Introduction: In India's immense population, the maternal mortality ratio in 2016-2018 was 113. We are still away from the sustainable development goals (SDGs) of MMR less than 70 per 100,000 live births set by the United Nations. 1 In obstetric patients, due to the occasional occurrence of critical conditions, it is hard to identify the initial signs of grievous illness. Focusing on mothers whose comorbidities place them at risk of severe maternal morbidity is a strategy for risk reduction. The obstetric comorbidity index (OB-CMI) is one such tool that summarizes the burden of maternal comorbidities with a quantified approach. Aim: To evaluate the performance of OB-CMI in identifying women at risk of severe maternal morbidity (SMM) during labor. Material and methods: We did a retrospective analysis of hospital records of pregnant women >28 weeks gestation admitted to the labor room, in labor, or planned for delivery (January-June 2019). On admission, the OB-CMI was calculated for each patient based on history, examination, and investigations. Any SMM (ACOG and Society for Maternal-Fetal Medicine consensus definition) experienced before discharge was recorded. Association between OB-CMI and SMM was analyzed. Results: Out of the 1678 women included in the study, 36 women experienced SMM (2.1%). The OB-CMI ranged from 0 to 10, with a median of 0. The median of patients experiencing SMM was 5 as compared to 0 in those who did not (p <0.000). For every 1-point increase in the score, patients experienced a 2.02 increase in odds of severe maternal morbidity (95% confidence interval, 1.75-2.34). The ROC analysis revealed good discrimination between OB-CMI and SMM (0.841, 95% confidence interval 0.752-0.930). Conclusion:The prevention of SMM is a priority and OB-CMI is a clinically valid tool to identify women at risk during delivery. It is useful as a screening tool, for triaging high-risk patients in specialized institutions that are well equipped. It could also complement physiologic-based screening tools and help in early intervention.
A BSTRACT Background: As the proportion of elderly in the population increases, they also become vulnerable to various types of intentional or unintentional injuries. Domestic accidents including falls among the elderly have been identified as a leading cause of injury-related morbidity and mortality in India and elsewhere. Aim: This study aims to assess the burden and pattern of domestic accidents in a rural part of Southern India. Methods and Setting: A community-based cross-sectional study among the elderly (≥60 years) was carried out in rural areas of Southern Karnataka. A semi-structured interview schedule was used to get the information on domestic accidents. Inferential statistical tests like the Chi-square test and logistic regression analysis were used. Results: A total of 500 persons aged ≥60 years with a mean age of 69.09 ± 7.42 years (Range 60–92 years) were included. One-third of the subjects have had an incidence of domestic accidents in the past 1 year contributing to a 35% prevalence of domestic accidents. A higher prevalence of domestic accidents was seen in those subjects who were ill (47.9%). Overall prevalence of falls was 21.4% ( P = 0.007). One-fifth of the subjects with domestic accidents had a residual illness. Conclusion and Contribution: One-third of our subjects gave a history of one or the other form of domestic accidents in the previous 1 year. Our study highlights the problem of unintentional domestic injuries among the most vulnerable group of the elderly and calls for a continuous assessment of the burden and nature of injuries.
Introduction and Aim: India experienced the peak of the second wave of COVID-19 during April to June 2021. Massive surge of cases resulting in shortage of beds and oxygen, home care was recommended as a strategy for management of asymptomatic/mild COVID -19 cases. The present study was undertaken to perform home visits and monitor COVID 19 patients who are a part of home-based care programme (HBCP) in Puttur taluk of Dakshina Kannada district, identification and immediate referral of patients with red flag signs/ symptoms and to identify barriers/challenges faced by health care staff in implementing the programme. Methodology: The present study was a cross-sectional study with universal sampling. It was carried out as part of a district programme for management of home isolation COVID-19 patients. The team visited the houses of COVID-19 patients and evaluated them. Results: A total of 112 COVID-19 patients were in home isolation during the study period in Puttur Taluk. Hypertension (29.5%) was the most common co-morbidity and nearly two-fifths (41.1%) of the study participants had one or more comorbidities. Almost two-third (63%) of the patients with comorbidities were symptomatic compared to only 29.4% of patients without any comorbidities. Of the six patients who had saturation of less than 95% five were more than 60 years of age, only one had received vaccination against COVID-19 and all had comorbidities. The HBCP had to face several challenges as the team members could not be in full PPE because of long distances between the houses and hard to reach areas. Conclusion: Overall, it is a helpful initiative for patients as the health services were provided at the doorstep during the time of restriction of movement. This can be an important tool in managing not only COVID pandemic but also future outbreaks that may follow.
Introduction: India is a leading consumer of antibiotics; rational use of antibiotics is of prime importance. Objectives: The majority of the population in India resides in rural areas; hence this study was conducted to capture their knowledge, attitude and practice regarding antibiotic use and antimicrobial resistance. Patients and Methods: A cross-sectional questionnaire-based survey was conducted among 130 randomly selected general public of rural Mangaluru. Descriptive analysis and Pearson’s chi-square were employed in data analysis. Results: Adequate knowledge was observed only in 18.5% of the participants. Around 30.8% of participants thought antibiotics killed all germs while 23.8% were of no opinion. Furthermore, 60.8% thought that antibiotics speed up recovery from flu. Only about 23% thought frequent use of antibiotics would make the bacteria stronger and ineffective in the future. A minimal of 16.2% knew that antibiotic resistance is a global problem. About 52.3% preferred to take an antibiotic whenever they had the flu. However, 47% wanted to take it after doctors’ consultation. The study showed that compliance to complete the course was better when a doctor explained the proper use of the prescribed antibiotic. Additionally 31.5% opted for self-medication using the previous prescription and 21.5% took the antibiotics suggested by anyone other than the doctor. Conclusion: The study findings help re-evaluate the current public awareness activity and provide insight into some of the areas required to be focused on and aid the adequate legislative changes for a better outcome.
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