Background: Dengue is a common vector-borne disease in countries like India, where it occurs in specific pockets including many in Maharashtra. During July–August 2018, an outbreak of dengue was suspected in a village of Wardha district, following an increase in the number of fever cases from the village, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic/larger outbreak. Objectives: The aim of this study was to find out more cases, source of infection and to recommend necessary actions to control the dengue outbreak. Materials and Methods: This was a cross-sectional epidemiological study, where we used pre-tested, pre-designed epidemiological case sheets obtained from Integrated Disease Surveillance Program (IDSP). A case definition was proposed before beginning the investigation. Line listing, collection of blood samples, distribution of paracetamol tablets to fever cases, and making a spot map were some of the important steps carried out during the investigation. Results: Out of a total of 64 suspected fever cases, 36 cases fulfilled the case definition of dengue, set for the purpose of outbreak investigation. Twenty-three of them got admitted in different hospitals among whom two of them died. Apart from that, four of them were found to be positive for both dengue IgM and NS1 antigen in their blood samples. It was age group of 21–30 years which was mostly affected. Compared to males, the female population suffered more from the illness. House, container, and Breteau index were found to be 0.26, 0.09, and 0.32, respectively. Conclusion: Following the investigation, a detailed report was made, which was shared with the district health authority. The report also contained recommendations for necessary actions to be taken to control this outbreak and to further prevent such outbreaks in future.

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Background: The concept of self-directedness is defined by the active participation of students in all phases of learning, from framing the learning objectives to the assessment process. Various scales have been developed to measure self-directed learning (SDL) among students. Fishers' SDL readiness scale (SDLRS) was validated among nursing students. The present study assessed the reliability of Fisher's SDLRS among medical students in India. Factor analysis was carried out to reduce the total number of items in the scale. Materials and Methods: The SDLRS used in the study consisted of 52 items classified under three domains. The scale was administered to a sample of 367 medical students between the first and seventh semesters. Cronbach's alpha was used to measure the reliability of the scale. For item-reduction and further abridgment, factor analysis was done using principal component analysis. Results: Cronbach's alpha was found to be 0.93 for Fisher's 52-item scale. Satisfactory reliability was observed across each domain (≥0.7). Factor analysis enabled the reduction of scale to 29 items with three domains. Conclusion: Fisher's 52-item SDLRS is a reliable scale for use among medical students in India. We propose the use of a reliable and shortened 29-item scale.

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Introduction: In the rural health-care delivery system of India, auxiliary nurse midwife (ANM) is the key frontline field-level functionary who interacts directly with the community. A heavy responsibility of implementation of health programs rests on the shoulders of ANMs. As ANMs are central to the delivery of services under the National Rural health Mission including supervision of the work done by the accredited social health activist, we thought it prudent to analyze their work pattern so that their efficiency could be improved upon. Objective: The objective was to study the workload and work pattern of ANMs and identify the causes for improving work efficiency of ANMs. Materials and Methods: This was an observational cross-sectional study conducted among four purposively chosen ANMs from a primary health center (PHC) in Central India using time-motion study as the tool. An ANM's work pattern and workload were studied by constructing 24-h recall. One ANM was followed for a week, similarly the other ANM for another week so that the activities of entire month were covered. To ensure quality, work schedules reported by the ANMs each day were cross-checked with the concerned supervisor or medical officer PHC. Results: A free-listing and pile-sorting exercise was performed with the ANMs, and the 41 activities reported by them were clubbed in to five major categories. It was found that on meeting day, meeting and record keeping were the most performed tasks, whereas other tasks were hardly performed. On the day of home visits, ANMs performed the disease-related activity for most of their time, and record keeping or supporting tasks were the second most performed activities. Majority of ANM's time spent over the week was on supporting tasks which were not directly related to their job profile. Conclusion: We conclude that clarity about job responsibilities of ANMs is lacking and available working time is not effectively utilized. Time spent on supporting tasks such as travel and waiting is maximum. Training to manage time for priority tasks and to improve skills is required.

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Background: In Uganda, only about one-third (32%) of children under age 5 have their births registered with the civil authority. There is limited information on factors linked to birth registration in Uganda. Therefore, the main objective of this study was to identify the factors associated with birth registration in Uganda. Methods: Data from the Uganda Demographic and Health Survey 2016 were analyzed. The study sample comprised only women from 16,206 households who had children 𕡑 years, selected using two-stage stratified sampling with probability proportional to size. A logistic regression model was used to study the determinants of birth registration. Results: The overall coverage of birth registration was 32.7%. Child's age, health-care provider, ownership of a radio or mobile phone, and region of residence were significantly associated with birth registration. On the contrary, relationship to the household head, age of the household head, television ownership, wealth index, and residence had no association with birth registration status. Conclusion: Birth registration is relatively still low in Uganda. The Government of Uganda should bring the birth registration services closer to health facilities, especially low-level health centers. The government should utilize mobile phone and radio technologies to promote and sensitize communities about birth registration due to their mass coverage and positive association with birth registration.

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Background: Kenya's gross national income per capita of $ 2250 is significantly lower than the global average of $ 6977. In addition, Kenya Government's health expenditure as a percent of the total government budget is approximately 7% which falls below the target of 15% recommended by the World Health Organization. It is, therefore, important that the country's health-care resources, specifically those allocated to the health sector, are optimally used. Methods: An one-stage data envelopment analysis (DEA) method was used to estimate the technical efficiency of county referral hospitals. A total of 34 county referral hospitals were randomly sampled and studied. Data analysis was performed in two stages as follows: first, input and output data were entered into MS Excel sheet after which DEA version 2.1 was used to determine the technical efficiency scores for the hospitals. In the second stage, interval regression analysis using censored interval regression model was used to identify determinants of technical efficiency for the sampled hospitals. Results: Results indicated that the mean constant return to scale technically efficient score was 82.4%, the mean variable return to scale (VRS) technically efficient score was 94.1%, and the mean scale efficiency technical score was 87.4%. The mean level of VRS technical inefficiency was 17.2%. The total inputs slacks in the inefficient hospitals were 104 beds and 840 staff which represented an input slack of 4% for the beds and 28% for the staff. Conclusions: Inefficient hospitals could have attained efficient frontiers using fewer resources, specifically 4% beds and 28% staff. The technical inefficiencies in county referral hospitals are occasioned by the use of inappropriate production functions characterized by the existence of excess production inputs and suboptimal outputs.

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