"CoviSainik Program" - A Novel Public Private Partnership Initiative in the Control of COVID-19 in Rural India

Background

"CoviSainik Program" was implemented in collaboration with the Ambuja Cement Foundation and Community Medicine Department in rural districts of eight states of India from May to December 2021 to create a cadre of volunteers. The aim of the present paper is to describe the program and evaluate it so that the findings can be the guiding tool for policymakers to replicate a similar program.

Material and Method

A cross-sectional, mixed-method - concurrent study design was adopted to evaluate the program for its short-term outcomes such as gain in the basic knowledge of COVID-19 amongst master trainers and their feedback and program output viz - the proportion of volunteers trained and their profile by census sampling. Motivational factors, experiences of volunteers, and outcomes of COVID-19 work in their villages were explored by purposive with maximum diversity sampling with 62 online in-depth interviews and 8 online focus group discussions (FGDs).

Results

There was a statistically significant difference in the pre-test (12.8 ± 5.6) and post-test (25.9 ± 9.3) scores of the Master Training Program evaluation test. Out of 6534 trained volunteers, 5901 worked as volunteers, and amongst those, 47.1%, 35.1%, and 17.8% worked for ≤3 months, 3 to 6 months, and ≥6 months, respectively, in their villages. The major themes generated for motivational factors to join the program were altruism, savior nature, generating awareness, and concern for others. The major outcomes generated by trained volunteers COVID-19 vaccination were in raising awareness on COVID-19 appropriate behavior and early identification of COVID-19 cases in their villages.

Conclusion

The "CoviSainik Program" was successful in creating cadres of trained volunteers.

Low Emotional Intelligence: A Precursor of Mental Health Derangements Among Adolescents

INTRODUCTION

Emotional intelligence (EI) is the most researched psychological construct in the 21st century. It predicts success and happiness in life and is suggested as a predictor of mental health (MH). We aimed to assess whether low EI among adolescents acts as a precursor of their MH derangements.

MATERIALS AND METHODS

A cross-sectional study was carried out in Pune Municipal Corporation in 2021 with all due approvals, consent, and assent. EI and MH of adolescents studying in Xth standard in randomly selected 24 out of 440 secondary schools were assessed by Schutte's Emotional Intelligence Test (SET) and Depression, Anxiety, and Stress Scale 42 (DASS-42) with collection of socio-demographic information. The presence of symptoms of mild to extremely severe depression, anxiety, and stress was considered as MH derangement. All research instruments were translated into the local language, pre-tested, and validated before use. Class teachers were trained for data collection. Data were imported to SPSS version 20 (IBM Corp., Armonk, NY) data editor for further analysis. After enlisting frequencies and proportions, associations and correlations were tested by the chi-squared test and Spearman correlation coefficient, respectively.

RESULTS

A total of 622 participants submitted all research instruments. The mean age was 14.74 (+0.742) years. Boys and girls were 38% and 62%, respectively. The majority were Hindus, belonging to socio-economic classes II and III, residing in urban areas. Symptoms of severe to extremely severe depression and anxiety, but not stress, were associated with low EI (p < 0.0001, 0.001, and 0.229). Also, the EI score had a negative correlation with the depression score (ρ = -0.221, p < 0.0001) and anxiety score (ρ = -0.152, p = 0.001), but not with the stress score.

CONCLUSION

Low EI can be taken as a precursor of MH derangements, especially in the form of depression and anxiety among school-going adolescents.

RECOMMENDATIONS

Efforts to improve EI among adolescents will help to decrease MH derangements, subsequent MH disorders, and suicidality, with improvement in academic performance.

Job Satisfaction Among Healthcare Providers in a Tertiary Care Government Medical College and Hospital in Chhattisgarh

Background The job satisfaction of healthcare providers is particularly relevant in service management because employees' level of job satisfaction impacts healthcare service users. A positive association is observed between the job satisfaction of healthcare providers and patient satisfaction. This study was conducted to determine the job satisfaction levels and their determinants among healthcare providers (doctors, nurses, and support staff) in a tertiary care hospital. Methodology A cross-sectional study was conducted among 400 healthcare providers of a tertiary care medical college and hospital. The questionnaire method was employed to collect demographic data. Job satisfaction level was assessed using the Job Satisfaction Survey Scale (JSS Scale). Results The mean overall satisfaction score among doctors was 123.05 ± 17.06, for nurses 127.4 ± 14.58, and for the support staff 138.46 ± 22.09. Among all three groups, employees' support staff were found to be more satisfied (40%), followed by doctors (15%) and nurses (6.67%), while the proportion of dissatisfied employees was highest among doctors (20%) than nurses (6.67%) and the support staff (6.67%). Satisfaction was significantly higher among the support staff compared to doctors and nurses. The level of satisfaction was found to be more in the younger staff (38.14%), regular job holders (33.33%), and fresh recruits (37.5%). Overall, satisfaction levels were found to be positively associated with factors such as the type and nature of work (64%) and relationships with co-workers (40%) and supervisors (36%) while more dissatisfied with factors such as interpersonal communication (70%), salary (54%), and promotional opportunities (42%). Conclusion The overall satisfaction among employees was only 20%. Factors such as job security, young age, and work experience were strongly associated with job satisfaction. Employees were more satisfied with the type and nature of work and relationships with co-workers while more dissatisfied with salary, promotional opportunities, and interpersonal communication.

Emotional Intelligence from Gender Perspective during Mid to Late Adolescence in an Indian Context

Background

Emotional Intelligence (EI) contributes to overall success in life. Our objectives are to explore EI among adolescents and its gender differences as per some parameters of social environments.

Material and Methods

Present cross-sectional study was conducted in secondary schools in one of municipal corporations in western Maharashtra EI of adolescents studying in tenth standard in randomly selected secondary schools, was assessed by Schutte's Self-Reported Emotional Intelligence Test with collection of relevant sociodemographic information maintaining confidentiality. Data were analyzed by SPSS 20 software.

Results

Total 1060 adolescents in 14-16 years of age participated in the study. Socio-economic status affected EI of adolescent girls more adversely than adolescent boys (P = 0.003, P = 0.036 respectively). Co-educational type of school favored lower EI than gender specific schools (P < 0.001). After gender wise stratification, EI did not differ significantly among boys (P = 0.154) with respect to type of schooling, but differed significantly (P = 0.001) among girls.

Conclusion

Apart from continued efforts directed to for improvement in SES, mental health component of school health services needs to take a step forward for assessment and improvement of towards mental health parameters including EI of adolescents. EI training programs commenced in school activities based on gender, socio-economic status and other issues relevant to the situation shall prove beneficial in long run.

Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-A cross-sectional study

BACKGROUND

COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India.

METHODS

A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers.

RESULTS

Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66-3.41), income≥20000(AOR = 1.74, 95% CI, (1.16-2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09-2.46), contact tracing (AOR = 2.05, 95% CI (1.1-3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14-6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28-2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions).

CONCLUSION

The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

Epidemiological determinants of COVID-19 in the police personnel: A cross-sectional study

Background:

Police are the frontline warriors who themselves are at risk of getting corona infection. This research with considerable sample size is the first of its kind to assess the epidemiological determinants of coronavirus disease 2019 (COVID-19) infection in the police personnel.

Material and Methods:

The Institutional Ethics Committee (IEC) approval and permission from police authorities were taken. The cross-sectional, descriptive study was planned on randomly selected 375 police personnel in the month of September-November 2020. Police detected with COVID-19 were included and those who were critically ill were excluded from the study. The written informed consent was taken and data was collected by pretested questionnaire. The data were entered and analyzed using SPSS version 21.

Results:

The mean age of study subjects was 34.25 ± 9.1 years with 84% being males. There was no significant difference in age and sex distribution of study subjects. The most commonly affected police personnel were police constables (222 out of 375) followed by police nayak (42 out of 375). Around 88.2% were symptomatic. Symptoms were fever (64%), weakness (54.4%), cough (38.4%), loss of smell sensation (35.2%), cold (32.3%), shortness of breath (13.9%), diarrhea (11.7%), and pain in the abdomen (6.4%). “Cold” symptom was significantly higher in the younger age group as compared with the older age group. Shortness of breath was significantly higher in males as compared with females (P value < 0.05). The perceived probable sources of infection were from a colleague (33.9%), family member (4.5%), residential society member (2.4%) while performing duty (23.2%), and while traveling in public transport (4%). Regarding preventive measures, almost 99%, 94%, and 87%, followed hand hygiene, mask-wearing, and physical distancing, respectively, prior to getting corona infection. AYUSH self-care practices such as daily drinking of turmeric milk, warm water, and breathing exercises were practiced by 66.9%, 85.9%, and 54.1% of the police personnel, respectively.

Conclusions:

There is male preponderance for corona infection among police personnel. Breathlessness is common in males as compared with female police. The cold symptom is mostly observed in young police personnel. Police personnel needs to judiciously follow physical distancing and practice general measures recommended by AYUSH.

Can a Gender Equity and Family Planning Intervention for Men Change Their Gender Ideology? Results from the CHARM Intervention in Rural India

We assess the effect of CHARM, a gender equity and family planning counseling intervention for husbands in rural India, on men's gender ideology. We used a two-armed cluster randomized control trial design and collected survey data from husbands (n=1081) at baseline, 9 months, and 18 months. We used a continuous measure of support for gender equity and a dichotomous measure of equitable attitudes toward women's role in household decision-making. To assess differences on these outcomes, we used generalized linear mixed models. After controlling for socio-demographic factors, men who received the CHARM intervention were significantly more likely than men in the control group to have equitable attitudes toward household decision-making at 9-months follow-up; there was a non-significant difference between the groups for the measure of support for gender equity. For household decision-making, differences were not sustained at 18-months follow-up. Given the role of husbands' gender ideology in women's contraceptive use, the CHARM intervention represents a promising approach for challenging root causes of women's unmet need for contraception.

Linking HIV & family planning services to improve dual methods of contraception among women infected with HIV in Mumbai, Maharashtra, India

Background & objectives:

Preventing unintended pregnancies among people living with HIV (PLHIV) is one of the strategies of WHO for preventing parent-to-child transmission (PPTCT). Given the limitation of only condom use, the objective of this study was to improve use of dual contraceptive methods among HIV infected women.

Methods:

An experimental study among HIV positive women was conducted at two tertiary care level hospitals in Mumbai. Linking HIV with family planning services was the focus of intervention at one site and standard level of care was maintained at the control site. At each site, 150 HIV+ve women attending counselling and testing centres, who did not intend to get pregnant in the next one year and were eligible to use dual methods, were enrolled and followed up to one year.

Results:

At the end of one year, 60 per cent women in the intervention group reached Family Planning Centres compared to eight per cent in the control group. There was three times more acceptance and continuation of use of dual methods along with increase in consistent use of condoms and less number of unplanned pregnancies in the intervention group than the control group.

Interpretation & conclusions:

The study findings demonstrate that linking HIV and family planning services may facilitate the uptake of dual methods of contraception without reducing consistent condom use among HIV infected women. The PPTCT programmes need to focus on the component of Prong 2 of PPTCT which aims to prevent unintended pregnancies among HIV positive women.

Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai

Background:

Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program's potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people.

Objectives:

To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV.

Materials and Methods:

A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire.

Results:

In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV).

Conclusion:

Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India.