National Journal of Community Medicine <p align="Justify">The National Journal of Community Medicine is a peer-reviewed open-access journal. It has a wide circulation amongst the health professionals, researchers, teaching faculties, and postgraduates in the specialty of Community Medicine and public health. The main objective of the journal is to promote wider dissemination of the research conducted by researchers in the fields of public health and community medicine.</p> en-US <p>Author/s retain the copyright of their article, with first publication rights granted to Medsci Publications.</p> (Prakash Patel) (Prakash Patel) Tue, 02 Aug 2022 05:07:48 +0000 OJS 60 Chronic Obstructive Pulmonary Disease and Smoking in India: A Meta-Analysis <p><strong>Introduction:</strong> WHO estimates show Chronic obstructive pulmonary disease [COPD] as a growing major global cause of morbidity as well as mortality. An estimated 90% of COPD- related deaths occur in low/middle income countries. India and China together constitutes about one third of the total humanpopulation, accounting for 66% of COPD mortality globally. In the south east Asia region, COPD associated mortality is projected to grow by 160% in the decades ahead. Much of this projection holds pansexual cigarette smoking, improved life expectancy, bulging geriatric population and high levels ofsmall particle pollution, as major causes behind increase in COPD case burden.</p> <p><strong>Methods:</strong> The aim of the meta-analysis was to investigate association between COPD and risk factors by pooled and subgroup analysis. We searched for case control studies and studies which are meeting the inclusion criteria. The publications listed in the NCBI PubMed and Cochrane library were searched using the following combination of the key words “COPD”; “smokers”; “health”; “risk” or “factors”;“diagnostic”; “burden”; “exposure”; “disease” or “prevalence” or “morbidity ” or “mortality”; “tobacco”; “smoking”; “smoke”, “India”. Random effects meta-analysis was applied to generate pooled SMD by using CMA software.</p> <p><strong>Results:</strong> Data base search identified twenty-nine thousand two hundred twenty-two records and 14 articles made to the cut after implementing the inclusion and exclusion criteria. Main risk factors for COPD were higher age [SMD=0.53, CI= (0.0018-1.05)], total pack years of Smoking [SMD=13.83,CI (10.060-17.616)], FEV1 [SMD=-13.15, CI= (-16.234 to -10.085) and FEV/FVC ratio [SMD=0.915.CI= (0.767-1.063)]. Higher age, smoking, low values of FEV1 and FEV/FVC ratio is directly associated with high risk of COPD.</p> <p><strong>Discussions:</strong> The findings of the study shows evidence of smoking history in terms of pack of years as a major risk factor for COPD prevalence. Further research is needed on COPD prevalence andincidence associated with other chemical exposure, to identify how to effectively reduce risks fromexposure to smoking.</p> Rashmi KS, Shashikala MD, Kruttika Naik Copyright (c) 2022 Rashmi KS, Shashikala MD, Kruttika Naik Sun, 31 Jul 2022 00:00:00 +0000 Monkeypox is Declared as a Global Health Emergency. Are We Prepared? Prakash Patel Copyright (c) 2022 Prakash Patel Sun, 31 Jul 2022 00:00:00 +0000 Book Review: Single Best Answer in Community Medicine <p>Publisher name: Paras Medical Books Pvt. Ltd.</p> <p>Location: Hyderabad, Telangana, India</p> <p>Price: INR 895/-</p> <p>Year of Publication: 2021-22 (1<sup>st</sup> Edition)</p> <p>Author: Kapil Gandha (Bhanushali)</p> <p>Pages: 30 chapters, 681 pages</p> <p>ISBN: 978-81-954097-3-0</p> Viral Dave Copyright (c) 2022 Dr. Viral Dave Sun, 31 Jul 2022 00:00:00 +0000 Is It The Right Time for India to Move From Targeted Cash Transfers to Universal Cash Transfers for Patients with Tuberculosis? Mihir Rupani Copyright (c) 2022 Sun, 31 Jul 2022 00:00:00 +0000 A Perspective On COVID-19 Vaccine Hesitancy in India <p>India started vaccination drives in January of 2021. One of the biggest challenges faced by the government was the hesitancy to get vaccinated. Vaccine hesitancy causes the vaccination process to be delayed, affecting the process of building herd immunity and allowing the virus to evolve. Certain anthropological factors are responsible for vaccine hesitancy in a community. These factors are broadly categorised as personal beliefs, the role of media, and religion. An in-depth analysis of available literature, including the grey literature indicated that these factors influence an individual’s decision-making. Vaccine hesitancy was largely affected by rumours surrounding it. Contradictory information regarding the vaccines created uncertainty about the consequences of getting vaccinated. A holistic approach is necessary to tackle vaccine hesitancy. The interventions from the government need to consider these social and cultural factors to address vaccine hesitancy in the future. Due to the diverse sample size, there is a need for various actors and stakeholders to come together and implement demographic-specific measures to address vaccine hesitancy in India.</p> Tanmaye Rameneni, Tooba Sayeed, Sumit Kumar Copyright (c) 2022 Tanmaye Rameneni, Tooba Sayeed, Sumit Kumar Sun, 31 Jul 2022 00:00:00 +0000 A Study of Adverse Effects Following Administration of Anti-Rabies Vaccination - A Hospital Based Study <p>Rabies is an acute viral zoonotic disease that affects all warm-blooded animals including mammals and occurs in more than 150 countries and territories. Although rabies is a 100% fatal disease, it can be prevented by the use of potent anti-rabies vaccines (ARV). The present study was a hospital based descriptive longitudinal study conducted during February 2019 to July 2020 amongst the animal bite patients attending the Anti -Rabies clinic (ARC) of Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC &amp; SJH), New Delhi, to study the adverse events (vaccine reactions) if any following administration of the ARV. The age of the study participants ranged from 2 to 65 years and the mean age was (29.3±15.2) years. No severe or serious adverse events were reported. Of the minor reactions, the most commonly reported symptom was pain at the injection site (34; 9.4%) followed by occurrence of tingling sensation (29; 8.1%), headache (22; 6.1%) and itching at the injection site (19; 5.3%). These findings corroborate with those found in previous studies in the literature. It was concluded that although there are possible local or mild or systemic adverse reactions to rabies vaccination, but once initiated, rabies prophylaxis should not be interrupted or discontinued.</p> Manasi Panda, Richa Kapoor Copyright (c) 2022 Manasi Panda, Richa Kapoor Sun, 31 Jul 2022 00:00:00 +0000 Prevalence and Patterns of Self-Medication Practices In Urban Field Practice Area, Dharwad <p><strong>Background</strong>: The estimated prevalence of self-medication practices globally and nationally are 95% and 71% respectively. Inappropriate self-medication leads to irrational use of drugs and development of drug resistance. Hence, the present study was conducted to estimate the prevalence and patterns of self-medication practices in urban field practice area, SDMCMS&amp;H, Dharwad.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted during 2018-2019 among adult aged 18-60 years. The estimated sample size was 335. Systematic random sampling technique was used to select the samples. Data was collected by administering questionnaire to the consented study participants.</p> <p><strong>Results</strong>: A total of 335 adults participated in our study. The prevalence of self-medication practices was 46%.&nbsp; Minor-illness 89(57.7%) and quick relief 50(32.46%) were the major reasons given for practicing self-medication. Fever and headache 146(94.8%) was the most common symptom and analgesic 128(83.11%) was the most common drug used. significant association was found between self-medication practices and religion, age, employment and presence of health care workers in the family.</p> <p><strong>Conclusion: </strong>Around half of the study participants practiced self-medication. Easy availability and limited knowledge are the reasons for wide range of practice. Creating awareness about dangers of self-medication is important to prevent untoward effects and drug resistance.</p> Arpitha VS, Pushpa S patil Copyright (c) 2022 Arpitha VS, Pushpa S Patil Sun, 31 Jul 2022 00:00:00 +0000 Covid-19 Hazard Index: A Spatiotemporal Risk Forecast Tool <p><strong>Background:</strong> In a given geographic region, risk of new cases of COVID19 are driven by internal factors such as agent, host and environment characteristics, as well as external factors, such as population mobility and cross border transmission of disease. COVID19 control measures are best implemented when local governments and health teams are well aware of these internal and external risks. These risks are dynamic in nature and hence need to be reviewed at regular intervals. <strong>Objective:</strong> To develop a composite spatiotemporal Hazard Index comprising of three factors – presence of susceptible population, population density and presence of active cases with corresponding growth rates, to rank areas within an administrative boundary by their fortnightly risk of active COVID19 cases.</p> <p><strong>Methods:</strong> Using Principal Component Analysis, the weights of each of these factors were determined and applied to transformed values of factors in the districts of Gujarat state for months of January to July 2021. Hazard Index thus obtained was used to rank the districts.</p> <p><strong>Results:</strong> Spearman correlation between the Hazard Index and number of active cases 15 days later was moderate and significant (p&lt;0.01) throughout the study period.</p> <p><strong>Conclusion:</strong> Hazard Index can predict Districts at highest risk of active cases in the given time period. These districts with high Hazard Index would require different control measures, depending on the factor that resulted in higher index value.</p> Manvendra Singh Rathore, Samudyatha UC, JK Kosambiya Copyright (c) 2022 Manvendra Singh Rathore, Samudyatha U.C., J.K. Kosambiya Sun, 31 Jul 2022 00:00:00 +0000 Prevalence Of Behavioural Disorders and Its Correlates Among Adolescents in Uttara Kannada, Karnataka –A Cross Sectional Study <p><strong>Background</strong>: Childhood and adolescence are critical stages of life for mental health. This is a time when rapid growth and development takes place. Half of all mental health conditions start by 14 years of age but most cases are undetected and untreated. Behavioural patterns of adolescents are not much explored in India. In this study, we aim to assess the behavioural pattern and its correlates among adolescents in Karwar of Uttara kannada district, Karnataka.</p> <p><strong>Methodology</strong>: It is a cross-sectional questionnaire-based study conducted on adolescents studying in Government Pre-University college of Karwar in the month of June and July 2019.The Strengths and Difficulties Questionnaire (SDQ) was used to assess the mental health status of adolescents. The total difficulties score is used to categorize adolescents as normal (0-15) and high [borderline (16-19) and abnormal (20-40)].</p> <p><strong>Results</strong>: Although majority of adolescents were in the normal range, a significant number of adolescents were in borderline (18.4%) and abnormal (14.1%) SDQ scores. Binary logistic regression analysis shows that use of social media, abnormal emotional grade, conduct grade, hyperactivity grade, peer grade and impact grade were found statistically significant.</p> <p><strong>Conclusion: </strong>Significant numbers of adolescents were in high range of SDQ scores and suffered from emotional, conduct, prosocial behaviour and hyperactivity problems.</p> Naveenkumar Havale, Vidyashri, AbhishekPrayag, Girish HO, Manjula MN Copyright (c) 2022 Naveenkumar Havale, Vidyashri, AbhishekPrayag, Girish HO, Manjula MN Sun, 31 Jul 2022 00:00:00 +0000 Is Adult Tetanus an Endemic in India? <p><strong>Background: </strong>Tetanus is a life-threatening disease in developing country like India, with high morbidity and mortality rate. Though maternal and neonatal tetanus is eliminated, adult tetanus still remains in boom and is overlooked.</p> <p><strong>Methods: </strong>An observational descriptive study using retrospective secondary data was undertaken among the patients admitted to a regional referral hospital to study the epidemiological factors influencing tetanus, clinical features and the outcome of tetanus.</p> <p><strong>Results: </strong>Analysis of 41 clinically diagnosed cases of tetanus showed that, majority were in 50-69 years of age group who resided in rural area and agriculture was their main occupation. Case fatality rate was 53.6% which revealed that mortality was the major outcome. And 95% of those infected were not aware of their immunization status.</p> <p><strong>Conclusion: </strong>An early diagnosis, a proper wound management immediately after the injury, health education programs to create awareness among the public not to neglect even trivial injuries would definitely lead India to the path of elimination of adult tetanus. Strong emphasis is to be laid on adult immunization beyond the age of 10 years.</p> Surabhi GS, Renuka Prithviraj, Lavanya R Copyright (c) 2022 Renuka Renuka, Surabhi GS, Lavanya R Sun, 31 Jul 2022 00:00:00 +0000 Prevalence of Anxiety Among Antenatal Women in An Urban Area of Belagavi <p><strong>Background: </strong>A woman is highly vulnerable to anxiety and stress during her pregnancy causing negative effect in somatic and psychological forms like Intrauterine growth restriction, low birth weight and preterm birth in child. Maternal anxiety not only leads to adverse effect on pregnancy outcome but also decreases maternal competence in childcare.</p> <p><strong>Aims/Objectives:</strong> To determine the prevalence of antenatal anxiety among women attending Ashok Nagar UHC and identify the associated risk factors.</p> <p><strong>Methodology: </strong>A cross sectional study was done for 3 months in 320 antenatal women attending antenatal clinic at Ashok Nagar UHC. Data collection was done using a pre designed and pre tested questionnaire.</p> <p><strong>Results: </strong>The prevalence of antenatal anxiety was 31.2%. Among them 30% had mild to moderate anxiety and only 1.2% had severe anxiety. Prevalence of anxiety was higher in younger women and with lower literacy status.</p> <p><strong>Conclusion: </strong>Antenatal anxiety is of major public health importance but its effect on mother is not considered to be a serious issue in the society. There is a need for regular antenatal screening, assessment and treatment of antenatal anxiety.</p> Jyoti Singh, Chandra S Metgud Copyright (c) 2022 Jyoti Singh, Chandra S Metgud Sun, 31 Jul 2022 00:00:00 +0000 A Cross Sectional Study on Assessment of Cognitive Impairment and Behavioural Risk Factors Among Senior Citizens Living in Old Age Homes in Chengalpattu District, Tamilnadu <p><strong>Background: </strong>Ageing is an irreversible, unavoidable, universal phenomenon accompanied by gradual reduction in functional capacity of the elderly. The number of elderly populations in India is expected to triple reaching 2 billion. This study aims to estimate the prevalence of cognitive impairment and evaluate the association between various socio demographic and behavioural risk factors.</p> <p><strong>Methodology: </strong>This descriptive cross-sectional study was carried among 330 senior citizens living in old age homes by using a two-stage multistage sampling method. A standardized pretested structured questionnaire containing Brief Interview for Mental Status (BIMS) scale was used. Data was analysed using SPSS (Version 22).</p> <p><strong>Results:</strong> Among 330 study respondents, around 44% had mild -to- moderate cognitive impairment and 36% had severe cognitive impairment. Nearly 74.8% have their habit of regular physical activity. Among the study subjects approximately 4% of them were current smokers, 5.2% had the habit of regular alcohol consumption previously.</p> <p><strong>Conclusion:</strong> Integration of NPHCE and NMHP can be beneficial in early diagnosis of mild cognitive impairment during weekly outpatient visits at PHC. Level of attention given towards Alzheimer’s disease is more when compared to screening for cognitive impairment which is an early precursor for Alzheimer’s Disease.</p> Sujitha Pandian, Swetha NB, Umadevi R, Angeline Grace G, Gopalakrishnan S Copyright (c) 2022 Sujitha Pandian, Swetha NB, Umadevi R, Angeline Grace G, Gopalakrishnan S Sun, 31 Jul 2022 00:00:00 +0000 Out Of Pocket (OOP) Health Expenditure and Utilization of Financial Risk Protection Measures Among COVID-19 Affected Individuals in Chennai- A Cross-Sectional Study <p><strong>Background: </strong>Pandemic has affected people physically, mentally and economically. India being a growing economic power house, spends only around 1.2% of GDP on health which thereby leads to high OOP spending. This study aims to estimate out of pocket health expenditure and proportion of financial risk protection.</p> <p><strong>Methods:</strong> Cross sectional study conducted among Covid-19 affected individuals in Chennai. It was a questionnaire based study with questions about covid-19 management status, cost and insurance utilization. Descriptive statistics and regression analysis was used for analysis.</p> <p><strong>Results: </strong>Total of 47 were treated at hospital and 85% of them were treated at private hospital.. The mean cost investigations for patients treated at hospital was of Rs. 50000<u>+</u>11547 and for medicines was Rs. 110000<u>+</u>57735. 53% of study participants had health insurance. 29 (54.72%) of them had Covid-19 treatment cost covered under insurance. The multiple regression analysis showed a statistically significant association between total OOPE incurred and age, religion and socio-economic status.</p> <p><strong>Conclusion: </strong>Majority of participants spent for their treatment through savings and borrowing money. OOPE was compensated by reimbursement through health insurance. Provision of quality health care in government hospitals, increase public health spending and creating awareness about health insurance are ways to reduce OOP costs.</p> Swetha NB, Angeline Grace, Sujitha P, Umadevi R Copyright (c) 2022 Swetha NB, Angeline Grace, Sujitha P, Umadevi R Sun, 31 Jul 2022 00:00:00 +0000 The Internet Addiction Pattern and Its Mental Impact Among Medical Students in Bangalore: A Cross -Sectional Study <p><strong>Background: </strong>In recent times internet addiction has become a leading cause of many personality and psychiatric disorders<strong>. </strong>Researches done on this field has shown that younger population is more vulnerable because of their psychosocial and environmental characteristics. The medical profession is also joining this parade.</p> <p><strong>Objectives: </strong>1) To assess pattern of Internet Addiction among medical students. 2) To estimate the prevalence of Anxiety, Depression and Stress among medical students. 3) To determine the correlation between Internet Addiction and its impact on mental health.</p> <p><strong>Methods: </strong>Cross‑sectional study was conducted among 308 undergraduate students of 1st and 2nd year MBBS in a medical college, Bangalore. Young’s Internet Addiction Test –20 was used for assessment of Internet Addiction and DASS-21questionnaire for the assessment of Depression, anxiety and stress. Spearman’s Rank Correlation was used to find the strength of association.</p> <p><strong>Results</strong>: In the present study mean age of the study participants was 20.6 years, around 54% were using internet from age of &gt;15 years. Overall prevalence of severe internet addiction was found to be 1.3%. Nearly 53% reported depression and 69% had a state of anxiety.</p> <p><strong>Conclusion:</strong> Chronic usage of internet including in odd hours was observed. Study showed strong positive correlation between Depression and Internet addiction and Stress and Internet addiction.</p> Rashmi R, Harsha GT, Vandana C Khargekar, Karthik KN, Narayanaswamy DM Copyright (c) 2022 Rashmi R, Harsha GT, Vandana C Khargekar, Karthik KN, Narayanaswamy DM Sun, 31 Jul 2022 00:00:00 +0000 Situational Analysis of Human Resource and Material Management Skills of Middle Level Health Care Managers at Primary Health Centres of Valsad, Gujarat: Identifying Barriers and Suggesting an Action Plan <p><strong>Background: </strong>Management of Human resources in health has been a major challenge. Availability of manpower and material are the key ingredients required for efficient and effective delivery of health services. Removing the barriers related to it can help to improve functioning of PHCs</p> <p><strong>Objectives</strong>:<strong> </strong>1. To analyze Human resource and Material management skills at PHCs by middle level healthcare managers. 2. To understand the constraints for effective management at PHCs. </p> <p><strong>Materials and Methods:</strong> A cross sectional study was conducted amongst 38 Medical officers who were selected by simple random sampling method. Data collection was done using a semi structured and scale-based questionnaire adopted from NIHFW, India.</p> <p><strong>Results: </strong>Almost half medical officers had experience of less than one year. Only 10.5% PHC/CHCs have full staff. 47.3% health facilities were lacking AYUSH MOs. 63.2% health facilities faced stock out of at least one item in last six months; Lack of manpower (34.8%) and overburden of work (27.9%) are major barriers.</p> <p><strong>Conclusions: </strong>90% PHCs have one or more posts vacant<strong>. </strong>Material management need to be improved for better provision of services. Major barriers are lack of Manpower, Infrastructure and Multitasking.</p> Neha A Patel, Bhavesh R Bariya, Rachana G Kapadia Copyright (c) 2022 Neha A Patel, Bhavesh R Bariya, Rachana G Kapadia Sun, 31 Jul 2022 00:00:00 +0000 Epidemiology of Body Dysmorphic Disorder Among Adolescents In Imphal West District, Manipur <p><strong>Background:</strong> Body Dysmorphic Disorder (BDD) is a psychiatric disorder characterized by preoccupation with a perceived flaw(s) in one’s appearance, leads sufferers to engage in repetitive behaviours to try to hide or fix the flaw(s) causing significant distress and interference. BDD is an unrecognized and undiagnosed problem among adolescents. Therefore, conducting a study in the Imphal West will identify the adolescents at risk. The objective of the study is to determine the prevalence of BDD among higher secondary students in Imphal West, Manipur.</p> <p><strong>Methodology:</strong> This study was conducted among higher secondary students during Aug 2019 -Feb 2020. Sampling was done by stratified two stage cluster design and self-administered validated Body Image Disturbance Questionnaire was used. Data were summarized using descriptive statistics. Chi-square test was used for comparing proportions.</p> <p><strong>Results:</strong> Out of the total 1207 students, 52% were female. Almost 92.2% of the students were concerned about some aspect of their appearance. About 2.6% met the DSM-V criteria for BDD. Females were significantly dissatisfied with their skin (71.3%), nose (59.3%), hair (34.7%), whereas men with their muscle build (54.8%) and eyes (40.3%).</p> <p><strong>Conclusions:</strong> The study revealed BDD was prevalent but many individuals were unaware about the condition and its treatment.</p> Rushitha Chibi, Megala M, Udhatabashkaran Kadirvelu, Dhanalashmi S, Chellavel Ganapathi K Copyright (c) 2022 Rushitha Chibi, Megala M, Udhatabashkaran Kadirvelu, Dhanalashmi S, Chellavel Ganapathi K Sun, 31 Jul 2022 00:00:00 +0000 A Study of Low Birth Weight and Associated Maternal Factors in A Rural Field Practice Area of a Medical College at Ahmedabad City of Gujarat <p><strong>Introduction: </strong>In developed countries, about 50% of all Low-Birth-Weight new born are preterm. Low birth weight is also a leading cause of neonatal death and major risk factor for infant and under-five morbidity and mortality.</p> <p><strong>Objectives:</strong> To find out prevalence of low birth weight&amp; to determine the association of socio-demographic variables, maternal medical and obstetric risk factors with low birth weight.</p> <p><strong>Methodology:</strong> Across sectional community-based study was conducted in a rural field practice area of a medical college. A total of 600 participants (mothers who delivered within 3 months) were included in the study.</p> <p><strong>Results:</strong> The prevalence of LBW was found to be 17% in the current study. Statistically significant association was obtained between age, education, occupation, socio-economic class of participants and birth weight of the child. The prevalence of LBW was found to be significantly high (51.7%) amongst children of those participants who consumed/used tobacco in any form.</p> <p><strong>Conclusion:</strong> The prevalence of the LBW was found to be 17%. Extremes of reproductive age group, illiteracy, occupation of labourer, SEC class IV, grand-multiparity, inadequate IFA consumption, short stature, weight of mother and use of tobacco were found to be significantly affecting the birth weight and associated with low birth weight.</p> KamleshKumar Jain, Bhavik Rana, Rujul Shukla, Vasu Rathod Copyright (c) 2022 KamleshKumar Jain, Bhavik Rana, Rujul Shukla, Vasu Rathod Sun, 31 Jul 2022 00:00:00 +0000