National Journal of Community Medicine

Contraceptive Use Before First Birth in North-East India: Trends and Socio-Demographic Inequalities Based on NFHS Data

Heisnam Ruhi Singh — 2025-04-01

Background: Taking part in human reproduction immediately after marriage will not be a good choice for those young couples from the point of view of population growth as well as the health of the mother and the newborn. As such, postponement of the first birth will benefit both the newborn's and the mother's health. The use of contraceptives before the first birth is a reasonable choice for delaying it. The objective of this paper is to analyse the trends in contraceptive use before first birth and to explore and identify potential socio-demographic covariates that significantly influence this trend in North-East India.

Methods: We analyse the trends of contraceptive use before first birth using data from the three latest National Family Health Surveys. We also investigate socio-demographic factors associated with contraceptive use before first birth using data from the latest round of NFHS-5. The method of multivariate logistic regression is applied to estimate the likelihood of contraceptive use before first birth among different socio-demographic groups.

Results: There is an increase in the percentage of women who use contraceptives before first birth from NFHS-3 to NFHS-4. However, there is a slight percentage decrease from NFHS-4 to NFHS-5. Place of residence, religion, family wealth, current age, and media exposure are some of the important covariates that significantly affect contraceptive use before first birth.

Health Program and Nutritional Determinants of Pregnancy Anemia in Boyolali District, Central Java, Indonesia: A Case-Control Study

Izzatul Arifah — 2025-04-01

Background: Pregnancy anemia is a significant issue in Indonesia's public health. The modifiable risk factors of pregnancy anemia were nutritional and health program factors. This research examines the determinants of pregnancy anemia in individual and nutritional health program factors in Boyolali Regency, Central Java Province, Indonesia.

Methodology: This facility-based case-control study was conducted in three areas of Primary Healthcare Centers. The case was 60 pregnant women whom health providers diagnosed as having anemia, and the control was 60 who did not.

Results: Bivariable analysis showed that the associated factors of pregnancy anemia were parity, family wealth index, maternal health literacy, antenatal care (ANC) compliance (six visits), and Iron-Folic Acid (IFA) consumption. Meanwhile, variables that were not significantly related were birth interval, gravida, monthly expenses, and daily iron intake. Multivariable analysis showed that pregnant mothers who did not followed the recommended ANC were 14.4 times more likely to experience pregnancy anemia than those who did (p-value <0.0001). Irregular IFA consumption, wealth index and parity were also significant determinants of pregnancy anemia.

Conclusions: Following health programs, such as attending ANC and IFA consumption, significantly reduces the risk of pregnancy anemia. Health providers should encourage pregnant women to achieve the recommended six ANC visits.

Understanding the Neck's Significance: Exploring Neck Circumference as a Marker for Obesity and Hypertension in Perambalur District’s 40–70 Age Group

Abinaya Ravi — 2025-04-01

Background: Neck circumference (NC) is an emerging anthropometric marker for assessing metabolic and cardiovascular health risks. This study assessed the relationship between NC and obesity prevalence and examined its potential as a predictive marker for hypertension among individuals in Perambalur District.

Methodology: This cross-sectional study included 392 participants aged 40-70 years. Anthropometric measurements and blood pressure were recorded. Correlational analyses and receiver operating characteristic curve (ROC) analyses evaluated the relationship between NC and health indicators.

Results: Weight showed a significant positive correlation with NC (r = 0.272, p <0.001), with a stronger relationship in females (r = 0.413, p < 0.001). Blood pressure parameters demonstrated consistent positive correlations across the population (systolic: r = 0.345, p < 0.001; diastolic: r = 0.337, p < 0.001). ROC analyses revealed optimal cutoff points: NC ≥37.5 cm for males and NC ≥34.75 cm for females. The predictive power for hypertension was notably stronger, with AUC values of 0.726 for males and 0.797 for females (p < 0.001).

Conclusion: NC emerges as a promising anthropometric marker for assessing obesity and hypertension risks, with significant gender-specific variations. This simple, cost-effective screening tool shows utility for cardiovascular and metabolic health risk assessment in adults.

Critical Factors Affecting Toddlers Development in Indonesia: Shaping Early Childhood Growth

Dien Gusta Anggraini Nursal — 2025-04-01

Background: Padang City, the capital of West Sumatra Province, is a central referral area with a high concentration of children. However, the Early Detection and Intervention Stimulation of Growth and Development Stimulation (SDIDTK) service at the Ikur Koto Public Health Center recorded the lowest achievement rate for toddler services at 66%, alongside the highest prevalence of developmental disorders (2.6%). This study aimed to identify factors associated with the growth and development status of toddlers in the Ikur Koto Public Health Center area in 2024.

Methodology: This quantitative study was conducted in August 2024 using a cross-sectional design with 64 toddlers selected through probability sampling. Data were collected using validated questionnaires and analyzed using chi-square tests for bivariate analysis and logistic regression for multivariate analysis. Ethical approval was obtained before the commencement of the study.

Results: The results showed that maternal awareness (p = 0.010), environmental sanitation (p = 0.002), and a history of low birth weight (p = 0.002) were significantly associated with the growth and development status of toddlers. Environmental sanitation was identified as the dominant factor (POR = 19.105).

Conclusions: Improving toddlers’ growth and development requires promoting environmental sanitation and empowering mothers to actively engage in stimulation and training activities that enhance psychological and motor skills development.

Health Literacy and Associated Factors Patients with Type 2 Diabetes Mellitus in Rural Thailand

Niwat Songsin — 2025-04-01

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that poses a significant public health challenge. Effective management requires patients to engage in self-care behaviors, including medication adherence, a healthy diet, and regular blood glucose monitoring. Health literacy plays a crucial role in enabling patients to understand and apply health information, reducing complications, and improving outcomes. This study aims to assess the health literacy of T2DM patients in rural Samut Songkhram Province, Thailand.

Methods: This cross-sectional descriptive study involved 403 T2DM patients from Samut Songkhram Province. Data were collected using a health literacy questionnaire assessing knowledge, information access, and decision-making abilities. Participants were selected through multi-stage random sampling, and data were analyzed using descriptive and inferential statistics, including stepwise multiple linear regression.

Results: The study revealed that the overall health literacy of patients was low (M = 34.72, SD = 6.28). Three factors significantly predicted health literacy: education level (Beta = 0.427), complications (Beta = 0.316), and occupation (Beta = 0.218). These factors accounted for 58.4% of the variance in health literacy, with statistical significance (R² = 0.584, p <0.05).

Conclusion: The study highlights low health literacy among T2DM patients. To address this, public health agencies should implement community-based educational programs, and healthcare providers should offer personalized health education to improve diabetes management and self-care behaviors.

Prevalence of Cognitive Impairment and Associated Factors in Diabetic Patients Attending a Rural Health Facility in Goa, India

Vedika Gad — 2025-04-01

Introduction: Diabetes prevalence is rising globally, projected to reach 643 million by 2030, with India's rate surpassing the global average. Cognitive impairment (CI) is a common, yet underdiagnosed complication.

Materials and Methods: This cross-sectional study was conducted from January to April 2024 at the Rural Health and Training Center. A total of 200 diabetic patients were selected for the study by simple random sampling method. The objective was to estimate the prevalence of cognitive impairment and identify associated factors among the participants.

Results: The study revealed 78(39%) of participants had mild cognitive impairment, 15(7.5%) had mild dementia, and 107(53.5%) exhibited normal cognition. A majority (65.5%) were aged 50 years or older. Males 133(66.5%) outnumbered females 67(33.5%). Most patients (81%) had lived with diabetes for less than a decade. Significant associations were found between cognitive impairment and factors like age, age at diagnosis, and diabetes duration.

Conclusion: Nearly half of the participants showed cognitive impairment, predominantly among older individuals. Regular cognitive screening and tailored care are crucial for diabetic patients.

Detection of Blastocystis hominis and Assessment of Personal Hygiene Practice in Elementary School Children in Kampa District, Kampar Regency, Riau, Indonesia

Esy Maryanti — 2025-04-01

Background: Blastocystis is an opportunistic intestinal protozoan and the pathogenicity of the disease is still unclear. It can cause malnutrition and disrupt growth and development in children. This study aims to detect Blastocystis and determine characteristics and personal hygiene practices.

Methodology: A cross-sectional study, with a sample of 104 students from 8 elementary schools in Kampa District. Detection of Blastocystis using stool culture with Jones Medium. Characteristics of subjects and risk factors using a questionnaire through guided interviews.

Results: The prevalence of Blastocystis was 45.2% and all of them had no symptoms. Most of them had unclean nails (70.2%), did not wash their hands with soap after defecating (57.7%). All students had good behavior in defecating. Generally, students drink from refillable water purchased at drinking water depots, 53.8% of students keep and have contact with pets. There was no significant relationship between personal hygiene and Blastocystis (p>0.05).

Conclusions: The prevalence of Blastocystis is quite high, although no significant relationship was found in this study, teachers and parents still need to pay attention to students' personal hygiene, such as keeping their nails clean and washing their hands with soap after defecating.

Human Metapneumovirus: An Emerging Respiratory Virus

Sonal Chand — 2025-04-01

Human metapneumovirus (hMPV), a significant yet often overlooked respiratory pathogen, causes mild to severe respiratory infections, particularly in children, the elderly, and immunocompromised individuals. Discovered in 2001, hMPV is now recognized globally as a leading cause of acute respiratory infections (ARIs) and severe acute respiratory illness (SARI). It spreads through respiratory droplets and exhibits seasonal peaks, often in winter. Studies in India, such as Chennai’s 2016–2018 surveillance, detected 4% positivity in pediatric ARI cases, aligning with global rates (7–19%). However, India's dense population, high respiratory disease burden, and limited healthcare access pose unique challenges. Unlike the Northern Hemisphere’s winter peaks, India’s tropical climate may influence seasonality, while co-infections with RSV, influenza, and adenoviruses complicate diagnosis. The virus also poses risks for elderly individuals, given India’s rising burden of COPD and asthma. Despite advances in molecular diagnostics, routine hMPV testing remains limited, leading to underreporting. Diagnosis relies on real-time PCR, with multiplex RT-PCR enabling co-infection detection. While no vaccine is available, preventive measures include hand hygiene, respiratory etiquette, and isolating infected individuals. Early detection through clinical suspicion, laboratory testing, and imaging is crucial for effective management. Expanding surveillance and epidemiological studies is vital to understanding hMPV’s burden and guiding public health responses. Strengthening diagnostic capacity and awareness can help mitigate morbidity and mortality, particularly in high-risk populations in India.

Harnessing Mobile Health Technologies to Improve Child Health Outcomes: A Systematic Review of Interventions for Under-5 Year Children in Low- and Middle-Income Countries

Manpreet Kaur Grewal — 2025-04-01

Introduction: The global health policy's main goal is to reduce the under-five mortality rate (U5MR), especially in low- and middle-income countries (LMICs), where children still die of various ailments. Mobile-Based Health (mHealth) methods may help improve health information and access to maternity and childcare services. This systematic review was aimed to evaluate the efficacy of m-Health in enhancing the health of children under five in LIMICs.

Methodology: A search strategy was carried out in the databases like PubMed, CINAHL, SCOPUS, Science Direct, PsycINFO including some grey literature with a focus on the studies published in English 2013 to 2024 were only included. From a total of 518 studies identified, twenty-two satisfied the criteria for inclusion after a selection process.

Results: The results emphasized the impact of m-Health in improving immunization rates, supporting breastfeeding, child growth monitoring, and health-seeking behaviours of the mothers. Text messaging, in particular, has been identified as a cost-effective and widely adopted mobile health approach for behaviour change, adherence to medical recommendations, and promoting healthcare service utilization.

Conclusion: The findings underscore the potential of digital health to bridge gaps in healthcare service delivery in resource-limited contexts, addressing critical shortages in human resources and infrastructure.

Unravelling Breast Cancer Risks and Early Detection Barriers in Above 30-Year-Old Women in Puducherry, India

Sreya Prakash — 2025-04-01

Background: Breast cancer is the leading cause of cancer death among women all over the world and one of the most treatable cancers if detected early. The objective was to find out the lifetime risk of developing breast cancer and various factors associated with its development, and to identify various barriers to early detection of breast cancer among women in Puducherry.

Methodology: A cross-sectional study was conducted among 400 women who attended the outpatient department in the selected urban primary health centre. A proforma recorded information on sociodemographic characteristics, risk factors for breast cancer, and barriers to early detection of breast cancer. The lifetime risk of developing breast cancer was calculated using the Snehita breast cancer risk calculator.

Conclusions: The lifetime risk of developing breast cancer is much higher among the study participants.

Teledentistry – A Multicentric Approach to Promote Oral Health Among Individuals with Cleft Lip and Palate in Rural Areas

Banu Priya S — 2025-04-01

Teledentistry is a novel mode of promoting oral health care. It provides an opportunity for families living in remote areas to access timely/periodic oral healthcare. This approach aims to promote oral health in individuals with repaired cleft lip and palate (CLP) through teledentistry and evaluate its reach. A teledentistry model was implemented in a cohort of individuals with CLP from three rural areas. Teledentistry involved teleconsultations, telemonitoring, and teleeducation through real-time and mobile health methods from a tertiary care center. Over five months, 138 individuals with CLP were teleconsulted, with 64 (46.3%) requiring dental treatment. Teledentistry successfully reached 138 individuals from rural areas, promoting oral health. This approach demonstrates the potential of teledentistry in increasing access to oral healthcare services for individuals with CLP in rural areas.

Pregnancy Outcomes in A Community-Based Cohort Study in Rural Dakshina Kannada

Rashmi Kundapur — 2025-04-01

Introduction: According to the 2011 census report, the 0-6 child sex ratio decreased by 5 points registering 947 female children to 1000 male children in Dakshina Kannada district as compared to 2001 census. The skewed sex ratio can adversely affect society in various ways. The objectives were to determine the proportion of total pregnancy loss and different trimester pregnancy loss in rural Dakshina kannada and to identify the causes of 2nd trimester pregnancy loss.

Methodology: A community based prospective cohort study was conducted in Dakshina Kannada. Multi stage sampling was done with application of thumb rule. Data was entered in Microsoft Excel for data management and data analysis. Total number of pregnancies in each PHC was calculated monthly. Incidence of pregnancy loss for each trimester was calculated along with the proportion of loss in each trimester. Causes for second trimester pregnancy loss was determined using a validated questionnaire.

Results: A total of 5135 pregnancies during the study period in the sampled PHCs were followed up. 138 of the registered pregnancies underwent abortion in various trimester. The proportion of pregnancy loss was found to be 67%, 27.5% and 5% in the first, second and third trimester respectively. Incidence of second trimester pregnancy loss was found to be 0.7%. The major cause for second trimester pregnancy loss was found to be spontaneous.

Conclusion: The study concludes that the proportion of pregnancy loss and incidence of second trimester pregnancy loss in the district is within the normal range.

Development and Preliminary Validation of a Questionnaire on Parental Perception of The Ketogenic Diet

Soma Basu — 2025-04-01

Background: Epilepsy is a prevalent neurological disorder in children, often requiring specialized management strategies. The ketogenic diet (KD), a high-fat, low-carbohydrate therapy, has shown efficacy in reducing seizure frequency in drug-resistant epilepsy. However, adherence is challenging due to dietary restrictions, complexity, and side effects. Understanding parental perceptions is crucial to addressing barriers and improving adherence. This study aimed to develop and preliminarily validate a questionnaire assessing parental perceptions of the KD.

Methodology: Two questionnaires (pre- and post-intervention) were designed to evaluate ten domains, including parental understanding, effectiveness, dietary management, concerns, support, and financial impact. Content validity was assessed using the Content Validity Index (CVI) with expert evaluation based on Lawshe’s method. Six experts, including dietitians and neurologists, reviewed item relevance and clarity. Internal consistency was analyzed using Cronbach’s alpha.

Results: Content validity scores ranged from 0.83 to 1.0 (I-CVI) and 0.94 to 1.0 (S-CVI), indicating excellent validity. Some discrepancies in four domains were resolved through expert consensus. Internal consistency was confirmed with satisfactory Cronbach’s alpha values.

Conclusion: The developed questionnaire demonstrated strong validity and reliability, making it a valuable tool for identifying adherence barriers. Further psychometric testing is required for comprehensive validation.

Prevention of Metabolic Syndrome in Young Population-Public Health Concern

Krishnaveni Desai — 2025-04-01

Norovirus and C. jejuni: Triggering a Guillain-Barré Syndrome Outbreak in Pune?

Akhil R Nair — 2025-04-01