSIONS: A rapid transition to development and implementation of an online teaching program was found to be feasible and acceptable to the primary stakeholders. Not only the content but student engagement and supportive environment for both students and teachers are essential requirements in the context of an online undergraduate teaching program.

Rapid transition to online practical classes in preclinical subjects during COVID-19: Experience from a medical college in North India.

BACKGROUND: COVID-19 pandemic compelled medical schools to opt for online mode in medical education. The competency-based curriculum started in India last year onwards allotted more hours to practical teaching than lectures. As the lockdown extended, there was a need to shift laboratory teaching to online mode. We describe our experience of developing and implementing a framework to rapidly shift practical lab teaching of preclinical subjects to online mode. METHODS: A mixed method study was conducted during the COVID-19 lockdown period in a public funded medical institute of India. A framework utilizing the principles of small group teaching using the available resources was developed and implemented. Online feedback was obtained from students, while in-depth telephonic interview was conducted for teachers. RESULTS: A Demonstrate-Engage-Assess framework for online Practical teaching of Preclinical subjects (DEAPP) was developed and implemented. Feedback was obtained from 103 first year students and six teachers from preclinical subjects. Around 62%-80% students were satisfied with online practical teaching or agreed with benefits of various online tools used in the teaching sessions. Teachers found the framework more planned, and resource efficient, while students found it to be more engaging, enjoyable, and motivated for learning. No face-to-face interaction, non-experiential learning, and adaptation to newer technology were the main barriers perceived in online practical laboratory teaching. CONCLUSION: DEAPP framework was found to be feasible for rapid online transition of practical lab teaching and reported by the students and teachers as engaging, enjoyable and motivated learning.

Module to facilitate self-directed learning among medical undergraduates: Development and implementation.

CONTEXT: Currently, self-directed learning (SDL) is emphasized in medical institutions all over the world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast-expanding medical knowledge. AIMS: This study aims to develop and implement an "SDL" module for medical undergraduates and find out their perception about the same. SETTINGS AND DESIGN: A cross-sectional study using a mixed-method design (having both qualitative and quantitative components) was conducted in the Department of Community Medicine, UCMS, Delhi, India. METHODS: A module was developed following an extensive literature review and focus group discussions with the teaching staff of the institute. First-semester undergraduate students were invited to participate in the study and asked for feedback using a semi-structured questionnaire. STATISTICAL ANALYSIS: Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was performed. RESULTS: The module was implemented with 160 students, in November for 10 hour distributed over 5 weeks. Feedback could be obtained from 130 students. Sixty-seven percent of students were satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed that though the students liked the learning process based on this module, they also felt facilitators could have been more active in imparting knowledge and skills. CONCLUSIONS: To make learners equipped with the ability to learn throughout a professional learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.

Nutritional status among elderly: A community-based cross-sectional study.

BACKGROUND: Malnutrition in the elderly is a significant public health problem and has serious implications on the overall health of the elderly. There are very few community-based studies on malnutrition among the elderly, especially in India. OBJECTIVES: The objective was to find out the prevalence of malnutrition and its associated risk factors among the elderly in urbanized villages of Delhi. METHODS: A cross-sectional study was conducted during November 2015 to April 2017 in two urbanized villages of East Delhi among 353 elderly (>60 years) individuals. A semi-structured interview schedule was used to record the sociodemographic and relevant personal details of the elderly. To determine the prevalence of malnutrition, Mini Nutritional Assessment scale was used. Statistical analysis included simple descriptive analysis and tests of significance such as Chi-square test. Multivariable logistic regression was used to identify the predictors of malnutrition. RESULTS: The prevalence of possible malnutrition was found to be 49.3%. On bivariate analysis, age, gender, education status, marital and residential status, per capita income, financial dependency, and family size were found to be associated with malnutrition (P < 0.05). Age >70 years, being tenant, and financial dependency were observed to be significant predictors of possible malnutrition in multiple logistic regression. CONCLUSION: Malnutrition needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging. Social and economic parameters are linked with the occurrence of malnutrition among the elderly and must be considered in the development of preventive strategies.

Functional disability among elderly: A community-based cross-sectional study.

BACKGROUND: Old age is often associated with functional decline and physical dependence, thus compromising the ability to carry out basic tasks required for daily living. There are very few community-based studies on functional disability among elderly, especially in India. This study was done to find out the prevalence of functional disability and associated risk factors among the elderly in urbanized villages of Delhi. METHODS: A cross-sectional study was conducted in two urbanized villages of East Delhi. A semi-structured interview schedule was used to record the socio-demographic and relevant personal details of the elderly (>60 years). Functional disability was defined as a disability in activities of daily living (ADL) or blindness or bilateral hearing impairment or a combination of these. Statistical analysis included simple descriptive analysis and tests of significance like Chi-square test. The multiple logistic regression was used to identify predictors of functional disability. RESULTS: Data were collected from 360 study participants. Around one-fourth (25.6%) of the study participants were having a functional disability. Older age, presence of chronic disease, and having possible malnutrition were found to be significant predictors of functional disability among the elderly by applying the multiple logistic regression. CONCLUSIONS: Functional disability needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging.

Development and implementation of a competency-based module for teaching research methodology to medical undergraduates.

CONTEXT: Research experience helps an undergraduate student to understand published works, to learn teamwork, and even to consider research as a career. Few medical institutions have attempted to engage undergraduates in research experience. Competency-based medical education has emerged as a core strategy to educate and assess medical students worldwide. AIMS: This study aims to develop and implement a competency-based research methodology training module for undergraduate students and find out students' perception about this. SETTINGS AND DESIGN: A cross-sectional study of mixed design was undertaken in the Department of Community Medicine, UCMS, Delhi, India. METHODOLOGY: A competency-based research training module was developed and implemented with 4th semester undergraduate students posted in the department. Students' feedback about the module was obtained. STATISTICAL ANALYSIS USED: For quantitative variables, means, ranges, medians, and percentages were calculated. To find out students' perception about the posting a qualitative analysis was done. RESULTS: The module was implemented with 25 students posted in the department in May 2017. However, feedback was obtained from 23 students. About 83% of the students reported as highly satisfied with the posting, 61% of the students mentioned that after completion of this posting, they felt motivated to do further research. A qualitative analysis of the feedback showed that students found the project helped them to enhance their knowledge and develop skills. CONCLUSIONS: Competency-based research methodology training can serve as a tool for teaching research methodology to undergraduate students.

A study on elder abuse in an urban resettlement colony of Delhi.

BACKGROUND: In India, proportion of elderly is increasing with decrease in mortality rate and increase in life expectancy. There is a paucity of studies on elder abuse, a problem faced frequently by an elderly. The present study planned to find out the prevalence of abuse and associated risk factors among community dwelling elderly in an urban resettlement colony of east Delhi. METHODS: It is a community-based cross-sectional study. This study was done among elderly residents aged 60 years and above in an urban resettlement colony of east Delhi. Study participants were interviewed using a pretested, semi-structured questionnaire. Data were collected regarding sociodemographic profile and prevalence of abuse. Simple descriptive tables were generated to denote frequencies. Cross-tabulation and chi-square test were applied to study the association between various sociodemographic characteristics and elder abuse. RESULTS: A total of 125 elderly were interviewed. Twelve (9.6%) reported experience of abuse. All abused participants faced neglect, four faced verbal abuse, and two participants reported physical and one financial abuse. Abused elderly belonged to a higher age group >70 years and did not have regular contact with family and friends (P = 0.00; no involvement in social activities (P = 0.001). Abuse was more likely when "finances were managed by others" (P = 0.02) and having dependency for daily needs (P = 0.00). CONCLUSION: Elder abuse is prevalent in India. The victims of abuse lack social support and network and are reluctant to report abuse.

Awareness of cervical cancer and willingness to participate in screening program: Public health policy implications.

BACKGROUND: Cervical cancer is one of the most common malignancies among women in India. There is a high mortality as patients usually present at an advanced stage because of lack of awareness and nonexistent screening programs. AIM: This study was planned to find out awareness about cervical cancer among women and their willingness to utilize screening services in an urban resettlement colony of Delhi, India. SETTINGS AND DESIGN: A community-based, cross-sectional study was carried out in a resettlement colony of North-West Delhi. MATERIALS AND METHODS: Semi-structured interview schedule was used to collect information regarding different aspects of cervical cancer. Analysis was done using SPSS package (SPSS version 16 (UCMS and GTBH, Delhi, India)). RESULTS: A total of 373 women were included in the study. Mean age of study participants was 39.14 years. Two-third of the study population were illiterate. Half of the study population was aware of cervical cancer, and only one-fourth of population were willing to participate in a screening test. Willingness was higher among educated, ever user of family planning method and having knowledge about at least one risk factor, signs or symptoms, or possibility of early diagnosis of cancer cervix. CONCLUSIONS: The country's national program advocates for opportunistic and targeted screening of women. An understanding of the factors that influences womens' willingness to participate in screening program is essential for the success of such programs. Hence, this study emphasizes the need for dissemination of knowledge about various aspects of cancer cervix which is critical for uptake of any screening program in a developing country.

Gall bladder cancer and the role of dietary and lifestyle factors: a case-control study in a North Indian population.

Most patients with gall bladder cancer (GBC) present in the advanced stage with a poor response to therapy. Prevention or early detection is the best way to prevent death, but this requires identification of susceptible subgroups. Keeping this in mind, this study was carried out to evaluate the association between selected demographic, lifestyle, and dietary factors and GBC. A hospital-based case-control study was carried out at the All India Institute of Medical Sciences (New Delhi, India). Cases were defined as newly registered confirmed primary GBC patients. Controls were defined as healthy relatives of patients other than that of GBC. Data were collected from February 2008 to October 2009 using a semistructured interview schedule from both cases and controls. Analysis was carried out using SPSS version 15 and Epi-Info version 6. Factors found to be significant in the bivariate analysis were entered in a multivariate logistic regression analysis. A total of 122 cases and 122 controls were included in the study. There was no significant difference in age (P=0.06) and sex (P=0.66) between the cases and the controls. In the bivariate analysis, factors found to be significantly associated with GBC were illiteracy [odds ratio (OR) 8.00, P=0.000], lower socioeconomic status (OR 2.45, P=0.000), parity more than 3 (OR 9.06, P=0.000), age at first pregnancy less than 20 years (OR 2.03, P=0.018), and the use of nonliquefied petroleum gas cooking fuel (OR 4.17, P=0.000). Higher vitamin C intake had a protective effect (OR 0.33, P=0.004). In the multivariate analysis, education, intake of vitamin C, parity, and type of fuel used were significant factors. The risk factors for GBC that have been identified in the present study delineate a high-risk population group that can be targeted for preventive measures including improvement in socioeconomic status, education and lifestyle, and dietary intervention, and avoidance of the use of nonliquefied petroleum gas as cooking fuel.

Passive smoking, indoor air pollution and childhood tuberculosis: a case control study.

BACKGROUND: Passive smoking and biomass fuel use most probably are more harmful to children than adults for two reasons. The first one is children's respiratory and immune systems are not fully developed. Secondly, they spend more time at home and are, therefore, likely to experience more intense and prolonged smoke exposure. AIMS: This study was planned to find out if there is any association between childhood tuberculosis and exposure to passive smoking and biomass fuel. METHODS: A hospital-based case control study was done. All registered consecutive newly diagnosed pediatric tuberculosis cases (0-14 years) from the outpatient department of a tertiary care hospital were recruited as cases. Age and sex matched controls were recruited from a public general hospital of the same locality. A semi-structured, pre-coded interview schedule was administered to parents or legal caregivers of all subjects after obtaining informed written consent. RESULTS: A total of 200 cases and 200 controls were recruited in the study period. The factors which were significantly associated with development of tuberculosis were education of the mother, (OR 1.411, 95% CI 0.888-2.243, p-0.001), a family member having tuberculosis in the last two years and residing in the same house (OR 2.797, 95% CI 1.353-5.789; p-0.004), being a passive smoker (OR 1.725, 95% CI 1.142-2.605; p-0.009). No association between biomass cooking fuel use and development of tuberculosis was found. CONCLUSION: Passive smoking is associated with development of childhood tuberculosis. This requires health education programmes and medical antitobacco advice and services.

Tuberculosis among health care workers in a tertiary care institute for respiratory diseases in New Delhi.

BACKGROUND: LRS Institute of Tuberculosis and Respiratory Diseases, a tertiary care pulmonary institute in Delhi, India. AIMS: To find out the risk of tuberculosis disease among health care workers (HCWs) of LRS Institute. METHODS: Retrospective study, where all members of the staff working in this hospital were interviewed regarding development of tuberculosis after joining this institute. RESULTS: A total of 40 cases of tuberculosis were reported by the health care workers between March 1999 to March 2008 yielding an overall risk of 727 per 1,00,000 population per year which is four times higher than the reported national average. Among these 40 cases, 25 (62.5%) were pulmonary and 15 (37.5%) were extra-pulmonary tuberculosis. CONCLUSION: This institute's health care workers have to deal with a large number of tuberculosis patients, the risk of exposure is more in them and thus having the disease. Multi-centric studies are needed to evaluate the true prevalence of tuberculosis among HCWs and effective intervention strategies are required to reduce nosocomial transmission.

Maternal morbidity during postpartum period in a village of north India: a prospective study.

This prospective community-based study was conducted in the village of Chhainsa, Haryana, India, in order to discover the incidence and types of postpartum morbidity and the factors associated with the morbidities. The subjects were followed up to 42 days of postpartum with a minimum of three visits; the first visit was within 14 days of delivery and subsequent visits were every 14 days. A first visit was made to 211 women and 174 (82.46%) completed the study. Seventy-four percent reported at least one morbidity and there were 1.75 reported morbidities per woman per postpartum period. Common problems reported were: weakness, lower abdominal pain, perineal pain, abnormal vaginal discharge, high fever, breast problems, excessive vaginal bleeding, etc. There was greater morbidity among women of lower socioeconomic status, parity >4, birth interval >36 months, having a breech or caesarean delivery or a delivery assisted by relatives/neighbours. A significant positive association was found between age and non-maintenance of the 'five cleans' during delivery. Seventy-five percent of those who had reported morbidity had taken some action, but only 20% sought help from a qualified doctor and 14% from other health workers.