Assessment of Knowledge Gap on Cigarettes and Other Tobacco Products Act (COTPA) among Tobacco Vendors in Puducherry: A Mixed-Method Study

Background

Tobacco usage has been identified as a leading preventable cause of mortality and is responsible for six million fatalities per year globally. India had enacted COTPA in 2003. Tobacco vendors are one of the key stakeholders for Cigarettes and Other Tobacco Products Act (COTPA) implementation.

Objective

To assess the knowledge gap on COTPA and to explore the perceived factors influencing implementation of COTPA among tobacco vendors in Puducherry.

Materials and Methods

A mixed-method study was conducted among tobacco vendors from Point of Sale (PoS) around 230 educational institutions (schools and degree colleges) in Puducherry for three months. Simple random sampling was applied to select educational institutions and the tobacco vendors from PoS located around these institutions were included. Data capture was done using a pretested, face-validated questionnaire incorporated in Epicollect software 5 and data analysis by SPSSv24. Purposive sampling was employed to conduct in-depth interviews among tobacco vendors till the point of saturation and manual content analysis performed. Written informed consents were sought. Institutional Ethical Committee approval was obtained.

Results

Majority (95.7%) reported that they were aware of tobacco control legislation, but only one person had heard of COTPA. Awareness about the display of signage boards at PoS was observed in 75.7% vendors. Around 41.7% reported that they should not advertise any kind of tobacco products. Three major themes were identified: facilitators, barriers, and suggested measures for COTPA implementation.

Conclusion

Tobacco vendors in Puducherry were aware of tobacco control legislations but not familiar with the COTPA and its provisions. It is necessary to put forth efforts to educate these important stakeholders to be more cognizant of COTPA and to effectively include them in anti-tobacco programs.

Effectiveness of a multimodal intervention in promoting physical activity among sedentary elderly population in socially and economically constrained settings - A quasi-experimental study

Introduction

Aging is becoming a major challenge for policymakers. Regular exercise helps keep elderly people mobile, enhances physical and mental abilities, and to some extent delays the effects of chronic illnesses.

Objectives

To evaluate the effectiveness of a multimodal intervention to increase physical activity levels among sedentary elderly living in socially and economically constrained settings.

Materials and Methods

A quasi-experimental study was conducted in selected old age homes in Puducherry, South India in 2022 for 3 months. Individuals aged ≥60 years, both genders residing in selected old-age homes were included through convenience sampling. The sample size was 36 subjects per arm [three arms namely E1, E2 (intervention arms), and C (control arm)]. Baseline data collection on physical activity was collected using a semi-structured questionnaire in all three arms. The intervention arms (E1 and E2) received a multimodal intervention to promote physical activity. In addition, E1 arms were instructed to perform exercises with an "exercise partner" and to maintain a daily log. At the end of 8 weeks, follow-up data collection was done using the same questionnaire in all three arms. Data entry was done by MS Excel 2010 and analysis using SPSS version 21.

Results

The mean (SD) of the days of physical activity per week and time of physical activity per day before and after the intervention among E1 and E2 were compared using paired t-tests. The difference between pre- and post-intervention was found to be statistically significant, that is, P value <0.05 in both the groups, thereby proving the effectiveness of the intervention. The difference between the three groups was found to be statistically significant, that is, P value <0.05.

Conclusion

This multimodal intervention is found to be effective in increasing the physical activity of the participants in the interventional arms. Furthermore, having an exercise partner was found to be beneficial in ensuring motivation and compliance to carry out physical activity among the elderly living in socially and economically constrained settings.

Assessment on Quality of Healthcare Services during Childbirth: A Community-based Mixed-method Study in the Women of Puducherry

Background

A women's right to a positive childbirth experience should be the heart of any care provided. To assess the quality of childbirth services and mistreatment by healthcare providers among reproductive age group women and to explore factors influencing the same between women and stakeholders.

Material and Methods

A community-based, mixed-method study was conducted from April to September 2021 in field practice areas of a medical college in Puducherry district. The sample size for the quantitative study was 348 and the women were chosen using a multi-stage sampling technique. Women were interviewed with a semi-structured questionnaire. In-depth and key informant interviews between women and stakeholders were done for the qualitative data collection.

Results

Three-fourths (77.0%) of women preferred government tertiary healthcare facilities for obstetric care. Although 69.0% and 75.6% of the participants did not experience any verbal and physical abuse, respectively, the qualitative study results were quite the opposite. While 92.8% of the women complained that no birth companion was allowed during their delivery. Moreover, 79.9% of the women did not have the freedom to choose their comfortable birthing position. The levels of mistreatment in the rural areas were slightly higher than that of the urban areas.

Conclusion

Quality care is a fundamental approach to maternity care. A fair bit of women experiences mistreatment during childbirth in healthcare setups. However, the chief concern here is the perception of such abuse by the mothers as normal due to their lack of knowledge regarding women's rights.

A perspective on the widening gap between Covishield vaccine doses in India

The Oxford University-AstraZeneca’s vector-based vaccine called Covishield (ChAdOx1 nCoV- 19 Vaccine) is being manufactured and distributed by Serum Institute of India (SII).  National roll out of this vaccine was in a phased manner starting from 16th January 2021. At present, many states are facing shortage of vaccines. Government of India kept changing its policy on dosing gap of Covishield vaccine based on researches. The latest recommendation citing “real-life evidence” from the UK is to extend the two doses of Covishield to 12-16 weeks. This reasonable approach will not only a breathing space for the government but also aids in free up doses for a larger number of people to get their first dose of the vaccine.

Men's involvement in women's reproductive health: A community-based mixed-method study

Background

Female dominion in family planning has underestimated men's participation in female reproductive health.

Objective

To assess male's involvement in female reproductive health with regard to safe motherhood and family planning and to explore the factors influencing the participation of males in reproductive and sexual health.

Methods

A community-based, mixed-method study was conducted from May 2018 to January 2019 in urban Puducherry. All eligible couples with at least one child were included. Two-stage random sampling with a sample size of 373 was considered. Data were collected separately among spouses using epi-collect 5 and analyzed using the SPSS software version 23. Qualitative data were obtained using free-listing and pile-sorting techniques, analyzed in Anthropac software.

Results

39.9% had planned their pregnancy. Only 33.5% of couples had decided together with the place of delivery. 76.7% of wives wish to involve their husbands in family planning. 88.2% of wives and 89.8% of husbands chose tubectomy as the preferred method of permanent contraception. Both husband and wife were involved in child rearing among 60.3% of participants. The changing dynamics of society, health-care provider initiative, and literacy level favored males' involvement in females' reproductive health.

Conclusion

Men were involved in planning the pregnancy, supporting their spouse by accompanying for antenatal checkups, discussing with their partners about the complications faced during pregnancy. Health care facility-related factors and faith were perceived as hindering factors for males' involvement in reproductive health by either gender.

Patients’ satisfaction survey on healthcare services among non-communicable disease patients at a tertiary care hospital in Puducherry

Background: Patient satisfaction is a scale to assess the services offered by the healthcare system. Patient’s feedback is necessary to identify problems that need to be resolved in improving health services. Aim & Objective: Keeping this in view, the present study is an initiative to estimate the patient’s satisfaction in service provision among NCD patients at a tertiary care hospital of Puducherry. Settings and Design: A Facility-based descriptive cross-sectional study was conducted among NCD patients attending General medicine OPD of a tertiary care hospital of Puducherry between April-June 2019. Methods and Material: Assuming 50% satisfaction level among study participants and 5% non-response rate, the sample size was estimated as 404. The NCD register maintained at the General medicine OPD was considered as the sampling frame & systematic random sampling was applied, so that every 5th patient satisfying the inclusion criteria will be included. A standardized patient satisfaction questionnaire with 31-items (4 domains) which is validated for Indian setting (Cronbach’s alpha 0.96) was used. Statistical analysis used: Data capture was done using Epicollect-5 android application and analysed using SPSS version 16.0. Results: Among the 404 NCD patients, the mean age was 56 ± 11.8 (SD) years and 60.6% were females. One in four patients felt poor in reception, doctor-patient relationship and dispensary services. The overall satisfaction of study subjects categorized as good, satisfactory, poor was 6%, 86% and 8% respectively. Conclusions: Majority of the study participants were satisfied with the service provision of the health facility. Still, there is a scope for improvement in dispensary, doctor-patient relationship and registration services.