Publications by authors named "Rajesh Kumar Sinha"

10 Publications

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Assessment of Nutritional Status of Mothers of Children Under 3 Years of Age and Its Determinants.

Indian J Community Med 2020 Oct-Dec;45(4):440-444. Epub 2020 Oct 28.

Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Objective: The study was conducted to identify associated factors of severe wasting among mothers.

Methodology: A prospective 12 months' study was conducted in 30 randomly selected villages of Khutpani Block of West Singhbhum with a sample of 600 households with children between 0 and 3 years of age using the prevalence of wasting in West Singhbhum district National Family Health Survey, precision of 0.05, design effect of 2 and accounting for error of 10%. Data on socioeconomic status, maternal anthropometry mid-upper arm circumference (MUAC), water, sanitation and hygiene (WASH) practices, gender-based violence, and food security were collected. Data collection was done between July 2017 and June 2018.

Results: Wasting and severe wasting prevalence using MUAC criteria among mothers were found to be 60% and 17%, respectively. The study showed higher rate of severe maternal wasting among households facing poverty, food insecurity, poor WASH practices especially related to hand washing and toilet use and women who faced gender-based violence.

Conclusion: Nonnutritional interventions addressing poverty, household food insecurity, gender violence, and WASH practices are required to address maternal wasting, in addition to existing nutritional programs.
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October 2020

Evaluation of a training program for life skills education and financial literacy to community health workers in India: a quasi-experimental study.

BMC Health Serv Res 2021 Jan 8;21(1):46. Epub 2021 Jan 8.

MAMTA Health Institute for Mother and Child, Delhi, India.

Background: Accredited Social Health Activists (ASHA) are community health workers responsible for improving the health status of people by facilitating their access to healthcare services. The life skills of ASHA are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on life skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about life skills and financial literacy.

Methods: We conducted a quasi-experimental, non-randomized, controlled study with pre-and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to life skills (communication skills, self-confidence, problem-solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, change perceptions on gender-, life skills-, and savings-related practices at the personal, community, and workplace levels were assessed in the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four life skills, financial literacy, and change perceptions on practices were correlated. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables.

Results: We analyzed the data of 171 ASHAs (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the life skills and financial literacy in the intervention group (p < 0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for change perceptions on practices) was positively associated with ASHAs aged 38 and above and with experience of ≤12 years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12 years of experience.

Conclusions: The P.A.C.E training program was found effective in improving the life skills and financial literacy of ASHAs in India.
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January 2021

A Preliminary Study of Real-time Capturing and Sharing of Routine Health Data among the Public Health Professionals.

Indian J Community Med 2020 Apr-Jun;45(2):176-180. Epub 2020 Jun 2.

Amity Medical School, Amity Education Valley, Amity University Haryana, Manesar, Haryana, India.

Context: Electronic health record (EHR) has the potential to make available the real-time data of the patient to the healthcare professionals by connecting all levels of the public health system, irrespective of their geographical boundaries.

Aim: This study aims to test the capturing and sharing of real-time patient data at primary, secondary, and the tertiary level.

Settings And Design: The cloud-based EHR system developed earlier was used to capture real-time data of the patient visiting a primay health center (PHC) in Udupi District of Karnataka.

Subjects And Methods: About 100 patient records including laboratory and pharmacy data have been captured into the EHR system. The confidentiality of patient data is assured.

Results: The result of the study indicated no errors while capturing and sharing the patient data in real time. The system also evidenced the availability of vital statistics about the patient visiting PHCs. The system also allowed the professionals at referral level to view patient data for providing quality healthcare.

Conclusion: EHR plays a vital role in capturing, storing, and sharing patient data for providing quality healthcare and it should be made mandatory by the central health agencies in the provision of patient care and reporting of notifiable communicable diseases at all levels.
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June 2020

Effects of participatory learning and action with women's groups, counselling through home visits and crèches on undernutrition among children under three years in eastern India: a quasi-experimental study.

BMC Public Health 2019 Jul 18;19(1):962. Epub 2019 Jul 18.

Institute for Global Health, University College London, London, UK.

Background: India faces a high burden of child undernutrition. We evaluated the effects of two community strategies to reduce undernutrition among children under 3 years in rural Jharkhand and Odisha, eastern India: (1) monthly Participatory Learning and Action (PLA) meetings with women's groups followed by home visits; (2) crèches for children aged 6 months to 3 years combined with monthly PLA meetings and home visits.

Methods: We tested these strategies in a non-randomised, controlled study with baseline and endline cross-sectional surveys. We purposively selected five blocks of Jharkhand and Odisha, and divided each block into three areas. Area 1 served as control. In Area 2, trained local female workers facilitated PLA meetings and offered counselling to mothers of children under three at home. In Area 3, workers facilitated PLA meetings, did home visits, and crèches with food and growth monitoring were opened for children aged 6 months to 3 years. We did a census across all study areas and randomly sampled 4668 children under three and their mothers for interview and anthropometry at baseline and endline. The evaluation's primary outcome was wasting among children under three in areas 2 and 3 compared with area 1, adjusted for baseline differences between areas. Other outcomes included underweight, stunting, preventive and care-seeking practices for children.

Results: We interviewed 83% (3868/4668) of mothers of children under three sampled at baseline, and 76% (3563/4668) at endline. In area 2 (PLA and home visits), wasting among children under three was reduced by 34% (adjusted Odds Ratio [aOR]: 0.66, 95%: 0.51-0.88) and underweight by 25% (aOR: 0.75, 95% CI: 0.59-0.95), with no change in stunting (aOR: 1.23, 95% CI: 0.96-1.57). In area 3, (PLA, home visits, crèches), wasting was reduced by 27% (aOR: 0.73, 95% CI: 0.55-0.97), underweight by 40% (aOR: 0.60, 95% CI: 0.47-0.75), and stunting by 27% (aOR: 0.73, 95% CI: 0.57-0.93).

Conclusions: Crèches, PLA meetings and home visits reduced undernutrition among children under three in rural eastern India. These interventions could be scaled up through government plans to strengthen home visits and community mobilisation with Accredited Social Health Activists, and through efforts to promote crèches.

Trial Registration: The evaluation was registered retrospectively with Current Controlled Trials as ISCRTN89911047 on 30/01/2019.
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July 2019

Determinants of Stunting, Wasting, and Underweight in Five High-Burden Pockets of Four Indian States.

Indian J Community Med 2018 Oct-Dec;43(4):279-283

Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Objectives: Prevalence of under-nutrition is very high in India. Under-nutrition is a result of interplay between different immediate, underlying, and basic causes. The study was conducted with the objective to identify significant predictors of stunting, wasting, and underweight.

Methods: Cross-sectional studies with 2299 children from five high-burden pockets of four Indian states were conducted. Primary data on their anthropometric measurements along with their households' demographic and socioeconomic characteristics were collected. Binary logistic regression analyses were performed to examine the predictors of stunting, wasting, and underweight.

Results: Results show very high prevalence of stunting, wasting, and underweight in all five regions covered in the study. Multivariate analyses show that food security, use of toilets, and low body mass index status of mothers were the major predictors of stunting and underweight among children. Acute respiratory infection disease was the major predictor of underweight and diarrhea was the major predictor of stunting. Younger children (<24 months) had lower odds of underweight and stunting compared to older children (24-59 months). The analyses showed higher odds of wasting among male children. Regional variations were also seen in the study with higher odds of underweight and wasting in Khuntpani block and higher odds of stunting in Naraini block.

Conclusion: The above findings indicate that for comprehensively addressing child under-nutrition, it is very important to address maternal nutrition, improve food security, and reduce poverty status, provide better water and sanitation facility to the community, control infections, and address regional disparity.
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January 2019

Spatio-Temporal Risk-Analysis of Cancer Endemicity in Sulthan Bathery Taluk of Wayanad District of Kerala-A Geo-Informatics Approach.

Indian J Community Med 2018 Jul-Sep;43(3):199-203

Department of Emergency Medicine, Fortis Hospital, Mumbai, Maharashtra, India.

Context: Asian countries have to confront with the global burden of cancer and various environmental factors predisposing the incidence. Geoinformatics can assist in spatial autocorrelation and statistical analysis in determining environmental and demographic correspondence to endemicity. What is of prime importance is the availability of the spatial datasets of cancer cases.

Aims: The aim of this study was to reveal the distribution pattern of cancer and its magnitude in the eight panchayats of Sulthan Bathery Taluk of Wayanad district. The present study also attempted to develop and implement a data frame facilitating better data collection.

Settings And Design: This was a taluk-level cross-sectional retrospective analysis and interventional study.

Subjects And Methods: A retrospective survey created a geodatabase with 547 cancer cases registered along the timeline of 2015-2016. Input datasets were geocoded using Google Earth Pro software.

Statistical Analysis Used: The analysis was performed using ArcMap-10.2 version.

Results: Registration revealed the high breast cancer incidences and temporal increment mainly in town areas. The incidence depicted male predominance and prevalence along the age group of 30-69 years. The pattern showed cancer incidence at a proximity to state borders and forest regions (Noolpuzha) which are high population density regions, instantiated relation of geographic variables, and cancer incidences. The implementation of data frame ensured structured data collection.

Conclusions: This study concluded the spatial association of cancer incidence demonstrating the high-risk regions with male predominance and role spatial risk analysis in cancer database management.
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October 2018

Economic evaluation of participatory learning and action with women's groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India.

Cost Eff Resour Alloc 2017 21;15. Epub 2017 Mar 21.

UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH UK.

Background: Neonatal mortality remains unacceptably high in many low and middle-income countries, including India. A community mobilisation intervention using participatory learning and action with women's groups facilitated by Accredited Social Health Activists (ASHAs) was conducted to improve maternal and newborn health. The intervention was evaluated through a cluster-randomised controlled trial conducted in Jharkhand and Odisha, eastern India. This aims to assess the cost-effectiveness this intervention.

Methods: Costs were estimated from the provider's perspective and calculated separately for the women's group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees (VHNSC) conducted in all trial areas. Costs were estimated at 2017 prices and converted to US dollar (USD). The incremental cost-effectiveness ratio (ICER) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions. ICERs were calculated for cases of neonatal mortality and disability-adjusted life years (DALYs) averted.

Results: The incremental cost of the intervention was USD 83 per averted DALY (USD 99 inclusive of VHSNC strengthening costs), and the incremental cost per newborn death averted was USD 2545 (USD 3046 inclusive of VHSNC strengthening costs). The intervention was highly cost-effective according to WHO threshold, as the cost per life year saved or DALY averted was less than India's Gross Domestic Product (GDP) per capita. The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses. The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective.

Conclusion: Participatory learning and action with women's groups facilitated by ASHAs was highly cost-effective to reduce neonatal mortality in rural settings with low literacy levels and high neonatal mortality rates. This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality settings.
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March 2017

Social determinants of inequities in under-nutrition (weight-for-age) among under-5 children: a cross sectional study in Gumla district of Jharkhand, India.

Int J Equity Health 2016 07 8;15(1):104. Epub 2016 Jul 8.

Ekjut- NGO in India, Chakradharpur, West Singhbhum, Jharkhand, India.

Background: Jharkhand, a state with substantial tribal population in Eastern India has very high rate of undernutrition. The study tries to understand the social determinants of inequities in under-nutrition (weight-for-age) among children aged less than 5 years, in Gumla District of the State.

Methods: Cross sectional study of 1070 children from 32 villages of 4 Blocks of Gumla District.

Results: 54.3 % (95 % CI 51.3-57.3) children were found to be underweight (less than -2SD), with insignificant difference between girls and boys. Multivariate analysis showed that poverty was the single most important predictor of undernutrition, where a child from the poorest quintile was 70 % more likely to be underweight (aOR 1.70, CI 1.13-2.57), compared to one from the least poor group (Quintile 5). While the difference in weight-for-age status between Scheduled Tribes and "OBC and other communities" was non-significant (95 % OR 1.12, CI 0.88-1.42) in the study context; community disaggregated data revealed that there were large variations within the tribal community, and numerically smaller communities also ranked lower in wealth, and their children showed poorer nutritional status. Other factors like maternal education beyond matriculation level also had some bearing. Bivariate analysis showed that chances of a child being underweight (<-2SD) was 43 % more and being severely underweight (<-3SD) was 26 % more for mothers with less than 10 years of schooling compared to those who had attended school for more than 10 years. Educational attainment of mothers did not show any significant difference between tribal and non-tribal communities.

Conclusion: Overall nutritional status of children in Gumla is very grim and calls for immediate interventions, with universal coverage. Risk was almost equal for both genders, and for tribal and non-tribal population, though within tribal communities, it was slightly higher for smaller tribal communities, calling for soft targeting. Comprehensive programme addressing poverty and higher education for girls would be important to overcome the structural barriers, and should be integral part of any intervention. The study highlights the importance of soft targeting vulnerable communities within the universal coverage of government programmes for better nutritional outcomes.
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July 2016

Attitude of Ayurveda doctors toward the impact of health information technology.

J Ayurveda Integr Med 2015 Apr-Jun;6(2):89-94

Department of Health Information Management, School of Allied Health Sciences, Manipal University, Udupi, Karnataka, India.

Background: Health information technology (HIT) equips healthcare professionals with the required information and tools for making quality decisions in patient care, but it is always advisable to assess their attitude before its actual implementation.

Objectives: To assess the attitude of Ayurvedic doctors toward the impact of HIT.

Materials And Methods: A cross-sectional survey was carried out among 140 doctors of an Ayurvedic center of Southern India. A validated questionnaire consisting of 18 questions based on a 5-point Likert scale was administered to the participants after receiving their due consent.

Results: About 75-80% of the respondents concurred that the HIT application, such as electronic health record, has the potentials to reduce the duplication of documentation work, is easy and has an instant processing and real-time access to patient information. They also felt the need of such application to report the patient data to local and national health institutions. A total of 85% of them mentioned that these applications can make the collection and accessibility of patient data much easier compared with paper-based records, whereas 87.4% of them claimed telemedicine as a platform for multidisciplinary collaborative research and patient care.

Conclusion: Even though most of the respondents agreed about the role of HIT in improving the quality of health care, there were many who held no opinion about HIT, including privacy and security of patient data. The need of proper awareness and training program is identified to make them aware about the HIT and its application in patient care, education and research.
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July 2015

In vitro plant propagation of Catharanthus roseus and assessment of genetic fidelity of micropropagated plants by RAPD marker assay.

Appl Biochem Biotechnol 2013 Feb 6;169(3):894-900. Epub 2013 Jan 6.

Centre for Biological Sciences-Biotechnology, School of Earth, Biological and Environmental Sciences, Central University of Bihar, BIT Campus, Patna 800014 Bihar, India.

An investigation was carried out to develop an efficient micropropagation protocol for Catharanthus roseus. Experiments were conducted to optimize suitable media for in vitro shoot multiplication and root induction. Out of the different media compared for in vitro shoot multiplication, Murashige and Skoog (MS) medium supplemented with 1 mg/l of 6-benzylaminopurine and 0.2 mg/l α-naphthaleneacetic acid showed better response in terms of the emergence of shoots from axillary buds as well as proliferation and multiplication of shoots. The shoots when placed on half strength of MS medium having 1 mg/l indole 3-butyric acid and 0.25 % charcoal showed cent percent root induction with maximum number of roots per shoot (4.2) as well as maximum root length (1.72 cm). Further, clonal fidelity of the in vitro-raised plants was carried out using randomly amplified polymorphic DNA marker and results indicated that all the tissue culture-derived plants are true-to-type and there were no somaclonal variations among these plants.
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February 2013