Journal of Education and Health Promotion

Abstract BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a considerably common 
childhood‑onset neurodevelopmental disorder, often associated with socio‑behavioral and academic 
difficulties. There is an increased risk for development of a range of future problems such as 
psychiatric disorders, difficulties in employment, and relationships. The aim of this study was to know 
the prevalence and determinants of ADHD among primary school children in district Dehradun and 
to assess the learning difficulties and classroom behavior in these students.
MATERIALS AND METHODS: In this cross‑sectional study, overall, 228 students (aged 6–12 years) 
studying in a primary school were assessed for ADHD after seeking the written informed consent from 
their parents. The data were analyzed using Excel sheet and SPSS software (22.0 version). For all 
qualitative measures, frequency and percentages were calculated, and for quantitative measures, 
mean and standard deviation were calculated. For analysis of categorical values, Chi‑square test 
was used. P < 0.05 was considered statistically significant.
RESULTS: The prevalence of ADHD was found to be 11.8% based on the teacher tool only and 
1.75% based on the parent and teacher tools combined. ADHD was found to be significantly more 
in males. Inattention was the most prevalent subtype of ADHD, and children screened positive for 
ADHD had significant learning difficulties at various levels.
CONCLUSION: The possibility of ADHD in students with academic difficulties should not be ignored 
as children with ADHD usually face significant problems at school such as learning difficulties and 
have been shown to be at increased risk for a broad range of negative outcomes. Early identification 
and treatment of ADHD can significantly reduce the rates of some of these poor outcomes. Screening 
these children in the early years will help the parents, children, teachers, and community at large.

Abstract BACKGROUND: According to the perception of majority of people, especially the elderly, it is believed 
that elderly people who are sent to old‑age homes are more prone to have depression compared 
to those who are living with the community. This study was aimed to assess the significance of the 
place of residence in relation to the presence of depression among the elderly.
MATERIALS AND METHODS: A cross‑sectional descriptive study was conducted between March 
and August 2020 to assess the depression among the elderly population residing in the Muar 
district, of Malaysia. A random table was generated of 250 house numbers in Muar where there is 
at least one geriatric person was living and a random sampling method was used for data collection. 
A questionnaire was distributed to a sample size of 250 old folks of Muar: those residing in old‑age 
homes (n = 125) and those residing in their own houses (n = 125). A standard sociodemographic and 
geriatric depression scale interview was employed for data collection. All details were keyed into the 
SPSS version 22 software Standard Gradpack 23, and simple description and inferential statistics 
such as mean, median mode, percentages, and Chi‑square tests were performed to compare the 
effects of different residences toward the mental health of the elderly.
RESULTS: The total mean age of the elderly in both the places was 73.06 ± 9.116 years. Female 
respondents of this research accounted for 52.8%. In terms of religion, Islam had the highest number 
of respondents of 46.8%, followed by Buddhist (33.6%), Christian (10.8%), and Hindu (8.8%). 
The percentage of elderly having more than three children was 45.2%. The marital status and 
employment status of the elderly in Muar area are mostly widowed (40.8%) and retired (50%). They 
are predominately literate (81.6%) and most have a monthly income less than RM 2000 (90.8%). 
We found that the prevalence rate of depression was 70.4% in the elderly residing in old‑age homes 
and 24.8% in the elderly living in the community. Females had a higher prevalence of depression 
than males (60.2% vs. 39.8%) among the elderly in old‑age homes, whereas males had a higher 
prevalence in the community than females (51.6% vs. 48.4%). Logistic regression analysis revealed 
the place of residence (P < 0.01 and employment status (P = 0.011) as the predictors of depression.
CONCLUSION: Results of this study revealed that the high prevalence rate of depression among 
the elderly is in old‑age homes compared to elderly living in the community.

Abstract BACKGROUND: The acceptability of hospital staff in the use of hospital information management
system (HIMS) is an emerging research area it can explain the fate of any HIMS development and
implementation project in hospitals. The aim of this study was to observe the level of acceptance of
HMIS among nursing officials working at a teaching hospital.
MATERIALS AND METHODS: This cross‑sectional study was conducted for 1 year in a teaching
hospital of northern India by using a pretested questionnaire. Our study participants were nursing
officers who were not under the probation period and we used a purposive sampling (10% nurses
from each ward). Our sample size was 256.
RESULTS: We have observed that majority of 174 (67.96%) participants had good acceptability
to the HIMS system. Our study revealed that most of the participants were aware of HIMS. Among
all participants, nearly half of them had good acceptability to the HIMS system. This is may be due
to their job profiles, distribution of their working places, and their past experiences with HMIS. The
bottlenecks such as connectivity problem, error prevention, and lack of training can be addressed
by the hospital management by proper measures.
CONCLUSION: The acceptance level of HIMS among the nursing officials working in a teaching
hospital was good.

Abstract BACKGROUND: Patient satisfaction is a comprehensive measurement of patients’ happiness with
the level of health care delivered to them both inside and outside the physician’s office. It is commonly
used as an indicator to assess the health‑care quality and affects a wide range of components related
to the provision of health services such as ease of access, medical malpractice, and clinical outcomes.
The study aimed to analyze patients’ satisfaction with the quality of health care they received at
the outpatient department of Klinik Kesihatan Maharani Muar Healthcare Facility (KMMHF), Johor.
MATERIALS AND METHODS: This cross‑sectional study was conducted between August and
December 2019 period. Demographic information and information on patients’ feelings about their
physicians, treatment, and health facilities provided were collected from 407 consented patients in a
simple random sampling survey using a researcher‑made, an adapted Medical Interview Satisfaction,
questionnaire which was pilot tested before administration to the patients. Data were analyzed with
SPSS version 23. Descriptive statistics and correlational and group comparison analyses were utilized.
RESULTS: Of the 407 patients studied for physician–patient satisfaction, the overall mean of all the
respondents responding was 4.089 ± 0.5, which was ranked the highest among the three objectives.
The effectiveness of treatment came as the second highest with the overall mean of 4.088 ± 0.5.
Finally, the overall health‑care facilities had the lowest overall mean of 4.077 ± 0.5 among the three.
CONCLUSION: Most patients who visited KMMHF were mostly satisfied with the outcomes of
physician–patient interaction in the clinic.

Abstract INTRODUCTION: We know that risk communication is equally important as risk identification, which
is usually not communicated properly to the patients and resulting in poor outcomes, especially in
hypertensive patients.
OBJECTIVE: Our study objective was to evolve and test a colour coded client segmentation based
public health approach to educate the community to deal with problem of hypertension.
METHODOLOGY: This cross‑sectional pilot study was done in March 2020 among purposively approached
in a primary health centre to 100 people aged above 18 years, among them 41 gave written consent for the
study and their demographic information was noted. They were given colour coded cards as per the current
blood pressure level and previous history of hypertension. On each colour coded card, specific advice
was written for that category. For all the participants, blood pressure and treatment seeking behaviour was
noted. For hypertensive patients, adherence to medication and non‑pharmacological measures was noted.
RESULTS: Mean age of the participants was 46.5 ± 13.06 years. Mean systolic blood pressure (SBP)
and diastolic blood pressure (DBP) of the participants were 135 ± 16.85 mm Hg and 86 ± 11.42
mm Hg, respectively. Among the participants, 10 (24.39%) had a known history of hypertension.
Among them, as per the blood pressure levels measured on the day of the study 50% (5) had their
blood pressure levels under control. Interestingly 16 (39%) participants were found hypertensive
incidentally.
DISCUSSION: It is evident from the studies that colour coded approach is used in multiple ways, in
multiple settings, for multiple diseases. To our knowledge, little focus has been given for hypertensive
disorders in the community level. We merely bother about making their risk profiling, even in the
digital age. Sometimes physicians in emergency become puzzled whenever patients collapsed in front
of them and we missed the “Golden Hour” for the treatment by searching patients’ medical details.
CONCLUSION AND RECOMMENDATIONS: The above problem can be solved by risk profiling of
chronic patients by colour coded OPD/Health cards.

Abstract Due to the short span available for consultation with clinicians, patients try to become well versed
with their clinical conditions before the medical consultation. They search Google for their medical
information; here comes the problem of authenticity of the sources. It is very difficult to obtain authentic
medical information for the patients from the Internet. As a result, sometimes, patients ask questions
to the overburdened doctors and irritate them. To solve this problem and wider dissemination of
authentic medical knowledge, the existing website of Post Graduate Institute of Medical Education
and Research (PGIMER) has been utilized. In PGIMER, Chandigarh, health education materials in
text and video formats have been uploaded on the PGIMER website for empowering patients. All
these have been successfully tested in the outpatient departments of PGIMER, Chandigarh. To our
knowledge, this unique approach is the first of its kind in India. We hope this approach of sharing
medical information through the PGIMER website may help patient empowerment to a large extent.
Later, this concept can be replicated in all medical colleges in India.

Abstract

Abstract

Abstract BACKGROUND: Training of health‑care providers about the various aspects of biomedical
waste (BMW) management and handling (M and H) rules can improve the safe disposal of BMW
and protect the patients and public from related hazards.
OBJECTIVES: Our study objective was to evaluate the existing knowledge regarding BMW
management rules among selected health‑care professionals and to evaluate the impact of training
program on BMW management on the knowledge and practices of health‑care professionals.
METHODOLOGY: The training program on BMW management rules was conducted in April 2018.
A total of 250 participants were trained. A structured validated questionnaire was used. The data
were analyzed, and the mean score of pre‑ and post‑test was compared by the paired‑t test.
RESULTS: Majority of the participants were female (83%) aged 20–30 years (56%). The majority
of the participants were married (74%) and were from urban areas (74%). The mean pretest and
posttest score were 14.00 and 19.94 respectively (P < 0.000).
CONCLUSION: The structured training on all aspects of BMW management led to statistically
significant improvement in the knowledge among health‑care professionals.
RECOMMENDATIONS: Such training programs need to be regularly conducted.

Abstract INTRODUCTION: In this era of globalization, urbanization, and rapidly expanding unhygienic food
corners across the globe, the incidence of food poisoning is very common nowadays.
AIM: The aim of our study was to investigate the perceptions and readiness of schoolteachers to
accept notifications on food poisoning as a part of education to the students.
METHODOLOGY: A descriptive cross‑sectional study was carried out with the help of a validated
questionnaire for data collection. Our research involved schoolteachers from both primary and
secondary schools in Muar. The questionnaire was pretested among the eligible trainee teachers
and yielded an internal consistency reliability coefficient (c = Cronbach’s alpha) of 0.082. This study
was conducted from October 29, 2017, to December 14, 2018, in Muar. Our sample size was 259.
Ethical consent was obtained from the Institution Ethical Committee.
RESULTS: A total of 259 schoolteachers from both primary and secondary schools in Muar were
included in this study. In our study, 81.1% of the teachers responded that they can easily educate
their students about food poisoning. Most of them (93.1%) were ready to receive notifications on food
poisoning in any mode, and about 72% of the teachers preferred WhatsApp as their mode of receiving
notification. The least (1.2%) preferred mode of notification was LINE (a social app). Teachers’
willingness to disseminate the information regarding food poisoning was also higher (98.5%).
CONCLUSIONS: We concluded that majority of the schoolteachers had a good perception and
were ready to receive the notifications on food poisoning through WhatsApp as a part of education
to the students.

Abstract INTRODUCTION: Disaster can occur at any time any place. Disaster preparedness plays an important
role to reduce the loss of a community/country. The aim of this interventional study was to ascertain
the impact of a video‑based educational intervention program on improvement in knowledge and
attitude of paramedical students in a hospital.
MATERIALS AND METHODS: A pre–post study (interventional study design) was conducted on
paramedic students. Our study period was 6 months which was divided into Phases I, II, and III. For
administrative purpose, we included all paramedical students, and our sample size was 119. The
baseline assessment of knowledge and attitude of paramedic students was done by a pretested
questionnaire (Observation 1) with having a baseline scoring. After that, intervention Phase 1 was
implemented, and later, end line observation (Observation 2) was made. Changes in knowledge and
attitude were observed by the score difference (Observation 2–Observation 1). Descriptive statistics
were calculated, and the mean of cumulative score was compared using the Wilcoxon signed‑rank
test. We applied Mann–Whitney U‑test for finding associations between dependent variables with
an independent variable using SPSS version 22 (IBM, Chicago, USA) software.
RESULTS: Our baseline results showed that most of our participants had average
knowledge (54.6%), followed by poor knowledge (24.4%). Approximately one‑fifth (21.0%) of the
participants had good knowledge regarding disaster preparedness.   A significant improvement was
observed in cumulative score (P < 0.005). A significant difference was observed in knowledge and
attitude with respect to age and courses (P < 0.05). Forty percent of the students responded that
they would like to get trained by that mock drill, and 26.1% were interested in disaster preparedness
workshops in the future.
CONCLUSION: Our present study results indicate that the overall knowledge and attitude level of
the students was average and required improvement. A similar result was reported in some studies
conducted globally for the same purpose. All of our students perceived that training for disaster
preparedness is necessary for all health facilities, and it is important to have an emergency plan
and disaster management committee. Regarding training methods, most of our students liked our
interactive audiovisual method. However, their preferred methods were mock drill and workshops.
It can be arranged in the future for them.

Abstract INTRODUCTION: Financial support system available to geriatric populations affects their adherence
level to the prescribed treatment leading to a rise in chronic disease burden.
OBJECTIVE: The aim of this study was to ascertain the disease pattern, health expenditure, and
adherence to the prescriptions among geriatric patients reporting to a hospital in North India.
METHODOLOGY: This descriptive, cross‑sectional study was conducted from July 2017 to June
2018. Patients who were 60 or above years in age, already diagnosed and were on treatment for
more than 3 months were included in the study. A total of 310 patients were selected using convenient
sampling method. Data were collected by a pretested and validated questionnaire.
RESULTS: The mean age of the patients was 66.16 years ± 5.37 years (54.8% males). Monthly
average family income was Rs. 15202.97 ± 1134.63. Overall, 25% of the treatment cost was met
through various social schemes (52% = pension scheme, 32% of patients had no such schemes
and only 2% through health insurance schemes). Rest was out‑of‑pocket expenditure. Common
diseases were hypertension (60.64%), diabetes mellitus (35.8%), cancer (28.38%), and coronary
artery disease (22.58%). More than half (52.9%) of the patients had two or more illnesses; about
35.8% of them were taking treatment for 1–5 years. Moderate adherence was observed among the
majority of the patients. Statistically significant (P < 0.05) difference in treatment adherence to the
prescriptions was observed.
CONCLUSION: Geriatric patients had many chronic morbidities. They had high out‑of‑pocket
expenditure and suboptimal financial support affecting their level of adherence to the prescriptions.

Abstract INTRODUCTION: Smoking is one of the leading factors of mortality in Malaysia. Most youngsters start
at adolescence, fascinated by the concept of smoking. Interventions that harness the broad availability
of mobile phones, as well as adolescents’ interest in their appearance, may be an innovative way
to advance school‑based prevention. This study aims to determine the perceptions of facial‑aging
apps among secondary school students.
METHODOLOGY: For this research, descriptive cross‑sectional study using simple random sampling
method was used. Population sampling was targeted toward three government schools. The total
number of respondents is 383, with all of them aged between 13 and‑ 16 years of age. Legal
considerations were taken to maintain the confidentiality of respondents. The specific objectives
are: 1. To determine the level of change of intention on smoking, 2. To know the perceived reactions
of the peer groups on the appearances of students as nonsmokers, 3. To determine whether the
students learned new benefits of nonsmokingand, 4. To measure the impact of a facial‑aging app
among students.
RESULTS: The number of respondents who smoke was 40 (10.4%), while the number of respondents
who do not smoke was 343 (89.6%). About 89% of the respondents agree that their three‑dimensional
selfie image motivates them not to smoke. In addition, 87.8% of respondents admit that the perceived
reactions of their classmates make them think that they look better as nonsmokers. After learning
the effects of smoking, about 86.4% of the respondents acknowledged that they would educate
their peer groups. Furthermore, 85.9% of the respondents found this “Smokerface” app enjoyable.
CONCLUSION: The facial‑aging intervention was effective in motivating Malaysian pupils to stay
away from tobacco use. Thus, the analysis on the study of facial app usage in smoking prevention
among youngsters concludes that most of the adolescents concur that the “Smokerface” app helps
in the prevention of smoking among youths.

Abstract INTRODUCTION: Food handlers with poor personal hygiene and lack of awareness in preventing
foodborne diseases working in hospitality sectors or hospitals could spread foodborne infections.
OBJECTIVE: Our study objective was to ascertain the impact of a video‑based educational
intervention program and administrative measures on improvement in personal hygiene of food
handlers in hospital.
METHODOLOGY: We conducted this pilot study among all 103 food handlers who were working in
a tertiary care hospital. A checklist‑based scoring and physical examination were conducted by the
investigator for the food handlers. After baseline scoring S1, intervention 1 and 2 was implemented,
and score was obtained as S2 and S3, respectively. Descriptive statistics was calculated, and score
was compared by repeated measures ANOVA test using SPSS‑22 software.
RESULTS: Our study revealed that a total of 19.2% of food handlers had health complaints. More than
half (54.8%) admitted that they had suffered from any kind of illness since last 6 months. Common illness
was viral fever (40.3%) followed by typhoid (5.7%), dengue (4.8%) and urinary tract infection (3.8%).
Most of the food handlers had long hair (62.5%) followed by long nail (57.69%). Nearly, one‑fifth (20.1%)
of food handlers nail was infected with fungus. Worm was found in 14.4% cases by stool examination.
Statistically significant (P < 0.05) improvement in score was observed after each intervention.
DISCUSSION: Poor hygiene (Score‑1 = 23.76) was observed at baseline study although there
was a mechanism in place for a yearly health checkup and regular (6 monthly) hygiene training.
After interventions (video‑based training and administrative measures), the score was improved to
Score‑3 (42.57). Statistically significant(P< 0.05) differences in hygiene score were observed for variables
such as state of residence, education level, and working experiences (inside or outside the hospital).
CONCLUSION: It is possible to improve personal hygiene among food handlers using video‑based
interactive training methods and administrative measures with no extra or minimal cost.
RECOMMENDATIONS: This “piggyback” approach of training can be imparted in addition to routine
training measures among the food handlers for improving their personal hygiene in the hospital setting.

Abstract BACKGROUND: Initial formative years in every children’s life are critical for their optimal development,
as these frame the foundation of future well‑being. With a varied prevalence of developmental
delays (DDs) in the world and most of the studies representing the hospital‑based data. The present
study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged
2 months to 6 years in the rural area of North India.
METHODS: This was a cross‑sectional study in which a multistage random sampling technique was
used. From 30 Anganwadi centers, 450 children aged 2 months–6 years were taken in the study.
Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family
Welfare, India, was used for developmental screening. Binary logistic regression analysis was done
to identify the predictors for DDs (domain wise).
RESULTS: Seventy‑three (16.2%) children were found to have DDs and 60 (13.3%) children had
the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%)
children who had delay in speech and language area. About 17/190 (8.9%) children had social
delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was
seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational
age (adjusted odds ratio [AOR] – 13.30), complications during delivery (AOR – 25.79), meconium
aspiration (AOR – 12.81), and child never breastfed (AOR – 8.34) were strong predictors for the
delay in different domains of developmental milestones.
CONCLUSION: Socio-economic, ante-natal, natal and post-natal factors should be considered for
prompt identification and initiation of intervention for DDs.
RECOMMENDATION: There is a need for increasing awareness and knowledge of parents regarding
the achievement of developmental milestones according to the age. A multipronged approach to the
holistic treatment of developmentally delayed children for early intervention is required.

Abstract BACKGROUND: Thalassemia is an inherited blood disorder which is one of the common genetic
disorders among children that is increasing worldwide.
AIM AND OBJECTIVE: This study aimed to identify clustering patterns among thalassemia‑affected
families based on their well‑being, transfusion interval, and risk factors using two‑step cluster
analysis (TCA).
METHODS: The study design is a descriptive, analytical cross‑sectional study. The study sample
consisted of 125 thalassemia children along with either one of the parents who referred to a
thalassemia treatment center of a pediatric hospital in Chennai, Tamil Nadu. The parents and
children were evaluated using the Ryff Psychological Well‑being Scale and Kidscreen Questionnaire
respectively. Data were analyzed using SPSS version 16.0 software.
RESULTS: Out of 125 parents, 86 were father (68.8%) and 39 were mother (31.2%). The mean
age of parents was 38 years. Similarly, out of 125 thalassemia‑affected children, the mean age of
children was 13 years. Six clusters were deducted from the TCA. Parents’ well‑being variable does
not have discriminating power to form cluster division. Three cluster formations were meaningful.
CONCLUSION: TCA, in this study, helps in finding the clusters of families with thalassemia‑affected
children associated with poor well‑being and familial risks, which require attention for medical
counseling.

Abstract Now, lifestyle diseases are quite common globally. The risk factors of lifestyle diseases such
as sedentary habits, lack of physical exercise, and lack of fiber result in the development of
noncommunicable diseases. However, when the point of discussion slightly shifted toward toilet
habits, it is always seems to be a secret affair. In fact, the discussion of defecation‑related matter
openly is considered a taboo. This is not uncommon even in medical fraternity. In fact, during the early
1980s, some researches on the association between the diarrhea prevalence, open‑air defecation,
and latrine use rate were documented. However, nobody acknowledges it socially desirable, now,
to discuss defecation‑related issues. The public health experts completely ignored the discussion
of ill‑effects of the use of pedestal latrine on human health. It is evident from scientific studies over
a period, that many of the abdominal disorders of the human due change in his toilet habits from a
squatting‑to‑sitting posture using a pedestal latrine. That disease correlation was ignored at that time.
The increase in disease burden is due to nonmaintaining the ergonomic design during the construction
of this kind of toilets. Squatting posture for the defecation is the most appropriate way, as in this case,
abdominal muscles work actively and complete evacuation takes place. To conclude, the time has
come to reacquaint people with their natural habits and put this unfortunate experiment to an end.