Information , Education And Communication Research Articles

Augmenting the Referral Pathway for Retinal Services Among Patients With Diabetes Mellitus at Reiyukai Eiko Masunaga Eye Hospital, Nepal: Protocol for a Nonrandomized, Pre-Post Intervention Study.

BackgroundDiabetic retinopathy (DR) is an important public health issue in Nepal with a huge social and economic impact. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. Published studies on referral pathways in Nepal are scarce. Improving DR awareness among general physicians has the potential to address these challenges.ObjectiveThe aim of this study is to evaluate the effect of a health education intervention on health personnel, establish a referral pathway, and assess the impact of the intervention on the attendance of patients with diabetes mellitus for retinal screening at Reiyukai Eiko Masunaga Eye Hospital in Nepal.MethodsThis is a nonrandomized, pre- and postintervention study. Health education on DR will be provided to selected health personnel of the intervention hospital (Scheer Memorial) using information education and communication (IEC) materials in the form of PowerPoint presentations, posters, pamphlets, videos, and pre- and postevaluation questionnaires along with referral slip. Pre- and postevaluation will be undertaken during the study period. Data will be analyzed using MS Excel and Epi Info 7.ResultsThe ethical approval for this study has been obtained from the Ethical Review Board of the Nepal Health Research Council (ERB Protocol Registration Number # 582/2020P). The study is expected to be completed in 18 months from the start of the project. The baseline data collection was from June to January 2020 for a period of 8 months. The postintervention data collection was from February to September 2021 for a period of 8 months. The last 2 months are planned for data analysis and report writing.ConclusionsHealth education intervention could be a low-cost solution to improve the awareness, access, and utilization of retinal health care services; this is an understudied topic in Nepal. Working closely with the stakeholders, this study will evaluate the role of health education interventions (which are already validated in other low-income settings) to strengthen referral and reduce the burden of DR in Nepal.Trial RegistrationClinicalTrials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084International Registered Report Identifier (IRRID)DERR1-10.2196/33116

Maximizing community participation and engagement: lessons learned over 2 decades of field trials in rural Ghana

BackgroundSuccessful implementation of community-based research is dominantly influenced by participation and engagement from the local community without which community members will not want to participate in research and important knowledge and potential health benefits will be missed. Therefore, maximising community participation and engagement is key for the effective conduct of community-based research. In this paper, we present lessons learnt over two decades of conducting research in 7 rural districts in the Brong Ahafo region of Ghana with an estimated population of around 600,000. The trials which were mainly in the area of Maternal, Neonatal and Child Health were conducted by the Kintampo Health Research Centre (KHRC) in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM).MethodsThe four core strategies which were used were formative research methods, the formation of the Information, Education and Communication (IEC) team to serve as the main link between the research team and the community, recruitment of field workers from the communities within which they lived, and close collaboration with national and regional stakeholders.ResultsThese measures allowed trust to be built between the community members and the research team and ensured that potential misconceptions which came up in the communities were promptly dealt with through the IEC team. The decision to place field workers in the communities from which they came and their knowledge of the local language created trust between the research team and the community. The close working relationship between the District health authorities and the Kintampo Health Research Centre supported the acceptance of the research in the communities as the District Health Authorities were respected and trusted.ConclusionThe successes achieved during the past 2 decades of collaboration between LSHTM and KHRC in conducting community-based field trials were based on involving the community in research projects. Community participation and engagement helped not only to identify the pertinent issues, but also enabled the communities and research team to contribute towards efforts to address challenges.

Exploring the Awareness Regarding E-waste and Its Management among Electronic Repair Workers and Scrap Dealers of South Delhi, India.

Introduction:In India, E-waste and its proper disposal is an emerging environmental and public health issue.Aim and Objectives:To assess the level of awareness regarding E-waste and its management among the electronic repair workers and scrap dealers of Delhi.Material and Methods:It was a community based, cross-sectional, descriptive study, was of one year (1st April, 2015-31st March, 2016). Electronic repair workers and scrap dealers were included after getting their written consent and selected by non-probability convenient sampling. A pre-tested, semi- structured, interviewer administered questionnaire was used. The data was entered in MS Excel and was analyzed using the SPSS version 21.0.Results:A total of 300 workers i.e. 150 electronic repair workers and 150 scrap dealers participated. Most of the electronic repair workers (57%) and scrap dealers (48%) were of 20-39 yrs old. 70% of electronic repair workers and 79% of scrap dealers had not heard about e-waste. As education among these groups increases, awareness regarding E-waste also increased and it was statistically significant.Conclusion:Adequate IEC (Information, education and communication) services focusing on health hazards of E-waste should be widely disseminated.

Rising epidemic of COVID-19 in India – knowledge, attitude and practices among general population

Background: Coronavirus disease 2019 (COVID-19) is an emerging disease caused by a novel corona virus, Severe Acute respiratory syndrome coronavirus 2 (SARS CoV2). It was first detected in December 2019 in Wuhan, China. The rapid spread and the novel nature of the disease has created an environment of confusion and panic among people.Methods: A cross-sectional study was conducted using web-based questionnaire in different languages, the link of the online questionnaire shared as text message was shared/posted/reposted through author’s social media accounts and e-mails. It consisted two parts: Demographic details and KAP containing total 19 questions (K-13, A-3, P-3). Data analysis was conducted using SPSS-20 statistical software.Results: It was found that higher education level has associated significantly with higher knowledge score (β= -0.213: p=0.00). Multiple regression analysis showed that attitude of people avoiding Chinese restaurants was significantly associated with younger age group (Expβ=0.975: p=0.021). The practice of wearing mask while leaving home was found significantly associated with education (p=0.024) and occupation (p=0.000) in univariate analysis. Similarly, the practice of washing hands was significantly associated with age in both univariate (p=0.049) and multivariate analysis (Expβ=0.932: p=0.049).Conclusions: The practice of majority of Indian residents was very cautious. But correct response rate for knowledge score was only 72.54% and positive attitude about COVID-19 control in India was demonstrated by 74.18% respondents, thus reflecting inadequate information about COVID-19 and lower confidence on its control. Information, education and communication (IEC) campaigns by various sources needs to be optimized across various sociodemographic groups to address those at higher risk.

A Study to Evaluate the effectiveness of IEC (Information, Education and Communication) package on prevention of female foeticide in terms of knowledge and attitude of adults in a selected urban area of Rohtak

A Study to Evaluate the effectiveness of IEC (Information, Education and Communication) package on prevention of female foeticide in terms of knowledge and attitude of adults in a selected urban area of Rohtak

Increasing breast cancer awareness and breast examination practices among women through health education and capacity building of primary healthcare providers: a pre-post intervention study in low socioeconomic area of Mumbai, India

ObjectivesThe present study aimed to improve breast cancer (BC) awareness and practices using Information, Education and Communication (IEC) modules and health educational sessions for women and primary healthcare providers in...

Blended Training Development on Technical Competency Training for Family Planning Instructors (PKB) with Junior Expert Position in National Population and Family Planning Board

This study aims to analyze the duties of the junior expert family planning instructors (junior expert PKB), analyze the existing technical training curriculum for the junior expert PKB, design the blended training curriculum for technical training for the junior expert PKB, and evaluate the blended training curriculum for technical training for the junior expert PKB. The method used in this research was design and development, developed by Richey and Klein with three stages: analysis, design and development, and evaluation. In general, the competency standards formulated for the junior expert PKB focus on assessment and evaluation of IEC (information, education, and communication), advocacy, recording and reporting to data and information analysis. Meanwhile, the strategy used in training was blended learning by combining face-to-face learning and e-learning. The evaluation was carried out using portfolio assessment. This training curriculum design was assessed by curriculum and e-learning experts in the form of expert reviews with very good results and suitable for use. Moreover, based on the feasibility test conducted on the user, the blended training curriculum developed was very good and suitable for use in technical competency training for the junior expert PKB

Risk factors of precancerous cervical lesions: The role of women's socio-demographic, sexual behavior and body mass index in Amhara region referral hospitals; case-control study.

BackgroundCervical cancer remains one of the major public health challenges in low and middle-income countries including Ethiopia. There was a scarce of evidence regarding the effect of woman’s socio-demographic characteristics and body mass index on the development of precancerous cervical lesions in Ethiopia. Therefore, the current study aimed at identifying the risk factors of precancerous cervical lesions among women visiting referral hospitals for cervical cancer screening in Amhara national regional state.MethodsA hospital-based case-control study was conducted from 22 December 2019 to 8 April 2020 among 200 women including 67 visual inspections with acetic acid (VIA) positive women (i.e., cases) and 133 visual inspections with acetic acid (VIA) negative women (i.e., controls). The study was conducted at randomly selected referral hospitals in Amhara national regional state. Data were collected mainly through face to face interview and chart review using structured questionnaire and checklist respectively. Data were then entered to EpiData version 4.6 and exported to SPSS version 25 for analysis. Binary logistic regression model was fitted and variables with p-value of < 0.2 at bivariable logistic regression analysis were candidates for the multivariable analysis. Level of significance was claimed based on adjusted odds ratio (AOR) with 95% confidence interval (CI) at p-value of ≤ 0.05.ResultsThis study illustrates that the odds of being positive for precancerous cervical lesion (PCL) were higher among women who had body mass index (BMI) of <18.5 kg/m2 (AOR = 3.83; 95% CI: 1.26, 8.76), early coitarche (AOR = 3.15; 95% CI: 1.50, 11.49, history of using oral contraceptive pills (AOR = 2.74; 95% CI: 1.6, 7.4), lifetime sexual transmitted infections (AOR = 3.73; 95% CI: 2.5, 12.28) and multiple sexual partners (AOR = 3.23; 95% CI: 1.82, 9.29). On the other hand, participants’ BMI of ≥25 kg/m2 (AOR = 0.46; 95% CI: 0.36, 0.75) and level of education of college and above (AOR = 0.29; 95% CI: 0.23, 0.77) were identified to be protective factors of PCL.ConclusionMost of the determinants of precancerous cervical lesions were modifiable and mainly related to women’s socio-demographic characteristics, sexual behaviors and body mass index. Therefore, strengthening awareness on safe sexual practices and healthy life styles through information, education and communication (IEC), and behavioral change communication (BCC) would decrease the incidence of precancerous cervical lesions.

Effect of Information, Education and Communication (IEC) on Knowledge and Attitude regarding Premarital HIV and Haemoglobin Genotype Testing among Adolescents

Background: Premarital screening is a test done for younger adults and couples considering marriage forprevention of genetic, infectious and blood transmitted diseases. Adolescent and college young adults must beeducated about potentially life-threatening infectious and genetic disorders for the promotion of their health,well-being as well their offspring too. For providing accurate and unbiased education and information, theIEC is considered to be an effective intervention strategy. Materials and Methods: The study was done toassess the effect of IEC on knowledge and attitude regarding premarital HIV and Haemoglobin genotypetesting among adolescents in a selected Pre-University Colleges, Bengaluru. An evaluative approach withquasi experimental pre-test and post-test control group design was used. A study sample comprised of 60adolescents in experimental group and 60 adolescents in control group. The sample was selected usinglottery method of the simple random sampling technique. The Structured knowledge questionnaire and Threepoint Likert scale was used to assess the knowledge and attitude level of adolescents respectively. Results:Study results revealed that the experimental group which received IEC showed significant difference in theimprovement of knowledge (p &lt; 0.001) and the attitude score (p &lt; 0.001). Conclusion: Based on the studyfindings, it can be concluded that IEC is a best strategy to spread awareness through proper use of materialsto young people to achieve a desired positive outcomes in terms of improving knowledge and positiveattitude on prevention of life threatening infectious diseases and genetic disorders.

Strengthening community and stakeholder participation in the implementation of integrated vector management for malaria control in western Kenya: a case study

BackgroundIntegrated vector management (IVM) is defined as a rational decision-making process for the optimal use of resources for vector control. The IVM approach is based on the premise that effective control of vectors and the diseases they transmit is not the sole preserve of the health sector. It requires the collaboration and participation of communities and other stakeholders in public and private sectors. Community participation is key to the success of IVM implementation at the local level.Case descriptionThe study was conducted in Nyabondo, a rural area of Kenya where malaria is endemic. The objective of the project was to promote adoption and sustainability of IVM and scale up IVM-related activities as well as increase community participation and partnership in malaria control through outreach, capacity-building and collaboration with other stakeholders in the area. Collaboration was pursued through forging partnership with various government departments and ministries, particularly the fisheries department, ministry of education, ministry of health, forestry department and the social services. In total, 33 community-based organizations working within the area were identified and their role documented. Through distribution of information, education and communication (IEC) materials alone, the project was able to reach 10,670 people using various social mobilization methods, such as convening of sensitization meetings—dubbed 'mosquito days'—mainly spearheaded by primary school pupils. A total of 23 local primary schools participated in creating awareness on malaria prevention and control during the project phase. The collaboration with other departments like fisheries led to stocking of more than 20 fishponds with a total of 18,000 fingerlings in the years 2017 and 2018. Fish ponds provided an opportunity for income generation to the community. In partnership with the county government health department, the project was able to re-train 40 CHVs on IVM and malaria case management in the area. Additionally, 40 fish farmers were re-trained on fish farming as part of income generating activity (IGA) while 10 CBOs made up of 509 members received both eucalyptus and Ocimum kilimandscharicum seedlings that were distributed to four CBOs composed of 152 members. Four primary schools made up of 113 health club members also received eucalyptus seedlings as part of IGA in addition to fish farming. In total, around 20,000 eucalyptus seedlings were distributed to the community as part of IGA initiatives. By the end of 2018, the project was able to reach 25,322 people in the community during its two-year advocacy and social mobilization initiatives.ConclusionThrough advocacy and social mobilization, the IVM strategy improved inter-sectoral collaboration, enhanced capacity building and community participation. However, more IVM related activities are needed to effectively mobilize available resources and increase community participation in malaria control.

Reaching Out to the Millions: A 5 Key Messages Rapid IEC Campaign During the COVID-19 Pandemic.

The ongoing COVID-19 pandemic has necessitated providing populations with simple and relevant, actionable informational messages for them to be informed on individual and community level measures to combat the pandemic. Distilling guidance from various sources into simple actionable message themes in a short time frame should be the hallmark of any rapid health promotion campaign. We developed and disseminated actionable Information, Education and Communication (IEC) messages on prevention and control during the ongoing COVID-19 pandemic by selecting five key message themes of prevention. A modified Delphi technique was used for the development process which was peer reviewed after consensus was generated. An online training model using specifically developed YouTube videos and Zoom Meetings was utilized to train Master Trainers and the further hierarchy reaching out to 6989 Community Resource Persons at the peripheral echelons. Conservatively the population reached out has been estimated to be more than 6 million (across 1.2 million households), over a two week period in April 2020. The implementing agency has created 300 videos in around 22 languages based on the 5 Key Messages, which are available online for universal access. A rapid IEC campaign that can be developed, designed and rolled out in a short span is required for emergency situations such as the ongoing pandemic. NGOs play an important role in reaching out relevant messages to the community, filling in the gaps by virtue of their relative systemic agility.

Vaccine Resistance-Vantage Point from Health Professionals of South India

Background: Vaccination is the most effective method of preventing infectious diseases. Early success brought widespread acceptance and mass vaccination campaigns have greatly reduced the incidence of many diseases in numerous geographic regions.&#x0D; Objectives: To study the perspective of health professionals regard to barriers and solution for vaccination program in a district of South Kerala.&#x0D; Materials and Methods: A qualitative study design was done using free listing technique for both barriers and solutions. The data was entered into notepad and was transferred to Visual Anthropac software trial version. The software helped to generate ten important free lists of barriers and solutions with percentage, rank and Smith S value.&#x0D; Results: The present study had discussed regarding trust of western countries promoting vaccination and conspiracy theories related to them. The work of antivaccine lobby globally was debated. The controversy of MMR Autism and political will of different countries were deliberated. The role of media especially impact social media and internet had paved pathway for swift spread of contents.&#x0D; Conclusion: Major interventions should be planned systematically by the government to address barriers for immunization. Strengthening Information education and communication (IEC) over digital media using appropriate technology should be engrossed for sustaining vaccine coverage.

Insecticide-treated net utilization and associated factors among pregnant women and under-five children in East Belessa District, Northwest Ethiopia: using the Health Belief model

BackgroundMalaria during pregnancy and childhood is one of the major public health challenges globally. Its prevalence is huge in Africa, especially in sub-Saharan countries and Ethiopia. Insecticide-treated mosquito net (ITN) use is one of the primary malaria preventive strategies. Previous studies did not adequately address the health belief and behaviour-related correlates of ITN using health belief model (HBM), although a number of studies were conducted in this theme. Therefore, this study was aimed at assessing the prevalence and associated factors of ITN utilization among pregnant women and under five children in east Belessa district, northwest Ethiopia, 2020.MethodsA community-based cross-sectional mixed study was conducted in east Belessa district from February 01–30/2020. A total of 724 eligible participants were included in the quantitative study. A multistage cluster sampling technique was used. The quantitative data were collected using an interviewer-administered structured questionnaire. Data were entered into Epi data version 4.6.0.2 and then exported to SPSS version 16 for analysis. The binary logistic regression model was fitted and the level of significance was declared based on AOR with its 95% CI and p-value ≤ 0.05. Meanwhile, the qualitative data were collected using focus group discussions and key informant interviews, and analysed using a thematic analysis approach.ResultsThe prevalence of ITN utilization was 56.5% (95% CI 53.0, 60.2) and independently predicted by a corrugated iron roof of the house (AOR = 1.53; 95% CI 1.15, 2.22), rural residence (AOR = 1.59; 95% CI 1.11,2.28), ≥ 2 number of rooms in the house (AOR = 1.56; 95% CI 1.06, 2.30) and high level of perceived barrier (AOR = 0.53; 95% CI 0.38,0.74). In the qualitative findings, the main barrier was connected to misconceptions and misperception towards malaria and ITN.ConclusionThe prevalence of ITN utilization in the study area was lower than the national target (100%). It was significantly associated with household characteristics, residence, and level of a perceived barrier. Reversing the community’s misconceptions through information, education and communication (IEC), and behavioural change communication (BCC) would enhance ITN utilization.

Health-seeking behavior of patients with diabetes mellitus

Introduction: Health-seeking behavior is a complex outcome of many independent factors operating at individual, family, and community level. Studies have shown that there is an improvement in compliance to treatment and a decrease in the complications with an increase in patients' knowledge about the disease and its complications. The current study was done to explore the health-seeking behavior among patients diagnosed with diabetes mellitus (DM). Materials and Methods: A community-based cross-sectional descriptive study was conducted among patients diagnosed with DM in an urban area of Pondicherry. A simple random sampling method was used to recruit the study participants in the community. A predesigned structured questionnaire was used to collect information from the participants by conducting face-to-face interview. Data entry was done in EpiData and the analysis was done using the Statistical Package for the Social Sciences Version 21. Results: In the present study, 109 participants were included and interviewed. Majority of participants (29.4%) belonged to 61–70 years. Most of the respondents (56.8%) seek treatment from a private health facility. The most common comorbidity reported was hypertension (59.6%). Participants shared that unhealthy diet (55%), family history (25.7%), sedentary lifestyle (23.9%), and obesity (17.4%) were the risk factors of DM. Only 12.8% of participants were testing their blood glucose level at monthly intervals. Eight participants were on irregular medication, and among them, three participants told that they were irregular on treatment because their blood glucose levels were normal. Conclusion: The level of awareness on diabetes among the participants is not satisfactory though the overall treatment-seeking behavior is found to be satisfactory among the study participants. It is recommended to plan and implement various Information, Education and Communication (IEC) activities in the study area to increase the level awareness.

Increasing utilization of public health insurance programs: Evidence from an experiment in India

Abstract Unlike most social programs that involve regular delivery of benefits (such as subsidized food or monthly cash transfers), public health insurance programs are used based on need. When households face health shocks, they are often unaware of how to avail health insurance benefits. This is especially true for households in remote rural regions of developing countries where the likelihood of low awareness about public health insurance programs is higher due to low levels of literacy, distance from healthcare facilities and limited opportunities to learn from others’ experiences. Conventional information, education and communication (IEC) methods such as information pamphlets and outreach through health camps are not always effective in disseminating information to these hard-to-reach populations. In this paper, we present results from a quasi-experiment that uses village-level awareness meetings to disseminate information about a public health insurance program in 61 villages of a district in southern India. We find that awareness meetings, though relatively more expensive than conventional IEC methods, not only increase utilization of the program but also provide government agencies a unique opportunity to monitor the implementation of the program in remote locations.

Schistosoma mansoni and soil transmitted helminths co-infestation among the 5-14 years old and risk factors in Buyende district, Uganda

Background: Schistosomiasis is a water-based disease transmitted by schistosomes. Schistosomes usually co-infest their hosts with soil transmitted helminths (STHs) parasites due to overlapping poverty-related factors favoring their distribution. This leads to severe morbidity, which may result into complications such as; long-term physical and mental growth retardation, poor cognitive development, disability as well as deaths. Efforts to achieve the elimination target are still a challenge mainly because of drug resistance and sanitation-related behavioral patterns. The objective of the study was to determine the co-infection prevalence of Schistosoma mansoni and STHs parasites among children, 5–14 years and the associated risk factors in Buyende district. Methods & Materials: Stool samples from 400 children distributed in nine purposively selected villages of Kagulu sub-county in Buyende district were processed for S. mansoni and STHs before a face–face standardized interview guide was administered to ascertain factors responsible for perpetuating the parasites in the communities. Results: The prevalence of co-infection of S. mansoni and STH was 5%, mostly co-infected with hookworms. Mono infection of S. mansoni was 10.8%, hookworm (14.3%), E. vermicularis (0.8%). There was a strong association between; school status (AOR = 17.51, 95% CI = 5.35–50.96, p < 0.001), education of the care take (AOR = 2.44, 95%CI = 1.56–4.23) p-value <0.001), the house building material from where the respondent resided (AOR = 1.61, 95% CI = 1.02–1.40), frequency of swimming per week (AOR = 2.44, 95% CI = 1.56–4.23, p < 0.002) and risk of being co-infected with Schistosoma mansoni and STH. Conclusion: Illiteracy of care takers and children not attending school being the critical risk factors should prompt an increased health education with information, education and communication (IEC) materials urgently for intervention especially among individuals of low socio-economic status in fishing communities.

An Exploration of the Communicative Efficacy of HIV/AIDS IEC Materials Among Secondary School Teenagers in Harare

The aim of this contribution is to determine the communicative efficacy of selected print-based HIV and AIDS information education and communication (IEC) materials (posters, leaflets and brochures) among secondary school teenagers (13–19 years) in Harare. Data were collected over a period of 2 months from six schools, selected using multistage cluster sampling. It incorporated use of a self-administered questionnaire involving a sample of 750 teenagers, and 6 focus group discussions (FGDs), each comprised of 10 purposefully sampled participants. The survey investigated a number of indicators of communicative efficacy, wherein the IEC materials were found to be clear by 38.4 per cent ( n = 288), informative by 45.2 per cent ( n = 339), credible by 80.5 per cent ( n = 604), appealing by 64.7 per cent ( n = 485), important by 69.5 per cent ( n = 521) and acceptable by 54 per cent ( n = 405) of the respondents. The outcomes of the FGDs showed that, although HIV and AIDS IECs were generally believed to be appealing and to significantly increase awareness among teenagers, these were also considered somewhat unclear and inaccessible. Moreover, perceptions were strongly inclined towards use of Shona language, social media and elimination of fear appeals in HIV information. Thus, in addition to adopting young people-centred communication modes, finding an appropriate balance between complex language and efficacy of HIV prevention messages is imperative.

Evaluating Health Status of Under-Five Children Following a Training of Community Based Volunteers (CBVs) With Information, Education and Communication (IEC) Messages on Malnutrition and Diarrhoeal Diseases in Two Southern Districts of Zambia

Evaluating Health Status of Under-Five Children Following a Training of Community Based Volunteers (CBVs) With Information, Education and Communication (IEC) Messages on Malnutrition and Diarrhoeal Diseases in Two Southern Districts of Zambia

Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

BackgroundMany malaria endemic countries are heading towards malaria elimination through the use of case management and vector control strategies, which employ surveillance, improving access to early diagnosis, prompt treatment., and integrated vector control measures. There is a consensus that elimination of malaria is feasible when rapid detection and prompt treatment is combined with mosquito-human contact interruption in an efficient and sustainable manner at community levels. This paper describes results of an integrated case management and vector control strategy for reducing malaria cases in 1233 villages over 3 years in district Mandla, Madhya Pradesh, India.MethodsThe project enrolled the entire population (1,143,126) of Mandla district for fever surveillance followed by testing of febrile cases and treatment of positive subjects using T4 strategy, which is Track (by fever), Test (by RDTs), Treat (by ACT) and Track (for completion of treatment). In addition to the active and passive surveillance for detection and treatment of febrile cases, the project conducted mass screening and treatment to clear the asymptomatic reservoirs of infection. Febrile cases were also tested in the out-patient department of the District Hospital from June 2018 to September, 2018 and in a community-based medical camp from November 7 to 14, 2019. The project also used vector control measures for interrupting human-mosquito contact, and information, education and communication (IEC) campaigns to increase demand for malaria services at community level.ResultsThis project has revealed about 91% reduction of indigenous cases of malaria during the period from June 2017 to May 2020, through case management and vector control strategies. A total 357,143 febrile cases were screened, out of which 0.19% were found positive for the presence of malaria parasites, with Plasmodium falciparum and Plasmodium vivax ratio of 62:38. The prevalence of malaria was higher in individuals > 15 years of age (69% cases). The positivity rate was 0.33% in 2017–18, 0.13% in 2018–19, and 0.06% in 2019–20. In all of the 3 years of the project, the peak transmission correlated with rains. Mass screening revealed 0.18% positivity in Sep-Oct 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. Imported cases into the district were mostly contributed by the distant state of Telangana (51.13%). Fever patients tested for malaria parasites in the District Hospital and medical camp revealed zero cases.ConclusionUsing the current intervention and prevention tools along with optimum utilization of human resources, a 91% reduction in indigenous cases of malaria was seen in the district in 3 years. The reduction was similar in the three high prevalence blocks of the district. These results reveal that malaria elimination is achievable in India within a stipulated time frame. The reduction of malaria at the community level was further validated when zero malaria cases were diagnosed during hospital and community-based studies in Mandla. Prompt detection and treatment of imported/migratory cases may have prevented outbreaks in the district. This project has demonstrated that field programmes backed by adequate technical, management, operational, and financial controls with robust monitoring are needed for achieving malaria elimination.

Proposition of Belief and Practice Theory for Men Undergoing Infertility Treatment: A Hospital Based Study in Mumbai, India.

The paper aims to understand the treatment seeking behavior and the experiences of men with male factor infertility. A cross-sectional study was conducted at consented hospitals/infertility centers in Mumbai, India in purview of the fact that men are not considered as important as a part of infertility treatment as women. An infertile man is defined here as one who is diagnosed with primary or secondary infertility, undergoing infertility treatment, irrespective of the fertility status of his wife. Primary data of 150 men undergoing infertility treatment from a variety of socioeconomic backgrounds was collected through semi-structured interviews. The initial effect of the infertility status led the men to feel depressed, guilty, shocked, and isolated. A large proportion of the respondents never discussed the problem with anyone except their wives. More than one third of the respondents consulted with Ayurvedic, Unani, Siddha, and Homeopathy (AYUSH) practitioners. Changes of doctors or clinics were more attributed to unsuccessful treatment cycles and success rate of other clinics than the referral by doctors. Destiny, bad luck, lifestyle, medical reasons, and late marriage are found as perceived causes of male infertility. Age above 40, younger age at marriage, marriage duration for 6 and more years, secondary infertility, self-employment, and higher income have significant association with longer time gap between marriage and initiation of infertility treatment. Based on study findings, we propose Belief and Practice theory where we elaborate the progression in treatment for male infertility. Men should be given due consideration in infertility treatment. They must be taken into consideration at an early stage of fertility evaluation due to the fact that minor problems of male infertility can be cured with modest medication. Proper Information Education and Communication (IEC) is essential for creating awareness in society on male infertility. Better counseling services during treatment and standardization of cost can help infertile men to manage treatment-related stress. Since infertility treatment is a time-consuming and exhaustive process, considering the timing for patient's income generating work, evening out patient department, and comprehensive knowledge dissemination at health centers can be improve male factor infertility treatment.