Department Of Community Medicine Research Articles

Prevalence and Association of Stress with Gestational Diabetes Mellitus among Pregnant Women in a Rural Area of Maharashtra: A Community-based Cross-sectional Study

Aim: Gestational diabetes mellitus (GDM) is a major public health problem. There is a scarcity of knowledge regarding the association of stress with GDM. Our objective was to determine the prevalence and association of stress with GDM among pregnant women in a rural area of Maharashtra. Methods: A community-based cross-sectional study was conducted among 965 pregnant women from the rural field practice area of the Department of Community Medicine, MGIMS, Sevagram. After taking written informed consent, a pretested semistructured questionnaire was administered. Diabetes in Pregnancy Study Group India recommendation was used (2-h plasma glucose > 140 mg/dL with 75 g oral glucose load to diagnose GDM irrespective of the duration of the last meal). Kessler Psychological Distress Scale (K10) was administered to assess the stress (anxiety and depression). Results: The K10 scale showed that 3.11% of participants were moderately affected, and 3.01% had mild symptoms of anxiety and depression. Only 1.14% of pregnant women had severe mental disorders. The participants with normal to mild depression (K10 score < 25) had 90% less chance (odds ratio: 0.10; 95% confidence interval: 0.05–0.23) of becoming GDM than participants with moderate to severe depression (K10 score > 25), which was statistically significant (P < 0.001). Conclusion: Our study highlighted that normal to mild stress had a lesser chance of getting GDM than moderate to severe stress during pregnancy, indicating that stress is a positive risk factor of GDM. Hence, it is advisable to screen for stress during pregnancy.

Organizing the Unorganized: A Long Road Home for India’s Road-Makers

A team from the Department of Community Medicine observed and photographed the dwelling of a road construction worker’s family residing in a temporary house near a construction site (1). This photographic panel sheds light on the plight of the unorganized sector of migrant workers in India. Working for the bare minimum wages with the uncertainty of stable employment, they suffer from various issues,

Prevalence and Associated Factors of Multimorbidity among Elderly People of Bangladesh

Background: Human aging is a dynamic and progressive natural process which is depends on interacting hereditary, biological, social, environmental, historical and cultural factors that determine the quality of life of an older individual. Multimorbidity was defined as the co‐occurrence of at least two chronic diseases in a person whether as a coincidence or not. Little attention has been paid to the study of the prevalence of multimorbidity among the elderly in Bangladesh. The study aimed to find out the prevalence and associated factors of multimorbidity among elderly people of Bangladesh. Methods: It was a hospital-based cross-sectional study, conducted in Department of Community Medicine, International Nursing College, Tongi, Bangladesh from January to December 2022. Data were collected from 250 participants. Categorical data were presented as proportion, and continuous data were presented as mean (SD). The Chi-square test and multivariate logistic regression were used to find out the association between frailty and other variables. Results: Total Two hundred fifty eligible elderly persons were approached for the study. So, were analysed (response rate = 85%). The mean age (SD) of the participants was 70 (7.0) years. About half (55.2%) of them were female, 48% were living in a rural areas, and 68% were Muslim by religion. About two-thirds (58%) of participants were married (currently in union), and were living with either their spouses or children. Nearly one-third (64.4%) of participants were illiterate. The prevalence of multimorbidity was significantly higher among women than among men, among illiterate than among literate persons, among persons who belonged to the non-poorest quintiles than among the poorest quintile, and also significantly higher among single than among married persons. The most common disorders were arthritis (57.2%) and hypertension (38.4%). The prevalence of arthritis was significantly higher among the illiterate than among the ..........

IJCM_93A: Anthropometric profile of under five children attending Pediatric at rural health training centre in Aligarh (U.P.)

Background: Child undernutrition is a global health concern. Malnutrition continues to be one of the leading causes of morbidity and mortality worldwide, particularly in developing countries like India. As per the NFHS-V, the prevalence of stunting, wasting and underweight in under-five children stands at 35.5%, 19.3% and 32.1% respectively. Anthropometry has become a practical tool for evaluating the nutritional status of populations, particularly of children in developing countries & the nutritional status is the best indicator of global well-being of children. Objective: To describe the anthropometric profile and assess malnutrition using anthropometric measurements of under-five children attending pediatric OPD at Rural Health Training Centre (RHTC), Jawan under Department of Community Medicine, JNMCH, A.M.U., Aligarh (U.P.). Methodology: This is a retrospective study with secondary analysis of anthropometric data of 255 under five children attending pediatric clinic for the first time at RHTC, Jawan, under Department of Community Medicine from January 1, 2023, to June 30, 2023. Collected data were entered into Microsoft Excel and analyzed by using the software SPSS, version 20.0. Results: The median age of the children was 24 months. 52.2% of them were boys and 47.8% were girls. Severe wasting (weight-for-height<-3SD) and severe stunting (height-for-age<-3SD) was present in 4.3% and 10.2% of all children respectively and there was no significant difference among different age groups. Prevalence of underweight and stunting was highest in children less than 6 months. Conclusion: Undernutrition is common in under-five children and 10.2% of children had severe wasting. In order to prevent severe forms of undernutrition health education to caregivers on various forms of undernutrition is crucial. IEC activities and health education regarding infant and young child feeding (IYCF) should be strengthened, especially to caregivers of children less than 6 months.

IJCM_137A: A cross-sectional study to find out prevalence of alcohol, smoking and other substance abuse among adolescent in Raipur city, Chhattisgarh

Background: The use of various psychoactive substances such as alcohol, cannabis and opioids has been observed in India for centuries, the current dimension of the extent and pattern of psychoactive substance use and the problems associated with their use are not well-documented. Substance use estimates from 2004 indicate that tobacco, alcohol and illicit drugs account for 8.7%, 3.8% and 0.4% of all deaths respectively, and 3.7%, 4.5% and 0.9% of Disability Adjusted Life Years (DALYs) lost respectively. National-level prevalence has been calculated for many substances of abuse, but regional variations are quite evident. Rapid assessment surveys have facilitated the understanding of changing patterns of use. Substance use among women and children are increasing cause of concern. Objective: To find out the prevalence of substance use among adolescentsat Raipur City C.G. Methodology: Study design: Community-based cross-sectional observational study. Study centre: Department of Community Medicine, Pt. JNM Medical College, Raipur Study area: Raipur city Study technique: Interview method Sample size: 300 Results: In the present study among 664 adolescents, 301 (45.3%) have a lifetime history of any type of substance abuse other than their medicinal use. The majority 53.5% and 26.8% belong to class II & III socioeconomic status as per the revised modified Prasad classification 2023. 39.5%, 17.6% and 5.7% of adolescents have a lifetime exposure to any form of Tobacco, alcohol & cannabis abuse respectively. Conclusion: In the present study, the prevalence of substance abuse is very high among adolescents and we found that 39.5% of adolescents are exposed to tobacco products while the Global Youth Tobacco Survey-4 (2019) estimates it was 18.1%.

IJCM_33A: Comprehensive Women’s Wellness and Family Welfare Clinic: A Promising Approach for Holistic Healthcare in PGIMER Satellite Sangrur, Punjab

Background: Women’s health disparities, often rooted in sociocultural discrimination, prompted the establishment of the ‘Women’s Wellness and Family Welfare Clinic.’ Objective: The objective of this clinic was to address the adolescents and women-related issues, screening, counselling, mental health, diet and nutrition and, family planning services under one roof. Methodology: The initiative was launched in September 2023 with collaborative efforts between the Department of Community Medicine & SPH and the Department of Gynaecology and Obstetrics at the PGIMER satellite center in Sangrur, Punjab. The clinic comprehensively, recorded socio-demographic profiles, clinical histories and various health dimensions, including physical parameters, mental well-being, social factors, NCD risks, and family planning. Positive screening results prompted referrals for further evaluation. Results: A total of 252 participants underwent screening, of whom 98 (38.9%) were aged 30-39, 32 (12.7%) were planning pregnancy, and 146 (57.6%) were using contraception, with tubal ligation being a prevalent choice 64 (43.4%). Beyond gynaecological concerns, participants reported chronic lower backache (59; 23.4%) and numbness of hands or feet (56; 22.2%) as common symptoms. More than one-third, 96 (39.09%), were found to be at risk for non-communicable diseases (NCDs), with 19 (7.5%) having hypertension, 10 (3.9%) with pre- diabetes/diabetes, and 5 (2%) presenting with breast lumps. Visual Inspection with Acetic Acid (VIA) revealed a 1.2% positivity rate among 117 participants. However, 161 (63%) participants had a BMI over 25, and 121 (48%) consumed fried snacks daily. Domestic abuse was reported by a mere 2 (0.4%) participants, shedding light on the clinic’s potential role in uncovering hidden health issues. Conclusion: The success of this initiative underscores the feasibility of the model wellness clinic in an evolving phase of satellite centre. By offering comprehensive health assessments and facilitating timely referrals, the clinic stands as a promising approach to enhance early detection and treatment, contributing to the holistic well-being of women.

IJCM_378A: Introduction of Elective modules Block 2 in undergraduate new Competency based Medical Education (CBME) Curriculum: Perception of students

Background: The new competency based medical education curriculum (CBME) introduced 2 months electives (2 blocks of 4 weeks) in the curriculum for undergraduates medical students during their study periods (at the completion of phase 3 part 1). Elective is an optional course, generally of short duration, where students can opt ‘electives’ as per their topic of interest, career preference and availability at institutes. During electives students get an opportunity to differentiate during medical training, experience applicative use of knowledge and develop applied skills under the supervision and guidance of preceptors. Objective: To assess the Students perception regarding Elective modules (Block-2) necessity and benefit. Methodology: This was a cross sectional study conducted in Department of Community Medicine, Pt JNM Medical college, Raipur and Associated tertiary care hospital Dr. BRAM hospital. Raipur, Chhattisgarh in which 181 undergraduates medical students were interviewed through online mode using google form and was circulated to all via WhatsApp group. Results: Total 181 study subjects were participated in which 56.4% male and 43.6% female. Sixty-eight percent study subjects agreed that elective posting increases their knowledge and skill. Most of the students 66(36.5%) perceived elective posting very good Conclusion: This study concluded that students had very good overall experience of elective posting which proved to be helpful in improving their knowledge, clinical skills and enhanced their learning opportunities.

IJCM_370A: Assessment of factors associated with School Dropouts among adolescent: A Cross- Sectional study conducted in urban slums of Berhampur city

Background: As per National Education Policy (NEP) report, the gross enrolment ratio for class 6-8, class 9-10 and class 11-12 was 91%, 79%and 57% respectively. Education plays crucial role in development of economic, social and income of a country. Dropping out leads to under employments, mental health, delinquency and a lower quality of life for young people. Objective: To assess the determinants of school dropouts among adolescent and factor associated with it among adolescent. Methodology: A cross- sectional study was conducted for 3 months from the month of November 2023 to January 2024. Multistage random sampling was done. Participants were interviewed using pre- tested semi- structed questionnaire. Data was analyzed using SPSS in the Department of Community Medicine, MKCG Medical College, and Hospital. Results: All of the study population belonged to Hinduism, 64.29% were boys and 35.71% were girls. School dropouts were significantly less among adolescent whose mother were educated (65%) than in uneducated. The likelihood of dropout among older boys are 2times more than in younger boys who consumed any substances. Lack of interest in studies (38%), family reasons (29%) and paid work (22%) were predominant reasons among adolescents. Conclusion: There is need to improve socio- economic status, delay of marital ages of girls, and enhanced government incentives for education and spread awareness.

IJCM_217A: Literacy for health: Bridging the gap between female literacy and health seeking behaviour

Background: The private sector has maintained its dominance in the healthcare industry despite numerous government measures to improve public services. Public sector is still not a choice for treatment, various reasons being large distance from residence, poor quality of care, shortage of drugs, poor attitude of health care provider. Enumeration of the factors that defines pattern of the utilization of health services become utmost important. Hence, this study is being conducted to understand the factors behind the utilization of government health services. Objectives: i)To find the prevalence of Reproductive Tract Infections, among married women of reproductive age group, seeking treatment among rural and peri-urban areas of Aligarh. ii) To find the determinants of utilization of reproductive health services among married women in Aligarh. Methods: This cross-sectional study was conducted between 2020-2021 Data was collected through a pretested, semi-structured questionnaire through simple random sampling from 500 married women of reproductive age group, in the field areas registered under Department of Community Medicine, JNMCH A.M.U. Data was analysed using IBM SPSS 20.0. Proportion, frequencies, chi square were used to interpret the data. Results: Among total females interviewed 201 (40.2%) were found to have symptoms of Reproductive Tract Infections, out of them 165, (74.1%) sought treatment. Among 165 females who started treatment, 62.4 % of females seeking treatment were literate.69% females who delayed treatment were illiterate. Self-motivation for treatment was seen among 60.2 % of literate females. Area of residence, social class and female’s role in decision making also determined the treatment seeking behaviour. Conclusion: In our study female literacy has been found as major factor influencing the health seeking behaviour. Factors like place of residence, socio economic status, female role in decision making were significant. There is no denying the significant health benefits of supporting women’s education. Education has a crucial role in family planning, from the earliest stages to caring for one’s own health and newborn children.

IJCM_1A: Connecting Compassionately: An Evaluation of Medical Graduates and Postgraduates Attitudes Toward Learning Communication Skills

Background: Good communication skills are crucial for clinicians, influencing patient health and satisfaction. These skills build trust between patients and providers, preventing risks and conflicts. The 2019 introduction of the Attitude, Ethics, and Communication (AETCOM) module in MBBS curriculum by the Medical Council of India aims to enhance medical students’ communication skills, curb malpractices, and uphold patient’s trust in doctors. Methodology: It’s a cross-sectional study conducted in the Department of Community Medicine, J. N. Medical College, AMU, Aligarh. A total of 478 medical-graduates and PGs (divided into four groups of first (2023), second (2022+2021), third (2020+2019) MBBS-batch and fourth (Interns+ PGs) groups) were enrolled to fill up the communication skills attitude scale (CSAS) questionnaire online which consists of 13 positive and 13 negative, and also 13 affective, 5 cognitive and 4 respect attitude questions which was scored in five-point Likert’s scale. The data was analyzed using SPSS 20.0 software. Results: Overall score for positive, negative, affective, cognitive and respect domain were 36.6±7.0, 54.3±6.2, 43.5±4.6, 17.4±2.1 and 17.0±2.3 respectively. There is significant difference in score of negative attitude of first group with second and third group (34.4 vs 37.5, p=0.003 and 34.4 vs 37.8, p=0.001) respectively while positive attitude remained same. Also, significant difference in affective (42.6 vs 44.3, p=0.036) and cognitive (17.1 vs 17.9, p=0.034) component between first and fourth group while no such difference was found in respect attitude. Conclusion: Study reveals a positive inclination among medical graduates and PGs towards CSLP while a decrease in negative attitude of interns and PGs from final year students, may be due to increase in clinical exposure with the patients. The favorable attitude underscores the potential for successful integration of such programs into medical education, fostering effective communication, enhancing the quality of patient care.

IJCM_300A: Clinical medicine and Public health: Is the dichotomy justified? Epidemiological investigation of a Hepatitis A case admitted at a tertiary care hospital

Background: Outbreaks of Hepatitis A Virus (HAV) infection have been associated with poor sanitation, inadequate sewage disposal and contamination of food and water. Objective: To identify the epidemiological factors associated with a patient who presented with fever and vomiting and diagnosed with Hepatitis A. Methodology: 23-year-old, female patient was admitted in the general medicine department of a tertiary care hospital with complaints of fever and vomiting. IgM ELISA tests for Hepatitis A and Hepatitis E were positive. The patient’s mother had similar symptoms. Community Medicine department was informed about the patient. A team comprising of postgraduate students, MSW, ASHA worker and Anganwadi worker visited the patient’s house. Information including clinical history, source of drinking water, history of food and water intake from outside, sanitation and waste disposal methods of the house hold were collected. Stakeholders including the counsellor and members of the self-help group of the area were informed. House to house visit of all houses in 200 meters radius from patients’ house was done to look for more cases and to assess the environment sanitation. Results: The team identified that the source of drinking water of the patient’s family was a well which was not sanitary. A nearby house was identified with an open well with open sullage less than one meter away. Seven children of that household had fever and jaundice and were treated from a local hospital, one week prior. Stakeholders were also informed and both the wells were chlorinated and the families were educated about the importance of boiling water before consumption, proper disposal of sullage and waste disposal. Conclusion: Interdepartmental communication between clinical medicine and public health played an important role in identifying and eliminating the source of infection even when one patient was diagnosed and helped to prevent HAV outbreak.

IJCM_416A: Health Profile of Anganwadi Workers: a camp-based study conducted at a Tertiary Hospital, Mumbai, India

Background: As part of the Integrated Child Development Services program, The Anganwadi system is mainly managed by the Anganwadi worker (AWW). The fundamental tasks performed by Anganwadi workers are crucial and must be completed as effectively as possible. Hence the good health of Anganwadi workers decides how efficiently they can do their allotted work. So, this study was conducted to assess the health profile of Anganwadi workers. Objective: To assess the health profile of Anganwadi workers attending a Health checkup camp at a Tertiary Hospital. Methodology: A cross sectional descriptive study was conducted at a free health camp in a Tertiary Hospital of Mumbai, India, by the staff and interns of the Department of Community medicine. All AWWs who attended the camp were included in the study. AWWs who attended the health checkup camp were assessed for morbidity. Data collected by semi structured questionnaire was entered into Microsoft Excel and analysed using SPSS version-17.0. Results: Most of AWWs were from the age group of between 41-50 years; more than half of them were matriculate and 34(69.38%) workers had an experience of more than 10 years. Around 49% of them were having abnormal BMI and 53% were anaemic. PAP smear findings were abnormal in 4% AWWs. Conclusion: AWWs are considered cornerstone in providing ICDS services, but in this study, we found that most of AWWs themselves were not at their good health. Regular health checkups of healthcare workers of each level should be done to efficiently deliver the healthcare services to people of our country.

IJCM_224A: Routine Immunization coverage in less than 2 years residing in the filed practice area of a Medical college, Dharwad, Karnataka

Background: Immunization is the process whereby a person is offered protection from or is made resistant to an infectious disease, typically by the administration of a vaccine. Immunization is most successful and cost-effective public health interventions which averts about 3 million deaths annually. According to (NFHS) 4, children in the age group of 12 to 23 months who were fully immunized with BCG, measles, and 3 doses each of polio and DPT was 62.0% at the national level and 62.6% for Karnataka. Objective: The present study is an attempt to know the factors influencing the coverage of immunization in children between 12 -23 months who are residing in the field practice areas of the department of Community Medicine of SDMCMSH, Dharwad Methodology: A community based cross-sectional study was conducted among 91 rural children and 134 urban children between age group 12-23 months under field practice area of SDMCMSH, Dharwad Results: Out of 225 children studied, 134 from urban setting 74.6% were fully immunized. 91 from rural setting 89% were fully immunized. While un complete immunization coverage in urban and rural is 25.4% and 11% respectively Furthermore it was observed that factors like number of ANC visits the mother had, gender of the child, distance of the immunization center from the home, and educational level of the parents did not significantly influence the immunization status. Conclusion: We conclude from our study that the complete immunization coverage is 74.6% in the urban setting and in rural setting complete immunization coverage is 89%.

IJCM_67A: Unmet need for family planning and the factors affecting it in rural area of Udupi district, Karnataka

Background: The world population is expected to increase from 8 billion currently to 9.7 billion in 2050. China (1.4 billion) and India (1.4 billion) remain the two most populous countries of the world representing 18 percent of the world’s population respectively. Unmet need for contraception and unintended pregnancy are important public health concerns for India in this context. Objectives: 1. To estimate the prevalence of unmet need for family planning among eligible couples. 2. To assess the knowledge and attitude towards contraceptive usage among the eligible couples Methodology: After obtaining the approval of institutional ethics committee, a cross sectional study was conducted in Shirva, a rural area of Udupi district, Karnataka. List of eligible couples residing in areas coming under the sub centres of CHC Shirva which is a field practice area of the Department of Community Medicine, KMC, Manipal was obtained. Married women of the age group 18-49 years who are were included in the study. Data was collected by personal interviews using a semi structured, pre -designed, pre-tested questionnaire. Data was analyzed using SPSS version 26. Regression analyses was performed to find out the independent effect of various factors. Results: From the preliminary analysis of 539 participants, the unmet need for family planning was found to be 43.4%. The mean age was found to be 33.68 with a standard deviation of 6.27. The mean age at marriage and the mean age at birth of first child were found to be 22.40 and 22.97 respectively. Most of participants belonged to Hindu religion (57%), followed by Muslims (38.2%) and Christians (4.6%). 36.7% were educated up to secondary school and 21.3% up to graduation and above. Conclusion: From this study, the unmet need for family planning was found to be high.

IJCM_247A: Perception of Medical Students on Family Adoption Programme; A Study conducted in a Medical College of Odisha.

Background: Community engagement in medical education gives the students an insight into the living conditions of the public and how they influence their health. Community Medicine department accomplish this through field practice and family health studies. The Family Adoption Programme (FAP), newly mandated for all medical undergraduate students, brings its own set of challenges and opportunities. Family Adoption Programme aims to provide an experiential learning opportunity to Indian medical graduates towards community-based health care and thereby equity in health Objectives: 1. To study the perceptions of Phase I MBBS Students on Family Adoption Program. 2. To determine the output of FAP implementation in MBBS curriculum. Methodology: A Cross-sectional study was conducted between August to November 2023 including 1st year MBBS students of MKCG Medical College, Berhampur, Odisha. A brief orientation was conducted by Dept. of Community Medicine on needs and competencies of FAP as recommended by the National Medical Commission(NMC). Students were sensitized to the FAP proforma prepared by the department. Periodic FAP visits for students in 4 groups was planned & conducted along with their assigned mentors at the selected nearby village. During these visits, students interacted with the families and details regarding health profile of the family were documented. Students perception & feedback was taken by Questionnaire using Google Form. A total 250 students were enrolled in FAP and 172 submitted their feedback. Data was analyzed using appropriate statistical tests and software. Results: The study included 172 1st year MBBS students with age range of 18-26 years & mean age of 20.58± 1.315 years. Among them, 66.9% were males & 33.1% were females.66.9% of students responded that FAP was a very good experience.55.2% of study participants were satisfied with their adopted family. Most of the students were interested to be a part of such activity throughout the professional years. Conclusion: Implementation of FAP requires meticulous planning, intersectoral co-ordination, good sensitization and training activities

Exploring the Role of Medical Social Workers in Teaching and Non-Teaching Hospitals: A Study on the Potential Establishment of a Department of Medical Social Work

Medical social work plays a pivotal role in ensuring comprehensive and quality healthcare delivery, particularly in hospital settings. This paper delineates the multifaceted responsibilities undertaken by medical social workers, encompassing ethical treatment, transparency in hospital management, and advocacy for the welfare of vulnerable patients. It examines the historical evolution of medical social work in India, tracing its roots to the pioneering efforts of institutions like the Dorabji Tata Graduate School of Social Work. Furthermore, it elucidates the guidelines set forth by the Medical Council of India, emphasizing the critical need for medical social workers in both rural and urban healthcare facilities. In exploring the possibility of establishing dedicated departments for medical social work, this paper proposes a complementary framework to the existing department of community medicine. By delineating the roles and responsibilities of medical social workers in rural and urban health training centers, it underscores their significance in addressing community health determinants and facilitating access to essential services. It also highlights the potential for medical social workers to contribute as multidisciplinary team members across various hospital departments, thereby amplifying their impact on patient care and rehabilitation processes. In conclusion, the paper underscores the imperative of recognizing and strengthening the role of medical social workers in healthcare delivery systems. By fostering greater awareness, professional development, and institutional support, we can harness the full potential of medical social work to promote health equity and social justice for all individuals.

Assessment of Dependency in Activities of Daily Living (ADL) and its Predictors: A Cross-Sectional Study among the Elderly Rural Population in a Sub-Himalayan UT of India.

With an increase in life expectancy over the last few decades, there has been a parallel increase in the prevalence of disabilities among the elderly population. To estimate the prevalence of dependency in activities of daily living (ADL) and its predictors among the rural elderly population. This was a cross-sectional study carried out in the community among the rural geriatric population in the field practice area of PG Department of Community Medicine, Government Medical College Jammu. The Barthel Scale Index was used to measure ADL dependency. PSPP software was used to analyze the data. The mean age of study participants was 68.31 ± 7.9 years. ADL dependency was observed in 46.3% of the subjects, with the majority demonstrating mild to moderate dependence. Only 2.5% of the respondents reported a severe degree of ADL dependence. The mean ADL score was 94.47 ± 8.98. On multivariate logistic regression analysis, age, educational status, the presence of stress in the family, personal history, and the presence of co-morbidities emerged to be independent predictors of ADL dependence. High prevalence of physical disability in the geriatric population is now an area of major concern. This emphasizes the significance of setting up geriatric care centers especially in rural areas preferably integrating with health and wellness centers.

Perception about Community Medicine as a subject and career preference among undergraduate students

Background: In the pursuit of cultivating primary physicians, the Department of Community Medicine (CM) emphasizes value-based education for undergraduates, aiming to shape the foundation of a first-contact doctor. Despite this, only a minority ultimately selects CM as their specialty. Aim & Objectives: The objective of this study was to evaluate how undergraduates perceive CM as both a subject and a career choice. Additionally, the study aimed to identify the factors influencing students' decisions to either choose or not choose CM as a career path. Methods and Material: We conducted a cross-sectional survey among medical college undergraduates, utilizing a pre-tested, self-administered questionnaire with a Likert scale through Google Forms, ensuring informed consent. Results: Among 411 students, 259 participated, with a mean age of 21.23 ± 1.39 years. While participants generally held a positive perception of CM, only 1.1% considered it as a career choice. Top reasons against opting CM were "unpopularity compared to clinical subjects," "lack of clinical exposure," and "insufficient information on future prospects." Conclusion: Students recognize the significance of CM and possess a positive opinion, yet there exists reluctance in choosing it as a career.

Barriers Faced by Healthcare Providers during Home Visits of Palliative Care Patients - A Qualitative Study.

We, the Department of Community Medicine, have been training healthcare providers for palliative care in the hospital and community setting. There were many difficulties in providing proper palliative care. The objective is to explore the various difficulties faced by Junior Residents, auxiliary nurse and midwife (ANM) and medical social workers (MSWs) during the home visits of palliative care patients and to address those difficulties in future visits. The study was conducted in our peripheral institutions such as the Rural Health Training Centre and the Urban Health Training Centre among Junior Residents, ANMs and MSWs who had provided palliative care for the patients. Qualitative study design includes participatory research action techniques such as force field analysis, cobweb diagram, and pairwise ranking, and Systematic techniques include the Delphi technique. Indicators for difficulties faced by Junior Residents were derived and plotted based on priorities and joined to form a cobweb diagram. Difficulties were time constraints, lack of resources such as medications and transport facilities, need for specialist care, and non-adherence to the advice. Driving force and restraining force for palliative care were derived and plotted on the force field analysis. The favourable factors in providing palliative care services of the healthcare providers are self-satisfaction with treating the patient, satisfaction due to treatment at the doorstep, understanding the patient's psychological or social factors affecting their health, skill development and counselling of the patient. The restraining factors in providing palliative care services of the healthcare providers are time constraints, lack of resources, patient not following the advice properly, improper care by caregivers and unable to fulfill certain needs of the patient. Pairwise scoring/ranking was done for MSWs by plotting the issues faced in palliative care visits in rows and columns. The difficulties were time constraints, lack of resources, lack of proper knowledge of staff and need for specialist care. The possible potential solutions derived from the Delphi technique were proper planning to reduce time constraints and intense counseling of patients on adherence to treatment. It helped to identify the difficulties faced by healthcare providers and to plan for solutions in future palliative home care visits.

Frequency and distribution of co-morbidities in protein energy malnutrition children admitted in nutrition unit DHQ Hospital, District D.I. Khan, Pakistan.

Objective: To determine frequency and distribution of co-morbidities by type, age groups and gender in PEM children. Study Design: Cross-sectional study. Setting: Department of Pediatric (Nutrition Unit) and Community Medicine, GMC. Period: 15-8-2022, to 30-12-2022. Material & Methods: Data for diagnosed PEM cases was retrieved from Nutrition Unit DHQ Hospital DI Khan for which non-probability consecutive sampling technique was used. Research variable was type of comorbidities while demographics variables were age groups and gender. Association of gender and age groups with the presence or absence of co-morbidities in PEM children were found using Chi Square test. Results: Out of 400 participants, most frequent co-morbidity was gastroenteritis (GE) in 157(39.3%) patients in which females were 87(55.41%) and males 70(44.58%). 101(64.33%) were in 1–5-year age group and 56(35.66%) in under 1 year. Second to GE was pneumonia with 84(21%) patients in which females were 45(53.57%) and males 39(46.42%). Pneumonia in 1-5 year affected 61(72.61%) and 23(27.38%) patients were less than 1 year. Anemia affected 74(18.5%) patients in which females were 45(60.81%) and males 29(39.18%). 58(78.37%) patients were in 1-5 years and 16(21.62%) in less than 1 year. Other co-morbidities were seen in small number of patients. Difference in age groups were statistically significant at p-value of 0.005006 (<0.05) while there was no association of gender with comorbidities at p-value of 0.459344 (>0.05). Conclusion: Most common comorbidities were GE, pneumonia and anemia and their prevalence was higher in females and 1–5-year age group.