Shekhar Grover

Awareness About Anti-Smoking Related Laws and Legislation Among General Population in Slums of Delhi, India

Introduction Almost 40% of Delhis population lives in slums and is vulnerable to tobacco use. It is therefore important to assess their opinion and ensure compliance to antismoking legislation. The present study was undertaken to assess the awareness of the general public residing in slums in Delhi regarding the smoke-free initiative of 2009, 3 years after intensive implementation. Methods It was a cross-sectional study conducted among participants selected by cluster sampling from the slums in six districts of Delhi using a pretested semistructured questionnaire. A total of 708 slum dwellers were interviewed. Results Out of the total, only 16.1% (n = 114) of the participants had heard of The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA), though, they were aware about some of the provisions of the COTPA. Majority (n = 529; 74.7%) perceived the smoke-free zones as the places where smoking forms of tobacco are banned. Regarding the awareness about the places designated as smoke-free zones, 82.1% (n = 581) of the respondents named educational institutions. About 61% of the people interviewed reported to have seen people smoking at public places on the day of interview while only 21.5% reported to have seen any one getting punished for smoking. Conclusions Awareness about COTPA was low. The study respondents perceived that no action was being taken against persons acting in violation of the law. Thus, there is a need for stricter implementation of COTPA and increased spreading of awareness among the general public. Implications While awareness about antismoking legislation among general population (particularly slums) has been studied world over, this has not been the case in India. The study depicts opinion of one of the susceptible populations regarding tobacco control legislation, which has hitherto not been studied in the Indian context. This study has an important implication as it highlights the need for stringent enforcement of antismoking legislation for tobacco control.

Integrating screening for non-communicable diseases and their risk factors in routine tuberculosis care in Delhi, India: A mixed-methods study

Background Evidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs). Bi-directional screening for TB and diabetes mellitus (DM) is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme. Objective To assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017. Methods It was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). Results Amongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p<0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening. Conclusion Integrating screening for NCDs and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.

Beliefs Supporting Violence, Attitudes and Aggressive Behavior Among School Adolescents in Rural Delhi

Violence and aggression amongst adolescents is increasing across the globe. However, the research on adolescent violence in India is limited. The present study was undertaken to study aggressive beliefs, attitudes, behavior rural schools in north district of Delhi. It was a cross-sectional study conducted among adolescents studying in grade VIII–X in three rural schools in Delhi, selected by non-probability sampling. The data was collected using a questionnaire adapted from CDC Compendium of tools measuring aggression. Out of the total 270 adolescents, there were 119 boys (44.1%) and 151 (55.9%) girls. The mean score of beliefs, attitude aggressive behaviour for private co-ed school was highest while all girls’ school had lowest (p < 0.001). Being male (p < 0.001), studying in private co-ed school (p < 0.001) and having attitude towards violence (p = 0.02) contributed significantly to total aggression score. The study highlighted that type of school, gender and attitudes influence adolescents’ behavior towards aggression.

Decadal impact of Directly Observed Treatment Short course program on age and gender among New Infectious Tuberculosis cases in Delhi

BACKGROUND Burden of tuberculosis in India remains enormous. The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly Observed Treatment Short course (DOTS) strategy, was launched in 1997 in India. The question of what DOTS has or has not accomplished over the past 15 years is a central technical question. OBJECTIVES To assess the decadal impact of DOTS strategy on some epidemiological factors such as age and gender of new sputum positive (NSP) TB patients in Delhi. MATERIAL AND METHODS Secondary Data for Delhi was obtained from the state wise performance of RNTCP (Annual Summary) for the year 2001 and year 2012. Data was analyzed in Microsoft Excel 2007. RESULTS The population of Delhi covered under DOTS has considerably increased over the decade. The case detection rate has also shown a considerable increase from 196/100,000 population in 2001 to 306/100,000 population at the end of Quarter 3 of 2011. The number of NSP male and female patients have increased in all age groups from 2001 to 2011 except in 25-34 years age group. NSP male patients on DOTS aged 15-44 years showed a left ward shift in increase, a significant right ward shift was noted in increase in female NSP patients of similar age group. CONCLUSIONS The decadal assessment of DOTS in Delhi on TB epidemiology has pointed towards beginning of epidemiological transition in TB control in India.

Past, present, and future of iodine deficiency disorders in India: Need to look outside the blinkers

Iodine deficiency disorders (IDDs) have been recognized as one of the major nutritional disorders throughout the world affecting 200 million people who are at risk and another 71 million suffering from goiter and other IDDs. These groups of disorders can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment. The existence of endemic goiter in an extensive belt along the southern slopes of the Himalayas, Alps, and Andes has long been described, but consistently high prevalence of IDDs outside the endemic zones and failure to attain goals set by the National Iodine Deficiency Disorder Control Program questions the strategy and achievements till date. Therefore, the present article is an attempt to critically examine the program since inception in India.

Experience of violence amongst female medical and nursing students and their perception regarding violence against women in Delhi, India

Abstract Background Health care providers are often the first point of contact for the victims of violence against women (VAW). Therefore, it is important to understand their perception about VAW. Objective To assess the proportion of female medical students who experienced violence, and elicit their perception regarding the same. Methods It was a cross-sectional study undertaken among 50 medical and 50 nursing students of a medical college in Central Delhi. A self-administered, questionnaire was used for data collection. Results Of the total, 18% had experienced molestation while 77% had experienced eve-teasing during their lifetime. But, only 2% reported the incident to police. Perception regarding the victim’s role and self-determination was favorable amongst the female students. However, only 39% knew some basic self-defense techniques. Conclusion The proportion of students who experienced eve-teasing in their lifetime was high. The study highlighted the need to make the female students more pro-active and competent in terms of tackling violence.

Accuracy of body weight perceptions among students in a medical school in Central Delhi, India

Background: Body image is an important aspect of the complex creation of one′s self-identity. The relationship between nutritional disorders, like obesity, and one′s perception of her or his body is well documented. Obesity among medical students and health personnel is on the rise. Identifying and measuring the magnitude of distortion in body image self-perception among medical students is particularly relevant, as they are future healthcare providers. This paper assesses self-perceptions of body mass index (BMI) and physical activity among medical undergraduate students in an Indian medical school. Methods: A cross-sectional study was conducted among 161 sixth semester medical undergraduate students in a school in Delhi, India. A pretested questionnaire was used. Anthropometric measurements were taken. The participation rate was 93.6%. Results: Out of the total 161 students, there were 60.9% males and 39.1% females. Most participants were classified as normal (55.9%) according to BMI. The proportions of actual obese, overweight and underweight students were 4.4%, 30.4% and 9.3%, respectively. However, the proportion of students perceiving themselves as obese or overweight was only 37.3%. A significantly higher proportion of females (57.2%) than males (20.4%) perceived themselves as overweight (P < 0.001). The agreement between actual BMI and perceived weight was poor (kappa statistic: 0.33). Among actual overweight and obese students, only one-third were physically active. Conclusions: Students who were overweight or obese often failed to perceive themselves as such and, perhaps consequently, were not engaging in weight control practices. There is a need to develop health promotion interventions that help build healthy body habitus perceptions among this group of Indian medical students.