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This article addresses the pervasive issue of missing data in biomedical research and the potential solutions to prevent it. The focus is on proactive strategies for prevention at various stages of the research process. Advocating for a comprehensive study design, clear communication through information sheets during consent, and the use of well-designed data collection tools are key to preventing missing data issues in health research. In addition, the training and supervision for data collectors, especially in the context of potential biases arising from sensitive questions, are critical. Electronic data collection has the advantages of validation and checks to prevent missing data. Hence, adequate planning is a must to reduce missing values and improve the validity of the study outcome.

Purpose: To estimate the magnitude, determinants, and causes of visual impairment (VI) and blindness among people >40 years. Methods: In this cross-sectional survey, 2,968 people >40 years from 34 clusters were examined. A cluster random sampling method with a compact segment sampling technique was used to select the study participants. Prevalence of any VI (presenting visual acuity (PVA) 70 years, and OR 7.6 (95% CI: 2.2–26.5) for people aged between 60 and 69 years compared to those aged 41–50 years and people living near coastal regions (Within 50 km of coast) (OR: 3.9, 95% CI: 1.6–7.3). Conclusion: Blindness and vision impairment are of public health concern in this geographic region. Eye care services need to be augmented to address this challenge.

Abstract Background Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal. Methods In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital. Results We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% (n=109) in the intervention group and 42.9% (n=64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p

National surveillance data were collected to study the outbreak trends of infectious diseases/syndromes before and during the COVID-19 pandemic period, spanning from 2018 to 2022. The study found that out of 4208 outbreaks, 2972 occurred before the COVID-19 period, affecting 147,425 people, while 1236 outbreaks affected 52,324 people during the pandemic. The number of outbreaks for diseases such as acute flaccid paralysis, fever with rashes, leptospirosis, rabies, and scrub typhus increased during the pandemic. The geographic distribution of outbreaks remained similar for some reemerging diseases in both periods. The trends for dengue, Japanese encephalitis, and cholera remained consistent with peaks mostly from July to September in both periods. We observed a considerable reduction in morbidity and mortality due to outbreaks in India during the pandemic. Despite similar distributional patterns, the study indicates a strong suspicion of persistent outbreak-initiating factors, necessitating an efficient and vigilant surveillance system in the country.

Rabies is highly prevalent in India. It is almost always fatal but preventable by timely administration of vaccine and proper wound care. Rural population have high disease burden. This may be partly due to lack of knowledge regarding the disease. Objectives- To identify the knowledge, attitude & practice of rural people attending in a rural hospital for animal bite management. Materials and Methods- Cross sectional observational study with 119 patients (period prevalence in February 2013). Results- Dogs were the main biting animal (87.4%). Children were the main victim(47.9%). 21% (25) of the respondent said that animal bite may lead to rabies. Neighbors were the main source of knowledge (38.7%). Mean duration of delay in presenting to hospital was 5.02 days. Roughly one third applied soap water to clean the wound. Attitude and practice was significantly associated with knowledge and attitude respectively (p

Missing data can introduce biases and affect the generalizability of research findings, undermining the scientific rigor of studies and impeding the development of evidence-based practices. To overcome these challenges, health-care providers and researchers must adopt robust strategies to identify, prevent, and handle missing data effectively. This includes implementing standardized data collection procedures, utilizing advanced statistical techniques to account for missingness, and embracing emerging technologies that facilitate comprehensive and timely data capture. By prioritizing the management of missing data, health-care professionals and researchers can enhance patient care, improve research quality, and ultimately contribute to better health outcomes for individuals and populations.

الملخص: أهداف البحث: أجريت الدراسة لتقدير انتشار عدم الالتزام بالأدوية بين مرض السكري من النوع 2 الذين يحضرون إلى عيادة نمط الحياة في المستشفيات التخصصية في غرب البنغال ، الهند ؛ لتحديد العوائق البيئية التي تحول دون ممارسات الرعاية الذاتية ، بما في ذلك النظام الغذائي والتمارين الرياضية واختبار الجلوكوز والأدوية ؛ وتحديد المحددات الاجتماعية والديموغرافية والبيئية لعدم الالتزام بالأدوية. طريقة البحث: تم إجراء دراسة مقطعية بين مرضى السكري من النوع 2 الذين هم على أدوية مرض السكر عن طريق الفم في عيادة نمط الحياة في مستشفى تعليمي في عام 2021. تمت مقابلة المشاركين في العيادة باستخدام استبانة منظومه باللغة المحلية. تم تقييم الالتزام بالأدوية من خلال مقياس موريسكي للأدوية بينما تم تقييم الحواجز البيئية من خلال مقياس تقييم الحاجز البيئي. النتائج: من بين 178 مشاركا، تم العثور على مستوى عال من الالتزام حسب مقياس موريسكي للأدوية (درجة 8) بين 3 (1.7٪) من المشاركين، والالتزام المتوسط (درجة 6 إلى 7.75) بين عدد (37.6٪، مستوى ثقة 95٪، 30.3%، 44.9٪) من المشاركين. كان انتشار عدم الالتزام بنسبة 60.7٪ ( مستوى ثقة 95٪، 53.4%، 68.0٪). كان متوسط الدرجة الإجمالية لنتيجة الحاجز 134. تم توزيع جميع مكونات الحواجز البيئية بالتساوي بين المتغيرات التنبؤية باستثناء درجة النظام الغذائي التي كانت أقل بين الذكور (متوسط الفرق 1.3، مستوى ثقة 95٪، 0.04، 2.5) والأشخاص الحاصلين على تعليم عال (متوسط الفرق 1.8، مستوى ثقة 95٪، 0.6، 3.1). الاستنتاجات: وجدت الدراسة ضعف الالتزام بأدوية سكر الدم عن طريق الفم في هذه الفئة من السكان. تسود العوائق التي تحول دون ممارسة الرعاية الذاتية والالتزام بالأدوية في جميع الطبقات الاجتماعية والاقتصادية. يشكل التقيد الضعيف بالأدوية تحديا كبيرا للأطباء وخبراء الصحة العامة لتحقيق هدف العلاج. Abstract: Objective: The study was conducted to estimate the prevalence of non-adherence to medications among patients with type 2 diabetes attending a lifestyle clinic in a tertiary care hospital in West Bengal, India; to identify the environmental barriers to self-care practices, including diet, exercise, glucose testing and medication; and to identify the socio-demographic and environmental determinants of medication non-adherence. Methods: A cross-sectional study was performed among the patients with type 2 diabetes taking oral hypoglycemic drugs and attending a lifestyle clinic of a teaching hospital in 2021. The participants were interviewed in clinical settings via a structured questionnaire in the local language. Medication adherence was assessed with Morisky Medication Adherence Scale-8 (MMAS), and environmental barriers were assessed with the Environmental Barrier Assessment Scale (EBAS). Results: Among 178 participants, a high level of adherence (MMAS score 8.0) was found among 3 (1.7%) participants, and moderate adherence (MMAS score 6.0 to 7.75) was found among 67 (37.6%; 95% CI 30.3%, 44.9%) participants. The prevalence of non-adherence was 60.7% (95% CI: 53.4%, 68.0%). The overall mean barrier score was 134 (SD 13). All environmental barrier components were distributed equally among the predictor variables except the diet score, which was lower among men (mean difference 1.3; 95% CI: 0.04, 2.5) and people with higher education (mean difference 1.8; 95% CI: 0.6, 3.1). Conclusion: The study indicated poor adherence to OHA in this population. Barriers to self-care practice and medication adherence were observed acrross all socio-economic strata. Poor medication adherence poses a major challenge to clinicians and public health experts in achieving treatment goals.

Background: The treatment gap for people with common mental disorders is large, estimated to be 75–95% in India; the reasons are multi-factorial. It was found that 89% of the primary health centers are not providing mental health care services. Technology like the electronic-mental Health Global Action Program-Intervention Guide (e-mhGAP-IG) is necessary to fill this gap, which in turn helps to attain one of the aims of National Mental Health Program-1982. Hence, the study is planned to understand the feasibility and adaptability of WHO’s e-mhGAP-IG by the primary health workers in the delivery of mental health care for child and adolescent mental/behavioral disorders (CMH) and substance use disorders (SUB). Methods: It is an open-label randomized control trial planned to conduct at primary healthcare centers, Chittoor district. Primary health care staff working at PHCs/Sub-centers having one year experience, and being able to handle smart phones will be included in the study. Data will be collected using a self-structured case report form (CRF) and analyzed by applying per protocol analysis using JAMOVI software. The cost of intervention and the impact on disease outcomes will be taken concurrently to estimate the cost-effectiveness of the intervention. Trial registration: CTRI/2023/04/051899 dated 24/04/2023 under the clinical trials registry-India Protocol version: 1.0 dated 24/04/2023

Background: This study aims to analyse the undernutrition burden in India and assess the state-level distribution of nutritional indicators among children under three, using data from NFHSs. Methods: This analysis focused on children under three years old and examined the prevalence and trend of undernutrition indicators in India at national and state levels. Changes over a decade were assessed to determine the burden. The study employed a multilevel logistic regression model to measure undernutrition burden, incorporating household and individual factors. Results: From NFHS-1 to NFHS-5, wasting prevalence increased slightly from 19.9 % to 20.5 %, while stunting and underweight decreased from 51.9 % to 34.1 % and 45.8 %–29.4 %, respectively. Stunting and underweight saw a decrease of 6.36 % (↓) and 5.86 % (↓), respectively, while wasting showed a slight increase of 0.21 % (↑). Mother's education and the child's sex were significant factors influencing children's nutritional status. Conclusion: Despite advancements in reducing undernutrition indicators in India through national nutrition programs, the pace of progress remains slow. Prioritizing the fulfillment of nutrition-related SDG goals is crucial. Policymakers can leverage the study's results to create interventions for improving children's nutritional status. Coordinated efforts at both state and national levels are essential to achieve specific improvements in undernutrition indicators across programs.

Introduction: Iodine deficiency disorders (IDD) have remained an unresolved public health problem in India. In this survey, we have estimated the prevalence of IDD among 6–12 years of school children in rural areas of north Karnataka, India and estimated the prevalence of low iodine content (

Background: Self-care practices in diabetes are deemed as one of the mainstays of management, but often poorly practiced by people with diabetes. Aim: The study describes self-care practices among adult diabetics registered with a primary health-care setup. Methods: This was a community-based cross-sectional study based out of the Ramaiahguda primary health center in Vikarabad town of Telangana. Informed consent was taken from all participants before the commencement of the study. All eligible candidates were approached for the study. The seven domains of the “American Association of Diabetes Educators measures of outcome” were taken as the base for assessment of self-care practices among the participants. Results: The mean (standard deviation [SD]) age of the 155 study participants was 50.8 years (SD 12.4 years). Among the various components of self-care, drug adherence, glucose monitoring, and diet modifications were regular as per the advice. Comparatively, healthy coping, risk reduction, and problem solving are the areas where the participants had a major scope to improve. The median self-care score of the participants was 15.25 (interquartile range 14.5–16.25) ranging from 0.25 to 18.0. 86 (55.5%) participants had good self-care scores, and 69 (44.5%) participants had moderate self-care scores. Conclusions: The observations from our study point toward a lack of understanding and in-depth evaluation of the effectiveness of diabetic self-care practices, which may in turn be one of the factors affecting compliance to such practices among the diseased population.

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico-mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies (21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21–40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%–100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%–97.2%) and Trichophyton rubrum (0%–69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Objectives: India introduced BBV152/Covaxin and AZD1222/Covishield vaccines in January 2021. We estimated the effectiveness of these vaccines against severe COVID-19 among individuals aged ≥45 years. Methods: We did a multi-centric, hospital-based, case-control study between May and July 2021. Cases were severe COVID-19 patients, and controls were COVID-19 negative individuals from 11 hospitals. Vaccine effectiveness (VE) was estimated for complete (2 doses ≥ 14 days) and partial (1 dose ≥ 21 days) vaccination; interval between two vaccine doses and vaccination against the Delta variant. We used the random effects logistic regression model to calculate the adjusted odds ratios (aOR) with a 95% confidence interval (CI) after adjusting for relevant known confounders. Results: We enrolled 1143 cases and 2541 control patients. The VE of complete vaccination was 85% (95% CI: 79-89%) with AZD1222/Covishield and 71% (95% CI: 57-81%) with BBV152/Covaxin. The VE was highest for 6-8 weeks between two doses of AZD1222/Covishield (94%, 95% CI: 86-97%) and BBV152/Covaxin (93%, 95% CI: 34-99%). The VE estimates were similar against the Delta strain and sub-lineages. Conclusion: BBV152/Covaxin and AZD1222/Covishield were effective against severe COVID-19 among the Indian population during the period of dominance of the highly transmissible Delta variant in the second wave of the pandemic. An escalation of two-dose coverage with COVID-19 vaccines is critical to reduce severe COVID-19 and further mitigate the pandemic in the country.

Abstract Background In view of the growing popularity, reach and access for Massive Open Online Courses (MOOCs), India’s apex body for medical education, the National Medical Commission (NMC) mandated uniform foundational course on research methods for the medical post graduates (PGs) and faculty members of the medical institutions under NMC as MOOC. This course is a pioneering effort in the field of India’s PG medical education. NMC entrusted Indian Council of Medical Research (ICMR)-National Institute of Epidemiology (NIE) to design and offer the MOOC, named as Basic Course in Biomedical Research (BCBR). We describe the experience of designing and that of implementation challenges in the inaugural cycle of the course. Methods The course objective was to inculcate the fundamental concepts in research methods covering epidemiology and biostatistics in the form of video lectures, resource materials, discussion forum, assignments, feedback and a final proctored examination. The course was delivered over 16 weeks through MOOCs platform under the Indian Ministry of Education. We reviewed records, documents and faculty notes and described the course conceptualization, development, design and implementation process. We abstracted information from course portal on enrolment profile of the participants, self-reported course feedback (structured and open-ended on format, lectures and quality of contents), examination registration form, scores obtained in the assignments/examination and that of the participant queries. We described quantitative data using descriptive statistics. We presented the thematic analysis of qualitative data from open-ended questions in the feedback system and that of email interactions. Results The inaugural cycle (September-December 2019) was taken by 24,385 participants. Majority, 15,879 (65%) were from medical background. 13,242 (54%) were medical postgraduates and 2637 (11%) were medical teachers. Among the enrolled, 14,720 (60%) cleared the assignments. A total of 11,392 (47%), 8,205 (62%) medical PGs and 896 (34%) faculty members successfully completed the course. Feedback from 1305 (5%) participants had mean score of 4.5/5 (±0.7) for quality of teaching. We faced challenges in customizing the course for medical participants, unawareness among target group, digital illiteracy and the ongoing pandemic. Conclusions During the inaugural cycle of the online Basic Course in Biomedical Research course, nearly half of the enrolled participants successfully completed and received the certificate. India’s MOOC for enhancing research capabilities of future medical researchers encountered successes and challenges. Lessons learnt from the inaugural cycle will guide future directions and to address larger issues in terms of sustainability and replication by stakeholders in medical education in India or elsewhere.

Background: Yoga therapy can be a promising adjunct to antiretroviral therapy. However, evidence on the effectiveness of Yoga therapy is scanty. The proposed trial will estimate the effect of integrated yoga practice for six months on immune parameters (CD4 (cluster of differentiation 4), viral load) among adult people living with HIV (PLWH) and its cost-effectiveness from the healthcare system’s perspective. Methods: In this randomized open-label parallel-group trial, 110 PLWH in stage 2 HIV, between 18 and 49 years in the intervention arm and 220 PLWH in the same stage will be recruited by block randomization. Integrated yoga practice will be given for six months in the intervention arm, and health education on yoga practice in the control arm, besides antiretroviral therapy. After six months, the difference in immune parameters, cardio-metabolic indicators and quality of life (QOL) will be assessed. Besides, an economic evaluation will be done with sensitivity analysis. If found useful, the intervention can be tested at large scale for further confirmation of the outcomes. Irrespective of the study's outcome, the results will be disseminated through peer-reviewed journals. Trial registration: CTRI/22/09/045909 dated 27/09/2022 under the Clinical Trials Registry-India version: 1.0 dated 27/09/2022

Background: Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC). Objectives: As economic evidence in this area is scanty, especially in low- and middle-income countries, the objectives of the study are to perform an economic evaluation and compare the cost between EDC and PDC. Methods: A cost-comparison study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community-based survey. Step-down cost accounting was adopted with a bottom-up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e-SPSS and p-SPSS, respectively). We conducted scenario analyses based on the usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA, and p-STATA, respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results. Results: In the base-case analysis, total costs of EDC and PDC were ₹72,617 ($1060.9) and 87,717 ($1281.5), respectively, with estimated cost reduction of ₹15,100 ($220.6). In other scenarios, the estimated cost reduction for e-R, e-STATA, p-R, p-STATA was ₹−274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2), respectively, when compared to EDC-SPSS. On one-way and PSA, the results of the cost-comparison analysis were robust. Conclusion: EDC minimizes institutional cost for conducting health research. This finding will help researchers in efficiently planning for the budget for their research.

Introduction: The COVID-19 pandemic led to the disruption of medical teaching nation-wide and pushed the institutions to explore the probable role of online teaching methods. The aim of this review is to identify the untested perspectives and help in strategizing based on evidence generation for the preparation for future. Methods: We followed the Preferred Reporting Items for Systematic and Meta-Analysis guidelines for reporting the present review. We searched PubMed, Scopus, and Embase databases for the articles published between April 2020 and October 2021 for studies on online medical education in India during the COVID-19 pandemic. Results: We initially screened a total number of 1412 articles and finally recruited 45 articles for the analysis. Majority of the articles were from single institution, and reported the experience of the students and teachers on online teaching. The common teaching platform used such as Zoom and Google Meet were enumerated. Internet connectivity was the most reported challenge of online teaching. None of the selected articles reported on ethical issues related to online teaching. Conclusion: Even though there were some strong points reported for the successful implementation of e-learning, a more sustainable and well-informed plan should be devised for the future on online teaching.

Social protection schemes are available in India to mitigate the various challenges faced by people living with human immunodeficiency virus (PLWH) infection. The availability of the schemes should be uniform across the country and based on the rights of these people. We reviewed the schemes available in the high PLWH-burdened states of the country for the year 2019. We identified 83 social protection schemes for the PLWH in 13 representative states from different zones of India. The number of schemes was as low as two in the states of Mizoram and Telangana and 12 schemes in Rajasthan. Most of the schemes belong to the 'health' category (n = 26, 31.3%), nutrition (n = 14, 16.9%), financial aid (n = 12, 14.5%), insurance (n = 11, 13.5%), employment generation (n = 3, 3.6%), housing (n = 3, 3.6%), and legal support (n = 5, 6.0%). While health-related schemes are present in all the states, the distribution of the other social schemes varies widely across the states. The schemes commonly address the social safety of the children affected by human immunodeficiency virus (HIV), nutritional supplementation, direct financial assistance or subsidized services, and employment generation but vary considerably regarding the type and the number of services. We strongly recommend for evidence-based policy decision to provide uniform social schemes for PLWH.

Background: Vaccination against COVID-19 among people living with HIV (PLWH) infection is crucial. At present, evidence lacks to strategize vaccinating the hesitant PLWH. This study has estimated the proportion of PLWH vaccinated till October 2021, enumerated the various adverse events following vaccination, and identified the enabling and constraining factors associated with vaccination. Methods: A cross-sectional survey was conducted among PLWH by the snowball sampling in the Chittoor district of Andhra Pradesh, India. Data were analyzed using the descriptive statistics and qualitative analyses. Results: Two-hundred and forty-seven PLWH responded, out of which 52 (20.7%) were yet to be vaccinated. Seventy-five (30%) participants reported having adverse events, out of which five (7%) had pain at the injection site, and 72 (96%) had systemic reactions. Fever (n = 51, 68%), dizziness (n = 23, 31%), and joint pain (n = 23, 31%) were the major systemic reactions. Among the vaccinated, motivation by the health-care workers and village volunteers were the major enabling factors. On the contrary, uncertainty about the vaccine effects, negative feedback from the health-care workers, and lack of self-motivation were the important constraining factors in taking the vaccines. Conclusion: Some PLWH are still hesitant to take the vaccine. Evidence generation, coupled with community mobilization, is required to upthrust the vaccination campaign in achieving the herd immunity against COVID-19.

Abstract Background Intra-regional cultural and linguistic differences are common in low- and middle-income countries. To sensitise undergraduate medical students to the social and contextual determinants of health to achieve the ‘health for all’ goal, these countries must focus on innovative teaching methods. The early introduction of a Community Orientation Program (COP) as a Community-based Medical Education (CBME) method could be a game changing strategy. In this paper the methods, evaluation, and implication of the COP in an Indian setting are described. Methods The curriculum of the COP was developed based on the analysis, design, development, implementation, and evaluation (ADDIE) model for educational intervention. In this learner-centric and supervised educational program, the key aim was to focus on developing students’ communication skills, observation power and enhancing their motivation for learning through collaborative learning. To meet the objectives of the COP, a situated learning model under the constructivism theory was adopted. Results Between 2016 and 2019, 557 students were trained through the COP by visiting more than 1300 households in ten villages. To supplement the students’ observations in the community, more than 150 small group discussions, a health education programme for the community and summary presentations were conducted. The students’ feedback indicated the need to improve the clinical examinations demonstration quality and increase the number of instruments for clinical examinations. More than 80% of students felt that the program would assist them to improve their communication skills, their understanding of the various socio-demographic factors associated with the common diseases, and it will enable them to respect the local culture during their clinical practice. Conclusions Early initiation of the COP as a CBME method in the undergraduate medical curriculum in an Indian setting has shown promising results. Further evidence is required to adopt such a program routinely for under-graduate medical teaching in the low- and middle- income settings.

Context/Background: Malnutrition among children is a long-standing public health problem in India. Objective: To assess the nutritional status of pre-school children and to identify the socio-demographic determinants of malnutrition. Methodology: In this community-based cross-sectional study, 194 under-five children were recruited from rural and urban areas of Chittoor district, Andhra Pradesh. Anthropometric measurements including weight, and mid upper arm circumference were measured and age standardized weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated. The proportion of under nutrition (WAZ

Background: Social mapping, though an old approach in public health education and research, not practiced much in nursing education. This study was conducted to describe the social mapping process in a semi-urban area in the Chittoor district of Andhra Pradesh in India and to describe the implications of such social mapping from the students' perspective. Methods: This participatory rural appraisal was conducted for the Bachelor of Nursing Students in a semi-urban settlement in the state of Andhra Pradesh in India. The social mapping process was conducted in three broad steps- classroom-based teaching of social mapping, conducting social mapping in the community and a debriefing session with the students. The major outcome of this educational activity was the social map. In addition, we also came up with the students’ implications through group discussion. Results: A facility map was constructed by the community members which was replicated by the teachers. The map was triangulated by the teachers through a transect walk in that area. The students came out with various academic, clinical, and administrative implications from this educational session. Conclusion: Social mapping can be used as a potential tool in nursing education. More evidence is required on this learning approach before recommending it in the Community Nursing curriculum.

Background: Self-care practice by diabetic people is key to achieving therapeutic goals. The objectives of the study were to describe the self-care practice of adult people with type 2 diabetes in a rural area of Andhra Pradesh and to identify the determinants of poor self-care practice of this population. Methods: A community-based cross-sectional study was conducted among the known diabetics in a rural PHC between November 2018 and October 2019. Self-care practices among the registered diabetes patients were described in seven domains as recommended by the American Association of Diabetes Educators (AADE). Risk factors were identified using univariate, followed by multivariate logistic regression. The risk for poor self-care score was expressed in odds ratio (OR) with 95% confidence interval (CI). Results: A total of 727 participants were recruited for the study. The mean age of the participants was 57 years (SD: 9.5 years). The self-care was prominent in diet modification, physical activity, and physical activity components. The median self-care score of the participants was 14 (IQR = 12.5 to 15.5). 32.6% (95% CI: 31.6%–33.6%) participants had good self-care scores. With multivariate regression analysis, we found that widowed/separated (aOR 1.85, 95% CI: 1.2–3.0) was a risk factor for poor self-care scores; and skilled workers (aOR 0.28, 95% CI: 0.1–0.6) had a significantly lower risk compared to the unskilled workers. Conclusion: Overall, self-care practices are poor in problem-solving, risk reduction and healthy coping behaviours. Low education and poor socio-economic status could be the most likely reasons for poor self-care practices.

Introduction: Janani Sishu Suraksha Karyakram (JSSK) is a flagship program of India to reduce out of pocket expenditure (OOPE) of the families during childbirth and neonatal sicknesses. Objectives: To assess the utilization of JSSK while availing services for childbirth and newborn care in a secondary care hospital in Southern India; estimate the OOPE in services covered by JSSK and identify the associated factors with OOPE. Methods: 228 mothers who delivered in the previous 2 days, were recruited from a secondary-level government hospital in Chittoor. Expenditure incurred under various components of JSSK was asked during the recruitment and subsequently through telephonic interviews. Results: All components of JJSK, except transport, were fully utilized by the families. 138 mothers (60.5%, 95% CI: 54.0, 67.0), and all sick children (n = 138, 100%) who visited government hospital, incurred OOPE in the form of transport cost. The median expenditure of transport (from home to hospital and hospital to home) of the mothers was 250 INR (IQR: 100-513 INR). Transport expenditure was greater for the rural families (300 INR) than the urban families (100 INR) (p < 0.05). In multiple logistic regression, nuclear families were associated with high OOPE (AOR- 2.0, 95% CI: 1.1- 3.7). Though education of the mother showed high association (AOR- 2.7, 95% CI: 1.0- 7.8), it was not statistically significant (p = 0.05). Conclusion: The families utilize most of the components of JSSK, except transport. Family-centric counselling of the beneficiaries during antenatal check-ups and home visits by the healthcare workers can reduce transport-related OOPE.

Objectives: To assess the water, sanitation, and hygiene (WASH) practice among the tribal population of Tamil Nadu, India and to determine the physiochemical and bacteriological quality of drinking water at the principal source and at the households along with the household-level determinants of WASH practices. Methods: A door-to-door survey was conducted in 150 households, distributed across six villages of Jawadhi hills, a tribal area in the state of Tamil Nadu, India. Water samples were collected from the principal sources and a subset of households for assessing water quality. A composite scoring was formulated to determine the overall WASH practices. Results: Overall, a poor WASH score (≤4) was found in 103 (68.7%; 95% CI: 60.7, 75.6) households. The majority (96.7%) of the household water samples showed the presence of fecal coliforms. Poor WASH score was uniformly distributed across the villages. Low per capita income (≤1000 INR) was strongly associated with the poor WASH score (Adjusted OR 2.4; 95% CI: 1.04, 5.7). The per capita income had a strong negative association with the high fecal coliform count (Adjusted OR 5.07; 95% CI: 1.08, 23.74). Conclusions: We conclude that WASH-related practices among the tribal population of Tamil Nadu is not acceptable. The lack of administrative function and poor economic conditions are the likely causes attributed to the poor WASH conditions and drinking water quality. Urgent action from the stakeholders is the need of the hour to improve the water quality and living standards of such marginalized populations.

Objectives: To identify risk factors associated with Coronavirus disease 2019 (COVID-19) in a Tertiary care cancer hospital-based cluster and recommend control measures. Methods: We conducted tracing and confirmation among hospital and community contacts. We telephonically interviewed and abstracted information from hospital records and registers. We described the cluster by time, place and person. We conducted unmatched case-control study to compare risk factors and computed Odds Ratio (OR) and 95% confidence interval. Results: We confirmed COVID-19 in 21 of 1478 tested (1.4%). Secondary attack (%) of COVID-19 among 824 contacts was higher among in-patients of block A (18), household contacts (3.4), housekeeping staff (3.3) and nurses (1.7). The cluster started on April 22 with two successive peaks five days apart and lasted until May 8. Being male, patients aged >33 years [OR = 30·7; 95% CI = 3·6 to 264], having hypertension [OR = 4·3; 95% CI = 1·1 to 16·7] or diabetes [OR = 3·8; 95% CI = 1·0 to 14·1] were associated with COVID-19. Mask compliance was poor (20%) among hospital workers. Discussion: We recommended screening of all patients for diabetes and hypertension and isolation/testing of anyone with influenza-like illness for preventing COVID-19 clusters in hospital settings.

BACKGROUND: Diagnostic dilemma arises when patients with clinical suspicion of COVID-19 disease having moderate-to-severe respiratory symptoms yield negative result for COVID-19 in reverse transcription polymerase chain reaction (RT-PCR). This study evaluated the clinical, laboratory and HRCT thorax findings among RT-PCR-negative COVID-19 suspects with moderate-to-severe disease. MATERIALS AND METHODS: A hospital-based retrospective observational study was conducted between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID-19 suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU), who were negative for COVID-19 in RT-PCR. Data were abstracted from the medical records section of the hospital using a predesigned data abstraction form and presented by descriptive statistics. RESULTS: Mean age of study participants was 55.5 years (SD 14.1 years), and majority were males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea (n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C-reactive protein (n = 60, 100%), NLR (n = 49, 81.7%), d-dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%), vascular thickening (n = 35, ≥58.3%), and sub-pleural lines (n = 32, 53.3%). Median CT-SS value was 15 (IQR 11–19), and majority (n = 56, 93.3%) belonged to CO-RADS ≥4. CONCLUSION: Diagnosis of COVID-19 can be presumed in RT-PCR-negative suspected COVID-19 patients with moderate-to-severe disease, with marked rise of inflammatory markers and HRCT revealing typical findings of COVID-19 pneumonia.