Sujishnu Mukhopadhyay

Are the Adolescent Behaviors too Risky? A School-based Study in a District of West Bengal, India

A cross-sectional study was undertaken among 2068 school-going adolescents of a subdistrict area of West Bengal, India for assessment of entire array of risk behaviors and their correlates. Aggressive, suicidal, substance use and sexual risk behaviors were measured using a self-administered, multi-item, validated questionnaire in the local vernacular. Prevalence of physical fights, weapon carrying in the last 30 days and gang fights in the last 12 months were 27.1%, 7.3% and 13.0%, respectively. Current users of tobacco, alcohol and illicit substances were 7.1%, 3.4% and 2.0%, respectively. Suicidal ideation and attempts were reported by 11.7% and 3.5% of students. Almost one-tenth of respondents had premarital sexual intercourse. Male gender, low subjective economic status, exposure to electronic media and poor academic achievements were associated with most of the studied risk behaviors, except that females showed more propensities to suicidal behavior. The magnitude and pattern of adolescent risk behaviors, though less studied in India, warrants urgent, coordinated actions.

Enduring starvation in silent Population: A study on prevalence and factors contributing to household food security in the tribal population in Bankura, West Bengal

BACKGROUND Strengthening food security enhancement intervention should be based on the assessment of household food security and its correlates. OBJECTIVES The objective was to find out the prevalence and factors contributing to household food security in a tribal population in Bankura. METHODS A cross-sectional study was conducted among 267 tribal households in Bankura-I CD Block selected through cluster random sampling. Household food security was assessed using a validated Bengali version of Household Food Security Scale-Short Form along with the collection of information regarding the monthly per capita expenditure (MPCE), total to earning member ratio, BPL card holding, utilization of the public distribution system (PDS) and receipt of any social assistance through a house-to-house survey. RESULT AND CONCLUSION Overall, 47.2% of study households were food secure whereas 29.6% and 23.2% were low and very low food secure, respectively. MPCE ≥ Rs. 356, total to earning member ratio ≤ 4:1, regular utilization of PDS, and nonholding of the BPL card were significantly related with household food security.

A study on utilization of Janani Suraksha Yojana and its association with institutional delivery in the state of West Bengal, India

Background: India launched the Janani Suraksha Yojana (JSY) on the principles of conditional cash transfer providing monetary incentive to needy women to improve access to institutional childbirth. Objectives: This study was conducted among JSY-eligible women who delivered between April 2012 and June 2012 to assess the utilization of cash incentives toward institutional delivery, along with other associated factors influencing institutional delivery. Methods: It was a cross-sectional, descriptive study conducted between July 2012 and May 2013 on 946 women selected through stratified random sampling of subcentres from better and worse performing districts of West Bengal. Results: 74.7% of the study population was JSY-eligible. 90.2% of those who took three antenatal check-ups (ANCs) and 36.8% JSY-noneligible women received cash. Government institutions were preferred for childbirth among all groups irrespective of JSY eligibility, receipt of cash, and number of antenatal visits. Overall, 78.8% opted for institutional delivery if they had received cash, which was significantly more than those who did not (64.5%). JSY-eligible women were 1.5 times more likely to deliver in government institutions compared to JSY-noneligible women. With no incentive, the likelihood of institutional delivery was halved. The distance of a 24 Χ 7 delivery hub beyond 5 km (74.8% vs. 81.8%), the religion of Islam (62.7% vs. 83.2%), and multiparity (63.9% vs. 83.6%) were significant deterring factors. Conclusion: Despite some inclusion and exclusion errors, cash incentive under JSY was associated with increased institutional delivery, especially in government institutions though there were other factors influencing the decision as well.

Does Janani Shishu Suraksha Karyakram ensure cost-free institutional delivery? A cross-sectional study in rural Bankura of West Bengal, India

BACKGROUND Janani Shishu Suraksha Karyakram (JSSK) was launched in India to ensure cost-free institutional delivery. OBJECTIVES 1) To assess the awareness of recently delivered women regarding JSSK 2) To estimate the cost of institutional delivery and its differentials. MATERIALS AND METHODS A community-based, cross-sectional study was conducted in a rural community in Bankura, West Bengal, India in 2013, among 210 women who delivered babies in the last 12 months. Information regarding sociodemographic and health service-related variables as well as item-wise costs incurred for institutional delivery were collected. Costs were expressed in Indian National Rupee (INR). A nonparametric, bivariate analysis was performed to examine the difference in median cost. RESULTS All components of JSSK were known to 12.9% women; the highest (77.1%) for admission and lowest (29.0%) for blood transfusion. The median (±IQR) costs of delivery in the Block level Primary Health Center (PHC), medical college, and private facilities were INR 205.0 (±825.0), 900.0 (±1013.0), and 6600.0 (±16195.0), respectively. Median cost of normal delivery in a private facility (INR 2750.0) was 3.6 times of that in a government facility (INR 765.0). Median direct cost of caesarian section (CS) in a government facility (INR 1100.0) was nearly one-fifteenth of that in a private facility (INR 16,350.0). Cash incentives under Janani Suraksha Yojana for poor and socially marginalized women could not cover the cost of CS delivery in a government facility. CONCLUSION Gaps existed in the awareness of beneficiaries regarding entitlement under JSSK. Drugs and transport were two major causes of out-of-pocket (OOP) expenditure in public health facilities.

Access to and utilization of voucher scheme for referral transport: a qualitative study in a district of West Bengal, India

Background: Lack of motorized transport in remote areas and cash in resource-constrained settings are major obstacles to women accessing skilled care when giving birth. To address these issues, a cashless voucher transport scheme to enable women to give birth in a health-care institution, covering poor and marginalized women, was initiated by the National Rural Health Mission in selected districts of India in 2009. Methods: The access to and utilization of the voucher scheme were assessed between December 2010 and February 2011 through a qualitative study in the district of Purulia, West Bengal, India. Data were collected from in-depth interviews and focus group discussions with women, front-line health-care workers, programme managers and service providers. Results: The main factors influencing coverage and utilization of the scheme were: reliance on ill-prepared gram panchayats (village councils) for identification of eligible women; poor birth preparedness initiatives by health-care workers; over-reliance on telephone communication; restricted availability of vehicles, especially at night and in remote areas; no routine monitoring; drivers’ demand for extra money in certain situations; and low reimbursement for drivers for long-distance travel. Conclusion: Departure from guidelines, ritualistic implementation and little stress on preparedness of both the community and the health system were major obstacles. Increased enthusiasm among stakeholders and involvement of the community would provide opportunities for strengthening the scheme.

A study on factors influencing treatment outcome of failure patients receiving DOTS in a district of West Bengal

Failure to primary treatment under RNTCP can be an enormous setback for the society. A record based retrospective cohort analysis of 212 patients failing primary treatment under Cat I or Cat III was done in Burdwan district of West Bengal to find the treatment outcome after re-registration under Cat II and its possible influencing factors. Retreatment of failed patients resulted in 24.06% chronicity. Important factors influencing the outcome of being failure were found to be Adolescence (AOR = 2.350; C.I. 0.660-8.281), Urban residence (AOR = 1.878; C.I. 0.705-5.002), primary categorization in Cat I versus Cat III (AOR = 5.036; C.I. 0.897-28.281), higher bacillary load at the beginning of retreatment regimen (AOR = 5.437; C.I. 0.787-37.562) and more than three weeks delay in instituting Cat II treatment (AOR = 3.550; C.I. 0.941- 13.393). 17.35% of such failed patients were still defaulters. Hence such factors may be looked into for more efficient control of Tuberculosis in our country.

Exploring the Bottlenecks: An Assessment of the Implementation Process of Janani Suraksha Yojana in the State of West Bengal, India

1Associate Professor, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, INDIA 2Associate Professor, Malda Medical College, Malda, West Bengal, INDIA. 3Professor, Murshidabad Medical College, Bahrampur, West Bengal, INDIA. 4Consultant (Management), IHFW, GN 29, Sector 5, Salt Lake City, Kolkata, West Bengal, INDIA. 5Chief Medical Officer of Health, Darjeeling, West Bengal, INDIA. 6Professor, Institute of Health and Family Welfare, GN 29, Sector 5, Salt Lake City, Kolkata, West Bengal, INDIA.