Evidence on Milk Consumption and Production Linkages from Rural Bihar, India

Background

Milk is an important source of protein for many Indian households. However, milk intake is very low. Hence, it is necessary to examine production-consumption linkages of milk within the paradigm of accessibility, availability, and affordability.

Objectives

This study examined linkages between milk consumption and production, accounting for sales and factors associated with production investments in rural Bihar, a major milk-producing state of India with very poor nutritional status.

Methods

A panel of households from the Gaya and Nalanda districts of Bihar were surveyed: the first round in July and August 2019 (n = 2026 households) and the second round from December 2019 to January 2020 (n = 2001 households). Data were collected on household consumption, production, and sale of milk, as well as other foods. The study examines the consumption-production linkage of milk and the association of dietary diversity with consumption from own production, with households as the unit of analysis. Ordinary least square regression analysis of average monthly household milk consumption was used to identify factors associated with milk consumption, particularly milk production.

Results

The median (Quartile 1, Quartile 3) per capita milk consumption per day was 83.3 (41.6, 166.6) mL in the milk-consuming households. Average monthly household milk consumption in liters was higher in milk-producing households [β: 7.1; 95% confidence interval (CI): 6.1, 8.1] than households relying on market purchases. Household milk consumption was higher in the third tertile of milk production than the first tertile of production (β: 14.3 L/wk; 95% CI: 12.1, 17.2) and lower in the highest tertile of household sale quantity (β: -8.8 L/wk in tertile 3, 95% CI: -12.7, -5) than the first tertile of household sale quantity of milk.

Conclusions

The study provides evidence that consumption of milk in rural households is associated with own production such that households with higher production consume more. However, sale preferences restrict the quantity of milk consumed in milk-producing households.

Perspectives and presentation of mental health among women from rural Maharashtra (India): A qualitative study

Objectives

A significant gap is observed between the proportion of individuals suffering from mental health (MH)-related conditions and those receiving adequate MH care services, especially in rural areas. This study highlights and contextualizes MH concerns and its extant knowledge as well as gender roles in rural Maharashtra (India).

Methods

Using in-depth interviews, MH themes were highlighted analytically among 72 female beneficiaries of Svatantra from the six administrative divisions (Konkan, Nashik, Pune, Aurangabad, Amravati and Nagpur) in the state of Maharashtra, India.

Results

The notion that MH concerns exist among women from rural communities was well supported. Along with MH concerns, the participants reported somatic concerns in the context of adverse life experiences. Furthermore, systemic issues such as financial problems, familial concerns, presence of addictions and pressures of gender role-related responsibilities were significant triggers for MH problems.

Conclusions

Overall, this study aimed at improving the understanding of the MH needs of women in rural Maharashtra, which can further catalyze an exploration of their general MH and devise suitable interventions for the same.

Estimation of the Parasitic Burden of Soil-Transmitted Helminths Among Pregnant Women in the Maharashtra State of India Using qPCR: A Community-Based Study

Background

Soil-transmitted helminth (STH) infections are widespread in developing countries with inadequate sanitation facilities. These infections can lead to malnutrition, anemia, and other complications that can negatively impact both the mother's and fetus's health during pregnancy. This study aimed to estimate the burden of STH by Kato-Katz microscopy and quantitative polymerase chain reaction (qPCR) in pregnant women from rural India. The diagnostic accuracy of these two methods was also compared.

Material and Methods

A community-based cross-sectional study was conducted in rural areas of Wardha district of Maharashtra state. We randomly selected and interviewed 688 pregnant women. A total of 534 (77.61%) participants gave stool samples. Two containers (60 mL) labeled with a unique identification number were given to pregnant women to collect stool samples for Kato-Katz microscopy and qPCR. Stool specimens were transported to an accredited lab and examined within 24 hours. Suitable examinations were conducted to compare sensitivity between two tests.

Results

The results are presented for 534 participants who gave stool samples. The prevalence of any STH by Kato-Katz stool microscopy was 6.55% (95%CI 4.46-12.19), and that by qPCR was 20.41 (95%CI 17.53-29.40). The sensitivity of Kato-Katz microscopy was 29.17% compared to sensitivity of 90.83% by qPCR (P = 0.001). Pregnant women with STH infection have a significantly lower weight gain during pregnancy, and the majority were either mild or moderate anemic compared to those without STH.

Conclusion

The study highlighted significant differences in prevalence of STH among pregnant women by Kato-Katz microscopy and qPCR. The sensitivity of qPCR for detecting STH was higher than that of Kato-Katz microscopy.

Design-redesign, implementation, and evaluation of effectiveness of maternal nutrition and responsive parenting program on child development at 2 years of age from rural India: a cluster RCT

Background

To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children.

Methods

Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months.

Findings

At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%.

Interpretations

The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program.

Funding

The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020).

Awareness and attitude about mental illness in the rural population of India: A mixed method study

Context

Recent systematic review and meta-analysis of public attitudes have shown that despite improvements in mental health literacy, public attitudes and desire for social distance with mental illnesses have remained stable over time.

Aims

To assess the awareness and attitude of the rural community towards mental disorders using the CAMI scale.

Materials and Methods

This mixed method study was conducted under the ICMR-STS grant scheme after IEC approval. It included administration of a pre-tested questionnaire adapted from CAMI scale on 196 adults aged 18-60 years from an adopted village in the field practice area of medical college along with 8 in-depth interviews of key people in the same community. Thematic analysis was done for the qualitative part whereas for the quantitative part, Pearson's correlation coefficient, independent t-test, ANOVA and Kruskall-wallis test were used.

Results

Age was positively correlated with the attitude of authoritarianism, social restrictiveness, CMHI and showed a negative correlation with attitude of benevolence. Females showed higher scores for authoritarianism and social restrictiveness. There was a statistically significant difference between APL and BPL groups for authoritarianism attitude towards the mentally ill (P value = 0.02) and CMHI (P value = 0.033). It was observed that with increase in the education levels there was a rise in the mean score of the values for the attitude of benevolence but the difference wasn't statistically significant (P > 0.05). Thematic analysis of the key informant interviews suggested various perceptions of the community regarding mental illness, available options for management, current practices of the community and what can be done further to improve facilities for mental health.

Conclusions

People in the community have a varied perspective to mental illnesses which has changed for the better over time but community still approaches quacks first which warrants the need for more awareness. For this, feasibility and effectiveness of increasing involvement of females from the community in health-related decisions can be explored further. We recommend further awareness generation in the younger generation with community-based research on perceptions of the community about mental health. This will provide more practical and feasible solutions to complement the national mental health program.

The Trajectory of Depression through Disenfranchised Grief in Young Widows in Times of COVID-19: A Case Report from Rural India

The COVID-19 pandemic was one of this century's deadliest and most widespread viral outbreaks, with higher mortality rates in men than women. Disruptions in funeral rituals and customs, no social recognition of the losses, and limited social support have complicated the grieving process and are linked to disenfranchised (not openly acknowledged, socially recognized, or publicly mourned) grief. Depression is also highly comorbid with complicated grief. Losing a spouse can be devastating, and this is more severe for women with limited or no resources, who are vulnerable because of the patriarchal society. In the current COVID-19 era, increased uncertainty and disenfranchised grief can worsen the clinical scenario and hamper interventions, as highlighted by the present case report on disenfranchised grief with depressive symptoms in a 30-year-old woman from rural India who, after a year of marriage, lost her husband due to COVID-19. This case study emphasizes the impact of multiple types of disadvantages due to sociodemographic and cultural determinants that can complicate the grieving process in the current context. The bioecological model of grief recovery considers individual features and societal/environmental factors to postulate the appropriate intervention. Finding meaning and purpose in life and restoration-oriented coping were successful for the clinical management of the patient.

Financial impact of oral cancer treatment on the households in rural India

Background

Oral cancer ranks second and accounts for over 20% of all cancers reported in India. Like management of all other cancers, oral cancers bring a heavy financial burden to their families. This study analyzes the financial burden on families during the management of oral cancer at Kasturba Hospital, Sewagram, a government-aided tertiary health care facility in central India.

Methods

The hospital-based cross-sectional study was conducted in the cancer unit of a government-aided tertiary hospital of central India. A total of 100 patients with oral cancer being treated in the hospital were included in the study. Information regarding cost incurred on management of oral cancer was inquired from a close family member or a caregiver of the study subjects.

Results

The out-of-pocket expenditure on treatment of oral cancer was approximately INR 100,000 (USD 1363). It has been found that 96% of families experienced catastrophic health expenditure as a result of treatment.

Conclusion

Although India aims for universal health coverage, it is important to protect cancer patients from catastrophic health expenditure.

Impact of the COVID-19 pandemic on some modifiable risk factors of dementia in an aging, rural Indian population

Introduction

The impact of the COVID-19 pandemic and associated lockdowns is likely to have caused adverse changes in lifestyle-related/cardiovascular risk factors and other such modifiable risk factors of dementia. We aimed to examine the pandemic's impact on some modifiable risk factors of dementia among rural Indians belonging to a large, prospective aging cohort-Srinivaspura Aging, NeuoSenescence, and COGnition (SANSCOG).

Methods

This was a cross-sectional study among adults aged ≥ 45 years (n = 3,148; 1,492 males and 1,656 females) residing in the villages of Srinivaspura in Karnataka state, India. SANSCOG study data (clinical and biochemical assessments) of these participants were obtained from three distinct periods: (i) the "pre-COVID period"-before India's nationwide lockdown on 24 March 2020, (ii) the "COVID period"-during the first and second waves of the pandemic, wherein the social restrictions were prominent (25 March 2020 to 30 September 2021), and (iii) the "post-COVID period"-after easing of restrictions (from 1 October 2021 onward). Proportions of participants with diabetes, hypertension, obesity, dyslipidemia (diagnosed using standard criteria), and depression (diagnosed using the Geriatric Depression Scale) were compared between the above three periods.

Results

The odds of having obesity, abnormal triglycerides, and depression among individuals in the COVID period were 1.42 times, 1.38 times, and 2.65 times more than the odds in the pre-COVID period, respectively. The odds of having hypertension, obesity, abnormal total cholesterol, abnormal triglycerides, abnormal LDL, and depression among individuals in the post-COVID period were 1.27 times, 1.32 times, 1.58 times, 1.95, 1.23, and 3.05 times more than the odds in the pre-COVID period, respectively. The odds of diabetes did not differ between any of the three periods.

Discussion

We found significantly higher odds of some of the studied risk factors in the COVID and post-COVID periods compared to the pre-COVID period, suggesting that the pandemic adversely impacted the physical and psychological health of this marginalized, rural Indian population. We call for urgent public health measures, such as multimodal, lifestyle-based, and psychosocial interventions, to mitigate this negative impact and reduce the future risk of dementia.

Comparison of risk factors for dementia among rural and urban elderly adults-data from two cohort studies in India

INTRODUCTION

Studies on risk factors for dementia in India, especially rural India, are sparse and therefore we aimed to assess risk factors in a rural cohort on aging and compare it with an urban cohort.

METHODS

We are presenting baseline data on proportion of hypertension, diabetes, obesity, physical inactivity, and Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) scores in both cohorts.

RESULTS

The rural cohort is younger and less educated than the urban cohort. The chi-square test showed that the proportion of participants with hypertension, diabetes, and obesity was lower in the rural cohort, whereas physical inactivity was higher in comparison with the urban cohort; however, the proportion of high-risk CAIDE scores was higher in the rural cohort.

DISCUSSION

Despite the rural cohort having a smaller proportion of participants with hypertension, diabetes, and obesity, the overall CAIDE score was higher-the main reason for this is low educational level.

COGNITO (Computerized assessment of adult information processing): Normative scores for a rural Indian population from the SANSCOG study

INTRODUCTION

Neuropsychological assessments are inexpensive and efficient methods to understand the cognitive abilities of individuals in research studies and clinical settings. Normative scores for such measures are crucial in serving as a reference standard for identifying cognitively healthy and impaired individuals belonging to similar sociodemographic characteristics.

METHODS

Study subjects in rural India recruited into the Srinivaspura Aging, Neuro Senescence and Cognition (SANSCOG) study were administered the COGNITO battery of tests, which traverse cognitive domains of attention, memory, language, and visuospatial abilities. Percentile norms based on age and education stratification were derived for the above cohort.

RESULTS

Percentile norms are commensurate with literacy levels in this population. The percentile scores for the cognitive tests show a decline for the individuals aged 75 years and above indicating lower cognitive functioning in this age group.

DISCUSSION

This is the first-ever study reporting norms for diverse cognitive domains for illiterate, literate, low-literate individuals enrolled in a large-scale community-based cohort study in rural India.

Approaches to engage an aging, rural cohort in southern India during the COVID-19 crisis and the psychological impact of COVID-19 in this cohort

INTRODUCTION

The COVID-19 pandemic produced an unprecedented crisis across the world. Long-term cohort studies were stalled, including our longitudinal aging cohort study in rural India.

METHODS

We describe approaches undertaken to engage with our cohort (n = 1830) through multiple rounds of calls and how we provided useful services to our subjects during the lockdown period. Consenting subjects also underwent telephonic assessments for depression and anxiety using validated, self-report questionnaires.

RESULTS

Subjects reported benefitting from our telephonic engagement strategies, including the COVID-related safety awareness and counselling service. The proportion of subjects with depression increased from 7.42% pre-COVID to 28.97% post-COVID.

DISCUSSION

We envisage that such engagement strategies would improve subject rapport and cohort retention, and thus, could be adopted by similar cohort studies across the world. This marginalized, rural Indian community had severe, adverse psychological impact in this pandemic. Urgent public health measures are needed to mitigate this impact and develop appropriate preventive strategies.

Occurrence of Diarrheal Disease among Under-Five Children and Associated Sociodemographic and Household Environmental Factors: An Investigation Based on National Family Health Survey-4 in Rural India

Diarrheal disease is a significant public health problem leading to mortality and morbidity among children aged 0-59 months in rural India. Therefore, the rationale of this study was to identify the sociodemographic and environmental predictors associated with diarrhea among under-five children in rural India. A total of 188,521 living children (0-59 months) were studied from the National Family Health Survey-4, (NFHS-4) 2015-2016. Bivariate and binary logistic regression models were carried out from the available NFHS-4 data for selected sociodemographic and environmental predictors to identify the relationship of occurrence of diarrhea using STATA 13.1. In rural India, children aged 12-23 months, 24-35 months, 36-47 months, and 48-59 months were significantly improbable to suffer diarrheal disease. Children of the female sex, as well as children of scheduled tribes (ST) and other backward classes (OBC), were less likely to experience diarrhea. The disease was more likely to occur among children of scheduled castes (SC); Muslim or other religions; children belonging to central, eastern, and western regions; children with low birth weight; as well as children with improper stool disposal and rudimentary roof materials. In the rural parts of India, sociodemographic and household environmental factors were most influential. Effective community education; improved handwashing practices; pure water supply; and proper waste disposal, including building and utilizing latrines, would help reduce the burden of diarrheal disease in children.

Availability, Prices and Affordability of Antibiotics Stocked by Informal Providers in Rural India: A Cross-Sectional Survey

Providers without formal training deliver healthcare and antibiotics across rural India, but little is known about the antibiotics that they stock. We conducted a cross-sectional survey of such informal providers (IPs) in two districts of West Bengal, and assessed the availability of the antibiotics, as well as their sales volumes, retail prices, percentage markups for IPs and affordability. Of the 196 IPs that stocked antibiotics, 85% stocked tablets, 74% stocked syrups/suspensions/drops and 18% stocked injections. Across all the IPs, 42 antibiotic active ingredients were stocked, which comprised 278 branded generics from 74 manufacturers. The top five active ingredients that were stocked were amoxicillin potassium clavulanate (52% of the IPs), cefixime (39%), amoxicillin (33%), azithromycin (25%) and ciprofloxacin (21%). By the WHO's AWaRe classification, 71% of the IPs stocked an ACCESS antibiotic and 84% stocked a WATCH antibiotic. The median prices were in line with the government ceiling prices, but with substantial variation between the lowest and highest priced brands. The most affordable among the top five tablets were ciprofloxacin, azithromycin, cefixime and amoxicillin (US$ 0.8, 0.9, 1.9 and 1.9 per course), and the most affordable among the syrups/suspensions/drops were azithromycin and ofloxacin (US$ 1.7 and 4.5 per course, respectively), which are mostly WATCH antibiotics. IPs are a key source of healthcare and antibiotics in rural communities; practical interventions that target IPs need to balance restricting WATCH antibiotics and expanding the basket of affordable ACCESS antibiotics.

Seroprevalence of SARS CoV-2 among children after the second surge (June 2021) in a rural district of South India: Findings and lessons from a population-based survey

OBJECTIVE

To determine the seroprevalence of SARS COV 2 among children in the Bangalore Rural district.

METHODS

We conducted a cross-sectional study after the second surge of COVID-19 from 14 June to 13 July 2021 and recruited 412 children through house to house visits from four villages in a rural district. We administered a questionnaire to collect demographics and details of COVID-19 infection and used the ABCHEK Antibody Card test (NuLifecare,India) which is an ICMR approved test for detecting antibodies (IgG & IgM) by immunochromatography using the finger prick method. We used Statistical Package for the Social Sciences version 20.0 for analysis.

RESULTS

Our participants had an age group ranging from 11 months to 18 years. There was an almost equal distribution of boys (48.3%) and girls (51.7%). We estimated seroprevalence of 45.9% (95% CI: 41-50.8) among children. Seroprevalence was significantly associated with a history of symptoms suggestive of COVID-19 in the past, the seropositive status of the parents, and any other family members being tested positive. Age and gender of the child, education and occupation of the parents were not associated with the seropositivity status of the child.

CONCLUSION

Seroprevalence of COVID-19 among children corresponds to adult seroprevalence during the same time interval. This knowledge can be of practical application where adult prevalence is documented. Unvaccinated children in low-resource settings need special attention with respect to monitoring for new mutations as well as managing endemic needs.

Biosocial life-course factors associated with women's early marriage in rural India: The prospective longitudinal Pune Maternal Nutrition Study

OBJECTIVES

By convention, women's early marriage is considered a sociocultural decision sensitive to factors acting during adolescence such as poverty, early menarche, and less education. Few studies have examined broader risk factors in the natal household prior to marriage. We investigated whether biosocial markers of parental investment through the daughters' life-course were associated with early marriage risk in rural India. We used an evolutionary perspective to interpret our findings.

MATERIALS AND METHODS

A prospective cohort recruited mothers at preconception. Children were followed from birth to age 21 years. Multivariable logistic regression models estimated odds ratios of marrying early (<19 years) associated first with wealth, age at menarche and education, and then with broader markers of maternal phenotype, natal household characteristics, and girls' growth trajectories. Models adjusted for confounders.

RESULTS

Of 305 girls, 71 (23%) had married early. Early married girls showed different patterns of growth compared to unmarried girls. Neither poverty nor early menarche predicted early marriage. Girls' non-completion of lower secondary school predicted early marriage, explaining 19% of the variance. Independent of girls' lower schooling, nuclear household, low paternal education, shorter gestation, and girls' poor infant weight gain were associated with marrying early, explaining in combination 35% of the variance.

DISCUSSION

Early marriage reflects "future discounting," where reduced parental investment in daughters' somatic and educational capital from early in her life favors an earlier transition to the life-course stage when reproduction can occur. Interventions initiated in adolescence may occur too late in the life-course to effectively delay women's marriage.

The Gender System and Class Mobility: How Wealth and Community Veiling Shape Women's Autonomy in India

It is often assumed that improvements in household wealth are associated with greater gender equality, including greater women's autonomy and decision-making power inside the home. Yet, evidence often shows the opposite: greater household wealth often curtails women's autonomy. Research has yet to reveal the driving forces behind this surprising finding. This paper focuses on one important social force, the community gender system, to show how it shapes the relationship between changing household wealth and women's autonomy. Drawing on a nationally representative panel of rural women in India and fixed effects models, I find that the prevalence of women's veiling at the village level, a notable marker of an exclusionary gender system, moderates the effects of increasing household wealth on women's autonomy. In villages with less veiling, increases in wealth have the perverse effect of suppressing women's autonomy. The study suggests that in these places, households curtail women's mobility because such behavior signals rising social status. In contrast, in villages with more veiling increasing household wealth does not reduce women's autonomy because most households across the class spectrum are already conforming to the norms of seclusion. The findings demonstrate how new wealth interacts with a community gender system which is anchored in gendered notions of family honor to reproduce structures of gender inequality.

Endophthalmitis prophylaxis study. Report 1: Intracameral cefuroxime and moxifloxacin prophylaxis for the prevention of postcataract endophthalmitis in rural India

Purpose:

Intracameral antibiotics are known to reduce the incidence of acute endophthalmitis. Various drugs are available for intracameral use. This prospective study was carried out to compare the efficacies of intracameral cefuroxime and moxifloxacin prophylaxis in reducing the incidence of acute endophthalmitis after cataract surgery in rural India.

Methods:

This was a prospective, nonrandomized, comparative, interventional study. Between October 2016 and March 2018, 15 eye care facilities spread over four Indian states were preselected to use either of the intracameral antibiotics, cefuroxime or moxifloxacin, following cataract surgery (phacoemulsification or manual small incision cataract surgery, SICS). The main outcome measure was the occurrence of acute clinical endophthalmitis within six weeks of the surgery. This was compared with the earlier rate of endophthalmitis in the same locations.

Results:

The study was done in 42,466 eyes. Of the total, 42.2% received intracameral cefuroxime and 57.8% received intracameral moxifloxacin. SICS was performed more often. Clinical acute endophthalmitis occurred in 15 eyes. This accounted to a 72.22% reduction, from the earlier 0.126% to 0.035%, of postcataract surgery acute endophthalmitis. The reduction in the incidence of endophthalmitis after intracameral cefuroxime was 0.017% and that after intracameral moxifloxacin was 0.049%. With either intracameral antibiotics, the reduction in incidence was statistically significant (P < 0.001), but not between the molecules. Intracameral cefuroxime showed 66.67% reduction and intracameral moxifloxacin showed 74.74% reduction.

Conclusion:

A 3.6-fold decrease in postcataract surgery endophthalmitis was observed upon the use of intracameral antibiotics in rural India. Both intracameral cefuroxime and moxifloxacin proved efficacious.

Photostory-A "Stepping Stone" Approach to Community Engagement in Early Child Development

Background: Capturing real-life practices through photographs provides an opportunity to create awareness and focus discussions on relevant issues in community. Photographs and narratives also engage decision makers, inspiring changes in policy and practice. Objective: Paper describes development and adaptation of an integrated photostory approach documenting actions and stimulating positive change in Early Child Development (ECD). Methodology: The Photostory method was built through a cyclical process to describe and explore early-childhood practices in central-India through photographs and stories. A systematic format to capture, archive and evaluate photographic material was developed. A standardized rating system was established to monitor levels of, and change in, community practices. We integrated Photostory process into routine visits undertaken during implementation of Stepping-Stones, an ECD intervention program. This paper utilized collected data to explore utility of rating framework to describe and measure behavior and to track change. We explored role of Photostory approach in engaging community in process of stimulating positive ECD experiences. Results: We developed a systematic framework to support data capture, analysis, and data utilization using multistep iterative mixed method process. A total of 161 Photostories were collected (72 at baseline and 89 at endpoint). Using a rating system which measured both the structure of the tasks, and the emotional engagement of the child and parent, many activities and practices observed were evaluated as providing at least an adequate learning space. In exploring change over the implementation process, at endpoint children were more likely to be observed as more engaged in their play activities (p < 0.05). Parental engagement levels remained stable, toward being less actively engaged. At endpoint we observed a trend toward activities being provided for children at a level of difficulty higher than child's level of developmental. The data provided the intervention team with local examples through which to engage parents in discussions on activities that stimulate effective child exploration and learning. We were also able to demonstrate the added value of photographs in stimulating detailed discussion amongst community members on early child development. Conclusion: Photostories can provide a systematic and rigorous methodology to stimulate engagement, monitor and measure change in community-based parenting interventions.

A cross-sectional study on prevalence and determinants of anemia among women of reproductive age in a rural community of West Bengal

Context:

Anemia is a serious public health concern especially in women of reproductive age (WRA) as it causes a high burden of morbidity and mortality and persists through intergenerational cycle. As most of the risk factors are preventable, a thorough understanding of its risk factors is necessary to design better interventions.

Aims:

Current study aimed to estimate the burden of anemia as well as explore determinants of various grades of anemia among WRA in a rural area.

Settings and Design:

A community-based cross-sectional study was conducted among non-pregnant, non-lactating women of reproductive age in rural field practice area of All India Institute of Hygiene and Public Health.

Methods and Materials:

House to house visit was conducted for interviewing with pre-designed pre-tested questionnaire along with blood hemoglobin and anthropometric measurement.

Statistical Analysis Used:

Descriptive statistics and test of significance like multinomial logistic regression and Kruskal-Wallis test (with post-hoc) were used.

Results:

Majority (70.8%) of participants were anemic. Proportion of mild, moderate, and severe anemia were 24.16%, 37.5%, and 9.16%, respectively. Different levels of anemia were significantly associated with higher age, lower education, poor iron-rich food intake, lack of dietary diversity, and adiposity. Significantly low hemoglobin level in both underweight and obesity was noticed suggesting U shaped relationship between BMI and anemia.

Conclusion:

Periodic screening for anemia among WRA especially in both extremes of malnutrition, i.e., undernutrition and obesity should be considered at the policy level. Year-round behaviour change communication campaigns must be carried out for the promotion of necessary food groups in diet.

Association between gender disadvantage factors and postnatal psychological distress among young women: A community-based study in rural India

Common mental health disorders are studied extensively among adult women globally. However, they remain under-researched among young women. This study aims to determine whether gender disadvantage factors are associated with psychological distress among young women in rural India, where the child sex ratio is lower than the national average. A cross-sectional survey was conducted in rural Pune, India. A total of 229 young married women who had a live birth in the last 12 months were screened for psychological distress. The predictors of psychological distress were estimated using multivariable logistic regression analyses. Psychological distress was found among 50 respondents (21.9%). Young women who were married before 18 years had 2.19 times higher odds of distress than women who were married after 18 years. Young women who gave birth to a female infant had 2.43 times higher odds of distress than those who gave birth to a male infant. Lack of partner support and experience of postnatal health complications were other predictors. Study findings ascertain the role of gender disadvantage factors in causing psychological distress. From a public health perspective, early identification and treatment of psychological distress, is imperative, along with addressing gender inequitable practices.

Prevalence of Food Insecurity at Household Level and Its Associated Factors in Rural Puducherry: A Cross-Sectional Study

Background

Malnutrition is a consequence of food insecurity. Food insecurity in India became a public health problem due to explosive population growth and widening gap between rich and poor. It also has a detrimental effect on factors related to health and social well-being of the family.

Objectives

The study was conducted to determine the prevalence of food insecurity at household level in rural population and factors associated with it.

Subjects and Methods

A community-based cross-sectional study was conducted among the households of rural Puducherry. The adult females in the households were interviewed with a pretested semi-structured questionnaire in which, along with sociodemographic factors, food insecurity was assessed using the Household Food Insecurity Access Scale. Univariate and multivariate logistic regression analysis was done to identify the factors associated with food insecurity.

Results

Out of 299 households that were assessed for food insecurity, 31.7% (95% confidence interval [CI]: 26.6-37.4) had food insecurity. Out of 95 households with food insecurity, 51 (17%), 37 (13%), and 7 (2%) had severe, moderate, and mild food insecurity, respectively. In univariate analysis, the presence of children in the family, using below poverty line ration card, and socioeconomic status were significantly associated with food insecurity. In multivariate analysis, socioeconomic status was significantly associated with food insecurity (rate ratio: 3.59; P < 0.001 [95% CI: 1.68-7.67]).

Conclusions

One in three families experienced the food insecurity, and it was more among households with children. It has to be addressed to prevent nutrition-related disorders in community, particularly in children.

Stroke Happens Suddenly so It Cannot Be Prevented: A Qualitative Study to Understand Knowledge, Attitudes, and Practices about Stroke in Rural Gadchiroli, Maharashtra, India

Background  Strokes have emerged as one of the leading causes of deaths in rural India but people often remain uninformed about it. This study sought to understand knowledge, attitudes, and healthcare-seeking practices about strokes in rural Gadchiroli, India.

Methods  A total of 12 focus group discussions were conducted with 34 female and 43 male participants from six villages. Responses were audio recorded, transcribed, coded, and analyzed using inductive method of qualitative data analysis.

Results  Respondents correctly recognized many symptoms of stroke and were aware of the sudden onset of symptoms. They were unaware of transient ischemic attacks. After stroke, healthcare was sought from private physicians, and physicians in the government run district hospital, or traditional herbal providers depending upon the accessibility, affordability, and perceived effectiveness of the therapy. Most of the respondents thought that stroke is a serious disease associated with disability as well as death and its occurrence in the community is increasing. However, only a few participants could correctly state how stroke occurs and its risk factors. Furthermore, many participants thought that stroke cannot be prevented as it occurs suddenly without any warning.

Conclusion  Rural people in Gadchiroli were aware of symptoms of stroke but awareness about the etiology and the risk factors was low. Suddenness of symptoms was perceived as a key barrier to taking any preventive action. Understanding such perceptions and addressing them can help improve counseling of patients by physicians and effectiveness of behavioral change communication to prevent stroke in rural areas.

Vaccination coverage and vaccine hesitancy among vulnerable population of India

Vaccination coverage in India has improved from 44% to 62%, an increase of 19% over a span of 10 y (2006-2016), the inequity continues among the vulnerable people belonging to tribal groups and migrant population. In order to leave no one behind strategy, their vaccination coverage, reasons for low coverage were analyzed from available literary sources through this review article. A systematic search for relevant articles was conducted and articles published in various journals over the past 5 y were included. The vaccine coverage among the vulnerable population ranged from 31% to 89% from various studies. It was found that parents' education status, income of the family and lack of awareness of the schedule were the most important reasons for vaccine hesitancy. Introduction of cash assistance integrated into other national program, digitalizing vaccination cards, involvement of local healers are few strategies suggested in this article.

Factors influencing suicidal attempt among the agrarian community of central Maharashtra

INTRODUCTION

Attempted suicides occur 8-20 times more frequently than completed suicides. Attempted suicides are just the tip of the iceberg of the completed suicides, now a universal phenomenon. Several factors such as financial constraints, altercation among family members, and easy availability of pesticides have been attributed as the common factors for attempted suicide among the rural population.

MATERIALS AND METHODS

On this background, we evaluated all the cases of attempted suicide admitted to our rural medical college during a period of 1 year. Details of sociodemographic profile, mode of attempt, and reason for the attempt were evaluated. All the cases were administered Beck's Depression Inventory. Factors influencing suicidal attempts among farmers and nonfarmers were analyzed using suitable statistical methods.

RESULTS

Out of a total of 117 cases of attempted suicide, only 21% of the cases were farmers. Majority of them were males and were married. The main mode of attempt was poisoning. The common psychiatric diagnosis was adjustment disorder followed by depressive disorder.

CONCLUSION

Although the study was conducted in a rural setup from an agrarian background, the majority of the cases were of nonfarmer. The most common mode of suicidal attempt among farmers as well as nonfarmers was pesticide ingestion owing to its easy availability among the agrarian population. Although the most common reason for attempt among the nonfarmer population was interpersonal problems, indebtedness still remains the most common reason for farmers. Attention of policymakers is drawn toward two important aspects: policy on the sale of usual pesticides and policy for the farmers to overcome loss in farming.

Multidrug-resistant Enterobacteriaceae colonising the gut of adult rural population in South India

Background

Multidrug-resistant (MDR) colonisers act as a reservoir for transmission of antibiotic resistance and are a source of infection. Exposure to antibiotics by the commensal flora renders them resistant. Antibiotic consumption and hospitalisation are two major factors influencing this. We studied, antibiotic-resistant bacteria colonising rural adult population who had restricted access to health care and presumably had low consumption of antibiotics.

Aim

Detection of multidrug resistance genes of extended spectrum β-lactamase (ESBL-CTX-M), AmpC β-Lactamase (CIT), Klebsiella pneumoniae carbapenemase (KPC) and New Delhi Metallo β-lactamase (NDM) in Enterobacteriaceae colonising the gut of adult population in a South Indian rural community.

Methodology

Faecal samples of 154 healthy volunteers were screened for Enterobacteriaceae resistant to commonly used antibiotics by standard methods, followed by phenotypic detection of ESBL by double disk synergy method, AmpC by spot inoculation and carbapenemases by imipenem and ethylenediaminetetraacetic acid + imipenem combined E-test strips and modified Hodge test. Polymerase chain reaction was done to detect bla_CTX-M,bla_CIT,bla_KPC-1 and bla_NDM-1 genes coding for ESBL, AmpC, KPC and NDM, respectively.

Results

Colonisation rate of enteric bacteria with MDR genes in the community was 30.1%. However, phenotypically, only ESBL (3.2%) and NDM (0.65%) were detected. While the genes coding for ESBL, AmpC and NDM were detected in 35.6%, 17.8% and 4.4% of the MDR isolates, respectively.

Conclusions

Carriage of MDR strains with a potential to express multidrug resistance poses a threat of dissemination in the community. Awareness for restricted use of antibiotics and proper sanitation can contain the spread of resistant bacteria.

Various addiction patterns, dietary habits, associated medical problems, and socioeconomic status in gastrointestinal malignancies: A prospective study in rural area of Maharashtra, India

Background

Gastrointestinal (GI) malignancies are increasing with advancing age. Various addictions and poor dietary habits are among the major risk factors. Early detection is difficult until patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in early diagnosis and better treatment outcome.

Objectives

This study is carried out to see various addiction patterns, dietary habits, associated medical problems, and socioeconomic status with various sites involved in GI malignancies, at a tertiary care teaching hospital of Western Maharashtra, India.

Materials and Methods

Prospective questionnaire-based study was carried out for 11 months. A total of 100 diagnosed carcinoma cases of GI tract malignancy were taken for study.

Results and Conclusions

Out of total 100 cases, 61 were male and 39 were female. The most common site involved was esophagus (41) followed by rectosigmoid, colon and cecum, stomach, and anal canal (29, 14, 13, and 3, respectively). There were 45% of cases above 60 years of age. The most common addiction was smokeless tobacco. Most of the patients belonged to lower and upper lower class (64%). Majority of cases (81%) were nonvegetarian, only 16% were pure vegetarian. Most of the cases (85%) were in advanced stage of disease (III and IV). Awareness program for harmful effects of various addictions and importance of high-fiber diet (vegetarian diet) will help in health promotion and prevention of various malignancies. Awareness about the early symptoms of GI malignancy will help in early detection of disease and better treatment outcome.

Adult convulsive status epileptic us: clinical, etiological, and predictors of outcome study from rural population of North India

AIM

To determine the clinical profile, etiologies and predictors of mortality in patients with convulsive status epilepticus (CSE) among rural population of North India in view of limited published data on epidemiology and etiology of status epilepticus (SE) from developing countries.

METHODS

One hundred sixty-two consecutive adult patients with CSE were evaluated from 2016 to 2018 for demographic profile, etiologies and predictors of poor outcome.

RESULTS

The mean age was 41.71 ± 19.72 years. Most of the CSE cases were acute symptomatic (48.8%) type with central nervous system (CNS) infections (24.1%) being the predominant precipitating factor. Antiepileptic drugs (AEDs) noncompliance accounted for 34.9% of the cases with pre-existing epilepsy. The median duration of CSE was 5.5 h (IQR-3-10 h). 82.1% cases responded to the first line drugs and their response was related with duration of CSE (p = .0045). Case fatality was 16.0% and the predictors of the mortality were; low Glasgow Coma Scale (GCS) (OR =9.64, 95% CI= 2.064-45.02; p = .0001), lack of response to first line drugs (OR =0.019, 95% CI= 0.003-0.11; p = .0001) and absence of past history of epilepsy (OR =0.525, 95%CI =0.104-2.66; p = .004).

CONCLUSIONS

CNS infection and AEDs noncompliance were identified to be the major cause of CSE which can be potentially preventable. Present study signifies that prompt and successful control of infections appears to be the most efficient preventive approach. Level of consciousness as a potential predictor of poor outcome can be quickly accessible to the treating clinician in optimizing treatment strategies.

Trends in the socioeconomic patterning of overweight/obesity in India: a repeated cross-sectional study using nationally representative data

OBJECTIVES

We aimed to examine trends in prevalence of overweight/obesity among adults in India by socioeconomic position (SEP) between 1998 and 2016.

DESIGN

Repeated cross-sectional study using nationally representative data from India collected in 1998/1999, 2005/2006 and 2015/2016. Multilevel regressions were used to assess trends in prevalence of overweight/obesity by SEP.

SETTING

26, 29 and 36 Indian states or union territories, in 1998/99, 2005/2006 and 2015/2016, respectively.

PARTICIPANTS

628 795 ever-married women aged 15-49 years and 93 618 men aged 15-54 years.

PRIMARY OUTCOME MEASURE

Overweight/obesity defined by body mass index >24.99 kg/m².

RESULTS

Between 1998 and 2016, overweight/obesity prevalence increased among men and women in both urban and rural areas. In all periods, overweight/obesity prevalence was consistently highest among higher SEP individuals. In urban areas, overweight/obesity prevalence increased considerably over the study period among lower SEP adults. For instance, between 1998 and 2016, overweight/obesity prevalence increased from approximately 15%-32% among urban women with no education. Whereas the prevalence among urban men with higher education increased from 26% to 34% between 2005 and 2016, we did not observe any notable changes among high SEP urban women between 1998 and 2016. In rural areas, more similar increases in overweight/obesity prevalence were found among all individuals across the study period, irrespective of SEP. Among rural women with higher education, overweight/obesity increased from 16% to 25% between 1998 and 2016, while the prevalence among rural women with no education increased from 4% to 14%.

CONCLUSIONS

We identified some convergence of overweight/obesity prevalence across SEP in urban areas among both men and women, with fewer signs of convergence across SEP groups in rural areas. Efforts are therefore needed to slow the increasing trend of overweight/obesity among all Indians, as we found evidence suggesting it may no longer be considered a 'diseases of affluence'.

How "Elderly Staying Alone" Cope Up with their Age and Deteriorating Health: A Qualitative Exploration from Rural Wardha, Central India

BACKGROUND

This study is done to explore the various changes and problems faced by the "elderly people staying alone" and how they cope up to maintain their life amidst the physical, familial, social, and financial crisis in their lives.

MATERIALS AND METHODS

This qualitative study was carried out in the villages surrounding Bhidi Rural Health and Training Center, located in the Vidarbha region of Maharashtra. A triangulation of free listing and pile sorting exercise was used. Elderly >65 years of age of either sex, living alone in their own houses, for at least 2 years were included in the study. Twenty-four such individuals were selected purposively who could figure out the different words and concepts regarding the three domains of our study for the purpose of line listing, namely, change of life since staying alone, problems faced while staying alone, and how they cope up with the problem of living alone. The data were analyzed using Anthropac software. The study findings were presented to the participants, who later pointed out few recommendations to be made.

RESULTS

The "elderly staying alone" face the problems of lack of family, social, and financial support in their day-to-day life. They cope with these problems by a number of ways. Although there are a number of government schemes to protect the elderly, none of these policies are dedicated to this special group of elderlies.

CONCLUSION

There is no social structure that can take care of this vulnerable group of elderlies in rural India. It is high time for the government to step in to bring some societal and familial reforms that will safeguard the elderly staying alone from the ongoing familial, social, and financial hardship.

Education Mitigates the Relationship of Stress and Mental Disorders Among Rural Indian Women

BACKGROUND

Common mental disorders (CMD) are a constellation of mental health conditions that include depression, anxiety, and other related nonpsychotic affective disorders. Qualitative explanatory models of mental health among reproductive-aged women in India reveal that distress is strongly associated with CMD. The relationship of perceived stress and CMD might be attenuated or exacerbated based on an individual's sociodemographic characteristics.

OBJECTIVES

To screen for Common Mental Disorders (CMD) among reproductive-aged women from rural western India and explore how the relationship between perceived stress and CMD screening status varies by sociodemographic characteristics.

METHODS

Cross-sectional survey of 700 women from rural Gujarat, India. CMD screening status was assessed using Self-Reported Questionnaire 20 (SRQ-20). Factors associated with CMD screening status were evaluated using multivariable logistic regression. Effect modification for the relationship of perceived stress and CMD screening status was assessed using interaction terms and interpreted in terms of predicted probabilities.

FINDINGS

The analytic cohort included 663 women, with roughly 1 in 4 screening positive for CMD (157, 23.7%). Poor income, low education, food insecurity, and recurrent thoughts after traumatic events were associated with increased risk of positive CMD screen. Perceived stress was closely associated with CMD screening status. Higher education attenuated the relationship between high levels of stress and CMD screening status (82.3%, 88.8%, 32.9%; P value for trend: 0.03). Increasing income and age attenuated the link between moderate stress and CMD.

CONCLUSIONS

Our findings suggest a high burden of possible CMD among reproductive-aged women from rural western India. Higher education might mitigate the association between elevated stress and CMD. Future efforts to improve mental health in rural India should focus on preventing CMD by enhancing rural women's self-efficacy and problem-solving capabilities to overcome challenging life events and stressors, thereby reducing the risk of CMD.

Lean Metabolic Syndrome: A Concept or a Reality?

AIMS AND OBJECTIVES

Metabolic syndrome (MetS) is fairly common in India. International Diabetes Federation (IDF) has defined it as the presence of central obesity with region/ethnicity-specific waist circumference as a mandatory defining criterion along with the presence of two other features from dysglycemia, systolic and/or diastolic hypertension, hypertriglyceridemia, and low high-density lipoprotein. Although obesity is not prevalent in rural parts of India, especially among the underprivileged population, other individual components of the syndrome are not infrequent among these lean/nonobese persons. In this study, we evaluated the prevalence of MetS in rural West Bengal. We also examined that if those persons above the recommended cutoff for waist are excluded, and thus only lean/nonobese persons are included, and the same definition of MetS (herein termed as lean MetS) is applied (three out of four criteria), what will be the prevalence of MetS and will it be lower in the nontribal population compared to the tribal population?

MATERIALS AND METHODS

A population-based study was done in the rural area of West Bengal comprising 205 [corrected] peoples from scheduled tribe (ST) population and 200 [corrected] people from the neighborhood community from non-ST population to compare the metabolic health with respect to anthropologic and biochemical parameters.

RESULTS

The prevalence of MetS from rural areas of West Bengal was found to be 21.48% as per IDF criterion, but applying NCEP ATP III criteria, the overall prevalence of MetS rose to 31.1%. The prevalence of normal waist/lean MetS was 12.8%, and there was no significant difference between nontribals versus tribal cohort (14.6% of the nontribes versus 11.6% of the tribal cohort, P = 0.436).

CONCLUSION

A significant number of persons with nonobese/lean MetS exist in the rural area. We suggest that if region-specific waist criteria are not satisfied, the diagnosis should still be sorted by NCEP ATP III criteria.

Quality of Life Determinants in Breast Cancer Patients in Central Rural India

Introduction:

Breast cancer is the most frequently diagnosed cancer among women throughout world, with incidence rates increasing in India. Improved survival in breast cancer patients has resulted in their quality of life (QOL) becoming an important issue. Identifying determinants for QOL may provide insights into how to improve their living conditions. This study aimed to assess socio-demographic and clinical factors, as well as the role of self-efficacy, in relation to QOL among women with breast cancer in rural India.

Methods:

A total of 208 female patients with infiltrating carcinoma of the breast participated in the study. A questionnaire was administered that included sections for socio-demographic characteristics, clinical stage of the cancer and patient delay in seeking health care. A standardized instrument to measure self-efficacy was applied. To assess QOL, the WHOQOL – BREF instrument was used.

Results:

The overall mean score for QOL was 59.3. For domain 1 (physical health) the mean score across all groups was 55.5, for psychological health 58.2, for social relationships 63.2 and for environmental factors, 60.4. The environmental domain in QOL was negatively associated with lower education. Being divorced/widowed/unmarried had a negative association with the psychological health and social relationship dimensions, whereas higher income was positively associated with QOL parameters such as psychology, social relationships and environmental factors. Self-efficacy was positively associated with all four domains of QOL.

Conclusions:

The present study demonstrated a moderate QOL in women with breast cancer in rural India. Young age, lack of education and being without a partner were negatively related to QOL, and employment as casual and industrial workers, high monthly family income and higher self-efficacy were positively associated with QOL. A comprehensive public health initiative is required, including social, financial and environmental support, that can provide better QOL for breast cancer survivors.

Adherence to the Tobacco-Free School Policy in Rural India

Background:

In India, 267 million adults use tobacco with prevalence of 35% in rural areas and 13% among those between 15 and 24 years. With 40% of India’s population below 19 years, tobacco-free schools (TFS) can be a critical strategy for preventing tobacco-use among youth. This study examined the extent of and factors associated with complete adherence to national TFS guidelines among rural schools in the state of Maharashtra.

Methods:

Trained observers visited 507 rural schools to check adherence to eleven TFS criteria and conducted a cross-sectional survey of school-level indicators. These data were coupled with school-based information from the District Information System for Education (DISE) to analyze factors associated with TFS-adherence.

Results:

Only 11% of schools adhered to all eleven TFS criteria. Majority (72%) prohibited sale of tobacco inside and within 100 yards of the school; 63% displayed no-smoking posters; and 59% banned tobacco use inside premises. However, only 18% consulted with state tobacco advisor and only 28% of schools had tobacco prevention messages on school stationery. Bivariate analysis revealed that complete TFS-adherence was associated with participation of school in sports (p<0.001) and extra-curricular competitions (p<0.001); internet connectivity (p<0.005) and e-learning facilities (p<0.05); and teachers’ attendance at capacity-building workshops (p<0.05). A logistic model identified competitive sports participation (OR=3.27, p<0.005) as a key predictor of adherence to the TFS policy.

Conclusion:

This is the first study in India that measures and examines compliance among rural schools with national TFS guidelines; thus filling an existing gap in the tobacco control literature. Schools that provide students and staff with opportunities for overall development seem more likely to implement tobacco-free guidelines. By understanding the hard-to-meet criteria, policy-makers and practitioners can support schools in becoming tobacco-free. Integrating tobacco control programs with overall development goals of the school is one way forward.

Gender differences in infant survival: a secondary data analysis in rural North India

OBJECTIVE

To examine gender differences in infant survival on the first day of life, in the first week of life, and in the neonatal and post-neonatal periods by socio-demographic and economic variables.

DESIGN

Secondary data analysis was performed on data from a cluster randomised trial on the effect of implementation of the Integrated Management of Neonatal and Childhood Illness programme, India.

SETTINGS

The study setting was Palwal and Faridabad, districts of Haryana, a state in North India.

MEASURES

Multiple logistic regression models taking the cluster design into account were used to estimate gender differences in mortality in different periods of infancy.

RESULTS

A total of 60 480 infants were included in these analyses. Of 4060 infant deaths, 2054 were female (7.2% of all females born) and 2006 were male (6.3% of all males born). The death rate was significantly higher in females in the post-neonatal period but not during the neonatal period. The odds of death at 29-180 days and at 181-365 days were 1.4 (95% CI 1.3 to 1.6) and 1.7 (95% CI: 1.4 to 2.0) higher in females compared with males, respectively. This increase was seen across all socio-demographic and economic strata.

CONCLUSION

Gender differences during the post-neonatal period are a major threat to the survival and health of female infants in India. Programmes need to identify measures that can specifically reduce female mortality.

TRIAL REGISTRATION

Clinical trials NCT00474981.

Negotiating Collective and Individual Agency: A Qualitative Study of Young Women's Reproductive Health in Rural India

The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.

Does violence affect the use of contraception? Identifying the hidden factors from rural India

Purpose:

The objective of this study is to investigates the relationship between domestic violence and use of contraception among married women in rural India.

Data:

Third round of National Family Health Survey (NFHS-III).

Methodology:

Cross tabulation as bivariate analysis and Binary Logistic Regression as multivariate analysis has been employed to fulfill the objective.

Findings:

The result shows that there are several hidden factors. between physical violence and contraception use. Alternate explanatory variables are significantly affected the use of contraception. With physical violence which reflects that there is a relationship between physical violence and socioeconomic status such as education, awareness, empowerment of women and subsequently the use of contraception.

Originality/value:

The paper throws light on the hidden factors which are obstacle in use of contraception with physical violence. Results of this study have potentially important implications for programs aimed at preventing violence and promoting family planning programs.

Improving Access to Institutional Delivery through Janani Shishu Suraksha Karyakram: Evidence from Rural Haryana, North India

Background:

In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet.

Objective:

To assess the impact of JSSK on institutional delivery.

Materials and Methods:

A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery.

Results:

Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK (p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively.

Conclusions:

JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to address barriers to institutional delivery.

Prevalence and Predictors of Unmet Needs among the Elderly Residents of the Rural Field Practice Area of a Tertiary Care Centre from Northern India

BACKGROUND

Surrogate markers simple enough to be used by primary care workers have not been closely investigated by the community experts in rural Uttar Pradesh. We assessed the physical disabilities in activities of daily living (ADL) and unmet need in physical disabilities among rural elderly. Predictors of unmet needs in physical disabilities among the elderly were also identified.

METHODS

A community based cross-sectional study was conducted among elderly residents of the rural field practice area of a tertiary care centre in rural Uttar Pradesh. Three hundred and thirty five (335) participants aged 60 years and above from 9 villages were selected using the Probability Proportional to Size (PPS) sampling technique. Study tools were the proforma regarding socio-demographic details, socio-economic status and Stanford Health Assessment Questionnaire. Multivariate logistic regression analysis was performed to identify predictors of unmet needs.

RESULTS

185 (55.2%) had physical disability in one or more activity limitation. Gender wise elderly females had more physical disability in one or more ADL categories than elderly males (66.8% vs. 42.0%). Almost one third (32.5%) of subjects had unmet need for one or more physical disabilities. the predictors of unmet needs that were identified in the study were female gender (P = 0.046), elderly aged 70 years and above (P = 0.032), those living alone (P = 0.035), low monthly family income (P = 0.044), financially fully dependent elderly (P = 0.0002), and those having 3 or more physical disabilities (P = 0.033).

CONCLUSIONS

The findings of the study highlight that large number of needs of the disabled are still unmet. Greater, targeted efforts are needed to identify at-risk elderly people living in the community. These predictors would act as surrogate markers and can be easily used by primary care workers to plan and provide services to the elderly people in rural communities.

Prevalence of dysglycaemia in rural Andhra Pradesh: 2005, 2010, and 2014

BACKGROUND

Communities in rural Andhra Pradesh may be at increasing risk of diabetes. In the present study we analyzed three cross-sectional studies over 9 years to estimate the changing prevalence of dysglycemia (diabetes and prediabetes).

METHODS

The 2005 study sampled 4535 individuals from 20 villages, the 2010 study sampled 4024 individuals from 14 villages, and the 2014 project of 62 254 individuals sought to include all adults aged 40-85 years from 54 villages. Blood glucose levels were estimated using a hand-held device in 2005 and 2014 and using HbA1c dried blood spots in 2010.

RESULTS

In primary analyses restricted to assays based on fasting samples (2005, n = 3243; 2014, n = 749), the prevalence estimates for dysglycemia were 53.7% (95% confidence interval [CI] 51.8%-55.7%) in 2005 and 62.0% (95% CI 58.5%-65.4%) in 2014 (P < 0.001). Over the same period, mean body mass index (BMI) increased from 22.2 to 24.3 kg/m² (mean difference 2.1 kg/m² ; 95% CI 2.0-2.2 kg/m² ; P < 0.001). In secondary analyses using data from all participants (2005, n = 4535; 2010, n = 4024; 2014, n = 62 254), regardless of measurement technique, the estimated prevalence of dysglycemia was 53.9% (95% CI 52.0%-55.9%) in 2005, 50.5% (95% CI 46.1%-54.9%) in 2010, and 41.3% (95% CI 40.9%-41.7%) in 2014 (P < 0.001).

CONCLUSIONS

The prevalence of dysglycemia was high at every assessment using every measurement method. Dysglycemia in this population is most likely to have risen with the rise in BMI. The decline in prevalence suggested by the secondary analyses was likely due to confounding from the different assessment methods.

Secular Trends in Heights and Weights in Boys and Girls Over 3 Decades in Rural India

BACKGROUND

Secular trends in height reported from developing countries are few and scarce.

OBJECTIVE

To assess secular trends in linear growth in boys and girls from birth to 18 years of life in rural households of India based on periodical cross-sectional surveys conducted over a period of 35 years.

MATERIALS AND METHODS

The present study uses data from baseline and final surveys of National Nutrition Monitoring Bureau from 1975 to 1979 (N = 6043) to 2012 to 2013 (N = 11 910) on anthropometry from birth to 18 years from 7 states in households of rural India.

RESULTS

The overall improvement in 18+ boys and girls was 3.1 and 1.0 cm, respectively, over a period of 35 years. The increments in height of 18+ were highest for both boys (7.4 cm) and girls (4.8 cm) in the state of Kerala followed by Tamil Nadu (boys, 7.3 cm and girls, 3.8 cm). Under-5 stunting rates reduced from 82% in the baseline survey to 45.7% in the final survey at 1.35% per year in the pooled states and was similar in both boys and girls. The recovery in stunting was highest in Tamil Nadu (1.63% per year) followed by Kerala (1.46% per year).

CONCLUSION

The pattern of secular trends in height in rural India seen over 3 decades was strikingly similar to that of developed countries. The phenomenal improvement in linear growth in Kerala and Tamil Nadu in children younger than 5 years and adolescents suggests that growth potential for Indians is similar to that of developed countries.

Prevalence and Risk Factors for Patient Delay Among Women With Breast Cancer in Rural India

Delay in seeking health care by women with breast cancer increases mortality risk. This study was conducted in rural India to identify risk factors associated with patient delay. A total of 212 women with primary breast cancer diagnosed between 2010 and 2012 were interviewed. Sociodemographic characteristics, time interval between seeking medical attention and appearance of symptoms, and reasons for delay were inquired. Patient delay was defined as more than 3 months between date of first symptoms and medical consultation. Logistic regression was applied to assess associations between potential risk factors and patient delay. Almost half the women with breast cancer experienced patient delay. Age more than 60 years (odds ratio = 4.9, 95% confidence interval = 1.3-18.0) was significantly associated with patient delay. Only 6.6% of patients had heard about breast self-examination. Significantly higher number of patients with delay presented with advanced clinical stage (P = .000). Health education programs should be introduced with specific strategies to shorten patient delay.

Dental caries and their treatment needs in 3-5 year old preschool children in a rural district of India

Background:

Dental problems in the preschool children are neglected by their parents as the deciduous teeth are going to shed off, and hence considered to be of no importance and more of economic burden if attended to them.

Aims:

This study was to determine the caries prevalence in preschool children (3-5-year-old) of rural Moradabad district, to analyze the specific pattern of dental caries experience in this population and to assess the treatment needs among them.

Material and Methods:

Children within the age group of 3-5 years attending Anganwadi centers of rural Moradabad district were included in the study. Caries diagnosis was based on decayed, extracted, filled surface (defs) and the treatment needs were recorded using World Health Organization (WHO) oral health assessment form 1997.

Results:

Out of 1,500 children examined, 48.7% males and 52.6% females did not require any treatment. The mean decayed, extracted, filled teeth (deft) value was found to be significantly high in 5-year-old participants when compared to 3-year-old participants (P < 0.01). Majority of the children required one surface filling followed by two surface fillings, caries arresting sealant care, extraction, crown bridge element, pulp care, and space maintainer.

Conclusion:

The most common pattern was pit and fissure, then maxillary anterior pattern, posterior proximal pattern, and posterior buccal lingual smooth surface pattern. The mean deft value was higher in males as compared to females. There is a greater need for oral health education among parents and teachers.

Perceptions of farmers' and farmworkers' wives on the use and hazards of agrochemicals in rural Vellore

Poor handling, storage, and application of agrochemicals have resulted in a steep rise in mortality and morbidity associated with their use. This study aimed at assessing the awareness of wives of farmers and farmworkers in rural Vellore on the use and health effects of agrochemicals to identify gaps in their knowledge. A cross-sectional survey among 512 wives was conducted. Nearly 75 percent of the wives (384/512) did not know that agrochemicals could pass through skin. Also, wives who owned between 1 and 5 acres of land had a higher odds of knowing that agrochemicals were harmful (OR: 1.71(1.03-2-85), p < 0.05) and need to be disposed safely (OR: 4.76 (1.47-15.36), p < 0.05), than those owning less than an acre or no land. There is a need to educate women associated with agriculture in India on the harms and proper use of agrochemicals in order to better protect and inform their households and communities.

Healthcare seeking behavior for back and joint pain in rural gadchiroli, India: a population-based cross-sectional study

BACKGROUND

Musculoskeletal back and joint pain is common in rural agrarian communities in India.

OBJECTIVES

To understand the healthcare seeking behavior for back and joint pain among adults in rural Gadchiroli, India.

MATERIALS AND METHODS

A cross-sectional survey of 315 randomly selected respondents from 84 villages between 30 and 60 years of age was conducted by community health workers (CHWs) between October 2010 and January 2011.

RESULTS

Among 280 respondents on whom good quality data were available, 215 (76.8%) respondents had back and/or joint pain in 6 months preceding the survey. A majority of the respondents with pain had sought care (170; 79.1%), mainly from private practitioners (116; 68.2%). Severe pain and inability to work were the reasons to seek care. Complete pain relief was considered the major indicator of an effective treatment. Injectable medications (127; 59.1%) and intravenous fluids (92; 42.8%) were considered highly effective; while about 50% were unaware of the role of physiotherapy and surgery for this problem. When asked about the preferred provider who should provide village level treatment of this problem, more than half (135; 62.8%) of the respondents chose a trained village health worker.

CONCLUSIONS

A majority of the individuals with back and/or joint pain in rural Gadchiroli seek care, mainly from private practitioners. However, for the village-level treatment of this problem, respondents preferred a trained village level worker. High expectation of complete pain relief, preference for injectable medications, and low awareness about nonpharmacological modalities will be the major challenges while providing community level care for this problem.

Cause of death during 2009-2012, using a probabilistic model (InterVA-4): an experience from Ballabgarh Health and Demographic Surveillance System in India

Objectives

The present study aimed to estimate the age and cause-specific mortality in Ballabgarh Health and Demographic Surveillance System (HDSS) site for the years 2009 to 2012, using a probabilistic model (InterVA-4).

Methods

All Deaths in Ballabgarh HDSS from January 1, 2009, to December 31, 2012, were included in the study. InterVA-4 model (version 4.02) was used for assigning cause of death (COD). Data from the verbal autopsy (VA) tool were extracted and processed with the InterVA-4 model. Cause-specific mortality rate (CSMR) per 1,000 person-years was calculated.

Results

A total of 2,459 deaths occurred in the HDSS during the year 2009 to 2012. Among them, 2,174 (88.4%) valid VA interviews were conducted. Crude death rate ranged from 7.1 (2009) to 6.4 (2012) per 1,000 population. The CSMR per 1,000 person-years over the years (2009–2012) for non-communicable diseases, communicable diseases, trauma, neoplasm, and maternal and neonatal diseases were 1.78, 1.68, 0.68, 0.49, and 0.48, respectively. The most common causes of death among children, adults, and the elderly were infectious diseases, trauma, and non-communicable diseases, respectively.

Conclusions

Overall, non-communicable diseases constituted the largest proportion of mortality, whereas trauma was the most common COD among adults at Ballabgarh HDSS. Policy-makers ought to focus on prevention of premature CODs, especially prevention of infectious diseases in children, and intentional self-harm and road traffic accidents in the adult population.

Burden, pattern and outcomes of road traffic injuries in a rural district of India

Road traffic injuries (RTIs) are a leading public health problem and the understanding of RTIs in rural India is limited. The present report documents the burden, pattern, characteristics and outcomes of RTIs in a rural district of India using combined data sources: police and hospital. RTIs contributed for 38% of fatal and 39% of non-fatal injuries with an annual mortality rate of 18.1/100,000 population/year. Young males were affected most and two-wheeler users and pedestrians were involved in 45% and 20% of fatal crashes, respectively. Nearly half (51%) of fatal RTIs occurred on national highways of the district; 46% died immediately at the site. Among those hospitalised, 20% were under the influence of alcohol while use of helmets and seat belts was <5%. Trauma care was deficient in the district leading to greater number of referrals. Road safety should be given high importance in rural India with a focus on safe roads, safe vehicles and safe people along with trauma care.

Factors associated with elder mistreatment in rural Tamil Nadu, India: a cross-sectional survey

BACKGROUND

There is limited evidence for the multifactorial aetiology of elder mistreatment. The goal of this study is to investigate the factors associated with the mistreatment of older adults living in rural Tamil Nadu, India.

METHOD

A cross-sectional household survey was conducted in a sub-district of rural Tamil Nadu by using a standard questionnaire. Face to face interviews were conducted with 902 older adults aged 61 years and older. The relation between the characteristics of older adults, family members and family environments with reported mistreatment was examined by univariate and multivariate logistic regression analyses.

RESULTS

The multivariate results reveal that elder mistreatment is related to several factors associated with the perpetrator and the family environment. Perpetrator factors include middle age, a tertiary education (protective), alcohol consumption and the mistreatment of other family members. Family environment factors include family stress and low cohesion. Among the factors related to older adults, only physical abuse of family members was associated with exposure to mistreatment.

CONCLUSION

The characteristics of older adults, family members and family environment are potent predictors of elder mistreatment. Multi-dynamic interventions should target dysfunctional families displaying alcohol use, relationship conflicts, low cohesion and the presence of some form of family violence.

Evaluation of a community-based HIV preventive intervention for female sex workers in rural areas of Karnataka State, south India

To examine changes in behavioral outcomes among rural female sex workers (FSWs) involved in a community-based comprehensive HIV preventive intervention program in south India. A total of 14, 284 rural FSWs were reached by means of a community-based model for delivering outreach, medical, and referral services. Changes in behavior were assessed using 2 rounds of polling booth surveys conducted in 2008 and 2011. In all, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. There was a significant increase in condom use (from 60.4% to 72.4%, P = .001) and utilization of HIV counseling and testing services (from 63.9% to 92.4%; P = .000) between the 2 time periods. This model for a community-based rural outreach and HIV care was effective and could also be applied to many other health problems.

Determinants of prelacteal feeding in rural northern India

BACKGROUND

Prelacteal feeding is an underestimated problem in a developing country like India, where infant mortality rate is quite high. The present study tried to find out the factors determining prelacteal feeding in rural areas of north India.

METHODS

A crosssectional study was conducted among recently delivered women of rural Uttar Pradesh, India. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected as the subjects, following systematic random sampling. Chi-square test and logistic regression were used to find out the predictors for prelacteal feeding.

RESULTS

Overall, 40.1% of mothers gave prelacteal feeding to their newborn. Factors significantly associated with such practice, after simple logistic regression, were age, caste, socioeconomic status, and place of delivery. At multivariate level, age (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.13-2.74), caste and place of delivery (OR = 2.23, 95% CI = 1.21-4.10) were found to determine prelacteal feeding significantly, indicating that young age, high caste, and home deliveries could affect the practice positively.

CONCLUSIONS

The problem of prelacteal feeding is still prevalent in rural India. Age, caste, and place of delivery were associated with the problem. For ensuring neonatal health, the problem should be addressed with due gravity, with emphasis on exclusive breast feeding.

Determinants of utilization of antenatal care services in rural lucknow, India

Background:

Antenatal care services are the first steps towards ensuring the health of mothers and the newborn. This is the key component for achieving Millennium Development Goals by 2015. But India's performance continues to be poor in providing antenatal care services to its huge population, particularly in the rural areas.

Objective:

To assess the determinants of utilization of antenatal services by rural beneficiaries in Lucknow, a district of north India.

Materials and Methods:

The study, cross-sectional in design, was conducted from August 2009 to July 2010. Multistage random sampling was used for selecting villages. A total of 352 recently delivered women were selected following systematic random sampling. Logistic regression was used to find out the determinants of three antenatal care services.

Results:

Overall, 85.5% of the beneficiaries surveyed were found to receive at least three antenatal care services from any health facility. Community health centre was the most common source for such care. Significant difference was found between beneficiaries who took three antenatal care visits and who did not in terms of age, socio economic status, and timing of registration. On multiple regression, only age (OR = 2.107, 95% CI = 1.132 – 3.923) and timing of registration (OR = 2.817, 95% CI = 1.487 – 5.338) were found to be the predictors for three antenatal care visits.

Conclusion:

Intervention should be focused on young and late registered women for ensuring sufficient care during pregnancy.