Vaccine hesitancy among the nursing officers working in a tertiary care hospital, Puducherry - A mixed-method study.

Background: Vaccination was considered one of the vital moves in controlling the spread of highly infectious COVID-19 pandemic. But, the initial acceptance level was highly improbable among nursing professionals (57%) in India.1 Thus, it was necessary to explore the reasons behind this reluctance, as they can act as trusted advisors for general population in decision-making. Objectives: This study aimed to determine the proportion of nursing officers with COVID- 19 vaccine hesitancy during the phase one drive (15th January to 28th February 2021) of vaccination and the various factors contributing to it. Methods: A cross-sectional analytical mixed-method study was done among 422 nursing officers working in a tertiary care hospital, Puducherry. Data was collected using a pretested semi-structured questionnaire along with WHO -SAGE Vaccine Hesitancy Scale for the quantitative component and an interview guide for qualitative part. Results: More than half of the participants were found to be COVID- 19 vaccine hesitant based on the operational definition, with fear of side effects being the most reported reason. Factors like work experience of five years or less, previous history of COVID- 19 infection, and delayed receipt of the first dose of the vaccine were significantly associated with vaccine hesitancy. Conclusion: Improper flow of evidence-based information was identified as one of the major concerns related to vaccine acceptance. Measures should be taken for proper awareness generation through dependable channels and at the same time for the prevention of spread of infodemics pertaining to the new interventions for better penetration and utilization.

Nutritional Supplementation Would Be Cost-Effective for Reducing Tuberculosis Incidence and Mortality in India: The Ration Optimization to Impede Tuberculosis (ROTI-TB) Model.

BACKGROUND: Undernutrition is the leading cause of tuberculosis (TB) in India and is associated with increased TB mortality. Undernutrition also decreases quality of life and economic productivity. METHODS: We assessed the cost-effectiveness of providing augmented rations to undernourished Indians through the government's Targeted Public Distribution System (TPDS). We used Markov state transition models to simulate disease progression and mortality among undernourished individuals in 3 groups: general population, household contacts (HHCs) of people living with TB, and persons living with human immunodeficiency virus (HIV). The models calculate costs and outcomes (TB cases, TB deaths, and disability-adjusted life years [DALYs]) associated with a 2600 kcal/day diet for adults with body mass index (BMI) of 16-18.4 kg/m2 until they attain a BMI of 20 kg/m2 compared to a status quo scenario wherein TPDS rations are unchanged. We employed deterministic and probabilistic sensitivity analyses to test result robustness. RESULTS: Over 5 years, augmented rations could avert 81% of TB cases and 88% of TB deaths among currently undernourished Indians. Correspondingly, this intervention could forestall 78% and 48% of TB cases and prevent 88% and 70% of deaths among undernourished HHCs and persons with HIV, respectively. Augmented rations resulted in 10-fold higher resolution of undernutrition and were highly cost-effective with (incremental cost-effectiveness ratio [ICER] of $470/DALY averted). ICER was lower for HHCs ($360/DALY averted) and the HIV population ($250/DALY averted). CONCLUSIONS: A robust nutritional intervention would be highly cost-effective in reducing TB incidence and mortality while reducing chronic undernutrition in India.

Food portion size educational programme in a workplace setting in Puducherry - Is it effective?

BACKGROUND: Consuming larger portion sizes, i.e., in excess of a typically recommended serving size, has been attributed to the obesity epidemic. The workplace acts as an efficient target for health promotion activities. AIMS: To assess the effectiveness of a food portion size educational programme in increasing knowledge among the employees of a software company in Puducherry. METHODOLOGY: An interventional study was conducted with a pre-post design. A single group of software company employees (N = 120), age ≥30 years selected by simple random sampling was included in the study. The intervention consisted of a health education programme on the portion sizes of common food items including fruits and vegetables. A self-administered questionnaire was used to collect information on personal and sociodemographic details. Self-regulation on eating was assessed using the Self-Regulation of Eating Behaviour Questionnaire (SREBQ). RESULTS: The mean age of the study participants was 27 ± 5 years. Most of the participants were males, i.e., 72 (60%). Of the total, 55 (47.8%) participants were obese and 18 (15.7%) were overweight. The median number of meals and snacks consumed by the participants was 3 (1-3) and 1 (1-2), respectively. The median (interquartile range [IQR]) knowledge scores of the food portion size significantly increased from 9 (0-16) to 14 (5-19) (P < 0.05). CONCLUSIONS: This study has demonstrated that an educational intervention in the workplace setting is feasible and effective in increasing the knowledge of food portion size over a short term.

Level, motivation and barriers to participate in physical activity among late adolescents in Puducherry.

BACKGROUND: One in every ten deaths globally is accounted for by physical inactivity-related risks. Adolescents constitute 18% of the world's total population and are at risk of becoming physically inactive in the future. Thus, this study aims to find the level of physical activity (PA) among late adolescents and factors that motivate and prevent them from being active. METHODOLOGY: Four hundred and fifty adolescents in the age group of 18-19 years were included in the study. Standardized self-administered questionnaires such as the Global Physical Activity Questionnaire and the Behavioral Regulation in Exercise Questionnaire were used to assess the level of PA and level of motivation, respectively. In addition, barriers to participating in PA were also elicited. RESULTS: This study found that about one third of the subjects (32.4%) were physically inactive. The motivation levels were more pooled towards the self-determined motives and girls are more motivated towards PA than boys. However, PA among males is significantly higher than females. Healthy practices in families was also found to have significant association with increased PA. The major barriers found were the excessive use of electronic gadgets and lethargy. CONCLUSION: One third of the adolescents in this study were physically inactive and several barriers that prevent them from taking up PA were elicited. Therefore, efforts should be taken to emphasize the importance of physical activity among individuals, family members and the peers at institutional level and community level so as to lay foundations for healthy lifestyles in the future. Basic prevention in the emergence of risk factors for non-communicable diseases (NCDs) like PA is vital to curb the growing burden of chronic diseases in our country.

Endocrine Abnormalities in Adolescents with Menstrual Disorders.

Purpose: To look for endocrine abnormalities like thyroid disorders, hyperprolactinemia, hyperandrogenism and PCOS among adolescents with menstrual disorders and to compare the above endocrine status with those without menstrual disorders. Methods: This was a case-control study carried out in adolescent girls aged 10-19 years in gynecology outpatient department of a tertiary care hospital. Sample of venous blood (5 ml) was taken for hormonal studies as clinically indicated-thyroid function test, serum prolactin, total testosterone, which were analyzed by chemiluminescence system. Results: Oligomenorrhea was the most common menstrual abnormality in our study, the prevalence being 61.0% in cases followed by primary amenorrhea (16.4%). Thyroid dysfunction was found in 13.6% girls with menstrual disorders compared to 3.5% in those without menstrual disorders, and this was statistically significant (p = 0.006). Biochemical hyperandrogenism was seen in 9.04% cases compared to 0.7% controls (p = 0.001). The overall prevalence of hyperprolactinemia was 0.94%, and there was no statistically significant difference in girls with and without menstrual disorders. The prevalence of PCOS was 12.4% in the study population and 22.6% cases. Oligomenorrhea and PCOS were the most prevalent phenotypes in 52.5% of PCOS girls. No endocrine abnormality was detected in cases of polymenorrhea, hypomenorrhea and intermenstrual bleeding. Conclusions: Although immaturity of hypothalamic pituitary ovarian axis is considered to be the most common cause of menstrual irregularities in adolescent girls, endocrine abnormalities, namely thyroid dysfunction and hyperandrogenism, may be responsible in some cases, thus warranting further evaluation.

Awareness and practices on eye effects among people with diabetes in rural Tamil Nadu, India.

BACKGROUND: Recently eye effects of Diabetes Mellitus (DM) are an important concern due to increase in its trend especially in developing countries. OBJECTIVES: To assess the awareness related to eye effects of DM and its prevention practices among people with diabetes. METHODS: This cross sectional study was conducted from January 2013 to April 2013 in Villupuram district of Tamil Nadu, India. All 105 people with diabetes from the service area of two sub-centres were included. Data on socio demographic details, history of DM, awareness on systemic complications of DM, effects of DM on eyes, practice on regular blood check-up, eye examination and source of information were collected by interview technique using a structured questionnaire. Univariate and multiple logistic regression analysis were done to assess the association of awareness of eye examination with socio-demographic variables. RESULTS: Mean age of the study population was 56.7 years. About 93 people with diabetes (88.6%) tested their blood sugar at least once in every 3 months. About 80 people with diabetes (76.2%) were aware of at least one systemic complication of DM. Although 78 (74.3%) people with diabetes were aware that DM could affect the eyes, majority of this group (68, 87.2%) did not know the specific effects of DM on eyes. In this group, about 28(35.9%) people with diabetes were not aware of the reasons for eye effects, while others mentioned that persistent high blood sugar level (n=26, 33.3%), longer duration of DM (n=14, 17.9%) and lifestyle (n=10, 12.8%) were the reasons for the eye effects of DM. Only 31 (29.5%) of them knew that their eyes must be regularly examined. People with diabetes who had post-secondary and above (>10th standard) level of education had significantly higher awareness on examination of eye (Adjusted OR=19.63). CONCLUSION: Although awareness of people with diabetes on systemic effects of DM was more, their awareness on specific eye effects and need for regular screening was low. Systematic efforts are required to increase awareness on eye effects and importance of regular screening in this population.

Attack rate and household secondary attack rate of acute conjunctivitis during an outbreak in South India: A community-based survey.

INTRODUCTION: Knowledge on epidemiology of the disease in the contemporary world will help to develop appropriate strategies to curtail the transmission during an outbreak. This study was carried out during an outbreak of conjunctivitis in selected areas of Puducherry, South India, to assess the attack rate of conjunctivitis, identify factors associated with developing conjunctivitis and calculate household secondary attack rate (HSAR) of conjunctivitis and its correlates. METHODOLOGY: During December 2014, a community-based survey was conducted in a selected urban and rural area in Puducherry, South India. Simple random sampling was used to select primary sampling units and systematic sampling to select households. All individuals in the selected households were studied. A questionnaire was used to obtain data on sociodemographic characteristics, conjunctivitis during September-November, 2014, and number of household contacts who developed conjunctivitis within 7 days of index case. The attack rate and HSAR of conjunctivitis was expressed as percentage. Multivariate logistic regression was used to find factors independently associated with developing conjunctivitis and also 100% HSAR. RESULTS: Of 3193 study participants from 772 households, 509 (15.9%, 95% confidence interval 14.7-17.2%) had an attack of conjunctivitis during the reference period. Of the 772 households, 218 (28.2%) had at least one case of conjunctivitis. Of 218 households, 33 (15.1%) households had 100% HSAR. Lower age, not being unemployed, low socioeconomic status, and residing in rural area were independently associated with developing conjunctivitis. Index case being male and living in a household with ≥5 members were independently associated with 100% HSAR. CONCLUSION: In the outbreak under study, more than one-fourth of households had at least one case of conjunctivitis and about one in every six individuals had an attack of conjunctivitis.

Awareness and Attitudes toward Organ Donation in Rural Puducherry, India.

BACKGROUND: For many of the end-stage organ diseases, organ transplantation is the most preferred treatment. The need for the organ transplantation is higher than the availability. For the transplantation program to be successful, awareness regarding organ donation is needed and people must have a positive attitude toward donating organs. AIM: This study aims to assess the awareness and attitudes regarding organ donation among the rural population and to evaluate the sociodemographic factors associated with their awareness. SUBJECTS AND METHODS: This community-based cross-sectional study was conducted among 360 people living in 4 villages of Puducherry. Face-to-face interviews were carried out using pretested questionnaire, which included the sociodemographic data. Data were entered into Excel and analyzed using Statistical Package for Social Sciences. RESULTS: Of 360 participants, 88% (317/360) were aware of organ donation. Among these 317 participants, awareness was highest in the age group 18-30 years 98.8% (87/88), male 91% (147/161), higher secondary and above 100% (58/58), and Class 1 socioeconomic status 92% (13/14). Source of awareness about organ donation was primarily through media 83% (263/317). The majority of the participants 88% (281/317) felt that the purpose of organ donation was to save life. Most of the participants 91% (290/317) said that all healthy adults are eligible organ donors and 87% (275/317) of the participants said that monetary benefits could not be accepted for organ donation. Most of the participants 70% (223/317) were willing to donate their organs after death. Among the participants who refused to donate their organs, family refusal 57% (25/44) was the most common reason. CONCLUSION: This study shows that there is a high level of awareness about organ donation among rural people and most of the participants are willing to donate their organs.

Does audit improve diabetes care in a primary care setting? A management tool to address health system gaps.

INTRODUCTION: Diabetes mellitus is one of the emerging epidemics. Regular clinical and biochemical monitoring of patients, adherence to treatment and counseling are cornerstones for prevention of complications. Clinical audits as a process of improving quality of patient care and outcomes by reviewing care against specific criteria and then reviewing the change can help in optimizing care. OBJECTIVE: We aimed to audit the process of diabetes care using patient records and also to assess the effect of audit on process of care indicators among patients availing diabetes care from a rural health and training center in Puducherry, South India. MATERIALS AND METHODS: A record based study was conducted to audit diabetes care among patients attending noncommunicable disease clinic in a rural health center of South India. Monitoring of blood pressure (BP), blood glucose, lipid profile and renal function test were considered for auditing in accordance with standard guidelines. Clinical audit cycle (CAC), a simple management tool was applied and re-audit was done after 1-year. RESULTS: We reviewed 156 and 180 patients records during year-1 and year-2, respectively. In the audit year-1, out of 156 patients, 78 (50%), 70 (44.9%), 49 (31.4%) and 19 (12.2%) had got their BP, blood glucose, lipid profile and renal function tests done. Monitoring of blood glucose, BP, lipid profile and renal function improved significantly by 35%, 20.7%, 36.4% and 56.1% over 1-year. CONCLUSION: CAC improves process of diabetes care in a primary care setting with existing resources.

Development and implementation of healthy workplace model in a selected industry of Puducherry, South India.

BACKGROUND: The workplace is increasingly being used as a setting for health promotion and preventive health activities; not only to prevent occupational injury, but to assess and improve people's overall health. OBJECTIVE: This study aims at developing and implementing a healthy workplace model in a software industry of Puducherry. METHODS: Operations research was carried out in a purposively selected industry in Puducherry. The study was planned in four phases-baseline assessment and risk profiling, intervention, final evaluation and dissemination of results. Baseline evaluation of employees (n = 907) was done by a self-administered questionnaire to collect sociodemographic variables and risk factor profile using noncommunicable diseases (NCDs) LITE Proforma. RESULTS: Healthy workplace committee comprising of several stakeholders was formed, and a formal launch of the health awareness campaign was organized. Broad themes for health education sessions and support activities were identified. Risk profiling of employees showed high levels of risk factors and morbidity-more than 15% were found to be hypertensive and around 55% were obese. Stress and back ache were reported by almost half of the respondents. Modifications in the workplace targeting physical and psychosocial work environment were suggested to the committee, as part of the initiative. This study has demonstrated the feasibility of developing and implementing a healthy workplace model in South India. This model can be replicated or adapted in other industries for health promotion and prevention of NCDs. CONCLUSION: Dedicated and concerted efforts of the management consistent with the requirements of safety, health and environment at work place with appropriate support from the health system can improve the quality of work and working life.

A randomized controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum hemorrhage.

PURPOSE: In India, two third of maternal deaths occur in rural areas where there is lack of transportation facilities, lack of refrigeration to store the injectable uterotonic drug such as oxytocin, lack of skilled personnel to administer them and lack of sterile syringes and needles. Hence, this study was conceived to evaluate misoprostol as a safe, effective, easily administered non-parenteral drug in the prevention of postpartum hemorrhage. METHODS: This study was conducted during the period from August 2012 to July 2014. Low risk women with singleton pregnancy at term admitted for vaginal delivery were eligible for the study. A total of 500 women were randomized to two groups, 250 in each group, either to receive 400 mcg misoprostol sublingually or 10 units oxytocin intramuscularly at the delivery of anterior shoulder. Patient factors, labor parameters, blood loss and side effects were noted. RESULTS: The women in both the groups were well matched with respect to age, parity, gestational age and labor parameters. There was statistical significance in the blood loss (p = 0.04) between the two groups. The average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin group. Shivering was the statistically significant side effect (p = 0.004) in the misoprostol group and nausea was the statistically significant side effect (p = 0.003) in the oxytocin group. CONCLUSIONS: Sublingual misoprostol is as effective as intramuscular oxytocin as a prophylactic oxytocic in the active management of third stage of labor for prevention of postpartum hemorrhage.

Palliative care in India: Situation assessment and future scope.

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems - physical, psychosocial, and spiritual. It is estimated that in India the total number of people who need palliative care is likely to be 5.4 million people a year. Though palliative care services have been in existence for many years, India ranks at the bottom of the Quality of Death index in overall score. However there has been steady progress in the past few years through community-owned palliative care services. One of the key objectives of the National Programme for prevention and control of cancer, diabetes, cardiovascular diseases, and stroke is to establish and develop capacity for palliative and rehabilitative care. Community models for the provision of home-based palliative care is possible by involving community caregivers and volunteers supervised by nurses trained in palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.

Prevalence of bronchial asthma and its associated factors among school children in urban Puducherry, India.

BACKGROUND: Bronchial asthma is an important public health problem at the global level. There is paucity of studies on bronchial asthma among school children in Urban India. OBJECTIVE: To assess the prevalence and associated factors of bronchial asthma among school children. MATERIALS AND METHODS: A cross-sectional study was conducted among 263 children studying in the 8(th), 9(th), and 10(th) standard using the modified International Study on Allergy and Asthma in Childhood questionnaire in Urban Puducherry. Data on associated factors that include family history of asthma, type of fuel used for cooking, placement of kitchen in the house, number of windows in sleeping room, pet animals, smoking among family members, birth order, and smoke outlet were collected. Data were analyzed by univariate analysis and expressed in proportion or percentages. RESULTS: Prevalence of ever bronchial asthma was found to be 5.3%, of which 4.2% had current episode of asthma during the last 1-year period. About 72.7% of the current asthmatics had cold or rhinitis and 54.5% each had itching or rashes and nocturnal dry cough. Prevalence is more among the 12-13 years age group (6.5%) compared to the 14-16 years age group (3.6%). Boys (5.4%) and girls (5.2%) had comparable prevalence rates. The prevalence was significantly more among those with a family history of asthma, having smoking habits in any of the family members, and the absence of smoke outlet in the house (P < 0.05). CONCLUSION: Bronchial asthma is an important health problem among children in urban Puducherry. Intervention on exposure to passive smoking and provision of smoke outlets may help to reduce the burden of disease at the community level.

Self-directed learning readiness among fifth semester MBBS students in a teaching institution of South India.

BACKGROUND: Lifelong learning is a skill that must be acquired by medical graduates and proposes that students take the responsibility for learning process. The present study was carried out to measure readiness for self-directed learning among fifth semester MBBS studentsin a tertiary care teaching hospital. METHODS: Readiness assessment was carried out among 87 fifth semester MBBS students using Fishers' 40-item self-directed learning readiness score (SDLRS) instrument after taking informed written consent. A total of 40 items were classified into three domains: Self-management (9 items), desire for learning (16 items) and self-control (15 items). Institute scientific society and ethical committee clearance was obtained. The data were entered and analyzed using IBM-SPSS version 21. Chi-square test was used to elicit relationship between readiness assessment and gender, presence of a physician in family and area of residence. RESULTS: Out of 87 students, 64 (73.5%) students consented to be assessed for readiness toward self-directed learning. The mean SDLRS score was 140.4 ± 24.4, with 19 students (30%) scoring more than 150 indicating high readiness.The mean scores in the three domains of self-management, desire for learning and self-control were 38.8 ± 9.8, 47.3 ± 6.9 and 54.3 ± 10.4, respectively. Males had a higher readiness for self-directed learning than females (P = 0.045). DISCUSSION: Self-directed learning scores were lower among our MBBS students than reported elsewhere in the literature.

Community-based physical activity intervention using principles of social marketing: a demonstration project in Southern India.

BACKGROUND: We aimed to study the development and implementation of promotion of physical activity in a rural community by applying the principles of social marketing and to determine participation behaviour in a physical activity programme in a community setting. METHODS: The intervention targeted 485 people, 20-49 years of age, residents of Periakattupalayam and Rangareddipalayam villages, Tamil Nadu. This community-based participatory research was based on the principles of 'social marketing'. Health education by one-to-one counselling, written materials and community events were used to popularize moderate intensity physical activity (brisk walking for 30 minutes on 4 days/week). We formed 30 walking groups under four coordinators, in a home-based setting with professional supervision and guidance. A log of physical activity sessions for the 10-week intervention period was maintained in the form of group attendance record. Village leaders, self-help groups and youth clubs were involved in promoting physical activity. RESULTS: Of the 485 subjects, 265 people (54.6%) engaged in brisk walking >4 days a week, while 156 subjects (32.2%) performed walking on 1-4 days per week during the intervention. The drop-out rate was 13.2% (64 subjects). Age, occupation and educational status were important determinants of participation and adherence to the physical activity programme. CONCLUSION: Application of social marketing techniques in an intervention to promote physical activity was successful in a rural Indian community. Studying the determinants of adoption of a physical activity programme and addressing the barriers to behaviour change are essential for designing relevant policies and effective programmes.

Diarrhoeal diseases in developing countries: a situational analysis.

Recent data showed that there is no much reduction in diarrhoea related morbidity in developing countries. This is important in view of the Millennium Developmental Goal (MDG) to be achieved by 2015. This study reviewed and analyzed after gathering the recent literature information from Pubmed, internet and other sources. The authors discussed public health issues related to diarrhoeal diseases that include problem burden, determinants, intervention strategies, management, prevention and recent developments for control of diarrhoea among under-five children in developing countries. The study emphasizes the need for strengthening of comprehensive diarrhoeal disease prevention strategy at primary level including improvement of water quality, hygiene and sanitation, along with provision of oral rehydration solution and zinc supplements, and research in the field of vaccine and cost effective interventions.