Search

Introduction: India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi. Methods: A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results: The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75–22.54)], females [AOR: 1.57 (95% CI: 1.04–2.37)], and middle class [AOR: 2.23 (95% CI: 1.45–3.43)]. Conclusion: Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class. [ABSTRACT FROM AUTHOR]

The sustainable development goals (SDG 7.1) reinforce to ensure that everyone has access to affordable, safe and renewable energy. In India, women are typically responsible for cooking and are most vulnerable to household air contaminants. We conducted a descriptive cross-sectional comparative study in Odisha, India between exclusive LPG (liquefied petroleum gas) users and non-LPG users. A total of 900 women, 450 from each group, were randomly selected. The LPG-users had a better predictor of physical, psychological, social, and environmental wellbeing than non-LPG users. We found the ophthalmic disorders (adjusted odds ratio (AOR) 2.87, 95% CI 1.16–7.10, p =.023), asthma (AOR 2.05, 95% CI 1.15–3.65, p =.015), and ALRI (acute lower respiratory infections) (AOR 9.19, 95% CI 2.06–40.96, p <.004) were significantly higher in non-LPG users in comparison to LPG users. Access to smokeless cooking fuel will improve women's quality of life by eliminating the consumption of biofuel and thereby providing a healthier cooking environment. [ABSTRACT FROM AUTHOR]

Background: Six diverse Demographic Development and Environmental Surveillance System (DDESS) sites were established in urban slum, urban resettlement, peri-urban, rural, and tribal areas located in Northern, North-East, Eastern, and Southern regions of India from June 2020 to March 2022. Understanding the community dynamics and engaging people in the community is critically important in the process of establishing DDESS. We ascertained the barriers, challenges, and facilitators during the establishment of multiple DDESS sites across India. Methods: This was a cross-sectional descriptive mixed-methods study. Results: Multiple barriers and challenges encountered were reported in the process of community engagement (CE), such as geographical inaccessibility, language barriers, adverse weather, non-responsiveness due to perceived lack of individual benefit or financial gain, fear of contracting COVID-19, COVID-19 vaccine hesitancy, etc. Facilitators in the CE process were pre-existing links with the community, constitution of community advisory boards, community need assessment, concomitant delivery of outreach health services, and skill-building facilities. Conclusion: Most community barriers in the development of DDESS sites in resource-limited settings can be overcome through a multipronged approach, including effective community engagement by focusing on demonstrating trust at the local level, enlisting community mobilization and support, utilizing pre-existing community linkages, initiating community diagnosis, and meeting perceived community health needs. [ABSTRACT FROM AUTHOR]

Objective: Measure the satisfaction level of patients visiting a tertiary level cancer institute in Odisha, identify the factors associated with the satisfaction level and assess the health system challenges related to quality service provision for cancer survival. Material and Methods: Analytical cross-sectional study was carried out using a mixed-methods approach in a tertiary cancer care unit in Odisha among 538 cancer patients using the Patient Satisfaction 32 questionnaire and the Patient Health Questionnaire (PHQ)-9 questionnaire. Results: There were 41% and 43% of outdoor and indoor patients who were below poverty line. Hindu was the predominant religion (>90%), 10% were illiterates and 90% were married in each category. Breast cancer (16%) was predominant among outdoor patients, whereas, it was stomach cancer (15%) among indoor patients. The PHQ median score for females was 1.5 and 1 each for indoor and outdoor patients, respectively. Nearly, 72% and 57% of males and females had mild depression to adjustment disorders statistically significant at P < 0.05. 90% of outdoor and 68% of indoor patients with a greater frequency of visits were significantly more depressed than their counterparts. All those accompanied by people other than their family members also showed higher values of adjustment and mild depressive features (69%) at P < 0.05. About 81% were satisfied with both general services and staff and nearly 40% with treatment and diagnosis. Conclusion: It gave us demographic details of cancer morbidity and its associates besides validating the survivorship framework in the Indian setting. Self-help anonymous and rehabilitation centres for a holistic integrative approach at the primary level of care need to be done. [ABSTRACT FROM AUTHOR]

Background: Due to the scarcity of organs available for transplantation, several patients lose their lives each year. Increased awareness and positive attitudes alone may be insufficient to increase an individual’s willingness to donate (i.e., the basic tenets of the knowledge‑attitude‑practice/ KAP model). Therefore, it is pertinent to examine other psychological determinants that are associated with engaging in the altruistic/prosocial act of organ donation. Objective: To understand the association between empathy and KAP of organ donation in an Indian population. This pilot is the precursor to a larger project which aims to develop and test an empathy intervention to promote organ donation. Methods: Using a cross‑sectional design, Indians (N = 419; female = 261; mean age = 28.48 years) aged 18 years and above were recruited using convenience sampling through an online survey. Questionnaires included the Awareness, Attitudes, and Practice of Organ Donation (Chakradhar et al., 2016) and Empathy Quotient‑8 (Loewen et al., 2010). Multiple regression analyses were carried out to analyze the data. Results: Results showed that empathy was related to: (i) Total KAP (β = 0.123, P = 0.014), and (ii) attitudes (β = 0.195, P < 0.001) towards organ donation. Conclusion: These pilot study findings indicate that public health messages focused on evoking empathy can use the technique of patient/ donor narratives, and training clinicians on empathic communication skills can help increase individuals’ KAP of organ donation. Further, this pilot elucidated the need to conduct mixed‑method studies with a donor and nondonor population and clinicians prior to developing and testing a larger empathy‑centered intervention aimed at promoting the KAP of organ donation. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is being recognized as a crucial maternal health challenge in India. However, pregnancy remains an exclusion criterion in most multimorbidity estimation studies resulting in a deficient understanding of the problem in this population. The present study aims to estimate the prevalence of multimorbidity, identify its correlates, and assess healthcare utilization and expenditure outcomes among women availing of antenatal care clinics. Methods: An exploratory cross-sectional study was conducted among 127 pregnant women attending three antenatal clinics of Bhubaneswar, Odisha, from February to July 2016. Data were collected using a "multimorbidity assessment questionnaire for primary care," contextualized for antenatal settings. The prevalence and correlates were determined using descriptive analysis, and the outcomes were measured by the number of healthcare visits, medications, and healthcare expenditure. About 15% of antenatal women were multimorbid. Result: Anemia (52.6%), hypertension (31.6%), acid-peptic diseases (26.3%), and thyroid (26.3%) were the leading chronic conditions. Statistically, significant association was found between multimorbidity and medical consultation, the medicines consumed, and functional limitation. The healthcare expenditure was significantly higher among the multimorbidity groups. Conclusion: Our findings suggest the inclusion of comprehensive multimorbidity assessment in routine antenatal screening. Preconception care should establish linkages between maternal and reproductive health with chronic disease prevention, and identify ways to reduce healthcare utilization and expenditure. Longitudinal studies to assess the trajectory and impact of multimorbidity on maternal and infant health are warranted. [ABSTRACT FROM AUTHOR]

Background: Since the novel SARS-CoV-2 has been detected and the ensuing pandemic, the search for a cure or prevention has been the only target of the medical fraternity. As the second wave racked havoc, vaccines seemed to be the only viable option to stop this global surge. World Health Organization (WHO) and subsequently the Government of India have issued emergency use authorization to two vaccines. Our study aims to estimate the prevalence of the anti-SARS-CoV-2 antibodies and identify predictors of antibody titers in vaccinated healthcare workers in VIMSAR, Burla. Methods: This is a part of the ongoing, repeated cross-sectional study. Participants were enrolled well above the sample size (322) to increase precision. Two rounds of the survey were conducted and are being reported. Serum IgG antibodies against spike protein of SARS-CoV-2 were estimated using Elecsys® anti-SARS-CoV-2S is an immunoassay by ECLIA-based Cobas e411 analyzer. Univariate and multivariate regression were used in statistical analysis. Results: Our results show that 95.1% and 99.5% of the vaccinated individuals have developed antispike protein antibodies after the first and second doses, respectively. Previous COVID-19 infection was significantly correlated with antibody production, and age was negatively correlated. No difference was reported for sex, occupation, and diabetes. Conclusion: Our interim analysis report is coherent with the available literature and research regarding the high efficacy of the COVID-19 vaccine as far as seroconversion is concerned. [ABSTRACT FROM AUTHOR]

The diabetes burden is rapidly accelerating in India, particularly since the 2000s. We explore the burden and contribution of modifiable risk factors in diabetes among reproductive women across geographic regions of India. The study uses data from the National Family Health Survey in India 2015–2016, Census of India 2011, and World Population Prospects 2015. We computed Population Attributable Fractions and the number of total and estimated avoidable diabetic cases across regions. The prevalence of diabetic cases in India were 24.4 per 1000 women, varying across geographic regions. Diabetes affected around 8.2 million women (15–49 years) in India. Overweight (PAF = 19.5%) and obesity (PAF = 18.3%) contributed to the diabetes burden; if mitigated optimally, these can reduce diabetic cases by 2.8 million in India. Controlling diabetes should be region specific for maximum impact. Extending chronic disease screening during maternal and child health consultations might help decelerate the growing menace of diabetes in the country. [ABSTRACT FROM AUTHOR]

Provision of primary healthcare in India received thrust of National Health Policy 2017. Vacancy, chronic absenteeism and non-availability of allopathic doctors is a chronic problem of the public health system. Engagement of alternative human resources could get the ailing health system rid of this shortage. AYUSH doctors in Odisha are involved in clinical and public health activities since 1970s. This study aims to examine perspectives of key stakeholders on 'task shifting' as a possible policy alternative. We reviewed the policies and guidelines of government of Odisha on human resources deployment, recruitment, retention and terms of reference of their engagement in the public health sector. Further, 76 AYUSH doctors and 30 key informants were interviewed. Ethical clearance was obtained beforehand. Most AYUSH doctors were involved in monitoring and supervising community-based public health programmes and village-level health service providers, respectively. Their involvement in the implementation of national health programmes was found to range from 8% to 62%. A sizeable proportion of AYUSH doctors had not been trained on management of national vector borne disease control, Tuberculosis control, immunisation (RI) and disease surveillance. More than 70% of respondents showed interest in implementing and managing public health programmes. Almost all key informants recommended for improved involvement of AYUSH doctors in public health activities. Inadequate logistics support, insufficient training on public health and unequal administrative authorities was perceived to be systemic bottlenecks. Job enrichment, management capacity development, and pre-deployment orientation of AYUSH doctors may precede the opportunity of 'task-shifting' of public health functions. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings. Methods: We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits. Result: The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1–1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1–2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1–2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0–2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6–4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1–3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13–2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01–3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals. Conclusion: Our findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQL) is an important outcome for chronic diseases such as diabetes mellitus that is associated with complications, comorbidities, and lifelong care. Objectives: The present study aims to explore the impact of comorbidities on the different dimensions of HRQL among type 2 diabetic patients attending primary care. Methods: A total of 912 type 2 diabetic patients attending primary care centers in India were assessed using a predesigned and pretested questionnaire – Diabetes Comorbidity Evaluation Tool in Primary Care. The HRQL was measured by physical and mental health summary scores [physical component summary (PCS) and mental component summary (MCS)] of the Short Form Health Survey 12. The associations of sociodemographic variables and clinical variables with PCS and MCS were assessed, and a minimal difference of 5 in the scores (on a scale of 0–100) was kept as clinically relevant difference for this study. Mean differences in mental (MCS) and physical (PCS) scores of quality of life by number and type of comorbid conditions in type 2 diabetic patients were calculated. Result: The presence of comorbid conditions was associated with lower scores of PCS and MCS (P < 0.001). Significant reduction in HRQL was found with increase in number of comorbid conditions, and negative association was established between the number of comorbidities and the PCS (r = −0.25, P < 0.0001) and MCS scores (r = −0.21, P < 0.0001). Among comorbidities, acid peptic disease, chronic lung disease, visual impairment, depression, and stroke had significantly and clinically relevant reduced scores. Duration of diabetes, use of insulin, and obesity were also associated with poor HRQL. Conclusion: Comorbidities considerably impair the HRQL among type 2 diabetic patients. National programs designed for diabetes management should also take into account the challenges of coexisting chronic conditions and its substantial effect on HRQL. [ABSTRACT FROM AUTHOR]

Context: Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha. Aim: To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities Settings and Design: A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers. Statistical Analysis Used: Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method. Results: Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level. Conclusions: On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (ASD) is globally a major cause of childhood disability. It is estimated that in India approximately 1.7-2 million children are affected with this disorder. Early diagnosis is an important criterion to start early interventions for ASD treatment. However, for every childhood problem that receives a medical diagnosis, there is a period between a parents' first recognition of unusual symptoms and the eventual diagnosis. Several factors influence this initial symptoms recognition and final diagnosis. Aims: The present study attempts to decipher parents' perception regarding ASD and to understand the early signs of ASD recognition among parents, treatment-seeking pathways adopted their experiences and challenges in the overall process. Setting and Design: A facility-based cross-sectional study was undertaken at Bhubaneswar, Odisha. Methodology: Parents of children with ASD were recruited for this study. Seventy-six interviews were conducted, and the data were analyzed. Results: The major symptom identified by the majority of the parents was social difficulty among their children. Maximum parents had not heard about ASD before their child was diagnosed with the disorder. Parents consulted multiple professionals or traveled long distances to confirm the diagnosis. Child psychiatrists often confirmed the diagnosis and referred patients to rehabilitation centers. Conclusion: Lack of awareness, unavailability of services, and stress contributed to the delay in ASD diagnosis. There is a need for designing proper awareness and genuine center for the treatment. Similarly, referral and counter-referral mechanism is also required to be established to save delay in diagnosis and initiate prompt treatment in the field of ASD. [ABSTRACT FROM AUTHOR]

Generativity, “a concern for others and a need to contribute something to the next generation,” is a dimension of successful aging in and of itself, but also predicts other positive health outcomes. We examine its manifestations and correlates among elderly in rural India and assess the association between generativity and quality of life (QoL). Three hundred and forty-eight rural Indian elderly completed an interviewer-assisted questionnaire assessing generativity, QoL, and other personal and familial factors. Regression models were used to examine potential correlates of generativity and the relationship between generativity and QoL. Higher education, inheritance income, more living children, and a son/daughter living in the home predicted higher levels of generativity. Higher levels of generativity were associated with higher QoL. There are both personal and familial correlates of generativity, and family relationships are important for generative development. Family-oriented interventions to increase generativity among elderly Indians could improve QoL. [ABSTRACT FROM AUTHOR]

Introduction: Patient satisfaction is as important as is the care itself. When the patient has a disease like cancer it becomes even more important. A cancer patient not only suffers from the disease but also undergoes substantial mental trauma, agony, stress, uncertainty, and apprehension. There are limited studies in India eliciting patient's views on the quality of care being received by cancer patients. Methodology: A cross-sectional triangulation data transformation model mixed method design (Quant + Qual) was used to conduct the study between March and May 2015 among patients attending specialty hospitals providing oncology services in Odisha, India. The quantitative data were collected using, Patient Satisfaction Questionnaire-18 to assess satisfaction. The qualitative data were obtained through in-depth interviews using open-ended questionnaire. Results: The results showed that general satisfaction among the patients was 60%. The maximum score was obtained for the communication of doctors. The qualitative findings revealed that travel for distant places for minor illness, waiting period, and lack of services at the primary care facilities were reasons for patient's dissatisfaction. Conclusion: The study found that the patients were generally satisfied with the quality of services. However, more studies should be conducted including perceptions of the patients as well as the caregiver. [ABSTRACT FROM AUTHOR]

Purpose: Little information is available on multimorbidity in primary care in India. Because primary care is the first contact of health care for most of the population and important for coordinating chronic care, we wanted to examine the prevalence and correlates of multimorbidity in India and its association with health care utilization.Methods: Using a structured multimorbidity assessment protocol, we conducted a cross-sectional study, collecting information on 22 self-reported chronic conditions in a representative sample of 1,649 adult primary care patients in Odisha, India.Results: The overall age- and sex-adjusted prevalence of multimorbidity was 28.3% (95% CI, 24.3-28.6) ranging from 5.8% in patients aged 18 to 29 years to 45% in those aged older than 70 years. Older age, female sex, higher education, and high income were associated with significantly higher odds of multimorbidity. After adjusting for age, sex, socioeconomic status (SES), education, and ethnicity, the addition of each chronic condition, as well as consultation at private hospitals, was associated with significant increase in the number of medicines intake per person per day. Increasing age and higher education status significantly raised the number of hospital visits per person per year for patients with multiple chronic conditions.Conclusion: Our findings of higher prevalence of multimorbidity and hospitalizations in higher SES individuals contrast with findings in Western countries, where lower SES is associated with a greater morbidity burden. [ABSTRACT FROM AUTHOR]

Background: The burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Methods: Secondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007–2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models. Results: The prevalence of multimorbidity in the adult population varied from 3∙9% in Ghana to 33∙6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0∙56, 95% CI = 0∙46, 0∙66), a higher likelihood of being hospitalised in India (AOR = 1∙59, 95% CI = 1∙45, 1∙75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88∙3% for outpatient, 55∙9% for inpatient visit in China) in most countries. Conclusion: Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity. [ABSTRACT FROM AUTHOR]

Neonatal care practices have been shown to vary across tribal communities. This cross-sectional study was conducted in tribal block in Nabarangpur district of Odisha, India, to measure perinatal and antenatal practices by qualitative inquiries of 55 mothers who had babies aged <60 days and from 11 traditional birth attendants. Reasons for home deliveries were cited as easy availability of traditional birth attendants and family preferences. Application of indigenously made substances on umbilical stump and skin of the baby, bathing baby immediately after birth, late initiation of breast-feeding and ‘Budu practices’ were common. Cultural issues, decision of family members and traditional beliefs still play a crucial role in shaping neonatal care practice in tribal communities. Awareness on child care, ethnographic understanding of health-seeking behavior of tribal community and mobilization of community by health workers can be useful in improving health status of mothers and newborn babies in tribal population. [ABSTRACT FROM PUBLISHER]

Background: Physicians constitute a considerable professional influential group; they may be most suited for tobacco use prevention and smoking cessation intervention among the growing tobacco using population. Methods: We assessed tobacco cessation knowledge and practice done by 91 physicians in two blocks of Khurda district by using modified version of survey instrument developed by Francisco G. Soto Mas. Statistical Package for Social Sciences (SPSS) 16 statistical software was used for the analysis. Results: The response rate was 75.83%, of which 77 (84.6%) were male. Study participants were in the age group 36-45 years. Nearly 13.2% of the respondents were active tobacco user. In tobacco-related practices, around 58 (62%) of participant physicians ask patients about tobacco use status always-frequently. More than (67) 70% of participant physicians advise their patients to quit tobacco but only 10-20% of study physicians assist them in referring to cessation programs. Seventy one (78%) of physicians felt providing counseling to patients using tobacco as their responsibility. Conclusions: The results indicate that physicians participating in this study do not meet the level of intervention recommended by National Tobacco Control Program. [ABSTRACT FROM AUTHOR]