Depression among older adults in an urban slum of Raipur city - a community based cross-sectional study

BACKGROUND

Older adults are at risk of chronic, silent depressive changes and the vulnerability of older adults in urban slums of India is rarely exposed. The objective of this study was to estimate the prevalence of depression among the older adults in the urban slums of India and to study the factors associated with it.

METHODS

This was a community based analytical cross-sectional study conducted in Urban Field Practice Area of a tertiary care teaching hospital in Chhattisgarh, India among older adults more than or equal to 60 years of age selected using two stage, simple random sampling. The data was collected in a sample of 400 older adults by face-to-face interview using self-designed, semi-structured and pretested proforma that included validated Hindi version of Geriatric Depression Scale (GDS-15) and analyzed using SPSS v23.

RESULTS

The prevalence of depression among older adults was 51.5% in the present study; with 27%, 12.8% and 11.8% having mild, moderate and severe depression respectively. Number of family members, living status of spouse, emotional attachment to family members, conflict in family, loneliness, social isolation, marginal friendship ties, functional status, physical exercise, active complains and diastolic BP were independent predictors of depression in older adults.

CONCLUSION

Early identification of depression in older adults using GDS-15 and incorporation of social isolation and functionality assessment routinely by healthcare providers for all older adults attending the outpatient departments is the need of the hour. A holistic approach to care of older adults is vital as healthcare providers seek to understand the impact of multiple, complex, interconnected factors on overall health and well-being of older adults.

Electronic cigarettes: Ally or an enemy in combating tobacco-use-associated diseases - An integrative review

Introduction

E-cigarettes (ECs) portable battery-operated devices developed as a strategy for tackling tobacco-related harm are now becoming a global threat to human health.

Objectives

This integrative review aims to throw some light on the effect of ECs on human health and determine the safety of ECs with or without nicotine with long-term usage.

Methods

This integrative review includes findings from Randomized and non-randomized clinical trials, and laboratory-based Human studies; published in the English language in the last four years. Literature search sources were online databases such as PubMed, Medline, EMBASE, Web of Science, Google Scholar. Results: Following systematic search using inclusion and exclusion criteria, 21 articles were included in the final review. ECs result in an acute increase in cardiac Sympathetic Nerve Activity (SNA), pronounced as Electrocardiogram (ECG) changes resulting in a greater risk of sudden death for those with co-morbidities. ECs with or without nicotine can adversely affect lung function and can precipitate obstructive pulmonary diseases. ECs may also adversely affect oral health due to increased bacterial pathogenicity and periodontitis. At last, these nicotine-containing ECs can yield nicotine comparable to Traditional cigarettes (TCs) and sometimes to a much greater extent, thus posing the threat of the user becoming nicotine dependent.

Conclusion

Although ECs are less harmful than TCs in combustible inhaled constituents, their long-term safety can still not be ascertained due to the scarcity of long-term studies and conflicting results.

Prevalence and determinants of social isolation among elderly in an urban slum of Raipur city-A community based cross-sectional study

BACKGROUND

Social isolation is a predictor of mortality and morbidity, as well as an outcome of many health-related predictors. The aim of this study was to estimate the prevalence of social isolation among the elderly and to study factors associated with it.

METHODS

This was an analytical cross-sectional study conducted in Urban Field Practice Area of a tertiary care teaching hospital in Chhattisgarh, India among elderly more than or equal to 60 years of age selected using random sampling. The data was collected in a sample of 400 elderly by face-to-face interview using predesigned, pretested, and semi-structured proforma that included Lubben Social Network Scale-6 (LSNS-6) and analyzed using Stata v16.

RESULTS

The prevalence of social isolation was 34.3%; highest among those 65-74 years of age (44.5%) and females (56.9%). Increasing age, elderly with less than three family members, lower socio-economic status, no children and financial dependence among socio-demographic factors; insufficient time with children, lack of emotionally attachment and conflict in the family among family support factors; lack of social participation, poor perception of health and feeling lonely among psychosocial factors; lack of physical exercise, spiritual activity and sound sleep among lifestyle factors; and presence of active complaints, raised blood pressure and being anemic among medical factors were significantly associated with social isolation. Overall, the independent predictors of social isolation in elderly were age ≥75 years, lack of participation in social functions, feeling lonely and lack of sound sleep.

CONCLUSION

The prevalence of social isolation among elderly from an urban slum in India was high and the existing evidence show a rising trend. Social isolation assessment and use of LSNS-6 by healthcare providers should be incorporated into elderly care at primary healthcare delivery points across the country.

Kangaroo mother care (KMC) for procedural pain in infants: A meta-analysis from the current evidence of randomized control trials and cross-over trials

Background:

Kangaroo mother care (KMC), which is also known as Skin-to-skin (STS) care, is supposed to be effective in alleviating the pain of the neonates occurring during various procedures carried out in routine medical care or during the medical examination.

Objectives:

The meta-analysis aimed to determine the effect of the kangaroo mother care method on procedural pain in infants receiving KMC to those receiving only standard care (SC).

Search Strategy:

For this meta-analysis, a systematic literature search was conducted in online database PubMed, Medline, Web of Science, Google Scholar, and the CENTRAL database using MESH terms such as kangaroo mother care method/classification, kangaroo mother care method, kangaroo mother care method/instrumentation, kangaroo mother care method/methods, pain threshold, pain, pain management/methods, pain management/instrumentation, pain management/therapy, and pain management/therapeutic with the help of Boolean terms.

Selection Criteria:

Only randomized control trials or cross-over trials published within ten years and reporting pain assessment during or within five minutes of the pain stimulating procedure assessed using Premature Infant Pain Profile (PIPP) score were considered.

Data Collection and Analysis:

The primary outcome measures were procedural pain assessed by PIPP score and reported in mean and standard deviation along with 95% confidence interval (CI). In cross-over trials, data were taken from the first phase, i.e., before cross-over.

Main Results:

The pooled estimate of the six studies revealed a potential statistically significant benefit of KMC over SC in pain reduction following a pain stimulating procedure (P = 0.01, Mean difference = -2.04, 95% CI: -3.65, -0.43, Chi² = 69.86, I² = 93%). A high level of heterogeneity was found, i.e., 93%.

Conclusion:

Kangaroo mother care seems to be an effective intervention in alleviating the procedural pain due to routine procedures or medication examination.

Effectiveness of chewable toothbrushes compared to manual toothbrushes in removing dental plaque - A systematic review and meta-analysis

Objective

Chewable toothbrushes (CT) are considered an effective tool for dental plaque removal; however, their effectiveness is still uncertain compared to Manual toothbrushes (MT).

Aim

To evaluate the effectiveness of CT compared to MT in dental plaque removal.

Methods

Studies comparing the efficiency of CT and MT in dental plaque removal measured by Turesky Modification of Quigley-Hein Plaque Index (TMQHI), Quigley-Hein Plaque Index (QHI), or Silness Loe Plaque Index (SLPI) were identified in PubMed, Medline Web of Science, Google Scholar, and the CENTRAL. Results and effect sizes estimate are presented as mean difference, and subgroup analysis is presented separately for non-randomised interventional studies and randomised intervention studies. Risk of bias was assessed using the Cochrane risk of bias tool (ROBINS-I and ROB2 tool).

Results

A total of 10 studies were included in the systematic review, whereas six out of 10 studies were included in the meta-analysis. Both CT and MT were effective in plaque reduction over time when compared individually using the TMQHI and SLPI scores. The overall pooled summary showed no difference in CT and MT's dental plaque removal ability when measured using the TMQHI score. Similarly, there was no difference in CT and MT's dental plaque removal ability when measured using the SLPI score.

Conclusion

There is no significant difference in CT and MT's plaque removal ability. Therefore, CT should only be recommended for children and individuals with a disability or manual dexterity.

Objective

Chewable toothbrushes (CT) are considered an effective tool for dental plaque removal.

Tribal population in India: A public health challenge and road to future

India with 8.6% of tribal population is finding it difficult to bridge the gap that exists between tribal and non-tribal population in regards to healthcare. Tribal population suffers triple burden of disease; in fact it is quadruple, namely, communicable diseases, non-communicable diseases, malnutrition, mental health, and addictions complicated by poor health seeking behavior. With increasing needs, an Expert committee on Tribal health has given recommendations with the goal to bridge the current gap in the health status of tribal people latest by the year 2027. An entirely parallel health system has been proposed with key focus areas, governance, and financing. To summarize and report the present scenario in terms of disease burden, health-seeking behavior, healthcare delivery system, and a roadmap for the future along the importance of primary healthcare in achieving it. Mere establishment of more health facilities cannot overcome the poor health of tribal population and so the role of trained manpower to deliver quality healthcare, in which case the role of traditional healers, local Tribal boys and girls comes in handy. It is high time and states should act swiftly to assess the needs, priorities of their own tribal population and set goals, targets to achieve the same through proven public health strategies.

Antenatal Care Service Utilization Among Adolescent Pregnant Women-Evidence From Swabhimaan Programme in India

Purpose: Pregnant adolescent girls (15–19 years) are more vulnerable to poor health and nutrition than adult pregnant women because of marginalization and lack of knowledge about the antenatal care (ANC) services. The present study aims to test this hypothesis and assess determinants of ANC service utilization among currently adolescent pregnant women.

Methods: Data were drawn from the baseline survey of SWABHIMAAN project, which had been conducted in three states of India: Bihar, Chhattisgarh, and Odisha. Out of a total 2,573 pregnant women (15–49 years) included in the sample, about 10% (N = 278) were adolescent girls (15–19 years) at the time of the survey, and the rest were adults. Sample was selected from the population using simple random sampling, and information was collected using pretested questionnaires.

Results: For all indicators of ANC service utilization, performance of adolescent pregnant women was better than adult pregnant women. However, significant variations were reported in the level of services received by adult pregnant women for different indicators. Religion, wealth, food insecurity, Village Health Sanitation and Nutrition Day meeting, Public Distribution System and Integrated Child Development Services entitlements, and knowledge of family planning methods had a significant effect on the ANC service utilization.

Conclusion: Adolescent pregnant women have shown better utilization of selected indicators than their adult counterparts. Utilization of full ANC services starting from first trimester itself for adolescent pregnant women is an urgent need in present context. Intervention program must pay attention to such adolescent married girls who are entering into the motherhood phase of their lives.

Integrated multisectoral strategy to improve girls' and women's nutrition before conception, during pregnancy and after birth in India (Swabhimaan): protocol for a prospective, non-randomised controlled evaluation

INTRODUCTION

Swabhimaan is a community-based programme to improve adolescent girls' and women's nutrition in the rural areas of three Indian states-Bihar, Chhattisgarh and Odisha with high prevalence of undernutrition.

METHODS AND ANALYSIS

Swabhimaan has a nested prospective, non-randomised controlled evaluation. Since 2017, five intervention sites receive community-led interventions through national government's livelihood mission supported women's self-help group federations and five control sites will initiate these activities 36 months later, in 2020. Community-led activities aim to improve coverage of 18 interventions including adequacy of food consumed, prevention of micronutrient deficiencies, access to basic health services and special care of nutritionally 'at risk' girls and women, improving hygiene and access to water and sanitation services and access to family planning services. The evaluation includes baseline (2016-2017), midline (2018-2019) and endline (2020-2021) surveys covering 6638 adolescent girls, 2992 pregnant women and 8755 mothers of children under 2. The final impact analysis will be by intention to treat, comparing primary and secondary outcomes in five intervention areas and five control areas. The primary outcomes are: (1) a 15% reduction in the proportion of adolescent girls with a body mass index (BMI) <18.5 kg/m²; (2) a 15% reduction in the proportion of mothers of children under two with a BMI <18.5 kg/m² and (3) and a 0.4 cm improvement in mean mid-upper arm circumference among pregnant women.

ETHICS AND DISSEMINATION

All procedures involving human subjects were approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences, Bihar, Chhattisgarh and Odisha and in compliance with guidelines laid down in the Declaration of Helsinki. Evidence will inform maternal and preconception nutrition policy at national and state level.

TRIAL REGISTRATION NUMBER

58261b2f46876 and CTRI/2016/11/007482; Pre-results.

WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India

BACKGROUND

Water, Sanitation, and Hygiene (WASH) practices may affect the growth and nutritional status among adolescents. Therefore, this paper assesses WASH practices and its association with nutritional status among adolescent girls.

METHODS

As a part of an intervention programme, this study is based on baseline cross-sectional data. It was conducted between May 2016-April 2017 in three Indian states (Bihar, Odisha, and Chhattisgarh). From a sample of 6352 adolescent girls, information on WASH practices, accessibility to health services and anthropometric measurements (height, weight and mid upper arm circumference (MUAC)) was collected. Descriptive statistics were used to examine WASH practices, and nutritional status among adolescent girls. Determinants of open defecation and menstrual hygiene were assessed using logistic regression. Association between WASH and nutritional status of adolescent girls was determined using linear regression.

RESULTS

Findings showed 82% of the adolescent girls were practicing open defecation and 76% were not using sanitary napkins. Significant predictors of open defecation and non use of sanitary napkin during menstruation were non Hindu households, households with poorer wealth, non availability of water within household premise, non visit to Anganwadi Centre, and non attendance in Kishori group meetings. One-third of adolescent girls were stunted, 17% were thin and 20% had MUAC < 19 cm. Poor WASH practices like water facility outside the household premise, unimproved sanitation facility, non use of soap after defecation had significant association with poor nutritional status of adolescent girls.

CONCLUSIONS

Concerted convergent actions focusing on the provision of clean water within the household premise, measures to stop open defecation, promotion of hand washing, accessibility of sanitary napkins, poverty alleviation and behavior change are needed. Health, nutrition and livelihood programmes must be interspersed, and adolescents must be encouraged to take part in these programmes.

Context for layering women's nutrition interventions on a large scale poverty alleviation program: Evidence from three eastern Indian states

Over 70 million women of reproductive age are undernourished in India. Most poverty alleviation programs have not been systematically evaluated to assess impact on women's empowerment and nutrition outcomes. National Rural Livelihoods Mission's poverty alleviation and livelihoods generation initiative is an opportune platform to layer women's nutrition interventions being tapped by project Swabhimaan in three eastern Indian states-Bihar, Chhattisgarh and Odisha. A cross-sectional baseline survey covering 8755 mothers of children under-two years of age, one of the three primary target groups of program are presented. Standardized questionnaire was administered and anthropometric measurements were undertaken from October 2016 to January 2017. 21 indicators on women's empowerment, Body Mass Index and Mid-upper Arm Circumference for nutrition status, food insecurity indicators as per the Food Insecurity Experience Scale and selected indicators for assessing women's access to basic health services were included. National Rural Livelihoods Mission operates in contexts with stark social and gender inequalities. Self-help group members exhibited better control on financial resources and participation in community activities than non-members. Using Body Mass Index, at least 45% mothers were undernourished irrespective of their enrolment in self-help groups. Higher proportion of self-help group members (77%-87%) belonged to food insecure households than non-members (66%-83%). Proportion of mothers reporting receipt of various components of antenatal care service package varied from over 90% for tetanus toxoid vaccination to less than 10% for height measurement. Current use of family planning methods was excruciatingly low (8.2%-32.4%) in all states but positively skewed towards self-help group members. Participation in monthly fixed day health camps was a concern in Bihar. Layering women's nutrition interventions as stipulated under Swabhimaan may yield better results for women's empowerment and nutrition status under National Rural Livelihoods Mission. While this opportunity exists in all three states, Bihar with a higher proportion of matured self-help groups offers more readiness for Swabhimaan implementation.