Odisha tribal family health survey: methods, tools, and protocols for a comprehensive health assessment survey

Tribal or indigenous communities have unique health behaviors, challenges, and inequities that nationally representative surveys cannot document. Odisha has one of India's largest and most diverse tribal populations, constituting more than a fifth of the state. State and tribe-specific health data generation is recommended in India's national roadmap of tribal health. The Odisha tribal family health survey (OTFHS) aims to describe and compare the health status of tribal communities in the state of Odisha and to estimate the prevalence of key maternal-child health indicators and chronic diseases. This paper summarizes the methodology, protocols, and tools used in this survey. This is a population-based cross-sectional survey with a multistage random sampling design in 13 (tribal sub-plan areas) districts of Odisha, India. We will include participants of all age groups and gender who belong to tribal communities. The sample size was calculated for each tribe and aggregated to 40,921, which will be collected from 10,230 households spread over 341 clusters. The survey data will be collected electronically in modules consisting of Village, Household, and Individual level questionnaires. The age-group-specific questionnaires were adapted from other national family health surveys with added constructs related to specific health issues of tribal communities, including-critical indicators related to infectious and non-communicable diseases, multimorbidity, nutrition, healthcare-seeking behavior, self-rated health, psycho-social status, maternal and child health and geriatric health. A battery of laboratory investigations will be conducted at the household level and the central laboratory. The tests include liver function tests, kidney function tests, lipid profile, iron profile, and seroprevalence of scrub typhus and hepatitis infections. The datasets from household questionnaires, field measurements and tests and laboratory reports will be connected using a common unique ID in the database management system (DBMS) built for this survey. Robust quality control measures have been built into each step of the survey. The study examines the data focused on different aspects of family health, including reproductive health, adolescent and child health, gender issues in the family, ageing, mental health, and other social problems in a family. Multistage random sampling has been used in the study to enable comparison between tribes. The anthropometric measurements and biochemical tests would help to identify the indicators of chronic diseases among various age groups of the population.

Access to Maternal and Child Health Services during the COVID-19 Pandemic: An Explorative Qualitative Study in Odisha, India

Background

Maternal and child health (MCH) care is one of the essential routine healthcare services, which got affected during the coronavirus disease 2019 (COVID-19) pandemic. Modeled projections had anticipated an 8.3%-38.6% rise in maternal mortality from different countries globally. In view of limited studies pertaining to issues related to accessing MCH services in the event of a pandemic, this study was carried out on pregnant and postnatal mothers in Odisha, India.

Methods

An explorative qualitative study through 36 in-depth interviews (IDIs) was conducted among 16 (44.4%) antenatal and 20 (55.5%) postnatal mothers in six of thirty districts of Odisha, India, from February to April 2021. The districts and blocks were randomly selected for better representativeness. The IDIs were conducted using a predesigned and pretested guide among mothers who had undergone delivery or availed of antenatal, postnatal, or child health services from October 2020 to April 2021. The IDIs were conducted till data saturation. The data were analyzed using MAXQDA software.

Results

The average age of mothers was 27.6 (+/- 2.2) years. Among the participants, 16 (44.4%) were antenatal and 20 (55.6%) were postnatal mothers; 19 (52.8%) were primipara and 17 (47.2%) were multipara. The majority explained that they received enormous support including door-to-door services from the community health workers (CHWs) even during the difficult times of the pandemic. Reduced transportation facility and fear of contracting the infection were reasons behind the unwillingness to visit health facilities and preference for home delivery. Furthermore, the pandemic had physical, mental, social, and financial impacts among pregnant and postnatal women.

Conclusion

The unprecedented COVID-19 pandemic has affected access to MCH services by antenatal and postnatal mothers. Health system preparedness and appropriate strategies including better community engagement and participation could avert such challenges in the future.

A multicenter prospective observational study on the use of type and screen method versus conventional type and crossmatch policy for pre-transfusion testing in the Indian population

Despite knowing the benefits of the type and screen (TS) method in pre-transfusion testing (PTT), most transfusion centers in developing countries continue to be reluctant to adopt a TS strategy over the conventional type and antihuman globulin (AHG) crossmatch (TX) policy in their routine laboratory practice because of the cost of obtaining antibody screening reagents. To generate strong evidence, this multicenter, observational study was conducted in which we collected data prospectively over a 1-year period from six major blood centers in India. The primary objective of this study was to identify the discordance between TS and TX results. A secondary objective was to identify the allo-antibody specificity in patients with positive antibody detection tests. All patients with orders for red blood cell transfusion who met patient selection criteria were subjected to parallel testing by column agglutination technology (CAT) for both the antibody detection test (screen) using a commercial three-cell panel and for the AHG crossmatch. A total of 21,842 patients were tested. In 148 patients with incompatible crossmatches, samples from six patients gave negative results with the antibody detection test, whereas the antibody detection test was positive in samples from 118 patients among the 21,694 crossmatch-compatible cases. The TS approach achieved a positive percent agreement of 95.95 and was found to be significantly effective in preventing the transfusion of serologically incompatible blood. The risk associated with abbreviating the AHG crossmatch was found to be 0.009 percent. Most of the identified clinically significant alloantibodies were directed to Rh antigens (D>E>c>C>e), followed by anti-K and anti-M. This study has generated sufficient robust data for the Indian population by including patients from all major geographical areas of the country and concluded a satisfactory agreement level as well as non-inferiority to the current PTT policy. Therefore, TS policy can be implemented in developing countries with no compromise on blood safety, provided sufficient technical and infrastructural support are available.

Community response towards health care providers delivering health care services during COVID-19 pandemic: A strategy framework based on findings of a qualitative study in Odisha, India

Context

While there are studies on peoples' behaviour toward health professionals (doctors and nurses) during the Coronavirus diesease (COVID-19) pandemic in hospital settings, there is limited literature on Community Health Workers (CHWs). Our study attempted to explore the behaviour of community people towards CHWs during the pandemic and its underlying reasons.

Material and Method

A qualitative study using In-depth interviews (IDI) and focus group discussions (FGD) was conducted among CHWs and community people from six districts of Odisha from February to April 2021. The researchers transcribed the audio recordings in the vernacular language of the Odisha province, i.e., Odia, and later translated them into English. A qualitative content analysis method was used to prepare the detailed report using Max Weber Qualitative Data Analysis (MAXQDA) software.

Result

The study found two major categories-Reflection on community behaviour towards CHWs during the COVID-19 pandemic and reflection on availing health care services by community people during a pandemic. Many CHWs revealed that the community people acknowledged their work and dedication and extended all sorts of co-operation and support. However, few community people were non-cooperative and non-supportive. Community reluctance owing to perceptions that the CHWs might be infected, was the significant cause that they faced a lack of support from the community. Further, to create awareness of COVID-19 infection among community people, CHWs adopted different strategies such as door-to-door visits, wall painting, poster display, and awareness through mikes.

Conclusion

The efforts made by the CHWs during health emergencies need to be recognized and appraised.

Effective interventions to ensure MCH (Maternal and Child Health) services during pandemic related health emergencies (Zika, Ebola, and COVID-19): A systematic review

INTRODUCTION

Ensuring accessible and quality health care for women and children is an existing challenge, which is further exacerbated during pandemics. There is a knowledge gap about the effect of pandemics on maternal, newborn, and child well-being. This systematic review was conducted to study maternal and child health (MCH) services utilization during pandemics (Zika, Ebola, and COVID-19) and the effectiveness of various interventions undertaken for ensuring utilization of MCH services.

METHODOLOGY

A systematic and comprehensive search was conducted in MEDLINE/PubMed, Cochrane CENTRAL, Embase, Epistemonikos, ScienceDirect, and Google Scholar. Of 5643 citations, 60 potential studies were finally included for analysis. The included studies were appraised using JBI Critical appraisal tools. Study selection and data extraction were done independently and in duplicate. Findings are presented narratively based on the RMNCHA framework by World Health Organization (WHO).

RESULTS

Maternal and child health services such as antenatal care (ANC) visits, institutional deliveries, immunization uptake, were greatly affected during a pandemic situation. Innovative approaches in form of health care services through virtual consultation, patient triaging, developing dedicated COVID maternity centers and maternity schools were implemented in different places for ensuring continuity of MCH care during pandemics. None of the studies reported the effectiveness of these interventions during pandemic-related health emergencies.

CONCLUSION

The findings suggest that during pandemics, MCH care utilization often gets affected. Many innovative interventions were adopted to ensure MCH services. However, they lack evidence about their effectiveness. It is critically important to implement evidence-based appropriate interventions for better MCH care utilization.

Resolution of Resilience: Empirical Findings on the Challenges Faced and the Mitigation Strategies Adopted by Community Health Workers (CHWs) to Provide Maternal and Child Health (MCH) Services during the COVID-19 Pandemic in the Context of Odisha, India

Community health workers (CHW) faced increased challenges in delivering maternal and child health services during the current COVID-19 pandemic. In addition to routine services, they were also engaged in pandemic management. In view of a dearth of evidence, the current study explores the challenges faced by CHWs while rendering maternal and child health services. A qualitative study through in-depth interviews (IDI) and focus group discussions (FGD) in six districts of Odisha was conducted from February to April 2021. Data were analyzed using MAXQDA software. Personal-level challenges, like lack of family support, stress, and fear of contracting COVID-19; facility-level challenges, like transportation problems and inadequate personal protective measures; and community-level challenges, like stigma, resistance, and lack of community support were major hindrances in provisioning routine MCH services. Prevailing myths and misconceptions concerning COVID-19 were factors behind stigma and resistance. Sharing experiences with family, practicing yoga and pranayam, engaging ambulance bikes, financial assistance to mothers, counseling people, and involving community leaders were some effective strategies to address these challenges. Development and implementation of appropriate strategy guidelines for addressing the challenges of frontline warriors will improve their work performance and achieve uninterrupted MCH services during pandemics or similar health emergencies.

148 Superovulation and embryo production response in oestrus-synchronized Arunachali yak

The Arunachali breed of yak is reared by the Monpa pastoral community of Arunachal Pradesh in India for their livelihood and nutritional security on highland pastures. In addition to fulfilling the basic needs of highlanders, this animal is associated with poor production potential linked to its inherent reproductive problems, including silent oestrus, seasonality, and inbreeding, making yak rearing a less-profitable venture. In the recent past, efforts have been made to improve reproductive efficiency of Arunachali yak through assisted reproductive techniques. However, a few regimens for superovulation have been tried to date with limited success in terms of superovulatory response and embryo recovery. Therefore, the present study was undertaken to evaluate the efficacy of two different doses and regimes of superovulation: Stimufol (400 and 200µg per animal) and Folligon (1500 and 1000IU per animal) in Arunachali yak. Twenty-four yaks were allotted in 4 groups (of 6 animals each) and subjected to respective superovulation treatment. Thereafter, the treatment response was assessed in terms of expression of oestrus, interval between treatment and oestrus onset, duration of oestrous, number of corpora lutea and embryos recovered, and analysed using two-way statistical analysis between treatment groups. The results (Table 1) showed a significant (P<0.01) variation in onset of oestrus after the treatment, whereas other responses did not differ among the groups. Further, the recovered embryos were categorized as excellent, good, fair, and poor according to cell size, shape, texture, and number of vesicles present in the blastomeres; 58.33, 20.83, 8.33, and 12.5% embryos in these categories were recovered, respectively. The overall embryo recovery rate was 30.77%, ranging from 10.53 to 52.38% in different treatment groups. The numbers of embryos recorded were less than the numbers of CL present, showing the possibility of non-availability of all ovulated oocytes for fertilization in the oviduct due to untrapping by the fimbriae. The effectiveness of treatments depended upon the precision of oestrus detection and the time of ovulation. In our study, the variation in onset of oestrus might be associated with poor expression of behavioural oestrus in the treated animals. Based on the present findings, we conclude that all the treatments are effective in superovulation and embryo recovery. However, the use of Folligon at 1500IU seemed to be comparatively more effective in Arunachali yak. Table 1. Mean (n=6) average of treatment responses in yak following different superovulatory treatment Variable Treatment Stimufol Folligon 400 µg/animal 200 µg/animal 1500 IU/animal 1000 IU/animal Oestrus response (%) 100 100 100 100 Interval between treatment and oestrus onset (h) 17.67±0.56a 20.83±0.79b 21.17±0.79bc 23.67±1.43c Duration of oestrous (h) 30.33±1.09 28.50±0.99 31.50±1.50 28.83±1.25 Corpora lutea (n) 2.83±1.22 3.50±1.18 3.50±0.67 3.17±0.87 Embryo recovered (n) 0.83±0.83 1.00±0.81 1.83±0.98 0.33±0.21 Recovery rate (%) 29.41 28.57 52.38 10.53 a–cMeans within a row with different superscripts differ P<0.05.

Effect of Butylated Hydroxy Toluene and Vitamin E on the Cryosurvivability of Buck Semen

BACKGROUND

The quality of frozen semen can be improved by supplementing Tris extender with antioxidant to prevent oxidation and maintain sperm motility.

OBJECTIVE

To study the effects of adding combinations of suitable concentrations of butylated hydroxy toluene (BHT) and Vitamin E in Tris extender on the quality of frozen goat semen.

MATERIALS AND METHODS

A total of 40 ejaculates collected from five Beetal bucks were used to study the effect on the quality of frozen semen of supplementing Tris extender with 200 µM BHT, 2 mM Vitamin E and 200 µM BHT + 2 mM Vitamin E.

RESULTS

The sperm motility, live sperm, live intact acrosome and HOST-reacted sperm differed significantly (P<0.01) between stages and between antioxidants. There was no significant difference (P<0.05) in interaction between stages (equilibration, freezing) and antioxidants, except for HOST-reacted sperm. Critical difference test revealed that Tris extender containing 2 mM vitamin E showed significantly (P<0.05) higher sperm motility, live sperm, live intact acrosome and HOST-reacted sperm, and significantly (P<0.05) lower release of alanine transaminase (ALT) and aspartate transaminase (AST).

CONCLUSION

Supplementation of Tris extender with 2 mM vitamin E maintained superior quality of frozen Beetal buck semen.

Single Versus Multi-visit Endodontic Treatment of Teeth with Apical Periodontitis: An in vivo Study with 1-year Evaluation

Background:

Apical periodontitis (AP) is one of the most prevalent diseases of the teeth. Treatment of AP is based on the removal of the cause, i.e., bacteria from the root canals. Achievement of adequate bacterial eradication in one appointment treatment remains a controversy.

Aim:

This prospective study was conducted with the objective to compare the periapical healing of teeth with AP treated in (a) single visit versus (b) two visits, either with or without Vitapex as an intracanal medicament.

Subjects and Methods:

Patients were selected randomly from the Department of Conservative Dentistry and Endodontics. Forty-three patients (81 teeth) met the inclusion criteria, i.e., AP (both symptomatic and asymptomatic) visible radiographically size ≥2 mm × 2 mm, not suffering from any immune-compromising disease, age between 16 and 65 years and tooth not accessed previously. Patients were randomly divided into three groups, i.e., single-visit group (Group 1), multi-visit group without any intracanal medicament (Group 2), and multi-visit group with Vitapex as interim intracanal medicament (Group 3). Comparison was done radiographically using periapical index (PAI). The primary outcome measure was the change in periapical radiolucency after 1 year assessed by PAI scores. The Mann-Whitney U-test was used to evaluate differences between groups at baseline (immediate postoperative) and at the 12-month follow-up evaluation. Change in PAI score for each group from baseline to 12-month follow-up evaluation was tested with the Wilcoxon signed rank test. The secondary outcome measures, proportion of teeth in each group that could be considered improved (decreased PAI score) or healed (PAI <2), were assessed with the Chi-square test.

Results:

No statistically significant difference in periapical healing was found between three groups.

Conclusion:

After 1-year evaluation, no difference in periapical healing was found between single-visit treatment and multi-visit treatment groups with the given sample size.