Anmol Gupta

Risk factors for cancer cervix among rural women of a hilly state: A case-control study

In Himachal Pradesh, cancer cervix is a major public health problem since it ranks as the number one female cancer. A case-control study of 226 newly diagnosed, histopathologically confirmed cases of cancer cervix and equal number of matched controls was conducted at Regional Cancer Center, Himachal Pradesh during the period from July 2008 to October 2009 with the objective to study the common factors associated with cancer cervix. Univariate analysis identified 10 risk factors associated significantly with the disease. On multiple logistic regression, however, only seven risk factors were found to be associated significantly with the disease. These were: Age at birth of first child, spacing between two children, age at marriage, literacy, socioeconomic status, multiparity, and poor genital hygiene. Risk factors such as poor genital hygiene, age at birth of first child <19 years, early marriage, illiteracy, multiparity, and low socioeconomic status were highly prevalent in the study subjects and were found to be significantly associated with cancer cervix.

Prevalence of cigarette smoking and its predictors among school going adolescents of North India

Background: Cigarettes smoking is a common mode of consuming tobacco in India. This habit usually starts in adolescence and tracks across the life course. Interventions like building decision making skills and resisting negative influences are effective in reducing the initiation and level of tobacco use. Aims and Objectives: The purpose of this study was to assess the prevalence of adolescent current cigarette smoking behavior and to investigate the individual and social factors, which influence them both to and not to smoke. Methodology: A cross-sectional study was carried out among school going adolescents in Shimla town of North India. After obtaining their written informed consent, a questionnaire was administered. Results: The overall prevalence of current cigarette smoking was 11.8%. The binary logistic regression model revealed that parents’ and peers’ smoking behavior influence adolescent smoking behavior. Individual self-harm tendency also significantly predicted cigarette smoking behavior. Parental active participation in keeping a track of their childrens free time activities predicted to protect adolescents from taking this habit. Conclusion: Our research lends support to the need for intervention on restricting adolescents from taking up this habit and becoming another tobacco industries’ addicted customer. Parents who smoke should quit this habit, which will not only restore their own health, but also protect their children. All parents should be counseled to carefully observe their childrens free time activities.

Anemia among adolescent girls in Shimla hills of north India: Does BMI and onset of menarche have a role?

BACKGROUND Anemia is a global public health problem. Adolescents are vulnerable to iron deficiency because of increased iron requirements related to rapid growth. AIMS AND OBJECTIVES To estimate the prevalence of anemia among adolescent girls and to study whether anemia is associated with body mass index and the attainment of menarche. MATERIALS AND METHODS A cross-sectional descriptive survey was conducted in selected schools of Shimla district. One thousand five ninety-six (10-19 yrs old) school girls were included in the study. The study was conducted from June 2011 to May 2012 (1 year). Data analysis was done using SPSSS software version 18 for windows. RESULTS Prevalence of anemia was found to be 21.4%. It was seen that among the anemic adolescent girls, 77.3% had mild anemia, 21.9% had moderate anemia, and 0.5% had severe anemia. BMI and onset of menarche had no significant effect on the prevalence of anemia. In bivariate logistic regression, age and urban residence were significantly related to anemia. CONCLUSION We observed a low prevalence of anemia among adolescent girls. We recommend that adolescents be screened periodically for anemia and multi-sectoral, community-based approach be adopted to combat this serious public health issue.

Pre-lacteal feeding practices and associated factors in Himachal Pradesh

BACKGROUND: Prelacteal feeds are dangerous for newborn health and thus should not be given. Studying the enabling factors of this harmful practice can help determine ways of how to get rid of it. AIMS AND OBJECTIVES: This study aims to assess the pattern of prelacteal feeding in a district of Himachal Pradesh and to study its predictive factors. SETTINGS AND DESIGN: A cross-sectional study was conducted among 200 mothers attending Anganwadi centers in Shimla district of Himachal Pradesh. MATERIALS AND METHODS: Data were obtained by trained field investigator using a pretested interview schedule. In-depth interviews were held to find out the reasons for providing prelacteal feeds. STATISTICAL ANALYSIS: Data were analyzed using Epi Info software for windows (Centre for Disease Control and Prevention, Atlanta). Logistic regressions were used to find out the adjusted odds ratios (AORs) for factors associated with the practice of giving prelacteal feed. RESULTS: The prevalence of prelacteal feeding was 49.5% (confidence interval [CI] = 42.5%–56.4%). In logistic regression analysis, living in joint family (AOR = 2.5, CI = 1.3–4.9) and higher socioeconomic status (AOR = 3.8, CI = 1.1–13.1) were positively associated with prelacteal feeding practice. Mothers who delivered by cesarean section were more likely to give prelacteal feeds to their baby (AOR = 3.4, CI = 1.3–8.8) as compared to those who delivered by normal vaginal delivery. CONCLUSIONS: It is concluded that prelacteal feeding is commonly practiced in both urban and rural areas of Shimla hills of Himachal Pradesh. Child health programs in the study area should use behavior change communication to decrease the harmful practice of giving prelacteal feeds to newborns.

Prevalence and risk factors for depression in elderly North Indians

Background: Depression in elderly is a public health problem. Aims and Objectives: To determine the prevalence of depression and its correlates among the elderly population. Materials and Methods: This cross-sectional study was conducted among elderly aged 60 years and above using two-stage cluster sampling technique among elderly residing in the rural and urban areas of Shimla district of Himachal Pradesh, India. A written consent was taken from each participant after explaining the purpose of the study. Results: Of the 800 subjects, 76 (9.5%) were found to be suffering from depression. The logistic regression analysis revealed that elderly having lower income, consuming tobacco, experiencing stressful life event in the past 1 year, having 3 or more chronic diseases, and lacking positive approach toward life and were found to be more depressed. Conclusion: The study conducted in Shimla district shows that one-tenth of the elderly residing in the study area suffering from depression. Elderly having lower income, residing in the urban area, experiencing significant life event, suffering from multimorbidity, and lacking positive approach toward life increase should be identified by screening. They should be focused on so as to reduce the probability of occurrence of depression.

Prevalence and predictors of the dual burden of malnutrition among adolescents in North India

Background: Dual burden of malnutrition comprising of both under nutrition and over nutrition constitutes an important public health problem among Indian adolescents. Objective: The objective of this study is to determine the prevalence of dual burden of malnutrition (underweight and overweight/obesity) among adolescents and to understand the role of dietary habits and physical activity in this regard. Methodology: A cross-sectional survey was conducted in Shimla district of North India. A total of 720 adolescents aged 14-19 years were selected to participate in the study. Data were collected on sociodemographic status, physical activity, dietary intake, and anthropometry. Statistical analysis was done using Epi info software for windows (version 6.0, Centre for Disease Control, Atlanta, USA). Results: A total of 298 (41.3%) of the adolescents were suffering from dual burden of malnutrition. The binary logistic regression revealed a statistically significant positive association of overweight/obesity with frequent fast food consumption (odds ratio [OR] = 4.45, confidence interval [CI] = 2.42-8.18). Individuals consuming less salt in the diet had lower odds of being overweight/obese (OR = 0.47, CI = 0.25-0.87). Similarly, individuals frequently consuming fruits in the diet had lesser odds of being underweight (OR = 0.61, CI = 0.42-0.86). Conclusion: The high prevalence of the dual burden of malnutrition in this study stresses the need for policy makers in India to adapt the current adolescent program so as to focus on both ends of the nutrition spectrum.

Is diagnostic protocol a cause of overestimation of extra-pulmonary tuberculosis in Himachal Pradesh? A report from a high-prevalence tuberculosis unit

Aims and Objectives: To study the diagnostic practices for diagnosis of extra-pulmonary tuberculosis (EPTB) in a high-prevalence tuberculosis unit (TU). Material and Methods: It was a cross-sectional study using a pre-designed and pre-tested structured questionnaire. The information was collected from new EPTB cases registered in Rampur TU between 1 July 2007 and 31 March 2008. Diagnostic practices of the medical practitioners for establishing the diagnosis of different types of EPTB were studied. Results: For the diagnosis of pleural TB the main tools used were X-ray chest (37 cases; 100.0%) and aspiration of pleural fluid (pleural tap) for color of pleural fluid (35 cases; 94.6%). For establishing the diagnosis of lymph node TB, eight (66.6%) cases were subjected to fine needle aspiration cytology (FNAC) examination of involved lymph nodes. Excision biopsy of lymph nodes was undertaken in the remaining four (33.3%) cases. The diagnosis of abdominal TB was primarily established on the basis of X-ray (six cases; 85.7%) and ultrasonography (USG) of abdomen for the presence of ascites in five (71.4%) cases. The patients of tubercular meningitis were diagnosed predominantly on clinical grounds whereas in bone and genitourinary TB, all appropriate investigations were performed for confirmation of EPTB of these organs. Conclusions: Except for lymph node TB and the patients in whom the diagnosis had been established in tertiary care institutions of the state, patients were being diagnosed on clinical grounds.

Role of intensive training in strengthening the skills of HIV counselors for imparting quality ICTC services

Counseling is a confidential dialogue between a client and counselor aimed at enabling the client to cope with stress and make personal decisions related to HIV/AIDS. When Voluntary Counseling and testing centers (VCTC) centers were started initially, their focus was on prevention of HIV infection, HIV testing, and dealing with social and emotional impact of a HIV positive test. The scope of services being provided has over the years expanded rapidly, with addition of prevention of parent-to-child transmission (PPTCT), access to anti retroviral therapy (ART), and better linkages with directly observed treatment short course (DOTS) centers.(1–4) In the third phase of National AIDS Control Program (NACP-111), these VCTC services are being further expanded to Community Health Center (CHC) and Primary Health Center (PHC) levels and clients will be provided comprehensive, quality services under one roof of integrated counseling and testing centers (ICTC). This planned expansion puts pressure on NACP-111 to recruit and train a large number of qualified and skilled counselors who will be the most important functionaries of these VCTCs, PPTCTs, and ICTCs throughout the country.(5) The HIV counselor needs to equip the client to prevent HIV infection, to make an informed choice about HIV testing, to cope with an HIV test result and to understand the implications of lifelong treatment.(6) National AIDS Control Organization (NACO) has developed an intensive 12 days training schedule for developing and fine tuning the counseling skills of these counselors so as to produce counselors who are sensitive to their clients problems, are well informed and can provide high quality VCT, PPTCT, and ART counseling. For this purpose, NACO has identified 18 institutes across the country who will impart trainings to HIV counselors. Our institute was selected to train counselors from Himachal and Haryana state. We tried to study the impact of 12-day intensive training program in enhancing the skills of these counselors.

A cross sectional study to assess the satisfaction level among people living with HIV/AIDS in a hilly state of northern India

Patient’s satisfaction is the patient’s perception of care received compared with the care expected by them. Its measurement helps in understanding patient’s experiences of health care, identifying their problems and evaluation of health care. If patient satisfaction increases, it leads to increase patient retention and decreases medical malpractice claims. Furthermore, a satisfied patient is more likely to develop a longer lasting rapport with their health care provider, leading to better compliance and continuity of care. Dissatisfied patients may have worse outcomes as they may not follow the required treatment plans.

Building evidence for coverage of fully vaccinated children of 12–23 months of age across Districts of North India, 2015

Context: Unprecedented low coverage (63%) of fully vaccinated (FV) children in the recent round of national survey district level household (HH) and facility survey 4 (DLHS-4) propelled health system of Himachal Pradesh for an independent rapid assessment of FV coverage. Aim: The aim of the study was to assess the FV coverage among 12–23-month old children in the state. Settings and Design: A community-based survey with an interviewer-administered questionnaire was carried out in all 12 districts of Himachal Pradesh from September 2015 to January 2016. Subject and Methods: WHO 30 × 7 cluster technique was used. Statistical Analysis Used: Chi-square and unpaired Students t-test along with 95% confidence intervals. Results: A total of 2492 children across 35,551 HHs (2.4% of state share) were surveyed with FV coverage of 98.1% (95% confidence interval [CI]: 97.5–98.6) and 86% (95% CI: 84.6–87.3) based on history and card, respectively. Conclusions: The reported FV coverage in the current study was observed too high in the state as reported in earlier round of the national surveys (except DLHS-4).