Vol 12, Issue 2, Apr-Jun, 2022

Aim/Background: The rapid growth of population in many developing countries has led to an increased generation of waste notably plastic and this has led to a serious environmental problem, which is of great public health concern. Unacceptable plastic waste disposal, due to insufficient human and financial capacity, is a challenge facing Kenya and other developing countries. This study investigated the effect of “polluter pay” principle on plastic handling and pollution in Lodwar town Turkana County. Materials and Methods: A cross-sectionaldescriptive study design targeting residents of Lodwar town, municipal workers, county National Environment Management Authority officers and public health department officers at the county was adopted. Data were then analyzed with descriptive and inferential statistics with the aid of Statistical Package for Social Sciences version 26. Results: The findings reveal that majority (48.1%) of the residents disagreed that the municipality sets certain fee and charges to the residents for residual waste per household, per square metre living space. In addition, majority (53.9%) also disagreed that Tax system has been put in place for landfill tax for contaminated site remediation. Majority (71.9%) of the residents agreed that Deposit System has been put in place waste types (for example glass bottles, plastic bottles. However, majority (43.2%) of the residents disagreed that there is producer responsibility driven systems for packaging, electric/electronic waste. From the chi-square analysis the “Polluter Pays” Principle is statistically significantly (X2=93.572) associated with plastic waste handling. Conclusion: The study concludes that “polluter pays” principle have a significant effect on plastic waste handling in Lodwar municipality. Contrary the municipality has not put in place for landfill tax for contaminated site remediation. Recommendation: The study recommends that County administration should put in place mechanisms to attract and leverage public private partnership as a vehicle to mobilize resources and enhance private sector participation in sustainable waste management and circular economy development activities. Keywords: Plastic waste, Financial resources, Influence, Waste handling, Lodwar municipality.

Information warfare (IW) involves manipulation, destruction or denying access to information altogether, while maintaining the target’s trust. Psychological operations, a type of IW, concerns majority of public as it aims to degrade their morale through infodemic and fake news. Fake news related to healthcare was present even before the COVID-19 pandemic. There is a broad range of content that comes under it, like communication of inaccurate information with or without any intention to cause harm, mistaken interpretation of satires and information spread with definitive socio-political agenda. We discuss here the various facets of fake news including its burden in the health sector, pathogenesis, the different psychological erspectives of its spread and strategies to counter it. Key words: Communication, Health literacy, Information literacy, Journalism, Psychological warfare.

Background: Mucormycosis is an invasive fungal infection that has shown a surge during the COVID-19 pandemic. A comprehensive assessment of COVID-19 associated mucormycosis (CAM) research is lacking. Methods: We searched Elsevier’s Scopus database for publications on CAM using a pre-defined search strategy. Data on publications numbers, citation metrics, contributing countries, institutions, authors, journals, and the most cited articles were analyzed using select bibliometric tools. Results: Published CAM research included 253 publications. These were cited 1560 times, averaging 6.1 citations per paper. Only 33 (13%) were funded. Original articles (55.7%) and reviews (17.7%) constituted the major share of global output. The studied age groups included adults (22.5%), middle-aged (19.3%), elderly (10.6%), and adolescents (0.8%). Studies on treatment accounted for the largest share (58.5%), followed by clinical studies (28.0%), complications (17.3%), risk factors (11.7%), epidemiology (7.9%), and pathophysiology (3.1%). The participating countries were 64; India, the USA, and Egypt led in productivity, whereas France, the USA, and Iran were more impactful. Of the 84 organizations, the leading organizations were PGIMER-Chandigarh, AIIMS-New Delhi and Cairo University, Egypt. A. Chakrabarti, V. Muthu, and S.M. Rudramurthy were the most productive of 160 participating authors. Indian Journal of Ophthalmology, Indian Journal of Otolaryngology and Head and Neck Surgery, and Journal of Fungi were the most active journals that published CAM research. Conclusion: Research on CAM has primarily been conducted in middleincome countries and is low on quality. High-income countries need to collaborate with lowand middle-income countries for a sustainable and universal CAM research impact. There is also a need to focus on research gaps such as pathophysiology and epidemiology in future CAM research. Key words: Coronavirus disease 2019, Fungal infections, COVID-19 associated mucormycosis, 0.5530/ijmedph.2022.2.11CAM, Bibliometrics.

Aim: This paper investigates vaccine storage and distribution in Kushtia, Bangladesh. Planning and executing the distribution of vaccines and maintaining their quality plays a vital role in preventing the spread of infectious diseases. This study aims to identify the vaccine distribution processes, vaccine handling, and systems management processes to achieve the goal of ensuring the successful operation of the vaccine supply chain system and to help determine if promoting the outsourcing of vaccine cold chain in Kushtia is a viable strategy. Materials and Methods: Survey data was collected from both public and private institutions. The research involved a total of 403 respondents (371 males and 22 females). The study integrates spatial analysis using static maps and web maps and contains data on the most commonly used vaccine, the most needed vaccine, the age group who receives the highest number of vaccinations, vaccine distribution information, vaccine logistics information, inventory information, and finally the problem of vaccine distribution. Results and Conclusion: The study identified that there is a need for proper system storage and distribution in the rural area of Bangladesh and offers recommendations to improve the existing status. Keyword: Vaccination, Immunization, Cold Chain, Kushtia, Bangladesh.

is considered as an integral strategy to achieve universal health coverage. Thus, it is prudent to explore and understand the CHWs individual and the system level interactions and their further translation into performance and actionable domains. Objectives: To quantify the relationship structure between envisioned competencies and CHW performance with factors operating at individual and the immediate system level as effect modifiers. Methods: A cross-sectional study was done in primary rural health care settings of Madhya Pradesh state in Central India. CHWs were stratified as relatively low performing (RLP) and relatively high performing (RHP) based on their annual performance-based incentives for the year (April 2017- March 2018). CHWs were administered a self-reported questionnaire that included socio demographic details, knowledge, skills assessment and availability of logistics. Results: Among the 90 eligible CHWs, 31 RLP and 30 RHP CHWs were interviewed. The CHWs performance was found to be significantly associated with age, education, caste, presence of under 5 children, knowledge and competency scores. However, while adjusting for the confounders only age and educational status were found to be significant. Further cluster analysis revealed two clusters based on individual and system characteristics which was found to influence the CHWs performance. Conclusion: The relationship between the CHWs truest competencies and performance based incentivisation tends to have been influenced by age and education which could help in developing a more focused supportive supervision catering to their needs. Key words: Community health worker, Performance, Health system, Competency, Care, primary health.

Background: Community Medicine specialists play a crucial role in the prevention and control of communicable and non-communicable diseases, monitoring and surveillance, healthcare planning and management and research but the awareness about the speciality even among the medical fraternity is limited. Aim: To determine the perceptions of Medical Professionals from Tertiary care teaching institutes towards the specialty of community medicine and its specialists. Materials and Methods: This was a web based cross-sectional survey conducted in October- November, 2021 among Medical professionals of Tertiary Care Teaching Institutes in the state of Uttar Pradesh, North India using a semi structured, pretested questionnaire circulated as google forms using WhatsApp and personal email ids. Results: A total 406 participants consented and completed the survey questionnaire out of the 456 contacted eligible individuals (response rate 89.04%) of which 231 (57.0%) were males and 175 (43.0%) were females. Majority (83.0%) of the participants agreed that the ‘information and knowledge gained in Community Medicine by them would certainly help in their future medical practice” and an overwhelmingly majority (91.1%) agreed to the statement that ‘a physician can’t effectively control most infectious disease without adequate knowledge of Epidemiology’. Around 70% of the participants agreed that Community Medicine Specialists have good work life balance and 87.4% agreed that speciality of Community Medicine offers adequate scholarly and research opportunities. Further, 77.6% of the participants agreed that Community Medicine has enough opportunities for direct public contact compared to other specialty and around 64% agreed that the speciality offers the opportunity to utilize newer technologies, Artificial Intelligence and Machine Learning. Around 61% of the participants agreed that COVID-19 pandemic will affect the choice of specialty among the PG aspirants. Conclusion: Majority of the Medical professionals have positive perceptions towards the speciality of Community Medicine and its specialists. The COVID-19 pandemic may be an important cause for the changing perception towards the speciality among the medical fraternity. Key words: Perception, Medical Professionals, Community Medicine, Speciality, COVID-19, Pandemic.

Community Medicine specialists play a crucial role in the prevention and control of communicable and non-communicable diseases, monitoring and surveillance, healthcare planning and management and research but the awareness about the speciality even among the medical fraternity is limited. Aim: To determine the perceptions of Medical Professionals from Tertiary care teaching institutes towards the specialty of community medicine and its specialists. Materials and Methods: This was a web based cross-sectional survey conducted in October- November, 2021 among Medical professionals of Tertiary Care Teaching Institutes in the state of Uttar Pradesh, North India using a semi structured, pretested questionnaire circulated as google forms using WhatsApp and personal email ids. Results: A total 406 participants consented and completed the survey questionnaire out of the 456 contacted eligible individuals (response rate 89.04%) of which 231 (57.0%) were males and 175 (43.0%) were females. Majority (83.0%) of the participants agreed that the ‘information and knowledge gained in Community Medicine by them would certainly help in their future medical practice” and an overwhelmingly majority (91.1%) agreed to the statement that ‘a physician can’t effectively control most infectious disease without adequate knowledge of Epidemiology’. Around 70% of the participants agreed that Community Medicine Specialists have good work life balance and 87.4% agreed that speciality of Community Medicine offers adequate scholarly and research opportunities. Further, 77.6% of the participants agreed that Community Medicine has enough opportunities for direct public contact compared to other specialty and around 64% agreed that the speciality offers the opportunity to utilize newer technologies, Artificial Intelligence and Machine Learning. Around 61% of the participants agreed that COVID-19 pandemic will affect the choice of specialty among the PG aspirants. Conclusion: Majority of the Medical professionals have positive perceptions towards the speciality of Community Medicine and its specialists. The COVID-19 pandemic may be an important cause for the changing perception towards the speciality among the medical fraternity. Key words: COVID-19, Anxiety, Depression, Stress, Community Psychiatry, Vaccination.

Background: Oral health is now increasingly regarded as a crucial component of overall healthand well-being. Fluoride varnish (FV) is thought to be safe, well-tolerated by children and simple to administer by health professionals for the prevention of dental caries. Since the year 2000, various reviews on the use of fluoride therapy in the prevention of dental caries have been published, but none on the frequency of fluoride varnish application. Hence aim of this systematic review is to evaluate the frequency of fluoride varnish application for prevention of dental caries in children. Objectives: To assess the effectiveness of frequency of fluoride varnish application in prevention of dental caries among preschool children. Methodology: Search Strategy: We searched the following databases for Randomized controlled trials (RCTs) in PubMed, Cochrane, Wiley, Proquest, Science Direct and Google Scholar which yielded 5657 articles. After screening the titles, 5657 articles were ruled out since they were unrelated to the systematic review’s goals. The remaining 75 articles were searched for duplication using Mendeley Software. Out of 75 articles, 12 articles were found to be duplicates. The remaining 63 articles were screened through abstracts and full text screening as next step. Out of 63 articles, 53 were excluded for various reasons like did not meet the inclusion criteria. Finally, 10 articles were qualitatively analyzed after which they were included in the systematic review and 6 in meta-analysis. Various key words included for screening were “Fluoride Varnish”, Dental Caries”, “Varnish Effectiveness” and “Frequency”. Extraction of the information and assessment of the methodological quality of the included studies using Risk of Bias was done by two authors (DV and RS). Meta-analysis using the random-effects model was conducted for the outcome (dmft score) after application of fluoride varnish. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals. Study Eligibility: All the studies published from January 2005 to April 2020, conducted among children between 0 to 5 years, articles published in English language were included. Studies conducted on animals, a review and a systematic review, participants aged above 5 years were excluded. Study appraisal and synthesis methods: Studies were assessed for quality with opportunities. Further, 77.6% of the participants agreed that Community Medicine has enough opportunities for direct public contact compared to other specialty and around 64% agreed that the speciality offers the opportunity to utilize newer technologies, Artificial Intelligence and Machine Learning. Around 61% of the participants agreed that COVID-19 pandemic will affect the choice of specialty among the PG aspirants. Conclusion: Majority of the Medical professionals have positive perceptions towards the speciality of Community Medicine and its specialists. The COVID-19 pandemic may be an important cause for the changing perception towards the speciality among the medical fraternity. Key words: COVID-19, Anxiety, Depression, Stress, Community Psychiatry, Vaccination.

Long term venous access is needed in patients suffering from cancer for administering drugs, chemotherapy, blood collection, transfusions etc. Central venous catheters introduced in the 1980s have been a boon for these patients minimizing their need for repeated trauma. Of the various types of central venous access devices (CVAD’s) available, in developing countries like India, some of the limiting factors to decide what type of CVAD is used are the cost involved and the necessary training for the maintenance of the device. Our aim was to review our experience of PICC (Peripherally inserted central catheter) lines over 3 years, to analyze conditions for which PICC lines were used, catheter indwelling period, incidence and types of complications, reasons for removal and quality of life of these patients. We also attempted to compare costs of PICC lines with Chemoport management in our institute. Total 100 patients were followed up for 3 consecutive years, of which 75 were solid tumours and 25 were haematological. The median age was 33 years (Range 2 –77 ). The average duration of indwelling catheter is ranged 2 days–12 months. PICC line was found to be more cost-effective than Chemoport insertion in the overall scenario. 21% of patients had complications related to the management of PICC lines. The overall quality of life was maintained well with PICC line. Conclusion: PICC lines in oncology patients are reasonably safe for long lasting CVAD with acceptable incidence of complications. They are also cost effective compared to Chemoports in developing countries. Keywords: Safe and reliable CVAD, Cost-effective, PICC lines, Acceptable complications, Long lasting.

Background and Aim: Breast cancers are relatively rare among young women amounting up to 6% of all breast carcinoma cases reported in that age group. In younger age groups, breast cancers, though, have a more aggressive behavior and poorer outcome in comparison to patients in the elderly age groups. The aim of the present study was to evaluate the histopathological characteristics of breast carcinomas reported in patients lesser than 40 years of age. Materials and Methods: Surgical specimens of carcinoma breast received at the Department of Pathology in a tertiary care hospital for a period of 2 years from January 2014 to December 2015 were included in the study. The histo-pathological slides were reviewed and clinical data was collected from the archival records and compared. Statistical analysis was done using IBM SPSS statistics 17 (Chicago, USA). Various tumor characteristics were correlated with the morphological features and the other clinico-pathologic data using Chi-square value (c2), paired t-test and Fischer’s test. p<0.05 was considered to be statistically significant. Results: Infiltrating Ductal Carcinoma-Not otherwise specified (IDC-NOS) was found to be the most common variant of breast carcinoma in both the younger and the elderly age groups followed by the invasive lobular carcinoma and mucinous carcinoma in the younger and invasive lobular carcinoma and mucinous carcinoma and papillary carcinoma in the elderly age groups. Also, stage II followed by stage III were the commonest stages reported in the younger and elderly age groups based on their prevalence as against stage I and IV (p=0.006). Conclusion: Breast cancers diagnosed in younger age groups present with an aggressive behavior and poorer outcome in comparison to patients in the elderly age groups. Also, such cancers often tend to present with advanced stages of the disease process and high grades of tumor with lymph nodal involvement and metastasis at the time they are first diagnosed conferring an inferior prognosis illustrating the need for more clinical trials to be conducted on younger patients with breast cancers with an aim to improve the overall outcome in this age group. Key words: Breast cancers, Tertiary care settings, Younger age groups, TNM staging, Histo-pathology.