Dineshwar Singh Dhadwal

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.

PREVALENCE AND CORRELATES OF SUBSTANCE ABUSE AMONG SCHOOL GOING ADOLESCENTS IN A HILLY DISTRICT OF HIMALAYAN REGION IN INDIA

BACKGROUND According to UNDCP World Drug Report, the problem of substance abuse in adolescence is fast assuming alarming proportions in both developed and developing nations. Kullu District of Himachal Pradesh has regularly been in media headlines for extensive cannabis cultivation and abuse of other substances. The study was conducted to provide an essential source of information about substance abuse and its correlates in this Himalayan region.

Validity of madras diabetes research foundation: Indian diabetes risk score for screening of diabetes mellitus among adult population of urban field practice area, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Introduction: IDRS is based on four simple parameters derived from known risk factors for diabetes; two modifiable risk factors (waist circumference and physical inactivity) and two non-modifiable risk factors (age and family history of diabetes), which may be amenable to intervention. The present study has been planned as the region specific validation is important before it can be used for screening in this part of the country. Aims: The aim of the present study was to validate MDRF-IDRS for screening of diabetes mellitus among adult population of urban field practice area, IGMC, Shimla, Himachal Pradesh, India. Methods: The present community based cross sectional study was conducted among 417 adults fulfilling the eligibility criteria using a two stage sampling design. Results: In the present study IDRS value ≥70 had an optimum sensitivity of 61.33% and specificity of 56.14% for detecting undiagnosed type 2 diabetes in the community. At an IDRS score of ≥70, the PPV was 23.47%, NPV as 86.88%, the diagnostic accuracy as 57.07%, LR for positive test as 1.398, LR for negative test as 0.69 and Youdens index as 0.17. However Youdens index was 0.19 at a cut of ≥60 i.e. higher than what was at ≥70. Higher IDRS scores increased the specificity but the sensitivity dramatically decreased. Conversely, lower IDRS values increased the sensitivity but the specificity drastically decreased. Area under the curve = 0.630 and a P value < 0.001. Conclusions: MDRF IDRS is user friendly screening tool but the criteria of including the parameter of physical activity for the calculation of the risk score needs to be clearly defined. In the present study the maximum sensitivity of 100% was seen at a cut off of ≥30. Hence we would recommend that all those in the medium and high risk group should be screened for type 2 Diabetes.

Indian public health standards in primary health centers and community health centers in Shimla District of Himachal Pradesh: A descriptive evaluation

Introduction: The health planners in India have visualized primary health centers (PHCs) and community health centers (CHCs) as the key healthcare delivery institutions in rural areas. These centers are supposed to have health manpower, infrastructure, and service delivery as per the Indian public health standards (IPHS) guidelines (2010). Materials and Methods: A cross-sectional study was conducted in seven CHCs and 12 PHCs, randomly selected from eight blocks of Shimla District and evaluated in terms of health manpower, infrastructure, and services from September 2011 to August 2012. Data was collected from the selected units using structured data collection instruments designed by the IPHS. Results: The health centers were assessed according to IPHS guidelines. Outpatient department services and referral services were provided in all the centers studied. No specialist doctor was posted at any of CHCs against a sanctioned strength of at least four (surgeon, physician, obstetrician, and pediatrician) per CHC. In 3 (42.8%) CHCs and 8 (75%) PHCs, no pharmacist was posted. Eight (75%) PHCs did not have any staff nurse posted. Three (42.8%) CHCs and 10 (83.3%) PHCs did not have a laboratory technician. In CHCs, separate labor room was available in 6 (85.7%) whereas a separate laboratory was available in all seven. Separate labor room and laboratory were available in four (25%) PHCs. Conclusions: IPHS guidelines are not being followed at PHC and CHC levels of the district. Health manpower shortage is the key bottleneck in service delivery. Political advocacy is needed to ensure sufficient health manpower availability to deliver quality healthcare.

Client's satisfaction with the health services under Janani Suraksha Yojana in rural area of Himachal Pradesh

Background: Satisfaction can be defined as the extent of an individual′s experience compared with his or her expectations. Client satisfaction is one of the commonly used outcome measures of patient care and is an important indicator of quality of primary care and healthcare performance. Objective: To assess the satisfaction with the services among Janani Suraksha Yojana (JSY) beneficiaries in a rural field practice area of Indira Gandhi Medical College (IGMC), Shimla, and to recommend measures for improvements of services being provided to the beneficiaries. Materials and Methods: A community-based, cross-sectional study was undertaken from April 2013 to March 2014 in the rural field practice area of IGMC, Shimla, among the JSY beneficiaries who delivered and received the services under the JSY Scheme in the previous 1 year. The data were collected using a pretested, predesigned, and semi-structured questionnaire and these data were analyzed using SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results: The study observed that 49 (69%) of beneficiaries were found to be satisfied with services received at subcenter and the amount of JSY incentive received. It was also revealed that out of 64 beneficiaries who delivered at hospital, most 52 (81%) of them were satisfied with the services received at the place of delivery. It was found that 51 (65.38%) and 16 (20.5%) beneficiaries were found satisfied and dissatisfied with the behavior of health functionaries at subcenter, respectively. Conclusion: Client satisfaction is one of the most important determinants of health service utilization. There is a need for regular training program for health functionaries on improvement of communication skills and quality of care.

Knowledge about the ill effects of tobacco use and “Cigarettes and other tobacco products (Prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) Act.” among adult male population of Shimla City

Background: Cigarettes and other tobacco products act 2003 (COTPA) is the principal law governing tobacco control in India. However, enforcement of the provisions under the law is still a matter of concern. The desired impact and level of enforcement of the COTPA legislation and the gutka and pan masala ban in Himachal Pradesh need assessment. Objective: The objective of this study was to assess the knowledge and attitudes about the ill effects of tobacco use and COTPA among the adult male population of Shimla City. Materials and Methods: This study was a cross-sectional community-based survey carried out in Boileauganj, Shimla. Data were collected using a structured schedule by interviewing 100 participants. Proportions, percentages were calculated, and the Fischers exact test was applied for the categorical variables. Results: About 58% had heard of ban on smoking in public places and 53% knew that Himachal Pradesh has been declared as a no smoke state. Only 50% of the participants had heard of COTPA. Conclusion: These dismal findings suggest average knowledge levels of male adults about COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.

Knowledge, awareness, and utilization pattern of services under Janani Suraksha Yojana among beneficiaries in rural area of Himachal Pradesh

Introduction: Safe motherhood is perceived as a human right, and the health sector is always encouraged to provide quality services to ensure the same. Government of India launched a scheme called Janani Suraksha Yojana (JSY) on April 11, 2005, under the flagship of National Rural Health Mission to reduce maternal and neonatal mortality, by promoting institutional deliveries for which financial incentives are provided to mothers delivering in the health facilities. Objective: To study the knowledge, awareness, and utilization pattern of services under JSY among the beneficiaries in rural area of Shimla, Himachal Pradesh, India. Materials and Methods: This cross-sectional study was conducted among the 78 JSY beneficiaries residing in the rural field practice area of Indira Gandhi Medical College Shimla, Himachal Pradesh, India. These beneficiaries were interviewed with pretested, predesigned, semi-structured close ended questionnaire by house-to-house visits, after obtaining informed consent. Results: Majority of the JSY beneficiaries (50; 64%) were in the age group of 20–25 years and 43 (55.1%) of them heard about the JSY scheme before the present pregnancy. Anganwadi workers 78 (100%) and female health workers (62; 79.5%) were the main sources of information. More than half of the study participants (44; 56%) had good knowledge about the scheme and 42 (53.85%) registered their name in health institution during thefirst trimester of last pregnancy. Forty-four (56.4%) beneficiaries had undergone three antenatal checkups and only 11 (14.1%) of them received three postnatal (PN) visits. All the beneficiaries received the JSY incentives 1-week the following delivery. Conclusions: Awareness regarding the JSY scheme, early antenatal registration, minimum three antenatal care visits, and three PN visits is still low among rural women which needs strengthening through intensification of IEC activities.