Department Of Community Medicine Research Articles

Assessment of risk of developing diabetes mellitus using Indian diabetes risk score (IDRS) among adult population living in an urban field practice area

ABSTRACT Background: The Indian Diabetes Risk Score (IDRS) is a simple and cost-effective tool for the early detection of undiagnosed cases in the community and is most suited for the Indian population to assess the risk of developing diabetes. Aim and Objectives: To assess the risk of Type 2 Diabetes Mellitus among the adult population living in an urban area by using the Indian Diabetes Risk Score (IDRS). To determine associated risk factors among the study population. Materials and Methods: A community-based cross-sectional study was done among 145 adults in an Urban field practice area under the Department of Community Medicine, Andhra, Medical College, Visakhapatnam. All males and females aged between 20 and 60 years living in the urban field practice area for the past year or more. The known diabetics and severely ill patients were excluded. Ethical permission was obtained and informed consent was taken from all the study participants. Results: Out of 145 study population, 66 people (45.5%) were found to be at the low-risk category, 41 people (28.3%) were in the medium-risk category and 38 people (26.2%) were at high risk based on their IDRS scores. Conclusion: The study showed a statistically significant relationship between factors such as gender, age, increased waist circumference, family history of diabetes mellitus, physical activity, and increased risk score.

“Cinemeducation” as a teaching–learning tool in Community Medicine for Phase II MBBS students

ABSTRACT Background: Many public health topics in the subject of Community Medicine have a psycho sociocultural aspect to them, and these are taught by traditional methods like didactic lectures with little or no interaction of faculty and students. This limits the comprehensive understanding of the students regarding sensitive issues. There is a felt need to improve the knowledge and understanding of many of these competencies among students through available cinema movies addressing these concepts. Objectives: 1. To assess effectiveness of “Cinemeducation” as a tool to teach identified competencies in Community Medicine subject. 2. To assess perception of students for “Cinemeducation” to enhance learning and communication skills. Methodology: Study Design: Nonrandomized intervention study. Setting: Department of Community Medicine, Government Medical College, Pali, Rajasthan. Participants: Year 2 from 2020 Batch. Sample Size: 159 students. Sampling: Complete enumeration. Intervention: All 159 students were divided into two groups and alternately shown movies, Toilet–Ek Prem Katha, Padman, Outbreak, and Steel Magnolias, or exposed to didactic lecture and were assessed using pre- and post-tests and student satisfaction and self-confidence in learning scale. Results: The post-test scores of cinemeducation showed an improvement by a mean of 1.88 ± 0.7 points. The self-confidence and learning scale showed that 86% of students agreed that cinemeducation was better than didactic lectures. The mean satisfaction index of cinemeducation as a teaching–learning method was 97.6. Three out of the four movies addressed the competency well, and the difference between the pre- and post-test scores was statistically significant following cinemeducation as compared to lectures. Conclusions: As the student correlates real-life situations in movies like Toilet–Ek Prem Katha, Outbreak, and Padman, they definitely understood the topic better with cognitive scores showing an increase.

Transect Walk in the Community, a Tool to Understand Community Resources by Medical Undergraduates of an Academic Institution

Introduction: A transect walk is a methodological walk in a well-defined pathway within a particular community/society while simultaneously drawing attention to the location of the community, distribution of resources, different social problems, and the opinion of local people regarding those problems. It is a well-accepted method related to participatory research action. However, the transect walk should have been utilized in the context of undergraduate medical education. Thus, we conducted this study to understand the feasibility and utilization of transect walks in undergraduate medical education. Methodology: We conducted a transect walk activity involving 25 undergraduate students in a village under the rural field practice area of the Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar. We prepared a checklist before conducting the transect walk based on available literature. The checklist was prepared for conducting a resource type of transect walk. The students were divided into four small groups and finally prepared a common diagram after merging all initial diagrams for better understanding and utilization of the activity. Results: The student identified different housing types, various water sources, and places for garbage disposal. They also identified important institutions like banks, local administration offices, and schools. The problem such as the absence of a wastewater disposal system, was identified during this activity. Conclusion: Students utilized the transect walk to understand the various public health issues and resources. This method was found to be an effective way of understanding different community resources.

To Evaluate Structured Competency-Based Curriculum for Health Programs among Community Medicine Postgraduates: Mixed Method Approach

Background: The postgraduate curriculum needs to be given a definite shape so as to make health programs more intensive and integrative. In the present scenario, most of the information is unclear and infrequent. A structured public health competency-based education is an important aspect to consider for integrative health care. Evaluate the structured competency-based curriculum (SCBC) prepared on health program matters. Methods: Mixed method model involving postgraduate students, faculties in community medicine departments of selected medical colleges and stakeholders from district administration. The SCBC was piloted and validated for use. The evaluation was then done based on pre- and posttest performance analysis, satisfaction survey, and questionnaires for reaction and learning components. Results: For a complete understanding of the program, students had to invest 52 hours of stipulated time. CBC assessment mean scores for a) problems in PHC and programmatic evaluation (78.9%) and b) identification of success and failure of programs (78.2%) were more than 75% mean score; whereas, assessment scores for topics on a) resource allocation and b) evaluation of program as write-up was 65% and 52%, respectively. As compared to the conventional method, the SCBC showed a critical evaluation score of 70% with a 0.001 significance level. Discussion and Conclusion: Students’ narratives were that they could understand as well as integrate them better on the field. There was enhanced satisfaction and encouragement. Structured curriculum will also help in making learning more student-centric and go a long way in boosting their creativity.

Knowledge, Attitudes, and Practices Regarding Exclusive Breastfeeding among Lactating Mothers in Rural Bangladesh

Background: Exclusive breastfeeding stands at the forefront of maternal and child health, serving as a fundamental pillar for ensuring the optimal growth and development of infants. It not only acts as a crucial source of nutrition but also plays a pivotal role in fortifying the physical and cognitive well-being of newborns, while simultaneously fostering a profound bond between mothers and their infants.Objective: This research seeks to gauge the level of awareness among lactating mothers regarding the significance and benefits of exclusive breastfeeding. It aims to comprehend their attitudes towards exclusive breastfeeding (EBF) and scrutinize their actual practices in implementing this vital aspect of infant care.Materials and Methods: A cross-sectional study was conducted at the Department of Community Medicine, ASWMC, Jashore, in 2018. Data collection took place in the Outpatient Department (OPD) of 'Ad-din Sakina Medical College Hospital' and 'Mother & Child Welfare Centre, Jashore.Results: The study demonstrates a high awareness and adherence to exclusive breastfeeding, with 94.4% aware, 90.9% knowledgeable about recommended duration, 49.9% recognizing advantages, 14.6% aware of disadvantages, and a substantial majority (92.5%) practicing exclusive breastfeeding, though 7.5% do not.Conclusion: Bridging knowledge gaps, cultivating positive attitudes, and promoting consistent breastfeeding practices emerge as crucial components of a comprehensive strategy to boost exclusive breastfeeding rates. The collaboration between healthcare providers, policymakers, and the community is indispensable for the success of such initiatives, ultimately contributing to the overall health and well-being of both infants and lactating mothers. KYAMC Journal Volume: 15, No: 01, April 2024: 46-49.

Knowledge and Experiences of Diseases with Associated Factors among Agricultural Workers in Manikganj District

Background: Farmers are generally the people of poor segment of the society and agricultural workers are prone to develop different types of health problems. Objectives: The study was conducted with a view to finding out the pattern of health problems of the agricultural workers in a rural area of Manikganj district. Methodology: This was a descriptive type of cross-sectional study carried out in Koshunda village of Manikganj district during the period of November, 2021 to April, 2022 in the Department of Community Medicine, Monno Medical College, Manikganj. For finding out pattern of diseases, knowledge and practice of the study subjects were determined by using pretested questionnaire. Results: Among the 300 cases, majority (124, 41.33%) of the respondents belonged to the age group 36-50 years. Most of the respondents (239, 79.67%) were male, being literate (195, 65.00%) had monthly family income of 10,001 or more BDT (139, 46.33%). Regarding cultivators’ knowledge of health problems during cultivation, majority (230, 76.67%) expressed occurring cut injury, followed by 206(68.67%) temperature injury, 85(24.08%) insect bite and others. Responding to question regarding injuries caused by tools and machineries of or animals involved in cultivation, majority (134, 44.67%) told that they are injured by handtools, followed by 51(17.00%) due to cattle’s kick, 46(15.33%) due to tractors and other machineries, and otherswhereas, majority of them (199, 66.33%) also reported that the injuries occur in hands, followed by 192(64.00%) in legs and others. Diseases experienced by the respondents during agricultural works included temperature-related injury (165, 55.00%), cut injury (96, 32.00%), skin problems (34, 11.33%) and others. Regarding the knowledge of the respondents’ choice of physician, majority (125, 41.67%) preferred MBBS Doctors, followed by rural medical practitioners (121, 40.33%), homeopathic doctors (67, 22.33%) and others. Conclusion: Most of the farmers shared their knowledge of suffering from different types of diseases with choice of treatment by MBBS doctors. Journal of Monno Medical College December, 2023; 9 (2):73-77

Characteristics and risk factors associated with developing prediabetes in Saudi Arabia

Objective Prediabetes is prevalent in Saudi Arabia and globally. It is associated with adverse health outcomes and complications. Consequently, this study aimed to determine the risk factors associated with developing prediabetes in Saudi Arabia. Methods This is a case-control study conducted at the Family and Community Medicine Department at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The cases included individuals with prediabetes (prediabetes group), and the control group included individuals with normal HbA1c levels who were not diagnosed with prediabetes or diabetes. The data collected included sociodemographic data, clinical parameters, laboratory tests, and medical conditions. Results The study included 46,201 patients (16,029 patients with prediabetes and 30,173 in the control group). The age of the patients (mean ± SD) with prediabetes was significantly higher than that of the control group (47.22 ± 14.04 versus 36.12 ± 11.83, p < 0.0001). A higher proportion of men was noted in the prediabetes group compared to the control group (36.32% versus 26.54%, p < 0.0001). The body mass index (mean ± SD) was higher in the prediabetes group compared to the control group (33.76 ± 6.75 versus 30.16 ± 7.26, p < 0.0001). The multiple logistic regression analysis showed six independent risk factors associated with prediabetes. These included age (aOR [95% CI] = 1.067 [1.065–1.069]) and gender, with women at a lower risk compared to men (aOR [95% CI] = 0.695 [0.664–0.728]). Other independent risk factors included polycystic ovarian syndrome (aOR [95% CI] = 58.102 (35.731–94.479]), obesity (aOR [95% CI] = 1.265 [1.075–1.487]), cardiac conditions (aOR [95% CI] = 4.870 [1.024–23.154]), and hypertension (aOR [95% CI] = 1.133 [1.031–1.245]). Conclusions The study showed that several risk factors are associated with the development of prediabetes in the Saudi population. Addressing these factors can help prevent prediabetes, and consequently, its burden and further progression to diabetes.

The future of AI clinicians: assessing the modern standard of chatbots and their approach to diagnostic uncertainty

BackgroundArtificial intelligence (AI) chatbots have demonstrated proficiency in structured knowledge assessments; however, there is limited research on their performance in scenarios involving diagnostic uncertainty, which requires careful interpretation and complex decision-making. This study aims to evaluate the efficacy of AI chatbots, GPT-4o and Claude-3, in addressing medical scenarios characterized by diagnostic uncertainty relative to Family Medicine residents.MethodsQuestions with diagnostic uncertainty were extracted from the Progress Tests administered by the Department of Family and Community Medicine at the University of Toronto between 2022 and 2023. Diagnostic uncertainty questions were defined as those presenting clinical scenarios where symptoms, clinical findings, and patient histories do not converge on a definitive diagnosis, necessitating nuanced diagnostic reasoning and differential diagnosis. These questions were administered to a cohort of 320 Family Medicine residents in their first (PGY-1) and second (PGY-2) postgraduate years and inputted into GPT-4o and Claude-3. Errors were categorized into statistical, information, and logical errors. Statistical analyses were conducted using a binomial generalized estimating equation model, paired t-tests, and chi-squared tests.ResultsCompared to the residents, both chatbots scored lower on diagnostic uncertainty questions (p < 0.01). PGY-1 residents achieved a correctness rate of 61.1% (95% CI: 58.4–63.7), and PGY-2 residents achieved 63.3% (95% CI: 60.7–66.1). In contrast, Claude-3 correctly answered 57.7% (n = 52/90) of questions, and GPT-4o correctly answered 53.3% (n = 48/90). Claude-3 had a longer mean response time (24.0 s, 95% CI: 21.0-32.5 vs. 12.4 s, 95% CI: 9.3–15.3; p < 0.01) and produced longer answers (2001 characters, 95% CI: 1845–2212 vs. 1596 characters, 95% CI: 1395–1705; p < 0.01) compared to GPT-4o. Most errors by GPT-4o were logical errors (62.5%).ConclusionsWhile AI chatbots like GPT-4o and Claude-3 demonstrate potential in handling structured medical knowledge, their performance in scenarios involving diagnostic uncertainty remains suboptimal compared to human residents.

Adapting a Longitudinal Structured Program to Enhance Research Skills in Undergraduate Medical Students: A Key Advancement in Competency-Based Medical Education

Background: Abundant literature signifies the imperative role of evidence-based research in the health sector which underpins the importance of training medical graduates in research skills early in their medical journey. Low awareness, less knowledge, and minimal practical involvement of undergraduates (UGs) in research have been identified all over India. The lack of structured delivery of research curriculum in the UG period has been the basis of uptaking this project with the aim of developing research competency in medical UGs. Materials and Methods: The study was conducted as a participatory action research with a mixed-method approach in the department of community medicine at a medical college. A structured validated module was developed by the core committee and then pilot tested. The 5 years’ journey through module development, pilot testing, longitudinal delivery, and then adapting it into a value-added course program at the university curriculum level was attempted. Results: “UG Medical Research” has been adopted as value-added course in the curriculum of MBBS in the university. The research program is being run in a longitudinal structured manner with all MBBS UGs being trained using the “Module for UG Medical Research” module followed by research mentoring by faculty and subsequently academic scholarships in Electives Research Block 1. Interdisciplinary voluntary faculty pool has been created for research mentoring of UG students. The research environment of the institute has improved in terms of the increase in the number of research projects being carried out by UG students, Short Term Studentship (STS) Indian Council of Medical Research (ICMR) research scholarships, conducting annual UG research exhibition/conferences in the campus, awards for best research works, and providing intramural research grant for UGs. Conclusions: The longitudinal structured research program was successfully incorporated into the UG curriculum which enabled UG students to demonstrate acquisition of research competency.

Pioneering family medicine: A collaborative global health education partnership in Ethiopia.

In 2013, Ethiopia launched its first Family Medicine (FM) residency programme at Addis Ababa University (AAU). The University of Toronto's Department of Family and Community Medicine (DFCM) was invited to support Addis Ababa University's Department of Family Medicine's (AAU-FM) educational programme activities forming the Toronto Addis Ababa Academic Collaboration in Family Medicine (TAAAC-FM). This paper describes the TAAAC-FM partnership, a capacity-strengthening initiative that focuses on four key levers of academic engagement and transformation: education offerings for AAU-FM trainees, partnership preparation of DFCM faculty, fostering AAU-FM faculty development and leadership, and lastly scholarship, knowledge sharing and mentorship. Toronto Addis Ababa Academic Collaboration in Family Medicine operates on principles of respect, flexibility and cultural sensitivity. Monthly virtual meetings and annual in-person faculty visits fostered curriculum support, teaching and leadership training, ensuring that the programme remained responsive to evolving needs. The partnership has contributed to a Community of Practice (CoP) to advance FM in Ethiopia, promoting shared learning. Addis Ababa University's Department of Family Medicine faculty leads in various roles, engages with global FM communities, and contributes to policy development, demonstrating significant progress in FM education and leadership. Looking ahead, TAAAC-FM aims to adapt its efforts based on the capacity built with AAU-FM, continue faculty development, and strengthen linkages within the global healthcare community. The partnership's success underscores the importance of collaborative, culturally informed high-low resource setting approaches to FM training and healthcare system strengthening, offering valuable insights for similar initiatives.

“Community-based intervention to dengue prevention: Insights from urban residents in Pune, using the health belief model"

BackgroundDengue infection is increasingly recognized as one of the world's emerging infectious diseases. The present study was carried out with the aim of assessing knowledge and health beliefs regarding Dengue fever among community in an urban slum area of Pune. This cross-sectional study was undertaken in an urban slum area of Urban Health Centre, Pashan, which is a field practice area of Department of Community Medicine. Aim & objectivesThis study is aimed at understanding the perception towards the Dengue Prevention using the Health Belief Model (HBM) approach, prevention measures adopted, their knowledge, opinion and confidence towards various control measures. MethodsA Cross-Sectional Study using a pre-tested, semi-structured questionnaire was conducted for assessing on knowledge, health beliefs and practice of dengue control. ResultsAbout 26.1 % knew the causes of dengue, 56.2 % had poor knowledge on the severity of dengue. The knowledge on causes (69.9 %), signs and symptoms (77.1 %), treatment (51.2 %) and carriers (86.3 %) of dengue was poor. The knowledge regarding insects breeding spots, potential breeding spots inside (26.1 %) and outside (38.1 %) and prevention was almost poor. The data was collected from the questionnaire, entered and analysed using Statistical Package for Social Sciences (SPSS) version 21.0. ConclusionMost people living across the community behaved in a similar manner, irrespective of age, education and socio-economic status. Perceptions of the community as explained by Health Belief Model was greatly influenced by their approach to the available health care services and for the subsequent behavioural change.

Awareness of Zika virus Disease Effects on Children, and Attitude towards Infected Unborn Babies, among Caregivers that Visit Immunization Clinic of a Teaching Hospital, Enugu, Nigeria

Aims: To assess caregivers’ awareness of Zika virus disease effects on children, infected by their mother during pregnancy; and attitude towards infected unborn babies. Study Design: This quantitative study, was of observational, descriptive, and cross-sectional design. Place and Duration of Study: The study was conducted in the Immunization unit, Enugu State University Teaching Hospital, Enugu, Nigeria; between November 2016 and February 2017. Methodology: A trained Resident doctor in the department of Community Medicine, interviewed 10 randomly selected female caregivers that brought children to the hospital for immunization. Thirty respondents were interviewed each week for eight weeks, since immunization activity was conducted three days in a week. Sixteen were interviewed on the ninth week; making a total of 256 respondents. Results: A total of 256 women participated in the study, with 89.5% of them being married, and 86.0% falling within the age range of 20 – 39 years. Overall awareness on Zika virus infection effect on children such as failure to thrive, involuntary muscle contractions, learning handicap, visual and hearing impairment, and less functional individual with reduced societal value were poor. None of the total scores were up to 50.0%. In situation where Zika virus is detected in an unborn baby, praying and leaving the outcome to God was the highest selected option (48.8%), while abandoning the baby in the hospital was the least selected option (6.6%). Other options were accepting and caring for the baby (41.8%), and terminating the pregnancy (14.8%). Conclusion: Though the declaration of Zika virus infection by the World Health Organization, as a Public Health Emergency of International Concern was lifted since November 2016; the infection could still be going on undetected, in many low- and middle-income countries. Efforts should be made to improve on the level of awareness on Zika virus, and effects on children.

Epidemiological Profile and Awareness Regarding Animal Bite Management in an Urban Area.

The most common way for people to contract the deadly zoonotic disease rabies is through animal bites. This study was designed because there is a shortage of community-based data to determine the true extent of rabies infection and a lack of understanding regarding patient misconceptions in urban areas. The objective was to determine the scope of the issue and the epidemiological features of animal bite incidents. This was a facility-based cross-sectional study conducted at the field practice area (Urban Health Training Centre) under the Department of Community Medicine, Government Medical College. The study duration was one year (May 2023 to April 2024). Consecutive patients (accompanied by an attendant) attending the Urban Health Training Centre were included in the study. A purposive sampling technique was used, and around 400 animal bite cases were recorded in one year at the Urban Health Training Centre. Out of 1503 male cases at the Urban Health Training Centre, around 255 were dog bite cases (50.6%), whereas out of 1302 females visiting the Urban Health Training Centre, around 145 were dog bite cases (48%). The majority (35%) belonged to the age group of 11 to 20 years for both males and females. The mean age of the cases was 19.4 ± 3.4 years. The study found a male preponderance (64%), with females constituting 36%. The right lower limb (49.5%), left lower limb (39%), and upper limb were the most frequently bitten sites. Fifty-one percent of the cases fell into Category II. According to local data, the most popular home management practices were ghee oil and cold treatments. Although Category III is the most severe bite, only 35% had taken the anti-rabies vaccine (ARV), and 8.75% had received rabies immunoglobulin. The public and medical community need to be made aware of the importance of wound care and the prudent use of the anti-rabies vaccine.

Assessment of sexual function and quality of life in breast cancer patients before and after the occurrence of therapy-related skin changes

Background Patients with breast cancer (BC) who receive adjuvant chemotherapy or other treatment modalities may potentially benefit from an enhanced prognosis of survival. Physical or aesthetic complications may, nevertheless, result in significant distress as a consequence of adverse dermatologic responses. There has been a heightened focus on matters related to quality of life (QoL) as the number of BC survivors has risen. Sexual disorders are reported by as many as 75% of women who undergo treatment for BC. Despite this, the majority of oncologists lack the necessary training to identify patients who are particularly susceptible to developing sexual disorders. Patients diagnosed with BC frequently experience female sexual dysfunction. Objective To compare and evaluate the impact of skin changes induced by different treatment modalities in BC patients on their sexual function and QoL. Patients and methods This is a prospective cohort research on 58 cases diagnosed with BC, which was conducted in the outpatient clinic of the Clinical Oncology department, Faculty of Medicine, Menoufia University from April 2022 to February 2023. The calculated sample size for the current study using Epi info 7 programs was 56 women. The power of the study is 80% with a confidence level of 95% as determined by the Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University. Both sexual function and QoL were assessed before and 3–6 months after the occurrence of skin changes related to different treatment modalities using validated questionnaires irrespective of their tumor stage. Results Of the 58 patients, there was statistically significant variance regarding dermatological life quality index (DLQI) (P&lt;0.001), with 8.6% of patients experiencing a very large influence on their QoL, which increased to 19%. However, the number of patients having an extremely large influence on their quality of life changed from 0 to 5.2%. There was statistically significant variance (P&lt;0.001) regarding female sexual function index values among the six domains of female sexual function index before and after the occurrence of skin changes. There is a negative correlation between DLQI score and desire, arousal, lubrication, orgasm, and satisfaction scores, while there is a positive correlation between DLQI score and pain score. QoL was negatively affected by the occurrence of such skin lesions. Conclusion There was a significant negative impact of skin changes induced by different treatment modalities in BC patients on their sexual function and QoL.

O42 USABILITY AND EFFECT OF A HYPERTENSION MOBILE APPLICATION IN KNOWLEDGE AND GUIDELINES ADHERENCE OF FAMILY AND COMMUNITY MEDICINE RESIDENTS

Background: Mobile health (mHealth) applications have become integral in medical education and information access, yet effectiveness varies, and barriers to engagement persist. OBJECTIVE: This study aimed to assess the usability and effectiveness of the mHealth application entitled Hypertension Now in increasing knowledge and guideline adherence among residents. Methods: A before-and-after educational intervention study was conducted among residents of the Department of Family and Community Medicine (DFCM), Philippines General Hospital from January to August 2023. The intervention was a newly developed medical reference app for managing hypertension based on the latest local and international hypertension guidelines. Usability, knowledge score, and adherence rate were measured using a questionnaire, pre- and post-intervention examinations, and medical chart audits. Results: All 32 DFCM residents participated in the study. The app was rated high on ease of use and usefulness for practice by the residents. It was also rated high on interface and overall satisfaction. It significantly increased the knowledge scores of the residents by 1.6 points (p=0.001). The proportion of those who passed the exam significantly increased post-intervention (37.5% vs. 59.4%, p=0.035). Moreover, the app increased the adherence of the residents to proper physical examination (82% vs. 91%, p=0.024), diagnosis (80% vs. 90%, p=0.012), and pharmacologic treatment (53% vs. 83%, p=0.001). There was no increase in adherence to proper risk assessment (83% vs. 78%, p=0.371), laboratory examination (35% vs. 40%, p=0.329), and non-pharmacologic treatment (77% vs. 81%, p=0.470). Conclusion: The mHealth app for hypertension management was usable and effective in increasing the knowledge of family and community medicine residents in managing hypertension. While the app increased guideline adherence to physical examinations, diagnostics, and pharmacological treatments for hypertension, it did not increase adherence to risk assessment, laboratory examination, and non-pharmacologic treatment.

Immunization Status of Children in Urban Slums of Rawalpindi and Barriers to Immunization

Objective: To determine immunization status of children residing in urban slums of Rawalpindi and identify the barriers to immunization. Study Design: Cross sectional study. Place and Duration of Study: Slums of Takht Pari, Rawalpindi Pakistan, from Jan to Mar 2020. Methodology: Children, aged 12-23 months, residing at Takht Pari were enrolled. Two sessions of a free medical camp were arranged at Takht Pari by Department of Community Medicine, Foundation University, Islamabad. Data was collected from parents visiting the medical camp with the mother labelled as the primary respondent. Immunization cards and mother’s recall were used to assess the immunization status of children. Results: Two hundred ninety-one (72.9%) children were completely immunized, partially immunized were 106(26.6%) while 2(0.5%) were unimmunized. Three hundred eighty-eight (97.2%) children were vaccinated through government centers while those who received vaccination through private clinics were 9(2.3%). Factors associated with incomplete immunization were education of parents (p&lt;0.001), number of children (p&lt;0.001), gender of child (p=0.001), access to TV or Radio (p&lt;0.001), and site of immunization (government/private) (p&lt;0.001). Conclusion: Immunization status of 73% shows that unremitting efforts are essential for attaining universal coverage of immunization with extra attention to underprivileged areas. Planning and placement of public facilities for preventive services needs to be an urgent priority improving service utilization and enhancing coverage as people tend to follow ease of accessibility for using immunization services.

Operationalizing Back Referral Concept In Teaching Hospitals Through Outreach Centre Of Community Medicine Departments: A Pilot Study

Operationalizing Back Referral Concept In Teaching Hospitals Through Outreach Centre Of Community Medicine Departments: A Pilot Study

Prevalence and Patterns of Ocular Comorbidities among Geriatric Population Residents in Rural Eastern India: A Cross-Sectional Study

Background: With the increase in overall life expectancy, the number of people above 60 years old will increase globally from 1 billion in 2020 to 1.4 billion in 2050 and is expected to double by 2.1 billion by 2050 with an increase in age-related comorbidities. Age-related ocular co-morbidities are a major comorbidity. According to India's visual impairment and blindness data, cataracts and severe and moderate visual impairment are the most common cases. Objective: To assess the ocular comorbidities among the geriatric population. Methods: A community-based cross-sectional study was undertaken in the field practice area of the Rural Health Training Center (RHTC), Jamujhari, Khordha, affiliated with the Department of Community Medicine, IMS &amp; SUM Hospital, Bhubaneswar. Stratified random sampling was done, and one stratum constituted three nearby adopted villages. Four strata were included to select the households, and the first household was selected randomly in each village. A socio-demographic profile and detailed clinical history were collected, and the required clinical examinations were conducted after obtaining consent. Results: The prevalence of ocular morbidity (OM) was found to be 96.8%. Refractive error (RE) has the highest prevalence (86.52%), including prescription-corrected glasses users, whereas age-related macular degeneration (ARMD) and ectropion (EC) have the lowest prevalence (3.2%). Conclusions: The study findings show a need for proactive management and earlier screening for better quality of life in the geriatric population.

Implementing virtual primary care: experiences, perspectives and identification of improvement opportunities in an academic primary care setting

BackgroundOne of the biggest changes to primary care triggered by the COVID-19 pandemic was the rapid integration of virtual care (VC). VC offers benefits to patients and providers but implementation...

“Intensified Case Finding of Tuberculosis among Diabetes Mellitus Patients attending Non-Communicable Disease Clinic in a Tertiary Care Hospital – An Implementation Research”

BackgroundFor ending the epidemic of TB by the year 2030, along in line with Sustainable Development Goals, it is essential to address the TB associated co-morbidities. Prevalence of diabetes influencing TB incidence and mortality is higher when compared to other co-morbidities like HIV infection, cigarette smoking, alcohol use and under-nutrition. Therefore, this study was conducted with the following objectives: 1.To evaluate the effectiveness of the intervention on implementation of TB-DM collaborative activity using four symptom complex strategy and to explore the patient and health providers related factors that contribute to implementation of activity. Material and MethodsThe present study was undertaken by Department of Community Medicine, Sri Manankula Vinayagar Medical College and Hospital, Puducherry for a period of 18 months in the Out Patient Departments of General Medicine, General Surgery, Obstetrics and Gynecology, Orthopedics, DOTS center and Designated Microscopy Centre. It was an embedded sequential experimental study, done among the health care professionals (CRRI, Postgraduates and staff nurse) who were involved in process of 4s complex screening for DM patients and the stakeholders who were involved in implementation of NTEP activity. The study was conducted in three phases. Phase I: baseline survey and identification of intervention strategies, Phase II: implementation of the intervention and Phase III: end line survey. Data entry and analysisManual content analysis was done for Qualitative data. The Quantitative data were entered into Epi Info software (version 7.2.2.6) and analyzed in SPSS software (version 24). Comparison of knowledge among the health care professionals before and after sensitization was calculated using Mc nemar test. It was considered statistically significant when the p value was <0.005. The analysis of free list and pile sort data was undertaken using Anthropac 4.98.1/X software. ResultsChallenges obtained from stakeholders in implementing the activity were categorized as patient related factor, health care professional related factor and screening and reporting related factor. Suggested solutions were generating awareness at patient level, display of IEC tools, periodical sensitization for the staff, inter-departmental co-ordination, monitoring and re-enforcing the activity in core-committee meetings. After sensitization, the knowledge on joint TB-DM collaborative activity was significantly improved among the health care professionals. By implementing the four symptom complex screening activity in NCD clinic, 6480 DM patients were screened and 176 (2.7%) presumptive TB cases were identified. Of which, 136 of them reached DMC for sputum examination. Among them 44 (35.4%) had active TB infection. The Number Needed to Screen to yield a case of TB was 147. Conclusionand recommendations: We found improvement in identification of TB cases using ICF approach with minimal resources. Thus, we recommend a support group to maintain and strengthen the ongoing activity. The challenges and solutions identified may help in optimizing the screening process. Implementing the activity in special clinics like oncology OPDs, nephrology OPDs, antenatal clinics can be recommended.