Background: Telemedicine has become an integral component of primary healthcare following the coronavirus disease 2019 pandemic. Evidence regarding telemedicine service delivery and utilization remains limited in eastern India. Objectives: The present study assessed telemedicine service utilization pattern and beneficiary satisfaction at urban primary health center (U-PHC) level in Berhampore municipality of Murshidabad, West Bengal. Materials and Methods: A descriptive cross-sectional study was conducted from September–December 2025 across all four U-PHCs of Berhampore municipality. Teleconsultation records for 3 months (August–October 2025) were reviewed for assessing utilization pattern. Beneficiary satisfaction was assessed among a calculated sample of 100 adult participants using a 10-item Telehealth Satisfaction Scale. Data were analyzed using descriptive statistics and appropriate tests of association. Results: The telemedicine service delivery pattern among 4408 teleconsultations shows more among those aged 31–49 years (48.1%) and females (53.2%). All consultations were health worker-assisted; managed in a single session without documented referral or follow-up; medicines were prescribed in all cases; and investigations were advised in 8.2% consultations. Gastrointestinal disorders were the most common morbidity (27.6%), followed by general/constitutional symptoms (18.9%). Overall, 72% of beneficiaries were satisfied with telemedicine services. The highest “excellent” ratings of satisfaction were observed for explanation of treatment (68%). Only the age of beneficiaries showed a significant association with satisfaction (P = 0.047). Conclusion: Telemedicine services at U-PHC level were mostly utilized for common primary conditions with a high level of beneficiary satisfaction. Scope of diversification of service delivery among different age groups and gender should be explored and prioritized. Strengthening follow-up documentation, privacy measures, and consultation duration may improve service quality.
Background: Defaulting from inpatient nutrition rehabilitation center (NRC) care and postdischarge dropout from follow-up are recognized as the largest contributors to treatment failure in the facility-based management of severe acute malnutrition (SAM) in South Asia. Child- and family-level predictors of both events remain inadequately characterized in Central India, particularly in the postpandemic programmatic context. Objective: The objective of this study is to identify the independent predictors of (a) defaulting during NRC inpatient stay and (b) drop out from a 6-month follow-up among SAM children admitted to the five NRCs of Gwalior district, Madhya Pradesh. Methods: Secondary analysis of a prospective multicenter cohort (n = 332) of SAM children admitted between January and December 2021. Defaulter was defined as the absence from the NRC for three consecutive days without discharge; dropout as failure to attend any of the four scheduled follow-up visits within 6 months. Univariate and multivariable logistic regression identified independent predictors. Missing data were minimal (<2% per variable) and complete-case analysis was used. Results: Sixty-two of 332 admitted children (18.7%; 95% confidence interval [CI]: 14.7–23.4) defaulted during inpatient stay; cumulative incidence rose linearly to day 14 and plateaued thereafter. Of 295 discharged children, 51 (17.3%; 95% CI: 13.2–22.2) dropped out of follow-up. Independent predictors of inpatient default were no pre-admission Anganwadi Center (AWC) contact (adjusted odds ratio [aOR]: 4.21; 95% CI: 1.42–12.50), distance >10 km from the NRC (aOR: 3.85; 95% CI: 1.87–7.92), length of stay ≤7 days (aOR: 2.91; 95% CI: 1.62–5.23), and maternal illiteracy (aOR: 2.18; 95% CI: 1.21–3.92). The predictor profile for dropout was similar. Conclusion: Default and dropout from NRC-based SAM care in Gwalior are independently associated with distance, maternal illiteracy, short inpatient stays, and absence of preadmission AWC linkage. These associations – derived from observational data and not causal-support a targeted, low-cost service-delivery package combining transport vouchers, AWW-linked tracing, and revised reimbursement to support longer stays.
Background: Medical education is a rigorous and demanding journey that can result in stress and depression among students. Depression in medical students might extend beyond their academic career and might influence their professional life. This study was planned to estimate the prevalence of depression among undergraduate students of a medical college in West Bengal and to find the association of depression with selected socio-demographic, behavioral, and academic variables. Materials and Methods: A facility-based observational analytical study, cross-sectional in design, was conducted among 261 undergraduate medical students in a medical college in eastern India. A predesigned, prevalidated structured questionnaire was used, comprising (i) sociodemographic variables and (ii) the Patient Health Questionnaire scale. Association was calculated by the Chi-square test. Those having a significant association with them were taken for a binary logistic regression. P <0.05 was considered statistically significant. Results: Among 261 study participants, 77 (29.5%) had moderate to higher levels of depression, and 37.93% had no depression. In multivariable logistic regression analysis, four variables were found to be independent predictors for having moderate to higher categories of depression after controlling for possible confounders. Those not involved in sports (adjusted odds ratio [AOR] 2.31), having one or more supplementary exams (AOR 2.09), having feelings of insecurity (AOR 5.42), and studying in a higher academic year (AOR 4.1) have higher odds of having moderate to higher categories of depression. Conclusions: The significant prevalence of depression among medical students indicates the need for regular screening and access to counselling services.
Background: Considering the rising burden of chronic kidney disease (CKD), the Government of Odisha initiated “free-of-cost” dialysis through the National Dialysis Program in 2018. This study describes the epidemiology of individuals with end-stage renal disease (ESRD) registered under the Prime Minister’s National Dialysis Programme in Dhenkanal, Odisha, from 2018 to 2022, by time, place, and person. Methods: We analysed secondary data from the ESRD line list at the Dhenkanal district hospital dialysis unit (DU). We calculated the ESRD cases per million population (ESRD rate) by age, gender, and residential block. Age and gender were compared across dead and alive individuals using Chi-square test. Estimated glomerular filtration rate (eGFR) was computed and categorised into CKD stages. A P < 0.05 was considered significant. Results: Among 371 individuals with ESRD (ESRD rate: 239), over half (56%) were aged 40–59, and most (84%) were males. Registrations peaked during January-March and July-September. Kamakhyanagar (505) and Sadar (411) blocks had higher ESRD rates. Among 371, 78% (n = 290) were still receiving care, 17% (n = 64) were dead, and 5% (n = 17) were dropouts. A significant gender difference was observed in deaths (male 19% [59/310], female 8% [5/61]; P = 0.041). Three-fourths (n = 62) of the individuals with serum creatinine value (n = 83) had an eGFR <15 ml/min/1.73 m2. Comorbidity data were missing. Conclusions: We identified a seasonal trend, with heterogeneity of spread and higher rates among males and middle-aged groups in the ESRD registrations at Dhenkanal. Opportunistic CKD screening in high ESRD rate blocks and a standardised reporting format in DUs are needed.
Context: Maternal deaths following interfacility referral are usually attributed to the terminal receiving facility, potentially overlooking preventable deficiencies elsewhere in the referral pathway. This referral-chain audit examined all maternal deaths among women referred with obstetric emergencies to a tertiary care center in Uttar Pradesh. Materials and Methods: This was a nested maternal-death referral-chain audit within a facility-based cross-sectional study of 675 women referred from public-sector health facilities for emergency obstetric complications and admitted to a tertiary care teaching hospital in Lucknow, Uttar Pradesh, India, between October 2019 and March 2020. All maternal deaths observed within this cohort were included. These deaths served as tracer events to identify gaps in antenatal risk management, prereferral stabilization, referral appropriateness, transfer processes, and receiving-facility preparedness. Data were analyzed descriptively. Referral quality was assessed using a structured framework categorizing cases as appropriate with adequate pre-referral care, clinically appropriate with quality concerns, potentially avoidable or insufficiently justified onward referral, or not classifiable from available documentation. Among six maternal deaths, the key referral-chain concerns were incomplete high-risk antenatal planning, nonspecific referral reasons, prolonged pre-transfer holding, absence of receiving-center pre-alert, incomplete documentation of stabilization, possible missed definitive management in postpartum hemorrhage, and insufficiently justified onward referral from medical-college level. Conclusion: In this nested audit, maternal deaths among public-sector obstetric referrals functioned as tracer events, revealing referral-chain vulnerabilities across antenatal risk management, prereferral stabilization, referral documentation, transfer communication and facility-level accountability.
