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Context: With the ageing of Indian society, providing a healthy life among older people is a public health precedence. Therefore, beforehand discovery and possible forestalment of frailty may help promote healthy ageing and dwindle the social, mental and financial burden of their families and caregivers. Aims: The study aimed to assess the proportion of frailty and its associated factors among the elderly aged 65 years and above in a rural community of West Bengal. Settings and Design: A community-based cross-sectional study was conducted among 270 elderlies selected from 15 villages out of a total 64 villages of Singur under the Hooghly District of West Bengal from January 2019 to February 2020. Materials and Methods: Cluster sampling technique was used. Data was collected using a pre-designed, pre-tested structured schedule including Fried frailty phenotype (FFP), geriatric depression scale short form (GDS 15) and mini nutritional assessment (MNA) tool. Statistical Analysis Used: Associated factors of frailty were assessed by univariate and multivariable logistic regression using SPSS version 16 software and MS Excel 2019. Results: The proportion of frailty was observed to be 23.7% and that of prefrailty 40.7%. Frailty was significantly associated with increasing age [AOR(CI) 1.2(1.1-1.3)], decreasing years of schooling [AOR(CI) 1.3(1.1-1.5)], loss of spouse [AOR(CI) 4.2(1.2-15.2)], financial dependency [AOR(CI) 19.3(2.7-139.0)], staying at home [AOR(CI) 16.3(2.7-98.2)], presence of anaemia [AOR(CI) 3.6(1.3-9.5)], at risk of malnutrition [AOR(CI) 6.5(1.9-22.3)], increasing number of falls in the last 1 year [AOR(CI) 4.3(1.2-15.6)], presence of 3 or more chronic diseases [AOR(CI) 154.7(12.1-1981.9)] and depression [AOR(CI) 8.3(2.5-27.0)]. Conclusion: The burden of frailty among the study population is relatively high. It’s an intimidating situation that needs bettered screening provisions for early discovery with special stress on nutritive upliftment. Screening for depression should also be done regularly.

Abstract Objective This prospective study aimed to evaluate the effects of a health education intervention on cardiovascular disease (CVD) risk factors among school teachers. Methods The study, conducted from August 2016 to May 2017, involved teachers from four schools in Baruipur, West Bengal, India. It was a multicentric, quasi-experimental study with an intervention group receiving tailored health education promoting lifestyle modifications, while the control group received no intervention. Baseline and endline assessments included behavioural and biological characteristics related to cardiovascular health and risk assessment. Data were analysed using JAMOVI. Results The intervention group showed significant improvements in physical activity levels [Cohen’s d (Cd): 0.43, p = 0.006] and the consumption of fruits and vegetables (Cd: 1.00, p =

Introduction: Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses. Methods: A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics. Results: Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage. Conclusion: Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.

This review explores how climate change exacerbates gender inequalities and the potential of social protection programs to alleviate these impacts. It examines how women disproportionately bear the brunt of climate shocks and discusses pathways through which programs like public works initiatives, cash transfers, and social insurance can bolster women’s resilience in this framework. Despite the potential of these programs, challenges such as implementation gaps and limited engagement of women in program design hinder the effectiveness of social protection programs. Limited research on the gendered effects of social insurance underscores the need for further investigation and gender-responsive policy interventions.

Background: Use of maternal near-miss (MNM) cases as an adjunct has been advocated to understand the processes of obstetric care because they share similar pathways as maternal deaths. Identifying the predictors and care pathway is crucial to improve the quality of care and end preventable maternal deaths. Materials and Methods: This case–control study was conducted at a tertiary care facility in Kolkata from May 2019 to March 2020. Women admitted with complications during pregnancy, childbirth, or within 42 days of postpartum, who met the World Health Organization (WHO) near-miss criteria, were identified as cases, and equivalent age-group matched controls were recruited. Sample size of 60 cases and 60 controls was estimated, assuming a power of 80%, level of significance 0.05, and case–control ratio of 1. After obtaining approval from the institutional ethics committee and informed written consent from the participants, data was collected through face-to-face interview and review of records. Statistical analysis including care pathway analysis (using three-delay model) was performed using Statistical Package for Social Sciences version 16. Results: Joint family type (adjusted odds ratio [AOR] [CI] = 5.06 [1.48, 7.28]), lack of antenatal checkups (AOR [CI] = 7.85 [1.47, 12.09]), previous history of cesarean section (AOR [CI] = 3.94 [1.09, 14.33]), first delay in seeking care (AOR [CI] = 13.84 [3.62, 32.83]), and preexisting medical disorders (AOR [CI] = 11.03 [4.62, 22.80]) were identified as significant predictors of MNM in the adjusted model. Significant difference in the proportion of first and second delays in the care pathway was observed between cases and controls. Conclusions: Identification of risk factors of MNM and pattern of delays in the care pathway will help improving quality of obstetric care.

BACKGROUND: Multi-transfused thalassemic children are at higher risk of acquiring transfusion-transmitted infections (TTIs). There are limited data available on TTIs among thalassemic children, especially on its impact on their quality of life (QoL). AIM: The aim of this study is to find out the proportion of multi-transfused β-thalassemia major (β-TM) children suffering from TTIs, its risk factors and impact on QoL. METHODS: This was a hospital-based, analytical observational study, cross-sectional in design, conducted among 328 β-TM children and their caregivers attending thalassemia day care unit of a medical college during May 2015–April 2016, with a structured schedule. Data were analyzed with appropriate statistical methods using the Statistical Package for the Social Sciences. RESULTS: Two-fifth (39.9%) of them were found to have TTIs with hepatitis C being the most common (34.5%), followed by hepatitis B (4.5%) and human immunodeficiency virus (1.8%). In the multivariable model, place of residence (adjusted odds ratio [AOR] – 2.23 [1.19–4.17]), per capita monthly family income (AOR – 1.84 [1.10–3.07]), and blood transfusion frequency (AOR – 1.19 [1.10–1.29]) were significant predictors of TTIs adjusted with their age, age at diagnosis, last pretransfusional hemoglobin level, size of spleen, and caregivers knowledge regarding the disease. The study participants with TTIs had a lower QoL compared to others as there were significant differences in between the total QoL scores ([49.9 ± 15.6 vs. 57.4 ± 15.5], P ≤ 0.001) and its various domains. CONCLUSION: There was high burden of TTIs among multi-transfused β-TM children and it has significant negative impact on their quality of lives.

Context: Multimorbidity is considered as a priority for global health research. It is defined as the coexistence of two or more chronic health conditions in an individual. It is increasingly being recognized as a major concern for primary care physicians due to its huge impact on individual, family, and societal level. Aim: The aim of this study was to find the quantum of gender-related inequalities and determinants of multimorbidity among the elderly people in a rural part of West Bengal. Materials and Methods: This is a cross-sectional study carried out among 246 elderly people (60 years and above) in a community setting from Oct 2017 to Sep 2018. Logistic regression analysis was done to find out the predictors of multimorbidity. Data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Results: Approximately 82% of the study subjects were suffering from multi-morbidity with a significant difference between males (80.9%) and females (88.5%). In binary logistics, people of both the genders aged >70 years, who had less than primary level education, had more than three children, whose source of income was from their children (sons/daughters), were dependent on others for daily routine were at high risk of being multimorbid; whereas depression was a significant predictor of multimorbidity in females and not in males. In multivariable analysis, age remained the only significant predictor for both the gender and for females; depression remained significant after adjusting with significant variables in binary logistics. Conclusion: Morbidity screening at each visit, individual as well as family counseling and lifestyle modifications help to cope with the rising burden of multimorbidity at the primary care level. More insight into the epidemiology of multi-morbidity is necessary to take steps to prevent it, lower its burden and align health-care services as per needs.

Introduction: Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. Thus, regular and accurate measurement of Blood Pressure (BP) is essential for its early diagnosis and follow-up. There is a surge in popularity of digital sphygmomanometer due to its convenience of use and functionality. In contrast, the traditional universally accepted sphygmomanometer is aneroid type, hence there arise a need for comparison of digital and universally accepted Aneroid Sphygmomanometer in terms of agreement and correlation. Aim: To evaluate the agreement and correlation between blood pressure measurement by digital and aneroid sphygmomanometer. Materials and Methods: The clinic based cross-sectional study was conducted in the Out Patient Department (OPD) of Urban Heath Centre, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India. Adults visiting the OPD on two chosen days of the week, between June 2019 to July 2019 were selected using systematic random sampling. A total of 400 participants were included. Agreement and correlation between BP measurements by digital and aneroid sphygmomanometer was analysed by Cohen’s Kappa, Bland Altman Plot along with sensitivity, specificity and predictive values using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 16.0. the p-value

Background: HIV infected children constitute a huge number. These children suffered from adverse consequences of HIV/AIDS. Objectives: In this context this study was conducted to elicit the impact of the disease on HIV positive children at individual and family level. Methods: This cross-sectional study was conducted at Paediatric Centre of Excellence in HIV Care, Kolkata among 202 HIV positive children. Data collection was done for a period of one year. Relevant information was collected by interview method and from Treatment cards of the HIV positive children. Results: Majority of the caregivers were mothers (64.6%).Two-third of the children (64.6%) belonged to upper lower or lower socio-economic class. About 29.2% of the children were thin while 36.6% were stunted. About two-third of the children were afflicted by one or more comorbidities. Both parents were HIV positive among129(67.2%) of the children. 36.9% HIV positive fathers had to change their job and 7.8% lost their jobs while 9.2% HIV positive mothers changed their jobs and 31.4% mothers had to work for a living. One-fifth of the children were AIDS orphans, while 27.6% lost their father due to AIDS. Most of the families reported decreased family income and increased expenditure (94.3% and 96.4% respectively) due to HIV/AIDS. School drop-outs were 14.0%. Discrimination experienced from family members (12.7%), neighbours (22.4%), school (29.2%) as well as health care workers (HCWs) (13.0%). Conclusion: HIV/AIDS children are in dire need of support, empathy and high quality health care.

Background: Barbers are occupationally predisposed to blood borne viral infection (BBVI) such as human immunodeficiency virus, hepatitis B and C. Unhygienic workplaces, improper disinfection and inadequate wound-care can increase the susceptibility of both clients and barbers to BBVI. There is paucity of studies on practices regarding BBVI among barbers, especially in India. Objectives: To identify the pattern and predictors of practices related to BBVI transmission among male barbers in a rural area of West Bengal. Methods: A cross-sectional study was conducted from June 2017 to August 2019 in Indas block of Bankura district among 138 male barbers, who were permanent residents and worked for >6 months. Barbers, randomly selected from 10 Gram Panchayats according to probability proportionate to size, were interviewed. Two barbering sessions were observed. Data were analyzed using SPSS version 16 software. Univariate and multiple linear regression was carried out to identify predictors of better practices. P < 0.05 was considered for statistical significance. Results: Dangerous practices such as reuse of blades (8, 5.8%) and face-towel (77, 55.8%), sale/distribution of used blades (77, 55.8%), improper disinfection of sharps (79, 57.2%), reuse of alum without disinfection (129, 93.5%), and improper wound care (71, 51.4%) were observed. Predictors of better practice regarding BBVI were better attitude regarding BBVI (B = 0.172, standard error [SE] = 0.046, P = 0.000) and increased years of schooling (B = 0.054, SE = 0.021, P = 0.012). Conclusion: Inimical infection control practices were noticed. They are serving the general people and therefore they should be imbibed with correct BBVI knowledge and must do away with all hazardous practice during their barbering activities.

Context: Garment Industry is considered to be the second-largest employment sector in India. Occupational health problems among workers are often ignored, work-related musculoskeletal disorders (WMSD) accounts for the majority of it. The leverage of a healthy workforce is indispensable in the smooth running of the country's economic machinery. Aims: To find out the prevalence of WMSD among the workers and to assess the relationship of WMSDs with sociodemographic, behavioral, and occupational factors. Settings and Design: A cross-sectional study was conducted from June 2017 to August 2019 among 222 workers in three garment factories located in a municipality area of south 24 Parganas District, West Bengal. Methods and Material: Sociodemographic and behavioral characteristics, occupational differentials, and morbidity profiles were assessed using a pre-designed, pre-tested schedule. Statistical Analysis Used: Data were analyzed by SPSS ver. 16.0. Logistic regression was done to determine the associates of WMSDs. Results: Most of the workers were males (70.27%), belonged to the age-group of 36–55 (42.34%) and were illiterate (33.78%). WMSD was prevalent among 70.72% of the workers. Presence of WMSD was significantly associated with educational status{illiterate (OR: 3.59; CI: 1.56–8.22), below secondary (OR-2.89;CI: 1.26-6.62)}, sitting job (OR: 2.02; CI: 1.01-4.03), unsatisfactory working environment (OR: 8.38; CI:1.95–36.06), and level of distress {mild (OR-2.89;CI: 1.26-6.62), moderate-severe (OR: 6.98; CI: 1.46–33.25)}. Conclusions: Improving health awareness and periodic health check-up is the need of the hour for the sustenance of the massive workforce, which can be achieved through the integration of basic occupational health services (BOHS) with primary health care (PHC) infrastructure.

Context: Tobacco smoking is one of the preventable causes of death. Global Adult Tobacco Survey 2 report showed that 19% Indian males were current smokers. It is important to find out factors which help smokers on smoking cessation, ultimately to prevent of lung and other morbidities. There are few community-based studies on intention and attempt to quit smoking in rural area. Aims: The present study aimed to determine the factors associated with intention and attempt to quit smoking among current smokers. Settings and Design: A cross-sectional study was conducted from June to September 2019 among 198 male daily smokers residing in the rural field practice area of AllH and PH, Kolkata. Subjects and Methods: After cluster sampling, data were collected by predesigned schedule by the face-to-face interview. Results: 151 (76.3%) study subjects intended to quit smoking. 63 (31.8%) study subjects attempted to quit in last 1 year. Thirty-one (47.5%) showed high-to-medium nicotine dependence. There was a significant association of intention to quit with agriculture as occupation (acquisitive crime [AOR]-2.17, confidence interval [CI]-1.01–4.63), low nicotine dependence (AOR-2.98, CI-1.43–6.21), doctor's advice (AOR = 2.84, CI-1.27–6.33), and family pressure (AOR = 2.16, CI-1.07–4.38). Attempt to quit was significantly associated with low nicotine dependence (AOR = 5.85, CI-2.85–12.00), family pressure (AOR = 2.94, CI-1.47–5.91). Conclusion: Along with counseling to reduce nicotine dependence, comprehensive approach both from family members as well as health care providers, is vital to escalate the quitting behaviour in smoking habit.

Background: Village Health and Nutrition Day (VHND) is a community participation program focusing on pregnant women, lactating mothers, children (0–5 years), and adolescent girls. Objectives: To assess the status of VHND functioning in the rural areas, and to determine the facilitators and barriers of health care service utilization among the beneficiaries. Also, to explore the challenges faced by the front-line workers while conducting the program. Methods: A cross-sectional descriptive study with a mixed-methods approach was conducted among the beneficiaries and the service providers in twelve selected VHND sessions from March to July 2019 in Singur, Hooghly district, West Bengal. Both quantitative and qualitative methods of research were applied to assess the status of the functioning of 12 VHNDs. Results: Among the beneficiaries who attended the sessions; 28.57% were pregnant women, 16.53% were lactating mothers and 17.44% were under-five children. Nonavailability of line-list of adolescent girls and nonavailability of Vitamin A in oil were major observations. Barriers leading to poor service utilization among beneficiaries were the long-distance of the VHND session site, lack of counseling on proper lifestyle practices, poor and inadequate infrastructure. House visits by the Accredited Social Health Activists regarding the information on VHND sessions found to be an important facilitating factor for beneficiaries. Major challenges identified among the healthcare workers were lack of logistics supply, inadequate workforce, and improper the maintenance of the VHND session site. Conclusion: Proper resource mobilization, maintenance and cleanliness of the session sites, appropriate and wholesome counseling can vastly improve the quality of VHND with the concurrent improvement of maternal and child health.

Introduction: Diabetes is one of the major disease burdens in the world. Globally around 463 million people (at a prevalence of 9.3%) suffered from diabetes recently. Apart from morbidity and mortality, diabetes poses high economic burden on healthcare systems, especially on national economies in developing countries like India. Estimation of the cost burden of diabetes can help decision-makers to understand the magnitude of the problem, prioritize research efforts and interventions, and plan resource allocation, especially in resource-poor settings. The focus of our review was to summarize cost burden of diabetes and its determinants from existing literature in the last 10 years in India. Materials and Methods: All literatures published in the period 2010–2020 were accessed through two databases: PubMed and Google Scholar. Reference lists of the article were again searched for further literatures. Cost calculated in different times was converted to current price in 2020 for ease of comparison. Results: Studies reported a wide range of expenditures in different settings of care. Inequity of expenses across income quintiles among patients was found. Complication of diabetes, insulin therapy, treatment in private facility, and events of hospitalization were the factors associated to high expenditure burden. Conclusion: Financial risk protection for vulnerable people and control over medicine market price will reduce out-of-pocket expenditure for diabetes. Comprehensive strategy to delay onset of complication as well as its early detection can be an opportunity to cut down diabetes-related economic burden.

Context: Anemia is a serious public health concern especially in women of reproductive age (WRA) as it causes a high burden of morbidity and mortality and persists through intergenerational cycle. As most of the risk factors are preventable, a thorough understanding of its risk factors is necessary to design better interventions. Aims: Current study aimed to estimate the burden of anemia as well as explore determinants of various grades of anemia among WRA in a rural area. Settings and Design: A community-based cross-sectional study was conducted among non-pregnant, non-lactating women of reproductive age in rural field practice area of All India Institute of Hygiene and Public Health. Methods and Materials: House to house visit was conducted for interviewing with pre-designed pre-tested questionnaire along with blood hemoglobin and anthropometric measurement. Statistical Analysis Used: Descriptive statistics and test of significance like multinomial logistic regression and Kruskal-Wallis test (with post-hoc) were used. Results: Majority (70.8%) of participants were anemic. Proportion of mild, moderate, and severe anemia were 24.16%, 37.5%, and 9.16%, respectively. Different levels of anemia were significantly associated with higher age, lower education, poor iron-rich food intake, lack of dietary diversity, and adiposity. Significantly low hemoglobin level in both underweight and obesity was noticed suggesting U shaped relationship between BMI and anemia. Conclusion: Periodic screening for anemia among WRA especially in both extremes of malnutrition, i.e., undernutrition and obesity should be considered at the policy level. Year-round behaviour change communication campaigns must be carried out for the promotion of necessary food groups in diet.

Background: Obesity is considered as one of the major noncommunicable diseases of the modern world. It is considered as a major risk factor for cardiovascular diseases, type 2 diabetes mellitus, and dyslipidemia. This study was planned to find the prevalence and predictors of central obesity and its relationship with serum lipids. Materials and Methods: This was a community-based observational cross-sectional study among 388 participants aged 18–49 years in an area of Kolkata from 2016 to 2018. Data collection was done using a structured questionnaire along with anthropometry, blood pressure measurement, and relevant blood tests (fasting blood sugar and lipid profile). Data were analyzed using Statistical Package for the Social Sciences Version 16.0, and logistic regression was done to determine the strength of association between central obesity and different risk factors. Linear trends between waist circumference (WC) and serum lipids were evaluated to explore the bidirectional relationship between the two. Results: Central obesity was present among 66% of study participants. Female gender, high per capita income, poor diet, sedentary lifestyle, decreasing high-density lipoprotein-cholesterol (HDL-C), and hypertension were found as predictors of central obesity. A statistically significant bidirectional association was found between serum lipids (triglycerides (TGs) and HDL-C) and WC. Conclusion: Central obesity was found as an important public health problem which is related to diet, lifestyle, gender, income, and other comorbidities. TG and HDL-C seemed to have bidirectional relationship with WC, and high WC may be considered as surrogate indicator for dyslipidemia (especially low HDL-C and high TGs level).

Context: In India, despite implementation of the strategies under National Tobacco Control Programme [NTCP], women are easily exposed to tobacco consumption that is smokeless (SLT) and smoking tobacco along with second-hand smoke [SHS], making them highly susceptible to tobacco hazards. Aims: This study aimed to assess the exposure of women to tobacco use and SHS at home and to elicit predictors of tobacco exposure in a rural community of West Bengal. Methodology: A community based, cross-sectional study was conducted among 176 women aged 18 years and above. Data was collected by cluster sampling technique (16*11) using predesigned pretested structured schedule. Tobacco exposure was measured using a composite score including tobacco consumption and SHS at home. Results: Tobacco use (SLT and smoking tobacco) was significantly associated with educational attainment [AOR = 2.12], occupation [AOR = 2.13] and knowledge [AOR = 1.22]. There was significant association between SHS at home with knowledge [AOR = 1.16] and attitude of the study subjects. [AOR = 1.93]. Overall tobacco exposure (SLT, smoking tobacco, and SHS), was found to be 79.5%. Significant association was found between high tobacco exposure with age group [AOR = 3.82], educational attainment [AOR = 1.74] and knowledge regarding hazards of tobacco [AOR = 1.31]. Conclusion: Prevalence of SLT use as well as exposure of women to SHS at home is unexpectedly high in the study population. Women specific information and education campaigns focusing on tobacco hazards (both tobacco use and SHS) through existing primary health care infrastructure should be strategized under NTCP.

Context: Rheumatoid arthritis (RA) is a known chronic debilitating disease accounting for a large percentage of disability globally. Pain and stiffness, decreased work function, depression and emotional state alteration, fatigue, disability, and social handicaps are some patient reported outcomes, which if considered with priority the health-related quality of life (HRQOL) of patients with RA could improve. Aims: This study was conducted with the aim to assess the HRQOL of the patients with RA and the determinants related to it. Settings and Design: This was a cross-sectional study conducted at Rheumatology Department of a tertiary care hospital, Kolkata. Subjects and Methods: A total of 252 patients with RA were selected in this study through systematic random sampling. Statistical Analysis Used: Data were analyzed using appropriate statistical measures with Statistical Package for the Social Sciences(SPSS) version 16.0 (Armonk, NY: IBM Corporation) software program, version 16.0. Univariate and multivariable logistic regression were carried out. Results: In the study, the mean age of the patients was 43.1 years (mean age ±SD: 43.05±10.63 years). The proportion of female subjects was 84.5%. Unsatisfactory QOL was found in 59.9% study participants. In multivariable logistic regression unsatisfactory quality of life was significantly associated to moderate to high functional disability [AOR: 6.04, CI: 2.86, 12.78], disease activity moderate to high [AOR: 5.41, CI: 1.87, 15.69], presence of comorbidity [AOR: 2.90, CI: 1.39, 6.04], extra-articular manifestations [AOR: 3.14, CI: 1.41, 6.96] and delay in starting Disease-Modifying Anti-Rheumatoid Drugs (DMARDs) [AOR: 1.24, CI: 1.08, 1.42]. Conclusion: Findings of this study clearly indicate the presence of high proportion of unsatisfactory QOL among the patients with RA. Early identification and prompt referral are the key strategies to prevent any permanent damage. Regular follow-up of the patients should be carried out to prevent or delay the disability progression and provide high-quality physical and mental health.

Background: The prevalence of metabolic syndrome (MetS) is increasing dramatically of late, across all ages irrespective of gender, socioeconomic status, and ethnicity. People with MetS have twice the likelihood of developing and dying from cardiovascular disease and more than seven times the risk of developing diabetes. Objectives: This study was undertaken to determine the prevalence of MetS among adults who were in their first three decades of adulthood and to find out the risk factors of MetS among them. Methods: This was a community based cross-sectional study among 388 subjects aged 18–49 years selected by multistage random sampling in an area of Kolkata, India, from November 2016 to October 2018 over 2 years. Data collection was done using a structured questionnaire along with anthropometry, blood pressure measurement, and relevant blood tests. Physical activity was classified by the International Physical Activity Questionnaire Short-Form questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (version 16.0), and descriptive statistics were calculated as frequency and percentage. Logistic regression was done to determine the strength of association between MetS and different risk factors. Results: The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females), and female gender, poor economic status, sedentary lifestyle, poor diet, and addiction of tobacco were found to be the risk factors of MetS in the final model using multivariable logistic regression. Conclusion: This research revealed the high prevalence of MetS in the community. The effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been employed to curtail the epidemic of MetS.

Context: With the aging of Indian society, maintaining salubrious cognitive health in late life is a public health priority. Early detection and possible prevention of cognitive impairment (CI), thus, will help in increasing the quality of life of elderly people and decreasing the social, psychological, and economic burden of their families and caregivers. Aims: The study aimed to assess proportion of CI and its predictors. Settings and Design: This community-based cross-sectional study was conducted among 135 elderly people selected from 15 villages out of a total 64 villages in rural field practice area Singur of AIIH&PH, Kolkata. Methods and Material: Cluster sampling technique was used and villages were selected according to probability proportional to size method. Data was collected using a predesigned, pretested structured schedule, which included sociodemographic and behavioral variables, Montreal cognitive assessment tool, Geriatric depression scale short form (GDS 15), and mini nutritional assessment tool. Statistical Analysis Used: Predictors of CI were assessed by univariate and multivariable logistic regression using MS-Excel 2016 and SPSS version 16 software. Results: Mean age of the study participants was 67.03 ± 6.7 years with 51.9% of them being females. Proportion of CI was observed to be 48.1% which was significantly associated with increasing age [AOR = 1.1 (1.02–1.13)], decreasing years of schooling [AOR = 1.1 (1.01–1.2)], depression [AOR = 2.7 (1.3–5.8)], and malnourished group [AOR = 4.5 (1.01–20.3)] Conclusion: The burden of CI among the study population was found to be quite high. It is an alarming situation which needs improved screening facility for early detection. Nutritional upliftment and screening for depression should also be done on a regular basis.

Background and Aims: Mothers constitute an important and priority group in any community due to their high pregnancy related morbidities and mortality. The prevention of pregnancy related complications was possible with proper utilisation of maternal health care services. This study was conducted with the aim of assessing the utilisation of maternal health care services among mothers with younger child aged ≤3 years in slums of Kolkata, West Bengal and to find out the factors associated with it. Methodology: It was a community-based, observational study with cross-sectional design conducted in slums of Kolkata from June 2017 to May 2018. 30 slums [under Kolkata municipal corporation] were selected by cluster sampling technique using probability proportionate to size method. 10 mothers were selected from each slum and a total of 300 mothers were selected for the study. A pre-designed, pre-tested, structured schedule was used for data collection. Results: The mean age of the mothers was 23.83 (±3.64) years with the age ranging from 18 to 35 years. 75.7% mothers were registered in 1st trimester of pregnancy and 100% mothers received ≥4 antenatal check-ups. But only 78% mothers consumed ≥100 IFA tablets and only 23.3% mothers consumed ≥360 calcium tablets in antenatal period. 80.3% of the mothers had unsatisfactory utilisation of maternal health care services. Unsatisfactory utilisation of maternal care services was significantly associated with the younger age of the mothers, a smaller number of pregnancies and teenage marriage. Conclusion: Utilisation maternal health care services was not satisfactory among mothers in slums of Kolkata. Awareness generation and behaviour change communication among mothers is necessary for proper utilisation of the services.

Background: Health seeking behaviour (HSB) of thalassemic children is one of the rarely explored entity. Aim: To explore HSB of β-Thalassemia Major (β-TM) children and its attributes. Materials and Methods: It was a cross-sectional design, observational study, conducted among 328 β-TM children and their caregivers attending a tertiary care health facility of Kolkata; West Bengal situated in Eastern India in between May 2016 and April 2017 with a structured schedule. The data were analyzed using SPSS 16.0 version. Results: At the disease onset, 79.6% of them consulted an allopathic doctor. In multivariable logistic regression model, those who were residing in urban area [adjusted odds ratio, AOR: 3.2 (1.2-8.7)], Hindu by religion[AOR: 3.0 (1.2-7.4)], had educated parents [AOR: 3.2 (1.1-9.2)], no family history of the disease [AOR: 3.6 (1.5-8.5)], belonged to higher socio-economic status (Class II, III and IV) [AOR: 2.9 (1.2-6.8)] and had caregiver with satisfactory knowledge related to the disease (≥4)[AOR: 12.2 (5.1-29.6)] were significantly more likely to seek healthcare from an allopathic doctor at onset of the disease. When we consider their HSB till date, 61.0% continued to consult allopathic doctors only. The multivariable determinants of satisfactory HSB till date were place of residence [AOR: 2.7 (1.4-5.2)], caste [AOR: 3.3 (1.6-6.7)], religion [AOR: 3.4 (1.7-6.9)], family history of the disease [AOR: 2.3 (1.2-4.6)] and caregiver's knowledge related to the disease [AOR: 5.3 (3.1-9.2)]. Conclusions: HSB of the study participants were significantly associated with their caregiver's knowledge regarding the disease, parents' educational level, socio-economic status, caste, religion and family history of the disease.

Background: Demanding clinical and academic environments have been potential sources of stress among nursing students. Inability to cope effectively often potentiates this stress. If not intervened early, this may have a detrimental effect on health and may eventually affect the future workforce in rendering care. Objectives: The objective of this study was to explore the levels and sources of perceived stress and coping behavior among undergraduate nursing students in West Bengal. Materials and Methods: This descriptive cross-sectional study was conducted in two nursing training institutions in West Bengal, from July to September 2018, using a validated pretested self-administered questionnaire comprising demographics, Perceived Stress Scale (PSS), and coping behavior inventory (CBI). Students having at least 6 months of clinical exposure were invited to participate. Of 256 eligible students, 182 returned completed questionnaires, giving an overall response rate of 71%. Descriptive statistics, Pearson's correlation, and multiple regression analysis were performed using SPSS 16.0 software. Results: “Stress from assignments and workload” and “problem-solving” was the most prominent stressor and coping behavior (Factor rank 1) respectively among students. Statistically significant correlation was observed between overall mean PSS and CBI score (r = 0.306, P < 0.01). Years of education, self-decision to join, increased screen time, staying at hostel significantly predicted stress (R2 = 0.248, F = 9.640, P < 0.01), and coping behavior (R2 = 0.223, F = 10.077, P < 0.01) among students. Conclusions: Stress from academics and clinics were high among nursing students. As they are the future carers, it is apt to intervene early to mitigate their stress and enhance their coping skills during professional training and practice.

Context: Rice mill workers usually belong to unorganized sector and lack in training regarding hazard prevention. Unprotected exposure to suspended particles and fumes can lead to respiratory morbidities among them. Workers, especially loaders, were susceptible to work-related musculoskeletal diseases. Aim: To find out the morbidity profile and associated factors among rice mill workers. Methodology: A cross-sectional workplace-based study was conducted during July--September 2018 among 143 workers of two rice mills in Indas block, West Bengal. Workers, employed for at least 6 months in the rice mills and who gave informed written consent was interviewed using a predesigned pretested questionnaire and were clinically examined. Nonfasting capillary blood glucose estimation and spirometry were carried out. Workers contraindicated to spirometry were excluded. Result: Commonest morbidities were musculoskeletal discomfort (65%), hypertension (20.9%), and chronic respiratory morbidity (16.9%). No personal protective equipment (PPE) was used by these workers. Significant association of musculoskeletal discomfort was found with tobacco abuse (Adjusted Odds Ratio (AOR) =2.90), job of loader (AOR = 3.51), and central obesity (AOR = 3.39). Hypertension was significantly associated with increasing age (AOR = 1.06), and increasing body mass index (AOR = 1.17). Whereas increasing age (AOR = 1.08), working inside mill (AOR = 7.58), working more than 48 hours a week (AOR = 7.37) were significantly associated with chronic respiratory morbidity. Conclusion: Optimization of working hours, effective continuous use of PPE, and use of proper ventilation technology are recommended. Proper work placement, preplacement examination, and periodic health screening with spirometry are also needed.

Context: Population across the globe are aging rapidly due to demographic transition. More than 50% of the elderly in India suffer from one or more chronic diseases and psychological distress is one of the most common morbidities among them. Aims and Objective: This study was conducted with the objective to assess the status of psychological distress among the elderly. Settings and Design: Acommunity based, cross-sectional study among 347 elderly aged 60 years and above. Methods and Materials: This study was done in 30 villages (clusters) in Singur block of West Bengal. A predesigned and pretested schedule was used to collect data. Statistical Analysis: Data were analysed by univariate and multivariate analyses. Results: The mean (± SD) age of the elderly was 67.67 (± 7.15) years, majority (67.4%) were in the 60–69 years age group. Most (62.8%) of the elderly were suffering from psychological distress which is significantly associated with below primary education level [AOR (95% CI)] = [25.09 (11.88-52.96)], living without spouse and child [AOR (95% CI) =7.88 (3.90-15.89)], financial dependence [AOR (95% CI) =20.23 (7.58-54.00)], dependent functional activity (assessed by ADL) [AOR (95% CI) =3.84 (1.25-11.76)], and decision for healthcare taken by others [AOR (95% CI)] = [3.84 (1.25-11.76)]. Conclusions: Alarmingly, the proportion of psychological distress was found to be high among the elderly of this rural area. Therefore, all steps must be taken with special focus on the mental health of the old people so that they may continue to contribute to the upliftment of the society.

Context and Aims: Tuberculosis (TB) in India is a leading public health problem plagued by social determinants such as stigma and discrimination, which may affect treatment seeking, adherence, and possibly treatment outcome. This study was conducted to elicit the perceived discrimination, its determinants, as well as to determine whether perceived discrimination is predicting treatment outcome among TB patients registered in an Urban Health District, Kolkata City, India. Settings and Design: An institutionbased follow-up study was conducted where all the TB patients registered within the 1st 4 months of data collection were followed up for their current course of treatment. Subjects and Methods: Perceived discrimination was assessed at treatment initiation, after intensive period and after continuation phase using a predesigned and pretested questionnaire. Statistical Analysis Used: Multivariable logistic regression analyses were performed to identify the determinants of perceived discrimination as well as the treatment outcome. Results: Perceived discrimination by family members, neighbors, and colleagues was reported by 9.4%, 36.5%, and 34.2% participants, respectively, overall discrimination being 37.9%. Multivariable analysis revealed that discrimination was significantly more among patients with older age group, females, and from joint families. Perceived discriminated was found to be significantly predicting unfavorable treatment outcome even after adjustment with background and treatment-related variables. Conclusions: Sensitization programs should incorporate measures to address stigma and discrimination and more emphasis needs to be placed on women and elderly patients.

Background: Low bone mineral density (BMD) is implicated in the pathogenesis of osteoporosis and osteopenia, and primarily manifest as fragile bones. This is a rapidly emerging global health problem with increasing prevalence in India. Objectives: The objective of this was to assess the status of bone health and find its determinants among women aged 40 years and above in a rural population of West Bengal. Methods: A community-based cross-sectional study was conducted from May 2017 to April 2018 among 260 women aged 40 years and above residing in the selected villages of Singur through multistage random sampling. Each respondent was interviewed using a structured schedule. Serum Vitamin D and calcium levels were investigated. BMD was assessed through calcaneal quantitative ultrasound. Osteoporosis was diagnosed among those with T-score ≤−2.5, while those with 25(OH) Vitamin D

Background: Dietary preferences and childhood eating behavior has marked influence on nutritional status of children. The objective of the study was to find out eating behavior of primary school children in a rural area of West Bengal using Child Eating Behavior Questionnaire and to determine association of body mass index (BMI) with eating behavior. Methodology: It was an institution-based observational study with cross-sectional design done from May to August, 2018. The study was done among 142 children studying at four primary schools at Singur, in the rural field practice area of our institute. The four schools were selected randomly using list of primary schools in the area. Eating behavior of children was assessed using Child Eating Behavior Questionnaire (CEBQ). BMI of the children was assessed using WHO Z scores tables for children. Data analysis was done using SPSS Version 16 and binary logistic regression was done to find out association of BMI with eating behavior of study participants. Results: The proportion of under-nutrition and overnutrition was 22.0% and 16.0%, respectively. Food fussiness was significantly associated with thinness [BMI below (−2SD)]. Enjoyment of food, satiety response was significantly associated with overnutrition [BMI above (+1 SD)]. Food avoidance subscale was significantly associated with thinness [OR: 2.5, CI: 1.11, 5.63] and this subscale was protective for overweight [OR: 0.22, CI: 0.07, 0.69]. Conclusion: This study showed association of BMI with child eating behavior. Therefore, awareness among parents should be created to change problematic eating of their children which would further help them to achieve normal BMI.

Introduction: Globally, every year, more than 6 million people die because of tobacco use. 20% of all global deaths attributed to tobacco occur in India. The behavioral difference in the rural and urban communities is an important aspect of tobacco problem in the country. In this context, we conducted a community-based cross-sectional study to determine the effect of area (rural-urban) in predicting tobacco consumption pattern. Materials and Methods: A community-based observational, cross-sectional study was conducted in a rural and an urban community of West Bengal from May 2014 to April 2015. A predesigned pretested schedule adapted from the Global Adult Tobacco Survey India Questionnaire was used for data collection. Males above 15 years of age, residing in the study areas, were interviewed during house-to-house visit. Results: Data obtained from the interview of 704 males (352 each from urban and rural area) above 15 years revealed that the prevalence of current tobacco use in any form is significantly higher in rural area (75.6%) than in urban area (67.6%). This was related to the fact that awareness and perception of the people in rural areas are significantly less than their urban counterparts. In bivariate analysis satisfactory consumption pattern was significantly more in urban area but when adjusted with all potentially explanatory variables, the odds of satisfactory consumption pattern in urban area was attenuated significantly. Conclusion: An appropriate intervention strategy, based on local area-wise behaviors of people to curb out the menace of tobacco use, is the need of the hour.

Background: On March 27, 2014, the Regional Certification Commission of the World Health Organization certified South-East Asian Region, which includes India, as polio free. Since then, as part of Polio Endgame Strategy, high-quality national and sub-national polio rounds are being conducted to maintain herd immunity through each year. With years of no fresh cases of polio, several sections in the community have raised doubts over the continuation of the Intensified Pulse Polio Immunization (IPPI) program in postcertification era. Thus, this study with mixed method approach was aimed at assessing the community perceptions toward IPPI using quantitative approach and stakeholder's perception using qualitative approach in a high-risk area of Kolkata. Methods: This cross-sectional study was conducted over a period of 2 months from March to April 2018 in Southern part of Kolkata which involved surveying 104 randomly selected households followed by key informant interviews with community influencers. Pearson's Chi-square test was performed to determine the association between categorical variables. SPSS v. 16.0 software was used for analysis. Results: Inadequate knowledge (32%) and unfavorable attitude (45%) regarding IPPI were observed among the interviewed respondents. Safety concern (5.7%), spouse/elderly pressure (4.8%), and sterility issues (1.9%) were identified as prominent barriers resulting in hesitancy (16.2%) during IPPI. Statistically significant association of respondent's attitude was observed between gender, religion, and education. Conclusion: Social behavior change communication involving community and community influencers would help to overcome the barriers to IPPI coverage and thus to mitigate the risk of re-emergence of polio in future.

Introduction: The Midday Meal (MDM) Program in India is for primary and upper primary school students. To continue an effective program, infrastructure and financial resources should be both maintained and sustained.Objectives: The objectives of this study are to assess the adequacy of infrastructures and fund support available for the MDM Program of upper primary schools of Kolkata. Methodology: An institutional-based observational study with a cross-sectional design was conducted in government and government-aided schools of Kolkata over a period of 2 years from November 2016 to October 2018. A sample of 52 schools from a total of 515 schools was selected by simple random sampling. Statistical Analysis Used: Data were analyzed using the Statistical Package for the Social Sciences software version 16.0 (IBM, SPSS Inc., Chicago, USA). Descriptive statistics and inferential statistics were performed. Results: Infrastructure was satisfactory in 29 (55.8%) schools and unsatisfactory in 23 (44.2%) schools. There was a statistically significant difference of infrastructure between government schools and government-aided schools (P = 0.043). Financial resource was satisfactory in 88.9% of government schools and 85.7% of government-aided schools and this difference was not statistically significant. Conclusion: This evaluation study showed more than half and most of the schools were satisfactory in terms of infrastructure and financial status of the mid-day meal programme of Upper Primary Schools of Kolkata respectively, still intensified efforts like proper allocation of resources and supervision were needed to fulfill the lacunae.

Introduction: The Mid-Day Meal (MDM) program is the world's biggest supplementary school lunch program and is being implemented all over India for primary and upper primary school students. To continue a healthy program, personal hygiene of food handlers and beneficiaries should be well maintained. Objective: This study aims at examining the status of food safety measures including personal hygiene of food handlers and beneficiaries of MDM. Methodology: An institution-based observational study with cross-sectional design was conducted in upper primary schools (government, government-aided school) in Kolkata over a period of 2 years from November 2016 to October 2018. A sample of 52 schools from a total of 515 schools were then selected by simple random sampling. Analyses were conducted using SPSS software (SPSS Inc., released 2007 SPSS for Windows, version 16.0). Results: Among 52 schools, 53.8% were government-aided schools and 46.2% were government schools. There were significant differences in cleaning practice by cook-cum-helper (CCH) (χ2 = 4.4, df = 1, P = 0.036), personal hygiene of CCH (χ2 = 19.01, df = 1, P = 0.000) and beneficiaries (χ2 = 9.3, df = 1, P = 0.002), practice during serving (χ2 = 4.4, df = 1, P = 0.036), and use and storage of oils and condiments in MDM (χ2 = 27.7, df = 1, P = 0.000) between government and government-aided schools. Conclusion: School authority should be concerned about maintaining proper hygiene. Adequate facilities and training program must be arranged for CCH to provide a healthy meal.

Context: Oral health means more than only good teeth. It is a state-of-being-free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders. The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to increase worldwide. Aims, Setting, Materials and Methods: A cross-sectional study was carried out among 158 elderly (>60 years) residing in a slum of Kolkata during the period from April 2017 to June 2017 to assess the impact of oral health on general health. Data were collected using a pretested predesigned schedule containing Geriatric Oral Health Assessment Index. Data analysis was performed in R software. Poisson regression was used to find the associates of the impact of oral health. Results: Mean (standard deviation) age was 68.54 (5.9) years. A total of 104 (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. More than half the participants reported that they have limited the kind of food they eat due to dental/gum condition and trouble chewing. Conclusion: There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all elderly, especially diabetics. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.

Context: “Frailty” is a multidimensional geriatric syndrome that increases the risk for adverse health outcomes, such as falls, hospitalization, increased morbidity, and mortality, among elderly persons. Aim: The objective of this study is to find out the proportion of frailty and its associates among elderly (aged ≥60 years) in a rural area of West Bengal. Settings and Design: It is a community-based cross-sectional observational study done during May–August 2018 among 165 elderly persons selected by systematic random sampling by probability proportionate to size method from three villages at the rural field practice area of our institute. Materials and Methods: Tilburg frailty indicator is used to measure frailty. An elderly is considered as frail if s/he scores ≥6 in this scale. Statistical Analysis: Data analysis is done by SPSS Version 16. The logistic regression is done to find out the associates of frailty. Results: Proportion of frailty is 38.8% (mean age ± SD: 67.03 ± 3.43 years) among the study subjects. Age, female gender, loss of spouse, illiteracy, economic dependency, no job/at home status, ≥2 chronic diseases are significantly associated with frailty in univariate logistic regression. In multivariable logistic regression, ≥2 chronic diseases [AOR: 8.4, CI: 4.6, 11.33] and illiteracy [AOR: 3.3, CI: 1.05, 9.8] retain their significance. Conclusion: Frailty should be recognized as a public health priority and awareness generation among elderly population for healthy ageing including self-motivation for proper management of their ailments should be emphasized for reduction of morbidity as well as for augmenting their quality of life.

Context and Aims: This study was carried out to assess quality of life (QoL) of tuberculosis patients receiving treatment from DOTS centres, to find out its change with treatment, and to ascertain its determinants. Materials and Methods: An institution based follow-up study was conducted in Bagbazar Urban Health District (UHD), Kolkata where all the tuberculosis patients registered within 1st 4 months of data collection were followed up for their current course of treatment. Quality of Life (QoL) was assessed using SF36v2 questionnaire at the start of treatment and after continuation phase (CP) (within 14 days). Statistical Analysis Used: General Linear Model was used to assess the predictors of change of QoL with treatment. Results: 61.4% and 16.4% patients were at the risk of depression at the start and end of their TB treatment respectively. Patient's per-capita monthly Income (PCI) and current smoking status interacted with time to predict trends in the Physical component scores. Similarly, PCI and educational status interacted with time to predict trends in the mental component scores. PCI and unemployment were found to be predictor of differences of Physical and mental component scores (between subject effects) respectively. Conclusions: QoL assessment in different stages of treatment should be incorporated in the ongoing RNTCP to make the programme more client-oriented and comprehensive, and to provide social support to those who need it most. Directly observed treatment should be supplemented with economic support, de-addiction campaign and Inter-personal counselling by the DOTS providers.

Background and Aims: Vitamin D Deficiency/Insufficiency (VDD/VDI) is now recognized as a pandemic. Vitamin D is a versatile yet crucial factor which is vital for many metabolic functions in our body. Till now there is no screening tool for VDD/VDI. The aim of this study is to develop and validate a screening tool Vitamin D Insufficiency Risk Score (VDIRS). Methods: This study was a rural community based cross-sectional study. It was done during May 2016 to April 2017 among 197 adults residing in rural West Bengal. After a thorough literature review and discussion with the field experts, four characteristics (BMI, Physical activity, Daily Sun exposure, Diet) were considered for VDIRS.Data was collected after taking informed consent. After interviewing every individual was examined for height, weight and blood was collected for vitamin 25-(OH) D. Weights were given to VDIRS characteristic according to Adjusted Odds' Ratio. Receiver Operating Characteristics (ROC) curves were utilized to validate and find out optimum cut off for VDIRS using Youden's index for VDD/VDI with the use of R software. Results: Only 133 (67.5%) had Vitamin D insufficiency. On ROC curves for VDIRS for VDI and VDD, AUC was 0.83 and 0.77 which signifies VDIRS as a good screening and predictive tool. A score of VDIRS ≥14 had sensitivity of 78.2% and specificity of 75.0% for VDI.Conclusion: Use of the VDIRS can make mass screening for undiagnosed VDI/VDD in India more cost effective. Researchers strongly believe and perceive a necessity of such validated score in the present scenario.

Context: Functional ability considered a proxy for healthy aging, not only related to mental and physical health but it also determines social well-being. Eliciting the determinants of functionality components among the elderly will assist in evolving with appropriate plans at both domiciliary and facility level to eliminate their sufferings and disabilities. Aim: The aim of this study is to find out the magnitude of poor functional status among the elderly and its predictors. Materials and Methods: This is a community-based cross-sectional study conducted among 246 geriatric people in a rural area of West Bengal from August 2017 to December 2017; data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Logistic regression analysis was performed to find out the factors associated with poor functional status (activities of daily living [ADL] and instrumental ADL [IADL]). Results: The study concluded that 32.4% and 59.3% were dependent for basic ADL and IADL, respectively. Binary logistics showed people aged >70 years, female gender, less than primary level education, widowed/separated, who lived in the joint family, poorest percentile of economic status, who were depressed and who suffered from multimorbidity had increased odds of dependency for ADL and IADL. In multivariate logit regression, age> 70 years and depression remained significant for ADL; in addition, marital status, education, and family type remained significant for IADL. Conclusion: There should be a provision for community-based comprehensive geriatric health and disability assessment, as it enables older people to avert the illness at the early stage, to delay the onset of disabling diseases. This will ensure their participation in the upliftment of the society, and they thus will be less dependent on their progeny.

Context: It is needless to state that health and hygiene go hand in hand and of the various categories of hygiene, oral hygiene has a colossal contribution to positive health for any individual. Zealous and correct lifestyle characteristics are related to high standards of oral hygiene, and good habits must be inculcated in the early years of one's life. With this background, a study was conducted among some school-going adolescents. Aims: The aim of this study is to find out the status of their oral hygiene and oral health along with their associated risk factors. Methodology: It was a school-based, observational, cross-sectional study conducted among students of standard 7th, 8th, and 9th of the school who were approached, and the parents of 151 students gave their consent for the oral checkup. Students first filled in a self-administered questionnaire following which their oral health and hygiene were examined. Data were analyzed using statistical package of social science software version 16.0 (IBM, SPSS Inc., Chicago, USA) Descriptive statistics and inferential statistics were performed. Results: Among 151 students, 64.2% had poor oral health, 52.3% and 64.2% student had unsatisfactory awareness toward oral health and oral hygiene practice, respectively. Females had better oral health awareness and better practice scores than males. Factors such as satisfactory practice of oral hygiene (odds ratio [OR] = 6.7 [3.4–12.2]); satisfactory awareness toward oral health (OR = 2.9 [1.9–3.5]); and gender (OR = 2.9 [1.5–5.8]) were associated with good oral health. Awareness toward oral health (OR = 5.8 [2.8–12.2]) are also strongly associated with the good practice of oral hygiene. In the final model of multivariable logistic regression analysis, factors such as the practice of oral hygiene (adjusted OR [AOR] = 6.8 [3.2–14.5]) and awareness toward oral health (AOR = 2.1 [1.3–3.6]) retained significance. Conclusion: Oral health promotion programs and periodic health checkups are needed.

Background: Globally, vector-borne diseases account for 17% of infectious disease burden. In India, despite accelerated efforts, both malaria and dengue are major public health concern. Understanding local community perspectives is essential to strengthen ongoing program activities. Objectives: The study aimed to assess the community perceptions and risk reduction practices toward prevention and control of malaria and dengue at slums of Chetla in South Kolkata and to explore the perspectives of relevant local stakeholders in this regard. Methods: This cross-sectional study with mixed-method design was conducted from June to September 2018. Quantitative data were collected in 288 sampled households through face-to-face interview of respondents and environmental checklist, whereas, qualitative exploration was done with five key informant interviews. Quantitative data were analyzed using SPSS version 16 Software. Qualitative data were analyzed thematically using “cut and sort” processing technique. Results: In household survey, majority had unsatisfactory knowledge (68.4%), attitude (64.2%), and practices (62.8%) regarding diseases prevention/control, which was further substantiated by qualitative findings. The use of electric fans (79.5%), mosquito repellents (53.8%) were predominant practices; however, only a few used bed nets regularly (26.0%). Reportedly, “heat” and “poor ventilation” were key reasons behind reluctance to use bed nets. Multivariable regression analysis revealed that increasing age, proximity to a nearby canal, and unsatisfactory knowledge significantly predicted unfavorable attitude, whereas, respondents' gender and unfavorable attitude significantly predicted poor practices. Conclusions: Intensified social behavior change communication with active community participation is the need of the hour to prevent malaria and dengue occurrence and future outbreaks.

Introduction: The automobile industry is a large and growing industry in India and this industry employs many workers as manufacturers, distributors, retailers, and automobile garage workers. Automobile garage workers suffer from many health problems among which Musculoskeletal Discomfort (MSD) is very common. Aim: To find the proportion of MSD among automobile garage workers in Chetla, Kolkata and to describe the factors associated with the musculoskeletal discomfort. Materials and Methods: The study was a work place based, observational study with cross-sectional design. The study was conducted among 101 automobile garage workers at nine automobile garages of Chetla, Kolkata. A pre-designed, pre-tested structured schedule was used to collect data. The outcome variable was MSD and it was assessed using Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). MSD score was categorised into mild, moderate and severe discomfort. Data was analysed using IBM SPSS Software version 16. Results: Around one-third (30.7%) study participants belonged to the age group 41-50 years with mean (SD) age 43.35 (13.46) years. Knee discomfort was present among 42% study participants while 21% had low back pain according to CMDQ tool. Around three fourth (73.3%) study participants had at least one kind of MSD and around 46.6% had moderate to severe musculoskeletal discomfort. MSD was significantly associated with increasing age and increasing duration of working hours per week in univariate and multivariable logistic regression. Conclusion: The proportion of musculoskeletal discomfort among automobile workers was quite high. Early diagnosis and regular screening of MSD is very much needed to introduce appropriate preventive and treatment measures at appropriate time...

Introduction: Diabetes mellitus is considered as silent epidemic worldwide including India. Peripheral neuropathy is one of the most common complications of diabetes mellitus. Diabetes Self-Management (DSM) is crucial in mitigating the afflictions of diabetes and it’s after effects. There was dearth of studies in view of Diabetic Peripheral Neuropathy (DPN) and diabetes self-management in Kolkata, West Bengal. Aim: To assess the associations between diabetes selfmanagement and DPN in Type 2 Diabetes Mellitus (T2DM) patients attending an urban health clinic in Kolkata. Materials and Methods: This study was conducted from December 2018 to March 2019 among known case of T2DM patients aged 30 years and above attending the NonCommunicable Disease (NCD) clinic at Chetla, under the purview of field practice areas of Urban Health Unit and Training centre (UHU and TC) of All India Institute of Hygiene and Public Health (AIIH and PH) Kolkata, West Bengal. A pre-designed and pretested schedule was used to collect data which were analysed using International Business Machines Statistical Product and Service Solutions (IBM SPSS) version 16.0 and represented using various tables. Results: The mean (SD) age of the participants was 54.89 (8.98) years. About 32.4% of the patients had DPN which was significantly associated with increased duration of T2DM {AOR (95% CI)}={1.52 (1.22-1.91)}, lower glucose management sub-scale score {AOR (95% CI)}={2.84 (1.42-5.67)} and lower healthcare use sub-scale score {AOR (95% CI)}={1.86 (1.05-3.31)}. Conclusion: Early screening and education regarding diabetes self-care would be helpful in glycaemic control and in prevention of DPN.

Introduction: Alzheimer Questionnaire (AQ) and Montreal Cognitive Assessment (MoCA) are tools for assessment of cognitive impairment. MoCA is a common tool for screening of cognitive impairment but it requires trained personnel. AQ questionnaire is informant-based, simple and less time consuming with or without the involvement of trained personnel. Aim: To estimate the prevalence of cognitive impairment and to find out the accuracy of AQ compared to MoCA in Cognitive Impairment screening among elderly population in an urban area of West Bengal. Materials and Methods: The Prospective cross-sectional study was conducted in urban field practice area of All India Institute of Hygiene and Public Health, Kolkata among 140 randomly selected elderly population from June to September 2019. Accuracy of AQ with MoCA tool as gold standard in screening cognitive impairment was analysed by Cohen’s Kappa, Receiver Operating Characteristics (ROC) Curve, Spearman rho Coefficient along with sensitivity, specificity, predictive values and likelihood ratio was obtained. Results: Prevalence of cognitive impairment using MoCA and AQ was 40% (95% CI=31.8-48.6) and 36.4% (95% CI=28.5- 45.0), respectively. AQ and MoCA showed good agreement (Cohen’s kappa, κ=0.834; 95% CI=0.739-0.928). The AQ and MoCA showed a strong negative correlation (spearman’s Rho=-0.709; 95%CI=0.764-0.884, p-value

Caregivers are the persons who provide care at the time of distress or illness. They face many stress and strain to provide the best possible medical care for their children. There are very few studies that explored the care-related quality of life (CarerQoL) of the caregivers of thalassemic children and its correlates. With this background, the current study was designed to explore the CarerQoL of the caregivers of β-Thalassemia Major (β-TM) children and its various correlates. It was a cross-sectional observational study conducted among caregivers of β-TM children attending a tertiary care health facility of Eastern India in between May 2016 and April 2017 with a structured schedule. The median CarerQoL score was found to be 5 with an interquartile range of 4–7 (range: 11). In the final multivariable logistic regression model, care receivers’ (thalassemic children) age [adjusted odds ratio (AOR): 2.2 (1.2–4.2)], spleen status [AOR: 4.1 (2.0–8.7)], blood transfusion frequency [AOR: 2.1 (1.1–3.9)], and quality of life (QoL) [AOR: 3.0 (1.6–5.5)] and caregivers’ educational level [AOR: 2.3 (1.2–4.1)], perceived social discrimination [AOR: 2.3 (1.3–4.1)], debt [AOR: 2.3 (1.2–4.3)], nongovernmental organization assistance [AOR: 2.0 (1.0–4.0)], and wage loss due to seeking treatment [AOR: 1.9 (1.1–3.4)] were significant predictors of CarerQoL of the study participants adjusted with their age, sex, working status, per-capita monthly income, knowledge level related to the disease, and care receivers’ comorbidity status. To conclude, CarerQoL of the study participants were significantly associated with QoL of their wards. Other significant associates of CarerQoL were caregivers’ education level, financial profile, patients’ age, and their clinico-therapeutic profile.

Background: Empathy is a desirable quality in every clinician. It is a crucial determinant of patient–physician communication and relation. There are very few existent Indian studies on empathy of medical students and its correlates. Aim: The aim of the study was to assess empathy level of medical students and its correlates. Methodology: It was a cross-sectional, hospital-based, analytical observational study conducted from July to November 2017. In total, 249 undergraduate medical students of a medical college of Kolkata were interviewed with a structured schedule. The schedule comprised of the sociodemographic questionnaire, career satisfaction, future career choice, and Jefferson Scale of Empathy. Results: The mean empathy score was 98.5 ± 12.5. Third-semester students had higher empathy scores (102.4 ± 12.4) compared to fifth (97.2 ± 12.9) and seventh semester (95.0 ± 10.9) students. The difference between the mean scores of different semesters was statistically significant. Female students were more empathic than male students. In the multivariable linear regression model, sex, semester, residence, career satisfaction, future career choice, and current place of living were significant predictors of empathy scores. Conclusion: Empathy level of medical students of our study was quite low compared to other studies conducted outside India. Empathy eroded with semester, which supports earlier pieces of evidence in this regard.

Background: Caregivers knowledge regarding thalassemia is one of the vital areas in the prevention of the disease. Studies related to caregivers knowledge and its sociodemographic predictors are very few in number which is helpful in designing interventions across different study settings. Objectives: the study aimed to find out the knowledge level of caregivers of thalassemic children and its sociodemographic determinants. Materials and Methods: It was a cross-sectional observational study conducted in a thalassemia day care unit of Eastern India. The study included 328 caregivers of thalassemic children attending thalassemia day care unit during May 2015–April 2016. Data were analyzed using Statistical Package for the Social Sciences (SPSS) (version 16). Results: Out of 328 caregivers only 47.6% knew about genetic etiology of the disease, while only 52.4% and 50.9% knew about premarital counseling and antenatal screening, respectively. Regarding treatment of the disease, 75.9% knew that both blood transfusion and iron chelation are the treatment of thalassemia, while only 19.2% and 2.7% of them had knowledge regarding splenectomy and bone marrow transplantation, respectively. Only 52.7% had satisfactory knowledge regarding the disease. In multivariable model, caregivers educational level (adjusted odds ratio, AOR-3.13 [1.87–5.25]), working status (AOR-2.18 [1.23–3.86]), place of residence (AOR-2.05 [1.19–3.52]), and socioeconomic class (AOR-2.11 [1.25–3.58]) were significant predictors of their knowledge. Conclusion: Caregivers' knowledge regarding thalassemia was not at all satisfactory. Regular counseling of caregivers should be done addressing the knowledge lacunae's among them.

Background and Objectives: Shopkeepers due to their sedentary lifestyle and lack of physical activity are more likely to suffer from high level of stress which, in turn, may increase the risk of various chronic diseases among them. The study aims to assess the stress level and its associated factors among shopkeepers. Materials and Methods: The study was a cross-sectional community-based study conducted from May to July 2016, among 147 shopkeepers in a permanent marketplace of Kolkata with a structured schedule. Data were analyzed using appropriate statistical methods by the Statistical Package for the Social Sciences, SPSS (version 16). Results: The mean stress score of the study participants was 8.1 ± 2.3. Only 43.7% of them were doing a moderate physical activity (≥600 MET-min/week). There was moderate correlation between stress and physical activity (ρ = 0.374, P = 0.000). Other significant correlates of stress were age (t = 2.132, P = 0.035), tobacco consumption (ρ = 0.167, P = 0.043), body mass index (ρ = 0.299, P = 0.000), and hypertension (ρ = 0.165, P = 0.046). Conclusions: Stress level among the study population was high with only two-fifths of them doing a moderate amount of physical activity. Health education regarding the importance of maintaining a healthy lifestyle, i.e., regular physical activity, weight reduction, and quitting addiction should be given to them regularly to reduce their stress level and reduction of their risk of developing various chronic diseases.

Background: Vitamin D deficiency/Vitamin D Insufficiency (VDI) is now recognized as a pandemic. Cutaneous exposure to ultraviolet-B causes photolysis of epidermal 7-dehydrocholesterol, converting it to pre-Vitamin D3 (precholecalciferol), which then undergoes isomerization to form the stable hormone Vitamin D3. Objectives: The objectives of the study is to determine the status of Vitamin D level among the adults residing in a rural area of West Bengal and to find out the optimal cutoff of the sun exposure for Vitamin D sufficiency. Methods: This study was a rural community based cross-sectional study. It was done from May 2016 to April 2017 among 197 adults residing in a rural block of West Bengal. Data were collected by interviewing the respondents with the help of a structured pre-tested pre-designed schedule. After interviewing, every individual was examined for height and weight and blood was collected for serum Vitamin 25-(OH) D. Receiver Operating Characteristic (ROC) curves were utilized to find out optimum cut-off for sun exposure using Youden's index. Binary logistic regression was performed to find out the associates of high sun exposure. All analysis was done using R. Results: Overall VDI was found in 133 (67.5%). Among them, 102 (51.8%) were female. On ROC curve for veritable sun exposure for Vitamin D sufficiency, area under curve was 0.7841 which signifies veritable sun exposure as a good screening tool. Conclusion: Proper information, education, and communication material regarding various aspects of sun exposure and Vitamin D should be prepared with due consultation of field experts and disseminated to increase awareness among the community.

Background: Empowerment is an important determinant of women's health. The most important social factor of women empowerment is her partner's perception toward it. The attitude of men toward women empowerment is one of the major public health and human rights issues in the world today. With this background, the current study was designed to explore the attitude toward women empowerment among husbands of eligible couples. Materials and Methods: It was a community-based observational study, cross-sectional in design conducted from March to June 2016, carried out in a rural area of Hooghly district, West Bengal among 125 husbands of eligible couples. Data were analyzed using IBM statistical package for social sciences, SPSS statistical software program (version 16) by appropriate statistical methods. Results: Among husbands of eligible couples, favorable attitude toward women empowerment was found to be 20%. In univariate logistic regression, husbands age (odds ratio, (OR)-2.9 [1.1–7.4]), educational status (OR-3.2 [1.1–9.4]), wives age (OR-2.9 [1.1–7.4]), type of family (OR-3.3 [1.1–9.4]), and religion (OR-7.3 [2.8–19.1]) were significant predictors of husbands attitude toward women empowerment. In the final multivariable logistic regression model, husband education (adjusted OR, AOR-3.3 [1.1–9.6]) and religion (AOR-4.7 [1.5–14.5]) were significant predictors of husbands attitude toward women empowerment adjusted with husbands age with (predictive accuracy rate) PAR of 81.6%. Conclusion: Favorable attitude toward women empowerment was quite low. Husbands educational status and religion were some key predictors of women empowerment. Awareness generation campaigns with the involvement of religious leaders to improve attitude toward women empowerment, especially in reluctant religious pockets, should be organized.

Background: Condom is an integral part of all interventions for female sex workers (FSWs). However, certain situations hinder them from practicing consistent condom use. This paper aims at identifying the situations that predict inconsistent condom use by FSWs of Sonagachi red-light area, Kolkata. Subjects and Methods: The cross-sectional community-based observational study was conducted among 296 brothel-based FSWs of Sonagachi. Outcome variable, that is, inconsistent condom use was said to be present if any sex act with any type of partner was not protected by condom. Association with sociodemographic, occupational, and behavioral characteristics of FSWs was examined. Results: Inconsistent condom use was present among 37.5% of the study participants, and this was predicted by the presence of a nonpaying partner (NPP) (adjusted odds ratio [AOR] [95% confidence interval (CI)]: 15.04 [7.52–30.08]), violence (AOR [95% CI]: 2.08 [1.07–4.03]) and sexual intercourse under the influence of alcohol (AOR [95% CI]: 1.86 [1.02–3.39]). The major cause behind nonuse of condom as reported by the participants was trust on partner. Conclusion: NPPs need to be given emphasis in program strategies for FSWs. The FSWs should constantly be motivated for safe sex emphasizing the fact that trust on partner may be detrimental for their health.