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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: 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: 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.

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: “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.

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.

India’s scheduled tribe population very often bears the brunt of inequity in accessing health care. The mixed-method research assessed the health care seeking behavior (HSB) of a tribal community residing in the eastern fringes of Kolkata metropolis. An adult, preferably the head, in 209 households was interviewed followed by qualitative interviews with relevant stakeholders. Conceptual framework of Andersen’s behavioral model helped in identifying the potential predisposing, enabling, and need factors that influenced HSB. A total of 25.4% respondents reportedly sought informal care during last illness episode. Multivariable hierarchical-regression model (Nagelkerke R2= 0.381) showed that respondents’ education level [adjusted odds ratio (AOR) = 2.52], household size (AOR = 3.14), nonenrollment to health insurance (AOR = 2.47), decision making by household head (AOR = 2.40), distance from the nearest urban primary health center (AOR = 3.18), and poor perception to illness severity (AOR = 2.24) were significantly associated to inappropriate HSB. Predominant health system barriers that emerged from qualitative interviews were irregular logistics, unfavorable outpatient timing, absence of female doctors, and nonretention of doctors at local urban primary health center. Community level barriers were poor awareness, self-medication practices, poor health insurance coverage, and poor public transportation. Recognition of these determinants may help in developing health promotion interventions tailored to their needs.

INTRODUCTION: “Gender” denotes the differences in the social roles of different sexes. This interaction results in variable health outcomes and care-seeking behavior. The present study was conducted to find out the attitude of school-going adolescents regarding gender equity and also to explore teachers’ perceptions in this context in a school of tribal belt of West Bengal. MATERIALS AND METHODS: A cross-sectional, mixed-method study was conducted among the students of classes eight to twelve, chosen by complete enumeration technique, with a predesigned, pretested validated questionnaire. The questionnaire was based on Gender Equitable Men scale and International Men and Gender Equality Survey questionnaire, comprising the following domains: ‘Gender restrictions’, ‘Gender attributes’, and ‘Gender domination’. The respondents were categorized into ‘high’, ‘moderate’, and ‘low’ groups as per their domain-wise attitude scores. In-depth interviews (IDIs) were conducted among seven teachers chosen purposively. Thematic analysis was done with the qualitative data. RESULTS: Out of 191 students, 112 were girls (58.6%) and 47 belonged to scheduled tribe category (24.6%). Overall, 170 (89.0%), 80 (41.9%), and 96 (50.3%) students had a high gender-equitable attitude regarding the domains of ‘gender restrictions’, ‘gender attributes’, and ‘gender domination’ respectively. Girls had higher percentage of high gender-equitable attitude in all the three domains (92.0%, 57.1%, and 50.9%, respectively). Regarding ‘gender restrictions’, 91.2% had high gender-equitable attitude in lower age group, compared to 81.4% in higher age group. Among the lower and higher age groups, 52.7% and 41.9% respectively, had high gender-equitable attitude on ‘gender domination’. Gender inequality amidst poverty, women deprived of health care, and gender violence were the major themes derived from the IDIs. CONCLUSION: Girls had a better attitude toward gender equity. Laws regarding gender dominance and violence should be focused. Conducting intensified awareness campaigns on gender equity and addressing women's right to health is a much-needed timely intervention for the health of womenfolk.

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.

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: Delayed diagnosis of tuberculosis (TB) is a significant problem both in individual as well as community level. Different studies around globe revealed that these diagnostic delays are attributed to both patient delay and health system-related delay. Aims: This study aims to assess the magnitude of delay in diagnosis and the association with sociodemographic profile among new sputum-positive pulmonary TB patients in Darjeeling district. Materials and Methods: A cross-sectional study was conducted among 374 TB patients from October 2011 to March 2012 using a predesigned pretested schedule by face-to-face interview. Statistical Analysis: Logistic regression analysis, odds ratios (OR), adjusted ORs. Results: Patient delay, health system delay and total diagnostic delay were 27 days, 20.1 days, and 20.6 days; mean delays were 23.64, 5.71, and 29.46 days, and median delays were 25, 5, and 32 days, respectively. Risk factors associated with patient delay were female gender, rural residence, illiteracy, smoking, alcohol consumption, taking two, or more alternate treatments; for health system delay were female sex, rural residence, time to reach health facility, time spent per visit; and for total diagnostic delay were female sex, alcoholism, and seeking more than two alternate treatment. Conclusions: The risk factors for delay identified may be the subject of future interventions.

Context: Urinary incontinence (UI) is a chronic debilitating disease which is often under reported, but laid significant impact on one's quality of life (QoL) thus is of public health importance. Aims: The aim of this study is to find out proportion of rural women have UI, its associated risk factors and treatment-seeking behavior, QoL of affected women. Methods: This was a cross-sectional clinic-based study conducted from October 2016 to January 2017 among 177 women aged 50 years or above attending a rural health facility with a structured schedule. Data were analyzed using appropriate statistical methods by SPSS (version 16). Results: Forty-nine (27.7%) out of 177 women were found having UI. The most prevalent type of UI was stress UI (51.0%), followed by mixed UI (32.7%) and urge UI (16.3%). In bivariate analysis, study participants who were illiterate, having a history of prolonged labor, having a history of gynecological operation, normal vaginal deliveries (NVDs) (>3), diabetic, having chronic cough, having constipation, and having lower urinary tract symptoms (LUTS) had shown significantly greater odds of having UI. In multivariable illiteracy (adjusted odds ratio [AOR] - 2.41 [1.02–5.69]), NVDs (AOR - 3.37 [1.54–7.37]), a history of gynecological operation (AOR - 3.84 [1.16–12.66]), chronic cough (AOR - 2.69 [1.21–5.99]), LUTS (AOR - 2.63 [1.15–6.00]) remained significant adjusted with other significant variable in bivariate analysis. Those with mixed UI had 5.33 times higher odds having unfavorable QoL. Only 30.6% sought medical help. Treatment-seeking behavior shown negative correlation with QoL while fecal incontinence and LUTS shown possitive correlation. Conclusions: The study revealed that rural women are indeed at high risk of developing UI. Majority of them did not sought treatment for UI which is matter of concern. Generating awareness regarding UI may help to improve health-seeking behavior and QoL.

Context: Maternal anxiety has an association with low birth weight. However, studies are scarce to determine any association between maternal anxiety and fetal growth. Aims: This study aims to determine the effect of maternal anxiety on fetal growth, measured by gestational age-dependent increase in fetal abdominal circumference (AC). The secondary objective is to determine the effect of maternal anxiety on other fetal parameters (biparietal diameter [BPD], head circumference [HC], femur length [FL]). Settings and Design: This cross-sectional study was conducted in a tertiary care hospital, Kolkata. Materials and Methods: Four hundred and ten pregnant mothers, between 14 and 40 weeks of gestation, were interviewed with socioeconomic and obstetric profile questionnaire and examined for anthropometric profile and presence and severity of pallor. Anxiety was assessed using Generalized Anxiety Disorder-7 (GAD) questionnaire. HC, AC, BPD, and FL were measured by ultrasound biometry. Analysis Used: A multivariable logistic regression analysis was done to determine the predictors of small-for-gestational-age (SGA). A robust mediation analysis was done to determine mediating effect of anxiety on gestational age-dependent increase in fetal AC. Results: Mild (odds ratio [OR]Adjusted = 6.23, [2.41, 16.15]) and moderate (ORAdjusted = 22.42, [5.00, 100.57]) anxiety was significantly associated with SGA fetus. Anxiety increased with the progression of gestation (βGAD: 0.011 [0.007–0.015]) and it had a negative effect on fetal growth (standardized indirect effect of gestational age-mediated by anxiety on AC: −0.037 [−0.059, −0.022]). Anxiety also attenuated gestational age-dependent increment of HC. Conclusion: Mother's anxiety has a gestational age-dependent temporally incremental negative effect on fetal growth and brain development.

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: Vitamin D deficiency is a recognized pandemic. Even in a tropical country like India, where there is plentiful sunshine, vitamin D deficiency is widely prevalent. Adult females, particularly those above the age of 40, are mostly affected because vitamin D determines the pattern of post-menopausal bone loss and age-related osteoporosis. Methods: A community-based cross-sectional study was conducted from April–December 2017 among 194 women aged 40 years and above residing in the village of Singur, West Bengal. For this study, multistage random sampling method was used. Each respondent was interviewed using a structured schedule to collect data on sociodemographic characteristics, dietary pattern, their daily sun exposure, tobacco use, and morbidity profile. Individuals with 25OH vitamin D

Objectives A clean India is the responsibility of all Indians. One of the objectives of the Swachh Bharat Abhiyan (Clean India Initiative) is to bring about behavioural changes regarding healthy sanitation practices. While large-scale programs in India have increased latrine coverage, they have to some extent failed to bring behavioural changes ensuring optimal latrine use, including the safe disposal of child faeces, which is a significant source of exposure to faecal pathogens. Hence, this study was done to explore child faeces disposal practices in rural West Bengal and to elicit the determinants of unhygienic faeces disposal. Methods Data collection was done using an interview method among the mothers of 502 under-5 children, following a pre-designed, semi-structured schedule during house-to-house visits in a set of villages in the Hooghly district of West Bengal. Results The prevalence of unsafe disposal of child faeces was 72.4%, and maternal education, per capita income, and water source were found to be significantly associated with unsafe child faeces disposal. Conclusions This study draws attention to the unsafe disposal of child faeces in this area of India and raises questions about the efficiency of sanitation campaigns in rural India that focus on expanding coverage rather than emphasizing behavioural changes, which are crucial to ensure the safe disposal of child faeces. Thus, it is urgently necessary to strengthen efforts focusing on behavioural changes regarding the safe disposal of child faeces in order to minimise adverse health outcomes.

BACKGROUND: Students must be made aware about the essentiality of optimum level of physical activity and the fact that it is the key to good health and an important technique to prevent and control a lot of noncommunicable diseases including depression and other related mental ill-health. MATERIALS AND METHODS: It was an institution-based intervention study among 187 Madrasah students of classes VII and VIII, conducted in five-phase assessment of the training needs of Madrasah students on different aspects of healthy lifestyle, development of a need-based module to be used by teachers to impart training of students through classroom setting, training of teachers to use the module to train students, training of students by the trained teachers in classroom setting, and evaluation of effectiveness of the training module. RESULTS: The mean pretest knowledge score in study Madrasah was 2.64 ± 1.35 (Mean ± SD) and post test score was 4.13 ± 0.88 (Mean ± SD). In paired t- test, t- value was 13.54 and P < 0.05 with effect size of 1.370 (Cohen's d). Practice related to the mean score in pretest was 2.38 ± 1.08 and posttest score was 2.73 ± 1.03. In paired test, t- value was 6.25 and P < 0.05 with effect size of 0.458 (Cohen's d). CONCLUSIONS: The study revealed the effectiveness of training by teachers using the module developed by the researcher to address significant changes in lifestyle-related issues.

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 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.

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.

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: One's house is believed to be the safest and the healthiest place to live in. Indoor air pollution (IAP) means the presence of unwanted substances in the indoor air at concentration toxic to health. Objective: The objective of this study is to study the presence of IAP, its associated factors and impact on health of women residing in an urban slum of Kolkata, West Bengal, India. Methods: It was a cross-sectional study done from January 2017 to March 2017 among 120 households of a slum. Data were collected using a pre-designed pre-tested schedule from the homemaker of the households. All analyses were conducted with R: A Language and Environment for Statistical Computing. Results: About 60% households used kerosene as cooking fuel predominantly. Smoke from the neighbouring houses troubled 57.5% respondents. More than 60% houses were overcrowded and more than 70% houses were poorly ventilated. IAP-related symptoms such as irritation in the eye, suffocation, dry cough significantly correlated with the presence of IAP sources and its contributory factors. Of 120, 78 (65%) perceived the presence of IAP in their houses. Lower per capita income (PCI), ground floor, and joint family were found to have higher odds of sources of IAP. Younger age, lower PCI, and ground floor were found to be strongly associated with higher contributory factors of IAP. Conclusion: The present study found that the majority of the households were exposed to IAP due to kerosene, neighborhood smoke while overcrowding and ill-ventilation accentuated it. Effective intervention with intersectoral coordination is the need of the hour.

Background: Malnutrition has become the biggest contributor to child mortality in recent years accounting for about half of all child deaths . The most important way to prevent this dismal status is by promoting optimal breastfeeding and infant feeding to all the babies. Intentions have been considered the strongest factor to influence one’s behaviour. Objectives: To assess the intention of pregnant women towards infants and young child feeding (IYCF) and the factors associated with it. Methods: A clinic based cross-sectional study was conducted in an antenatal unit of a primary health centre in Singur block of Hooghly district in West Bengal, India. A total of 137 pregnant women were interviewed using a questionnaire to assess their intention towards IYCF after taking their written informed consent. Descriptive characteristics, univariate and hierarchical logistic regression were used to analyse the data. Results: All the women (137) intended to breastfeed their future offspring. Only 88 (64.2%) intended to feed colostrum whereas 112 (81.75%) had intention to breastfeed exclusively. The majority (82.5%1) answered correctly when asked about the timing of initiation of complementary feeding. Overall 83 (60.58%) had favourable intention towards IYCF. The significant covariates of favourable intentions towards IYCF were higher socio-economic status [OR (CI); 4.4 (1.7-11.6)], working mothers [OR (CI); 4.3 (1.03-18.3)] and multigravida [OR(CI) ;9.7(2.2-42.7)]. Conclusion: Focusing on developing favourable intention towards IYCF during every antenatal visit of every pregnant woman and counselling will be a cost-effective intervention to ensure excellent growth and development among children and it is a well-established that healthy children will give forth to a healthy nation.

Survival data is a special form of time to event data that is often encountered while modelling risk. The classical Cox proportional hazard model, that is popularly used to analyse survival data, cannot be used for modelling risk when the proportional hazard assumption is violated or when there is recurrent time to event data. In this context we conducted this narrative review to develop an algorithm for selection of advanced methods of analysing survival data in the above-mentioned situations. Findings were synthesized from literature retrieved from searches of Pubmed, Embase, and Google Scholar. Existing literature suggest that for non-proportionality, especially due to categorical predictors stratified Cox model may be useful. An accelerated failure time model is applicable in case of different follow-up time among different experimental groups and the median time to event is the outcome of interest instead of hazard. Extended Cox models and marginal models are used in case of multivariate ordered failure events and the type of model depends upon the presence of clustering and nature of ordering. In the presence of heterogeneity, a shared frailty model is used that is analogous to mixed models. More advanced models, including competing risk and multistate models are required for modelling competing risk, multiple states and multiple transitions. Joint models are used for multiple time dependent outcomes with different attributes. We have developed an algorithm based on the review for appropriate model selection to curb the challenge of modeling survival data and the algorithm is expected to help the naive researchers in analysing survival data.

Introduction: During menopausal transition, there is a lot of fluctuation in the hormone levels making the peri and postmenopausal women susceptible to various mental and physical disorders. There is considerably lack of awareness about the effects of the menopausal symptoms in women in India. Studies on issues relating to menopause, especially among rural women, are also lacking. With this background, the current study was carried out in a rural area of West Bengal with the objective to assess the quality of life (QOL) of peri-menopausal women. Methodology: The study was carried out among 100 peri and postmenopausal women (40–60 years) in Dearah village of West Bengal which is the rural field practice area of All India Institute of Hygiene and Public Health during February–March 2014. The questionnaire used as study tool had two parts - Part 1: Sociodemographic characteristics. Part 2: About QOL due to menopausal symptoms based on four domains (vasomotor, psychosocial, physical, and sexual) using the 29-item Menopause-Specific Quality of Life Questionnaire. Results: Occurrence of vasomotor symptoms was average with 60% of them reporting hot flushes and 47% sweating. Most prevalent psychosocial symptoms reported were feeling of anxiety and nervousness (94%) and overall depression (88%). Physical symptoms were quite varying in occurrence with some symptoms such as feeling tired or worn out, decrease in physical strength and lack of energy occurring in 93% of the women to only 5% suffering from growth of facial hair. Overall sexual changes were reported among 49% who reported of avoiding intimacy with a partner and 26% complained of vaginal dryness. Conclusions: The results support that menopause causes both physical and psychiatric problems. Education, creating awareness and providing suitable intervention to improve their QOL are important which should be imparted to menopausal women at both individual and community level.

Background WHO, UNODC, and UNAIDS recommend a comprehensive package for prevention, treatment, and care of HIV among people who inject drugs (PWID). We describe the uptake of services and the cost of implementing a comprehensive package for HIV prevention, treatment, and care services in Delhi, India. Methods A cohort of 3774 PWID were enrolled for a prospective HIV incidence study and provided the comprehensive package: HIV and hepatitis testing and counseling, hepatitis B (HB) vaccination, syndromic management of sexually transmitted infections, clean needles-syringes, condoms, abscess care, and education. Supplementary services comprising tea and snacks, bathing facilities, and medical consultations were also provided. PWID were referred to government services for antiretroviral therapy (ART), TB care, opioid substitution therapy, and drug dependence treatment/rehabilitation. Results The project spent USD 1,067,629.88 over 36 months of project implementation: 1.7% on capital costs, 3.9% on participant recruitment, 26.7% for project management, 49.9% on provision of services, and 17.8% on supplementary services. Provision of HIV prevention and care services cost the project USD 140.41/PWID/year. 95.3% PWID were tested for HIV. Of the HIV-positive clients, only 17.8% registered for ART services after repeated follow-up. Reasons for not seeking ART services included not feeling sick, need for multiple visits to the clinic, and long waiting times. 61.8% of the PWID underwent HB testing. Of the 2106 PWID eligible for HB vaccination, 81% initiated the vaccination schedule, but only 29% completed all three doses, despite intensive follow-up by outreach workers. PWID took an average of 8 clean needles-syringes/PWID/year over the project duration, with a mid-project high of 16 needles-syringes/PWID/year. PWID continued to also procure needles from other sources, such as chemists. One hundred five PWID were referred to OST services and 267 for rehabilitation services. Conclusions A comprehensive HIV prevention, treatment, and care package is challenging to implement. Extensive efforts are needed to ensure the uptake of and retention in services for PWID; peer educators and outreach workers are required on a continuous basis. Services need to be tailored to client needs, considering clinic timing and distance from hotspots. Programs may consider provision of ART services at selected drop-in centers to increase uptake.

Background: Emergency Contraception (EC) is an important option for women exposed to unprotected sex to prevent unintended pregnancy and induced abortion. EC has a potential to offer women an important option for fertility control. The objective of the study was to assess knowledge about Emergency Contraception among currently married women of reproductive age in a rural area of West Bengal.Methods: A community based cross sectional study was conducted on 608 currently married women of reproductive age for 1 year from May 2017 to April 2018. Questionnaire was administered to women on knowledge of emergency contraception (EC). Data was analyzed in SPSS version 16.Results: Among the study participants 66% had knowledge of emergency contraception. A small number (8.9%) of the total participants ever used EC to prevent pregnancy. Only 65.3% of them had correct knowledge regarding timing of EC. Effectiveness of post-coital pill was known to them while none of these women were aware of the existence of Intra Uterine Contraceptive Device (IUCD) insertion as an option for EC.Conclusions: Marked lacunae were observed regarding knowledge and practice of emergency contraceptives among the WRA. Proper and correct knowledge on Emergency Contraception is of urgent need among all sexually active women especially in this country for population stabilization.

Context: Metabolic syndrome (MetS) is recognized as a major epidemic of the 21st century. People with MetS have twice the likelihood of developing and dying from cardiovascular diseases and more than seven times the risk of developing diabetes. Aims: This study was undertaken to determine the prevalence of MetS and its components among adults who were in their first three decades of adulthood. Settings and Design: 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. Subjects and Methods: Data collection was done using a structured questionnaire along with anthropometry, blood pressure (BP) measurement, and relevant blood tests. Physical activity was classified by The International Physical Activity Questionnaire-Short Form questionnaire. Statistical Analysis Used: Data were analyzed using the SPSS software version 16.0 and descriptive statistics were calculated as frequency and percentage. Results: The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females) and prevalence of central obesity, elevated fasting plasma glucose, raised triglyceride, raised BP, and reduced high-density lipoprotein cholesterol were 68.6%, 41.5%, 36.1%, 45.1%, and 64.9%, respectively, among the study participants. Conclusions: This research revealed the high prevalence of MetS and its components in the community. Effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been implemented to curtail the epidemic of MetS.

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: Childhood unintentional injury, a major public health problem in India, is largely preventable. The aim of this study was to determine the burden and determinants of unintentional injury of 12 to 59 months old child at household level.Method: A community based cross-sectional study was conducted at Singur block, Hooghly district, West Bengal, India among randomly chosen children using a predesigned and pretested interviewer administered questionnaire and a checklist for assessing household level injury hazard during the period of November 2015 to February 2016. Parental supervisory behaviour was assessed using PSAPQ questionnaire. Multivariable logistic regression was performed using SPSS 19.0 software.Result: A total of 163 were involved in the study. Over one-third (37.4%) of the children underwent any type of injury during last 3-month time period, predominant body part being upper limb. Parental supervisory behaviour [AOR-2.6, (95% CI-1.2-4.9)] and household level injury hazard (AOR-1.55, 95% CI- 1.3-1.7)] were found to be significant predictors of unintentional injury.Conclusion: Unintentional injury among children is prevalent in West Bengal in India. Dissemination of injury prevention information with special focus on household modification and increased parental supervision are effective strategies to prevent unintentional injury.

Rationale Resilience prevents the emergence of stress-related mental health problems among adolescents. Adolescents in tribal areas of India are more prone to develop such problems. Objectives The primary objective was to determine the effect of combined life skills-based health empowerment intervention on the resilience of school-going adolescents in a tribal area. The secondary objectives were to determine the effect of the intervention on internal health locus of control and self-determination and to compare the effect of intervention on resilience between non-tribal and tribal adolescents. Methods We conducted this quasi-experimental study using a Solomon four-group design among 742 adolescents in two schools of Purulia, West Bengal, India. Students of the pretested group were examined for resilience using the Child Youth Resilience Measurement scale. A life skills education-based health empowerment intervention was administered among students of the experimental group. Post-test data on resilience, self-determination, internal health locus of control and pathological behaviour was obtained 3 months after the completion of intervention. A multi-level general linear mixed model was constructed to determine the effect of intervention on resilience. Results Resilience was less among tribal adolescents at baseline. The intervention significantly improved resilience [βAdjusted = 11.19 (95% CI = 10.55, 11.83], with a greater increase for tribal adolescents [βtribal-nontribal = 1.53 (95% CI = 0.03, 3.03)]. The intervention also significantly improved internal health locus of control (marginal mean increment 1.38 ± 0.05), self-determination (marginal mean increment 3.71 ± 0.09) and reduced pathological behaviour of the adolescents. Conclusion Our study informed the current health policy that the existing life skills education-based programme should be reviewed and modified to include generic life skills, and the life skills education-based programme should be coupled with developmental interventions aimed at improving adult education and family climate for optimum effect on mental health and health behaviour of adolescents.

Introduction: Hypertension is one of the major public health problem affecting the whole world so its accurate measurement is of utmost importance for its early diagnosis and management. Concerns related to the potential ill effects of mercury on health and environment, has led to the widespread use of non-mercury sphygmomanometers. Aim: A study was conducted to compare the accuracy of readings of aneroid and digital sphygmomanometers in reference to mercury sphygmomanometers and determine the hypertensive classification agreement between the mercury and non-mercury devices. Materials and Methods: The study was conducted in an OPD of a health centre in a rural community of West Bengal which is the rural field practice area of our institute. An aneroid and a digital sphygmomanometer were compared to a properly calibrated mercury sphygmomanometer. All the subjects above the age of 25 years, in two days per week, selected randomly from five working days per week in a period of one month were selected. Two blood pressure readings of each of 218 study subjects was recorded with each pretested sphygmomanometer. Paired t-test, Kappa coefficients, sensitivity and specificity tests were done. Receiver Operating Characteristics curve analysis was done and Youden index was estimated to detect the optimal cut off point for the diagnosis of hypertension by non-mercury sphygmomanometers. Results: Data analysis of 218 study subjects showed the mean difference of the mercury reading and the test device was much less for aneroid than that of the digital device for both systolic and diastolic blood pressure. More than 89% of aneroid readings and less than 44% of the readings by digital device had absolute difference of 5mm Hg. when compared with the mercury readings for both systolic and diastolic blood pressure. Sensitivity and specificity of aneroid device was higher (86.7% and 98.7%) than digital device (80% and 67.7%). Receiver Operating Characteristic curve had larger area under the curve for aneroid device than digital device for both SBP and DBP. Conclusion: The aneroid device had better accuracy than the digital device as compared to mercury sphygmomanometer and should be used for proper and better management.

Background: Hypertension, also known as high blood pressure is a global public health concern. It is an important modifiable risk factor for cardiovascular disease and stroke. It remains silent, being generally asymptomatic during its clinical course and it accounts for a large proportion of cardiovascular deaths; lifestyle modification is the first line of intervention for all patients with hypertension, yet it was never been empirical. The aim of the study was to assess the pattern of self-care practices, if any and also to find out the factors associated with it, among the hypertensive patients in the outpatient department. Methods: A clinic-based, observational, cross-sectional study was conducted at health center under RHU & TC, Singur, which is the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata among 124 hypertensive subjects. Binary logistic regression was done to find out the factors associated with the self-care practices using SPSS software. Results: In the present study, 62.9% of study participants suffering from hypertension had unfavourable self-care practices. Logistic regression showed age above 60 years (OR-3.1), primary level education (OR-5.6), poor socio economic status (OR-2.4), widow/separated (OR-3.3) and people with self-perceived poor health status (OR-2.8)had significant association with unfavourable self-care practices. After adjusting with other variables, age (AOR-2.3) and education (AOR-3.8) remained significant predictor of outcome. Conclusions: The findings revealed that the self-care practices among hypertensive patients were unfavourable in rural area. This calls for a deep need in increasing the awareness about healthy lifestyle among hypertensive patients. This study provides key elements to affect policy changes and social interventions.

Background: Generalised and central obesity are established risk factors for metabolic syndrome and cardiovascular diseases. Easy assessment of overweight or obesity is the need of the hour from public health perspective. Waist circumference (WC) can be a simple screening tool for identifying overweight individuals since measuring WC is simple, inexpensive, less time consuming, convenient for self-monitoring and needs no complicated calculation as BMI.Methods: A community based cross-sectional study was conducted in January-February 2017 among 338 adults, in a village of Singur Block, West Bengal. Height, weight and WC were measured for each subject. Receiver Operating Characteristic (ROC) curve analysis was used to estimate the cut-off values of WC.Results: The sensitivity and specificity of WC ≥90 centimeters for men for identifying overweight (BMI ≥25) were 78.8% and 75.6% respectively, whereas those of WC ≥80 cm for women were 80.3% and 44% respectively. ROC curve analysis revealed good diagnostic accuracy at 88.5 cm for WC cut-off for men (area under curve (AUC) 0.854, sensitivity 86.5%, specificity 67.6%) and fair accuracy (AUC 0.744, sensitivity 80.3%, specificity 44%) for WC cut-off for 80 cm for women.Conclusions: This study shows, WC can be used for screening of overweight individual infield practice as measuring tape is inexpensive and easy-to-carry compared to a weighing scale. More research may be done on larger sample size to establish an optimal WC cut-off value for Indian population.

Background: Vector borne diseases (VBDs) form a major part of the communicable diseases in India. Ignorance and impoverished conditions of people contribute in creating source and spread of vector borne diseases and hinder disease control strategy. Slums are more vulnerable to vector borne diseases because of poor environmental condition, standard of living, poverty and ignorance of the people. This study is a small endeavour to highlight the awareness of residents of slum area of Chetla, Kolkata, West Bengal, India regarding vector borne diseases. Objectives were to assess the awareness of the study population regarding different vector borne diseases and to find out the association of awareness with relevant demographic variables.Methods: A community based observational, cross-sectional study was conducted among adult population in a slum area of Chetla, Kolkata, West Bengal, India. Multivariate logistic analysis was done to find out association of awareness with relevant variables.Results: Awareness regarding malaria was good and that of dengue was satisfactory while awareness regarding other vector borne diseases was poor. Age, sex, caste, education and social class were found significantly associated with satisfactory awareness. Younger population i.e. age ≤35years, males, general caste people, literacy status above primary school and social class III and above had better awareness regarding vector borne diseases.Conclusions: This study uncovered the lacunae regarding awareness of the study population regarding vector borne diseases. It can be concluded that intensified efforts towards creating public awareness and mobilizing the community regarding the identified issues should be addressed.

Background: Diabetes care is complex. Diabetes self-care activities are behaviors undertaken by people to successfully manage diabetes on their own. In populous and developing country like India where resources are limited, and treatment costs are on the rise, emphasizing on the self-care management may lead to improved outcomes in treatment and expenditure. Objectives: To assess self-care activities and associated factors among type 2 diabetic patients. Materials and Methods: A clinic-based cross-sectional study was conducted in Primary Health Centre in Singur among 195 patients (males 45 [23.1%], females 150 [76.9%]) who were interviewed with the help of a pretested schedule. Descriptive statistics, univariate logistic regression, and multivariable logistic regression were used to analyze the data. Results: Among the six domains of self-care activities, drug intake compliance was as high as 72.3% while correct diet intake and foot care were as low as 35.4% and 37.4%, respectively. Overall satisfactory self-care activities were among only 25.6% diabetic patients while adequate advice related to self-care activities was given to 38.5% patients. Longer duration (odds ratio [OR] - 3.1, confidence interval [CI] - 1.7-7.4), adequate advised (OR - 2.9, CI - 1.3-6.9), no diabetes distress (OR - 2.9, CI - 1.2-7.4), and glycemic control (OR - 4.0, CI - 1.8-9.3) were significant predictors of satisfactory self-care activities. Final model can predict the 34.5% of variance of self-care activities. Final model can predict 74.4% of the outcome accurately. Conclusion: Both self-care advises and activities should be an integral part of the control of the disease through high-quality health education and promotion programs guided by health personnel at all levels.

Objective: First aid is the helping behavior and initial care provided for an acute illness or injury. Students have the potential for changing the health scenario of the society if properly groomed and educated. The objective of the study is to evaluate the effectiveness of educational intervention on the first aid among middle school students of a rural school in West Bengal. Materials and Methods: A total of 230, 6th and 7th standard students were given a self-administered questionnaire for assessing their baseline knowledge about management of common injuries followed by educational intervention with a systematically devised teaching module during February to March 2016. Post intervention evaluation of their knowledge acquisition was done after 2 weeks with same questionnaire. Results: The baseline knowledge on the management of selected injuries was found to be insufficient among the study subjects. Paired t-test was performed to compare the pre- and post-test scores of knowledge and attitude of the students about first aid, and there was a significant change in knowledge from pretest score (mean = 1.50, standard deviation [SD] =0.47) to posttest score (mean = 6.53, SD = 1.30). To quantify the effectiveness of health education, effect size (Cohen's d) was derived. For knowledge score, Cohen's d was 5.14 with large effect size indicating highly effective impact of the training program. Significant change was also noticed regarding attitude regarding first aid as evident from increase in pretest score (mean = 1.19, SD = 0.96) to posttest score (mean = 3.17, SD = 1.03); Cohen's d was 1.88 with medium effect size. Conclusion: Inculcating first-aid training in the school curriculum can be a fruitful investment in ensuring proper and timely management of illnesses and injuries not only for the school children but also for the community at large.