Prevention starts here: effectiveness of substance abuse prevention module among adolescent students in Bengaluru - a quasi experimental study

OBJECTIVES

This study aims to evaluate the effectiveness of a structured educational module on substance abuse prevention program among adolescents in enhancing their knowledge against substance abuse.

METHODS

A quasi-experimental design was employed involving 120 students (mean age: 14.3±1.03 years, 59.2% boys) from two English medium schools. Participants were exposed to a structured module on substance abuse over a month. The study assessed changes in knowledge through pretest and post-test evaluations. Statistical analyses examined improvements in scores and the relationship between class of study and post-test knowledge scores.

RESULTS

The intervention significantly improved students' knowledge about substance abuse (p<0.001) across all measured domains, genders, and classes, with the exception of the 7th class. A positive correlation was found between the class of study and post-test scores (Rs=0.288, p<0.001), indicating that higher classes were associated with greater improvements in knowledge. These findings suggest that the training effectively increased awareness and understanding of substance abuse among participants.

CONCLUSIONS

The substance abuse prevention program successfully enhanced adolescents' knowledge and equipped them with resilience and coping strategies, thus reducing their vulnerability to peer pressure and substance abuse. Despite the lack of significant improvement in the 7th class, the overall positive outcomes underscore the importance of implementing such educational interventions to foster healthy development and well-being among students. Further research is encouraged to explore the specific barriers to effectiveness in younger classes and to refine program content accordingly.

Comparative Study on Elder Abuse and Neglect Among Geriatric Population in the Rural and Urban Field Practice Areas of a Medical College

Background

Elder abuse is a multidimensional problem of public importance. According to the World Health Organization (WHO), 16% of older people were victims of elder abuse. A study conducted by HelpAge India in 2018 showed that Mangaluru ranks the highest in elder abuse (47%). Given the scarce literature, this study sought to determine the prevalence of elder abuse and its associated sociodemographic factors.

Material and Methods

A community-based cross-sectional study was conducted among the senior population in the rural and urban field practice a medical college in Mangaluru for one and a half years. The sample size was 280.

Results

Most of the study population was in the age group of fewer than 75 years (75.4%), with 50.4% females, 60% Hindus, 56.4% married, 39.3% illiterate, and 88.9% of them retired. The prevalence of elder abuse was 44.6% (rural = 50.7% and urban = 38.6%). Binary logistic regression showed that elder abuse was statistically significant among the unemployed, extended family members, and staying with children.

Conclusions

The study brings to light the sociodemographic factors that play a role in detecting elder abuse. It also shows the importance of awareness of elder mistreatment among older people. These elements must be considered for implementing and enforcing laws and legislation to help curb elder abuse.

What is associated with caregiver burden for adults with bipolar affective disorder: Illness severity or financial well being?

Background

Persons with bipolar affective disorder (BPAD) need long-term care and support. As most of the expenses for this are met personally by the caregivers, it will have financial implications for them. However, we do not know how much financial well-being is associated with the caregivers' burden as compared to the illness severity.

Aim

This study aimed to examine the association between financial well-being and illness severity with the caregivers' burden in the context of BPAD.

Materials and Methods

This study adopted a cross-sectional descriptive design. The first 50 consenting caregivers of persons with an International Classification of Diseases (ICD)-10 diagnosis of BPAD, who visited the National Institute of Mental Health and Neurosciences (NIMHANS) within 2019-2021, were included in the study. The patients were assessed on the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF) for the severity of the symptoms and the current level of functioning, respectively. Caregivers were assessed on the Personal Finance Well-Being Scale.

Results

In this study, the majority of caregivers were males (62%), with a median, monthly household income of Rs. 24,000, and expenditure of Rs. 12,000. The median cost of medicine was Rs. 1000 per month. The majority (64%) of patients did not have any health insurance. A total of 28 (56%) caregivers reported the cost of damage due to illness behavior. It was found that the severity of illness and current level of functioning had a significant negative correlation with caregivers' burden. The financial well-being as reflected through income and health expenditure did not have a significant correlation with the caregivers' burden.

Conclusions

Caregivers of persons with BPAD meet the treatment expenditure out of their pocket. Though they have the financial burden, it is the illness severity and functioning capacities that are associated with caregivers' burden. These findings have implications for mental health care in persons with BPAD.

A Community Trial in Coastal Karnataka using Life Style Modifications to Assess its Impact on Hypertension and Diabetes

Introduction

In the management of hypertension and diabetes mellitus, a systematic response like modifications in lifestyles is needed along with the medication. The study was conducted to determine the impact of comprehensive lifestyle modifications on hypertension and diabetes and to compare it with that of physical activity alone as a health education intervention.

Materials and Method

A risk factor-based community intervention trial was conducted for one year in 3 villages in coastal Karnataka. The sample of 305 was calculated depending on the expected change in blood pressure and an equal sample size was drawn from each of the villages using a systematic random sampling method. Baseline data on blood pressure level, random blood sugar, and HbA1c levels were recorded. After 1 year of intervention, all the parameters were further recorded along with the adherence to medication for these non-communicable diseases.

Results

The mean difference between the groups suggested that participants with physical activity intervention reported a statistically significant reduction in systolic blood pressure. In the comprehensive lifestyle modification group, there was a significant reduction in both diastolic blood pressure and glycated hemoglobin levels (21 mmHg and 2.1%; p < 0.001).

Conclusion

The study indicates that in the management of hypertension and diabetes mellitus, the impact of comprehensive lifestyle modifications was more significant compared to physical activity alone.

Understanding the need for developing a structured competency-based curriculum for health policy and programs among community medicine postgraduates: A grounded theory approach

Introduction

Many plans and policy changes about health outcomes have evolved, but none of them have ever given a definite shape to the postgraduate (PG) curriculum so as to make it more intensive and integrative, which needs to be so structured and tailored that it is more patient, community centric, and less knowledge based.

Objectives

The objective of this study was to identify the gap in existing curriculum in learning of health policy and program among PGs of community medicine and recommend a structured model for the same.

Materials and Methods

A qualitative study (grounded theory approach) with all PGs of community medicine in one teaching institute in South India (8 PG students) was taken up.

Results

PGs felt that they never had any day-to-day update. They wanted to understand the working pattern and ground reality of policy and program which was unavailable to them. People who came to postgraduation after being medical officers felt that the monitoring and evaluation done by inexperienced MD Community Medicine students was never accepted by state public health because they did not understand the implementation problems and so could not rightly critically evaluate the programmatic challenges.

Conclusion

With the shift in medical education patterns and expectations of residents, it becomes important to justify the need of developing a structured based curriculum, more so for policy and programs, which will make them capable enough by polishing their managerial and financial skill set. The evaluation technique should focus more on practical aspects on field instead of their theory examination.

Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis

Background & objectives

The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district.

Methods

A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed.

Results

Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement.

Interpretation & conclusions

The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

Challenges and solutions adopted by frontline health managers in the management of routine health services during the COVID-19 pandemic at the grassroots level in India: A qualitative quest

Background

The public health emergency due to COVID-19 has placed an immense burden on the health care system. The strain for provision of health care services has also extended to routine services. The future impact of this decline in facility provision can be seen in morbidity and mortality indicators of the country. In a time when the country is working toward meeting the sustainable development goals (SDGs), COVID-19 has become a setback.

Objective

This study tries to find the very challenges faced by frontline workers and the measures adopted to overcome the same.

Materials and Methods

This was a mixed methods study conducted at various selected states across the country based on their vulnerability index. Data was collected via in-depth interviews among 120 frontline managers. Transcribed responses were coded. Framework analysis with preformed codes were done. Quantitative data are represented as frequencies and percentages.

Results

Analysis showed increased work pressure, innovative approach adopted locally, and allaying fear by reinstating services helped as coping mechanisms to take care of routine health care services at the grassroots level.

Conclusions

The conscious effort of all involved with the use of local solutions and innovations, along with intersectoral coordination and efficient use of resources paved the way for a good deliverance of health care to the society. The frontline managers minimized the damage by using available resources consciously and wisely.

Mapping of pathways of care, assessment of delays and gap analysis in provision of care following road traffic injury among patients in selected tertiary hospitals in urban Karnataka, South India

Background: Evidence-based public health advocates decision making based on best available scientific evidence, hence it is important to gather evidence of current scenario of trauma care. Aim & Objective: To determine pathways of care and delays among Road Traffic Injury patients and assess gaps in resources. Settings and Design: This cross-sectional study was conducted in selected tertiary care hospitals in Mangaluru taluk, Karnataka. Methods and Material: Participants were administered validated proformas on prehospital and hospital care. WHO trauma care checklist was used for capacity assessment and gap analysis. Statistical analysis used: Time intervals are expressed as measures of central tendency and dispersion. Descriptive analysis is given as percentages and proportions. Results: Median pre-hospital time was 30 minutes. Overall, 67.5% of the patients reached within golden hour. Majority (64.1%) were directly transported to current hospital. All patients received first aid, but only 0.8% received it at the RTI site. First aid was mostly administered by doctors (68.7%) or nursing staff (31.1%) and none by bystander. Insurance coverage was 32.8% and 87.9% incurred out of pocket expenditures. Scores were low in GP level hospital. Conclusions: Although transport was within the golden hour, pre-hospital care was poor. Out of pocket expenditures were high.

Provision of Care Following Road Traffic Injuries in a District in South India: A Qualitative Analysis of Stakeholder Perspective

Introduction:

It is essential to explore ways to prevent and reduce the severity of injuries in road crashes. This study attempts at getting a ground-level understanding of perspectives surrounding road traffic injury among various stakeholders.

Materials and Methods:

In-depth interviews and focused group discussions were conducted over a period of 6 months among traffic police, toll booth operators, road transport officers, nurses, and intensive care specialists. The transcribed data were coded and analyzed, and a percentage of final themes as well as codes were drawn.

Results:

The common reasons cited for delay in transport of accident victims were fear regarding medicolegal issues among the first responders (36.9%) and delay in ambulance (41.5%). 26.1% agreed that time delay in transport can be reduced by generating awareness. Teaching first aid to the general public is essential as opined by 75% of nursing staff and 66.7% of emergency physicians. Documentation procedures (15.4%), long waiting hours (10.2%), and out-of-pocket expenditure and financial constraints (10.2%) were the commonly cited reasons for problems faced by patient bystanders.

Conclusions:

Creating awareness and improving access to ambulance were the two essential recommendations to prevent delay in prehospital care. Majority of the care providers and patient bystanders agreed that improving insurance coverage is essential to reduce financial constraints.

An Audit of Loss of Pregnancy as an Answer to Differentiated Sex Ratio

Context: Abortion and unintended pregnancy in India is on the rise, and a large proportion of these unintended pregnancies end up in induced abortion. The soaring rate of abortion among Indian women can be influenced by a plethora of reasons. Aims: 1) To identify the rate of second trimester abortion2) To determine the reasons behind second trimester abortions Settings and design: An audit of all the abortions in a district of South India was conducted. Material and methods: The data was obtained from the records of abortion reported in the year 2018 from the District Health Office and analysed. Statistical analysis used: Descriptive statistics Results: Majority of the pregnant ladies with abortion (55.73%) were aged between 21-30 years and abortions in second trimester were observed to be comparatively higher (50%). Among the myriad of reasons found for second trimester abortions, spontaneous abortions contributed to around 30% while 11.92% had no cause mentioned. Conclusion: A high rate of second trimester abortion throws suspicion towards sex selective abortions.

Factors influencing age at menarche – a school based cross sectional study

Hormones, life style, animal proteins etc are factors that influence menarche. Like-wise a declining trend in age at menarche has been noticed over the past few years. This study was taken up with the objectives to study factors that are associated with menarche in our study population. Hence a school-based cross-sectional study was undertaken for the same which showed the mean age of menstruation was 12.5 years. It was significantly influenced by milk intake (p <.05). Mothers’ age at menarche was also found to be significantly associated with their daughters’ age at menarche. Conclusion: This study provides an insight into determining factors affecting age of menarche, focusing on dietary and maternal factors. Milk consumption was found to be an important factor.

COVID- 19 Quarantine and the way forward

Quarantine is a tool that was used anciently and now used as a public health measure in a more strategic manner for containment of a disease. It requires a lot of planning for implementation depending upon the burden of disease, resources to carry out the same in a stringent manner. Benefits and outcomes need to be measured carefully while imposing quarantine especially of a larger scale. We have tried to put up the rationale behind the current quarantine measure carried out in the wake of COVID 19 and factors to keep in mind for the future.

COVID 19 – Observations and speculations – A trend analysis

The pandemic of COVID 19 having spread to more than 200 countries across the globe it is time to rethink strategies to contain the spread of the disease. The virus being novel and the natural history still incompletely understood the world seems to be in hit with the panic button. Seeing no race, gender, social class the virus has affected both developed and developing countries alike. However, to understand if existing measures followed are going in the right direction, we need an understanding of the existing situation in countries across as well as our own. The study attempts to analyse the trend patterns around the world especially focusing on China, US, the neighbouring countries of India and then looks into the patterns of COVID 19 in India.

Perception regarding child gender preferences among mothers in Dakshina Kannada district: A mixed methods study

Background: A reflection on the census 2011 data tells us that gender preference has only been on the rise these past years. Objective: To assess perception regarding gender preference among mothers in Dakshina Kannada district. Materials & Methods: 2 tertiary care centres attached with medical college were selected in Dakshina Kannada district. Quantitative variables were collected using a questionnaire and qualitative component was done through focused group discussion. Results: Child preference was seen among 32.2% of the subjects. Preference for Male child if the first child was a girl was significantly associated with lower education and low income (p<0.05). Conclusion: Son preference is still existent in the society but not universally. It is more so when the first born is a female child.

Client Satisfaction among the clients attending tertiary care centers in Mangalore, South India

Background: Provision of services in line with the wishes and needs of patients is central to a human health care system .The hospital market has today as changed from a seller's market to a buyer's market and there is a need to improve the quality in the health care delivery. Client satisfaction is a key determinant of quality of care provided in health care centers.

Objectives: To determine the client satisfaction among the patients attending tertiary care centers in Mangalore.

Materials and Methodology: The study was a cross sectional study which was conducted among the clients attending five teaching hospitals in Mangalore. With 60% of client satisfaction obtained in our pilot study, the sample size was 384 and adding 20% for dropouts the total sample size came up to 462.The clients were selected randomly from each hospital. A pretested Proforma was used outside the hospital with strict confidentiality.

Results: In our study we found that,87.6% of the clients felt that the clinic hours at health facility were adequate,79.3% felt health care was easily accessible,89.2% were happy with hygiene and comfort of waiting area. Average waiting time was 116mins.Only 45.4% could meet the same service provider in follow up visit and only 51.5% availed similar services as in the first visit in the follow up. Satisfaction with provider's skill and ability was seen in 82.5% of the clients. Only 69.2% of the clients were satisfied with the cost of services available.

Conclusion: Our study revealed that waiting time was a major concern for the client's satisfaction.

KNOWLEDGE REGARDING RCH SERVICES AMONG HEALTH WORKERS, PREGNANT MOTHERS AND ADOLESCENTS IN RURAL FIELD PRACTICE AREA

Maternal mortality and morbidity are significant health problems in developing countries. Improving maternal health has been an essential element for achieving health for all and has been included in MDG to be achieved by 2010. Apart from mothers and children, the health of adolescents came into light as one of the important area mainly because of their role as future or immediate mothers. Role of health care providers especially the grass root level workers becomes particularly important not just in imparting the intending services, but also in imparting knowledge about reproductive health.

To assess the knowledge about RCH services among the health care workers, pregnant women, mothers and adolescent girls.

A cross sectional study was conducted in the rural field practice areas of K. S. Hegde Medical Academy. A total of 37 health workers, 50 pregnant women and mothers and 56 adolescents were interviewed using a pre tested questionnaire for assessing their knowledge regarding RCH services. Descriptive statistics was used in the analysis.

Knowledge regarding high risk pregnancy identification, normal birth weight and identifying anaemia in the field was good among health workers. Only 10.8% of them knew the minimum strength of medical officers in a FRU and only 5.4% knew about fast breathing in less than 2 months old infant. With regard to mothers knowledge 64% were aware of the number of ANC visits, 44% knew about correct interval between 2 pregnancies, 38% knew about methods to prevent STI transmission. 82% of adolescents had good knowledge regarding legal age for marriage. 75% were aware of various methods of contraception.