Barriers of household toilet utilization among toilet owners in a rural area of Northern India: An analytical cross-sectional study.

Background: Open defecation continues to prevail among toilet owners despite effective implementation of the Swachh Bharat Mission (Gramin). We conducted this study to determine toilet utilization rates and learn about the barriers to toilet use in the rural areas. By understanding the barriers, physicians can provide targeted education and become better equipped to manage their patients' conditions and advocate for their demands. Materials and Methods: We conducted a cross-sectional study on the households of the rural field practice areas of the department in central Uttar Pradesh by the census method. House listing was procured from the departmental records. The questionnaire was directed at both the household level and individual level. Results: The proportion of households with access to a toilet was found to be 91.1% of which 504 households were included in the study. Among the toilet owners, 115 (22.8%) households were not using toilets exclusively by all the members. At the individual level, age groups (of 20-59 years, and ≥60 years) and female gender were found to be significantly associated with open defecation. At the household level, government assistance for toilet construction and livestock keeping was found to be associated with open defecation. Major barriers to toilet use were childhood habits, dearth of toilets in the farming grounds/workplace, women during menstruation and having a non-functional toilet. Conclusion: This study indicates that merely installing a household toilet does not ensure exclusive utilization of toilet and the practice of open defecation might continue to be prevalent if corrective measures are not undertaken.

Comparison of clinical profile and outcome of de novo convulsive status epilepticus with those with a past history of epilepsy in the elderly populace.

AIM: To compare the clinical characteristics and etiological differences between de novo convulsive status epilepticus (CSE) with those with a past history of epilepsy in the elderly populace and the predictors of in-hospital mortality. METHODS: One hundred twenty-two elderly (≥60 years of age) hospitalized patients with CSE were evaluated for clinical profile, etiologies and predictors of in-hospital mortality. RESULTS: The mean age of the study population was 67.2±7.7 years. Among them, 77 (63.1%) cases were of de novo CSE and 45 (36.9%) cases had a past history of epilepsy. Most common etiologies in de novo CSE were acute symptomatic in 68.8%, followed by remote symptomatic in 24.7% of cases. Inhospital mortality in de novo CSE was 38.9 % and on multivariate analysis, it was found variables significantly related to mortality in CSE were the presence of comorbidities (odds ratio (OR) = 0.229, 95% confidence interval (CI) = 0.059- 0.897; p=0.03) low Glasgow Coma Scale (GCS) (OR =0.045 , 95% CI =0.013- 0.160 ; p= 0.01) and de novo CSE ( OR= 0.093, 95% CI = 0.017- 0.503 ;p= 0.01 ). CONCLUSIONS: De novo CSE in the elderly was associated with poorer outcomes in comparison to those with a past history of epilepsy. In-hospital mortality in CSE was related to the presence of comorbidities, low GCS and de novo CSE. Prompt and aggressive management of de novo CSE is the most effective way of preventing in-hospital mortality in the elderly.

Adverse effects after first and second dose of covishield and covaxin: A longitudinal study.

Background: COVID-19 vaccines have been rolled out recently in several parts of the world. Although the protective efficacy is frequently discussed, little is known about the factors associated with COVID-19 vaccine adverse effects. The study was conducted with the aim to evaluate the occurrence of adverse events following immunization (AEFI) with two doses of covishield and covaxin and to assess factors associated with these adverse effects. Methods: A longitudinal study was conducted for a period of three months in the adults above 18 years of age attending rural health training center (RHTC) either to receive their first or second dose of covishield or covaxin. After vaccination, the participants were observed at the health facility for 30 min for any AEFI and also followed up telephonically on seventh day from vaccination. Data was collected on predesigned and pretested questionnaire and appropriate statistical tests were applied. Results: Out of 532 participants, 250 (47%) came for their first dose while 282 (53%) came for second dose. In both the groups maximum participation was seen by males and those belonging to age group 18-30 years. Majority of the participants reported local tenderness (39.3%) after first dose of covaxin and fever (30.5%) after first dose of covishield. Mainly significant association was observed after vaccination in participants with comorbidities. Conclusion: The short-term adverse events with both the vaccines were observed, but these were mild and short lived. In this context, our study becomes more relevant in disseminating short-term safety data post vaccination. This will help individuals in their decision to accept vaccination.

Are the labour rooms of primary healthcare facilities capable of providing basic delivery and newborn services? A cross-sectional study.

OBJECTIVES: The study aimed to assess the functionality of labour rooms by evaluating the labour room infrastructure with reference to the standard guidelines, the status of the availability of human resources, the availability of essential equipment and consumables in the labour room and by documenting the knowledge of the healthcare provider in terms of labour room practices. The study also explored the facility parameters associated with its delivery load taking the facility as a unit of analysis. DESIGN: A cross-sectional analytical study. SETTING: India has realised the importance of improving the quality of care in public health facilities, and steps are being taken to make healthcare more responsive to women's needs. With an increase in the proportion of institutional deliveries in India, the outcome of the delivery process can be improved by optimising the health facility components. PARTICIPANTS: The study was conducted in 52 health facilities and healthcare providers involved in the delivery process in the selected facilities. RESULTS: The infrastructure of the facilities was found to be the best for medical college followed by district hospitals, Community Health Centres (CHCs), Primary Health Centres (PHCs) and subcentres. Similar findings were observed in terms of the availability of equipment and consumables. Lack of healthcare providers was observed as only 20% of the posts for health personnel were fulfilled in CHCs followed by PHCs, subcentres and district hospitals where 43, 50 and 79% of the available vacancies were fulfilled. The level of knowledge of healthcare providers in terms of partograph, active management of the third stage of labour and post-partum haemorrhage ranged as per their designation. The specialists were the most knowledgeable while the Auxiliary Nurse Midwife (AMNs) were the least. All the components of structural capacity, i.e. infrastructure (r 2 = 0.377, P value < 0.001), equipment and consumable (r 2 = 0.606, P value < 0.001) and knowledge of healthcare providers (r 2 = 0.456, P value < 0.001) along with the overall facility score were positively correlated with the average delivery load of the health facility. The results from multivariate linear regression depict significant relation between the delivery load and availability of equipment and consumables (t = 4.015, P < 0.01) and with the knowledge of healthcare providers (t = 2.129, P = 0.039). CONCLUSIONS: The higher facilities were better equipped to provide delivery and newborn care. A higher delivery load was found at high-level facilities which can be attributed to better infrastructure, adequate supply of equipment and consumables and availability of trained human resources.