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Despite efforts taken by the Government of India, still mothers and new-borns are excluded from the postnatal care services, especially during the critical first 24 h after delivery. Hence, we have done this study to find the determinants of postnatal care for mothers and new-borns in India. We have analysed the NFHS-4 data gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Point estimates were reported as proportions with 95% Confidence Interval (CI). In total, 190,797 women who had at least one live birth were included. About 25.2% and 27.1% of the new-born received post-natal care within 24 and 48 h of delivery. The proportion of women who received post-natal care within 24 and 48 h after delivery was 63.4% and 65.2% respectively. Higher socioeconomic status, women living in Southern region, utilization of proper antenatal and intranatal care, and Caesarian mode of delivery had significantly higher postnatal care coverage among mothers and new-borns. This finding informs the policy makers regarding the status of postnatal care coverage, that can be incorporated to identify target populations for further strengthening of service delivery.

Objective To assess the spatial pattern and determinants of HIV infection in India. Methods We conducted a secondary data analysis using the National Family Health Survey-4 data obtained from the Demographic Health Survey programme. We accounted for clustering and stratification in the sampling design using the svyset command. Spatial analysis was performed by generating the Moran's I statistic and local indicators for spatial association (LISA) maps. Logistic regression was performed to identify the determinants of HIV infection. Results 230 213 individuals were included. Prevalence of HIV infection in India was 0.24% (95% CI: 0.21%-0.28%). Being separated/widowed/divorced (aOR = 2.58, 95% CI: 1.22-5.40), living in an urban area (aOR = 2.46, 95% CI: 1.79-3.37), being resident in the North-Eastern (aOR = 4.25, 95% CI: 2.60-6.93), Southern (aOR = 3.13, 95% CI: 1.99-4.91) or Western region (aOR = 2.17, 95% CI: 1.08-4.33), having a history of multiple sexual partners (aOR = 1.99, 95% CI:1.42-2.79), a suspected STI (aOR = 2.32, 95% CI: 1.38-3.90) or self-reported TB (aOR = 7.80, 95% CI: 2.52-24.05) were significantly in association with HIV infection. Moran's I was 0.377, suggesting positive spatial autocorrelation. The LISA cluster map indicated 60 hotspot districts in India, mostly in southern states such as Karnataka, Andhra Pradesh and Telangana followed by north-eastern states such as Nagaland, Manipur, Mizoram, Tripura and Assam. Conclusion HIV infection among adults aged 15-54 years in India is spatially clustered with the majority occurring in southern and north-eastern states. Hence, region- or district-specific strategies with focused interventions should be adopted.

IntroductionTobacco use has been steadily increasing among the females in developing countries. It has led to rise in tobacco–related morbidity and mortality among females. Knowing the geographic distribution of the habit is essential to identify high–priority areas and direct the healthcare intervention. Hence, this study was done to assess the spatial patterns and determinants of tobacco consumption among females in India.Aims and MethodsUnivariate and bivariate Moran’s I statistic and local indicators for spatial association maps were generated to determine the spatial clustering of tobacco consumption (smoked and smokeless form). Ordinary least-square regression, spatial-lag and spatial-error models were performed to assess the determinants. Poverty (belonging to poorest and poorer quintile of wealth index), illiteracy (no formal education), marital status, ST population, tobacco use by family members, and alcohol use were the explanatory variables.ResultsUnivariate Moran’s I was .691 suggesting positive spatial autocorrelation. High–prevalence clustering (hotspots) was maximum in the central, eastern, and northeastern states such as Chhattisgarh, Madhya Pradesh, Odisha, Bihar, Manipur, Tripura, Meghalaya, Mizoram, and Assam. This pattern was similar for both smokeless and smoked form. Results of spatial-lag and spatial-error model suggested that alcohol use, scheduled tribes, illiteracy, poverty, marital status, and tobacco use by family members were significant determinants of female tobacco consumption. The coefficient of spatial association was maximum for alcohol use (β = .20, p < .001) followed by widowed/separated/divorced (β = .12, p < .001).ConclusionsTobacco consumption among females in India is spatially clustered. Multisectoral coordination and targeted interventions are required in the geographical hotspots of tobacco consumption.ImplicationsThis is the first study to explore the geospatial pattern of tobacco consumption among females in India. We found that the pattern of tobacco use among females is spatially clustered in India. Clustering was predominantly found in central, eastern, and northeastern regions of the country. Tribal population in these areas and complementarities between alcohol and tobacco use contributed significantly to the high–prevalence clustering. These findings will be helpful for policymakers and planners to devise specific intervention package targeting the high–risk regions.

Physical violence during pregnancy can have negative impact on health status of mother and fetus. Hence, the current study was done to determine the prevalence and determinants of physical violence and its impact on birth outcomes during pregnancy in India. We have analyzed the most recent National Family Health Survey 4 data (NFHS-4) gathered from Demographic Health Survey (DHS) program. Stratification (urban/rural) and clustering (villages/census enumeration blocks [CEBs]) in the sample design was accounted using svyset command. In total, 62,165 ever pregnant women aged 15 to 49 years were included. Prevalence of physical violence during pregnancy in India was 3.3%. Husband/partner (2.7%) was the person most commonly responsible. Women who were widowed/separated/divorced (aPR = 1.88), belonging to the poorest quantile (aPR = 2.32), women who were employed (aPR = 1.42), women in the Southern states (aPR = 3.24), and women whose husband/partner has lesser educational qualification (adjusted prevalence ratio [aPR] = 2.02) had significantly higher prevalence of physical violence during pregnancy ( p < .001). Women who faced physical violence had significantly higher proportion of miscarriage (4.3%), abortion (3.3%), and stillbirth (1.1%) when compared with women who did not face any violence (4.1% had miscarriage, 1.8% had abortion, and 0.5% had stillbirth; p < .001). These findings show the importance of providing general supportive measures and strengthen the existing punitive legislations to prevent the violence during pregnancy.

Objectives To evaluate the budget impact and cost-effectiveness of dengue vaccination following pre-vaccination serological screening in India. Methods We used a static cohort model (combination of decision tree and Markov model) to compare dengue disease and cost burden with and without dengue vaccination program with serological screening for a hypothetical cohort of 10-year-old adolescents. Budget impact was expressed in terms of total budget required for implementation of vaccination programme. Program impact was expressed in terms of disability-adjusted life-years (DALYs) averted. Cost effectiveness was expressed as costs per DALY averted. All costs are expressed in 2018 US dollars. Sensitivity analysis was performed for ICERs in different vaccination scenarios. Results The total budget for implementation of dengue vaccination programme is approximately around US$ 530 million (INR 3620 crores). Our model results suggest dengue vaccination result in a net gain of almost 86,000 DALYS. We found the Dengue vaccine to be a cost-effective intervention with an ICER of $3364 (INR 2,30,098) which is less than three-times GDP per capita of India ($6047; INR 413,601). One-way sensitivity analysis shows that the ICER is most affected by the overall incidence of dengue infections followed by vaccine price. Probabilistic sensitivity analysis shows that ICER for dengue vaccination varied from $1182 (INR 80,837) to $6367 (INR 435,439). Conclusion Our study shows that dengue vaccine with pre-vaccination serological screening programme is a cost-effective intervention with the conservative estimates.

Objectives To determine the prevalence of Second Hand Smoking (SHS) and assess the factors related to exposure, knowledge and response to SHS among adolescents in rural Puducherry, South India. Methods A community based cross-sectional study was conducted among adolescents during March and April 2018. Two out of four villages were selected randomly and all the adolescents were contacted through household visit and questionnaire was administered. Semi structured questionnaire contained three sections: sociodemographic details, environmental assessment and third section contained knowledge about SHS, COTPA and response towards being exposed to SHS, as well as exposure history. Continuous variables like age were summarized as mean (SD). Categorical variables such as awareness, attitude and practise towards SHS were summarized as proportions with 95% confidence interval. Results Total number of adolescents interviewed was 789. The mean age of the study participants were 14.1 (2.4) years and majority, 440 (55.8%) were boys and 684 (86.7%) belonged to nuclear family. More than one fourth, 210 (26.6%) belonged to middle class of socio-economic status. Environmental assessment of household showed more than half, 456 (57.8%) were staying in pucca house and majority 642 (81.4%) had adequate cross ventilation. It was found that about 70.1% had adequate knowledge about SHS and its harmful effects. Prevalence of exposure to SHS was 49%. Majority (40.5%) told that they will scold or advice the family member to stop smoking if they are exposed to SHS in the living place. However, almost 80% of adolescents mentioned that they will no’t react if they see someone smoking in a public place. Conclusions Current study found that almost half of the adolescents were exposed to SHS. Even though, almost three fourth had adequate knowledge, attitude towards preventing SHS in public place was found to be poor. Hence, adolescents need to be motivated enough to address the problem in the public place through motivational counselling in adolescent clinics by health care workers.

Background: Hypertension is one of the leading causes of premature deaths worldwide. Drivers have an additional risk of hypertension when compared to the general population because of the nature of their profession. Hence, the current review was done to estimate the global burden of hypertension among professional drivers. Methods: We conducted a systematic search for articles on the prevalence of hypertension among drivers published from 2000 to 2017 in Medline and Embase. Meta-analysis was performed using the random-effects model and pooled prevalence of hypertension was reported. Heterogeneity was assessed using the likelihood ratio (LR) test and publication bias was assessed using Egger's test. Results: In total, 26 studies with 15,702 drivers were included. The pooled prevalence of hypertension among the drivers worldwide was 34% (95% confidence interval [CI]: 27–40%). World Health Organization (WHO) region-wise estimates showed that prevalence was highest among the drivers in the Western Pacific region (56%) and lowest in the Eastern Mediterranean and African region (21%). Studies showed significant evidence of heterogeneity (Χ2 = 1816.1, P < 0.001) but there was no significant publication bias (P = 0.967). Conclusion: More than one-third of drivers have hypertension globally which is in excess of the general population. Hence, more focus needs to be given for allocating resources and developing workplace interventions for prevention and control of hypertension.

Introduction: Type 2 diabetes mellitus has huge economic burden for both patient and health-care system. Management of the condition in India faces multiple challenges such as paucity of trained medical and paramedical staff, poor quality, lack of satisfaction with services, and unaffordability of services. Objective: To determine the level of satisfaction and the out-of-pocket expenditure for type 2 diabetes patients receiving treatment from public and private sectors in urban Puducherry. Methods: This was a cross-sectional analytical study conducted in Urban Health Centre area of tertiary care center from August to September 2016. A total of 200 patients suffering from type 2 diabetes mellitus for 1 year or more and resided for at least a year in Puducherry were included in the study. Among the 200 participants, 100 were receiving care from government and 100 from private facility. Result and conclusion: Median cost of diabetes care in government facility was 2000 INR while in private facility was 13050 INR. About 70.1% of the patients were satisfied with the health-care services received. There was no significant difference in the level of satisfaction between government and private health facility. Almost three-fourths of the diabetes patients are satisfied with the care received irrespective of the type of health facility. The cost of diabetes care is more for patients seeking care from private sector than public sector. Availability of insulin and free syringes in the primary health center, provision of specialized footwear, and spectacles free of cost can help in reducing the out-of-pocket expenditure.

National Nutritional Monitoring Bureau survey (2017) has found that more than half of the adults in India were overweight and obese. To halt this rising epidemic, development of various policy measures has been suggested in National action plan for prevention and control of noncommunicable diseases. One such measure is the introduction of fat tax which is a surcharge or tax placed on food and beverages containing high amounts of fat. Government of India has made various direct budgetary initiatives for boosting the sectors related to the production of items rich in fat, sugars and salt without realizing the potential public health consequences. Hence, increasing the taxes for unhealthy junk foods should encourage the people to take healthier food options which in turn lead to positive impact on health. However, fat taxationfaced several challenges during implementation in countries like Denmark, Hungary, France and United States. Major challenges were the taxation debate, setting tax limit and encroaching into the autonomy rights of people. Evidences have shown that taxation alone cannot bring down the burden of non-communicable diseases but should be combined with measures like subsidies and access to healthy food items, public health education campaigns and programmes.

WHO has declared COVID-19 as a pandemic on March 11, 2020. Like the virus affects the entire body, the pandemic affected the entire global trade and economy, leading to the loss of jobs and businesses. Thus, it would be appropriate to quote COVID-19 as a social disease rather than treating only as a medical condition. The COVID-19 pandemic, being a social disease, affects all the individuals of the society in terms of their physical, mental, social health and challenges the economic status of the entire population, irrespective of whether they were physically sick. However, the mental health impact of the COVID-19 pandemic has been overlooked, given its benign nature. We can anticipate a higher prevalence of psychological distress during any pandemic than typical situations. The COVID-19 instils fear and anxiety among people. Isolation and quarantine to reduce disease transmission have a negative impact on one’s mental health. The lockdowns lead to the closure of educational institutions and workplaces, loss of jobs, economic loss, lack of physical activity, restrictions on travel and gatherings. All these factors cumulatively affected the mental stamina of millions worldwide. Given its importance, we have reviewed the impact of COVID-19 on the psychological status of general population.

Background To assess the pattern and extent of male and female gender preference and its associated factors among currently married women of reproductive age group in Puducherry, coastal south India. Methods This community-based cross-sectional study was conducted from 2016 to 2017 among 2228 currently married women residing in selected rural and urban areas of Puducherry, India. Details of pattern and associated factors of gender preference were assessed based on National Family Health Survey questionnaire. Sociodemographic and personal factors were collected by structured proforma. Log binomial regression analysis was done to find the factors associated with gender preference. Results About 1979 women participated. Preference for male and female child was 27.9% and 22.5% respectively. Others had equal (46.1%) or no preference (3.5%) on gender. Majority of them preferred two children (1528, 77.2%) and among them, 59.2% (904) preferred one boy and one girl. Those who preferred one child, male child preference (51.8%) is more than female child preference (20.1%). Number of living children (1,2, ≥3), preferred children (1,3) and those from urban areas had more male preference; age group (35 to 39 years), number of living children (1,2, ≥3), preferred children (3,4,5) and those from urban areas had significantly more female preference compared to their counterparts in the adjusted analysis. Conclusions Overall, preference of male child was higher than female child. Those who preferred one child, margin is wider with male preference more than female preference. This group requires special support and follow up health care services like counselling to equalize the preference.

Financial incentives influence behavioural changes and the current review was done to assess the effectiveness of this intervention in improving HIV care continuum. We conducted systematic searches in MEDLINE, Cochrane library, ScienceDirect and Google Scholar from inception until July 2019. We carried out a meta-analysis with random-effects model quantifying inconsistency (I2) for heterogeneity and reported pooled Risk Ratios (RR) with 95% confidence intervals (CIs). A total of 22 studies with 38,119 participants were included. All the six outcomes showed better results in financial incentive arm compared to standard care with statistical significance in three outcomes—HIV testing uptake (pooled RR: 2.42; 95%CI 1.06–5.54; I2 = 100%), antiretroviral therapy (ART) adherence (pooled RR: 1.30; 95%CI 1.13–1.50; I2 = 44%), and continuity in care (pooled RR: 1.24; 95%CI 1.09–1.41; I2 = 86%). To summarize, financial incentives can be helpful in improving the uptake of HIV testing, ART adherence and continuity of care while it was better for achieving viral load suppression among studies conducted in high-income countries.

Background: Epworth sleepiness scale (ESS) has been used widely in the assessment of daytime sleepiness for research and clinical purposes. Hence, this study was done to translate the ESS in Tamil and to assess the construct validity and reliability of the Tamil version among adolescents in rural Puducherry, South India. Materials and Methods: Translation of the ESS by native language experts and pilot tested with subsample of adolescents. Final Tamil version was administered among 789 Tamil-speaking adolescents in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis through principal component method. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient. Results: Two factor structures were obtained with Eigenvalues of 3.49 and 1.09, respectively. Both factors accounted for about 57.4% of the variance. Two-factor model assessed by confirmatory factor method found Chi-square value of 215.57 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.91). The reliability coefficient (Cronbach's alpha) for complete ESS was 0.81. Factor-based analysis showed that the Cronbach's reliability coefficient was 0.83 and 0.75 for the first and second factor, respectively. Conclusion: Our study concludes that the ESS questionnaire is internally valid and consistent with good reliability coefficient for application in Tamil-speaking rural adolescents. However, further research can be done to content validate the questionnaire with standard diagnostic tool.

Background: Decline in measles cases has not been uniform across countries and regions. Hence, we assessed the trend of measles from 1980 to 2016 with respect to WHO regions, World Bank income groups, and globally. Methods: We have conducted secondary data analysis by using the data on measles incidence from Global Health Observatory. For clustering adjustment, random intercept modeling with negative binomial distribution was used. Results: Globally, there was decline in the measles incidence from 4211,431 in 1980 to 132,325 in 2016. This accounts for around 8% decline in the measles cases every year (IRR – 0.92, P < 0.001). The results showed that there was a true declining trend after adjusting for clustering at regional (IRR – 0.90, P < 0.001) and income group level (IRR – 0.91, P < 0.001). Conclusion: Current study showed that there was significant decline in the incident number of measles cases based on worldwide, regional, and income group estimates, but insufficient to achieve the measles elimination target by 2020.

Background: Recent evidences showed that outdoor air pollution had significant influence on cognitive functioning of adults. However, little is known regarding the association of indoor air pollution with cognitive dysfunction. Hence, the current study was done to assess the association between indoor air pollution and cognitive impairment among adults in rural Puducherry. Methodology: A community-based cross-sectional study was done among 295 adults residing in rural field practice area of tertiary care institute in Puducherry during February and March 2018. Information regarding sociodemographic profile and household was collected using pretested semi-structured questionnaire. Mini-Mental State Examination was done to assess cognitive function. We calculated adjusted prevalence ratios (aPR) to identify the factors associated with cognitive impairment. Results: Among 295 participants, 173 (58.6) were in 30–59 years; 154 (52.2%) were female; and 59 (20.0%) were exposed to indoor air pollution. Prevalence of cognitive impairment in the general population was 11.9% (95% confidence interval [CI]: 8.7–16.1). Prevalence of cognitive impairment among those who were exposed to indoor air pollution was 27.1% (95% CI: 17.4–39.6). Individuals exposed to indoor air pollution (aPR = 2.18, P = 0.003) were found to have two times more chance of having cognitive impairment. Conclusion: About one-fourth of the participants were exposed to indoor air pollution, out of which more than one-fourth was found to have cognitive impairment which is twice that of the general population. Hence, prevention of exposure to indoor air pollution needs to be done through increased availability to cleaner fuels for household usage.

To assess the awareness and utilization of Adolescent Friendly Health Clinic (AFHC) services among school going adolescents (14–19 y) and to explore the forces ‘for’ and ‘against’ the utilization of AFHC services in Puducherry, India. This mixed-methods study was conducted in two primary health centres. Record review assessed the utilization of AFHC service. Survey assessed the awareness on AFHC services and self-reported illnesses and their treatment seeking behavior. Group interviews were conducted with adolescent girls, boys and healthcare providers. A summative content analysis was done to organize the ‘for’ and ‘against’ forces for service utilization. Of the 311 adolescents, less than 50% were aware of the services available at AFHC. Utilization of Weekly Iron and Folic Acid Supplementation was good. Only 2–10% of adolescents consulted the outpatient services of the Primary Health Centre for the treatment of their health problems. The authors found low utilization of AFHC services (15% among girls, zero among boys). One of the reasons for low utilization was poor awareness. Though free sanitary napkins motivated the girls to avail the services, boys considered the AFHC as a girl’s clinic. Healthcare providers suggested that building rapport and trust with adolescents and their parents, involving school teachers and ensuring privacy in the clinic would increase the utilization. There is a huge gap between the awareness and utilization of AFHC services. The reasons for non-utilization were poor awareness and misconceptions about the clinic. Training of health staffs on communication skills, and supportive supervision could improve the utilization.

Background: Trend in morbidity and mortality due to noncommunicable diseases (NCDs) is rising because of poor control status. Medication nonadherence is one of the most common and modifiable causes of inadequate control status. Objectives: To examine the barriers in drug adherence among NCD patients in rural Puducherry. Methods: This qualitative study includes in-depth and key informant interview conducted among 6 NCD patients and 4 health-care providers. Interviews were audio-recorded, and transcript was prepared in verbatim format. Thematic content analysis was done to derive the categories and themes. Results: Major barriers for nonadherence to medications found were stress, substance abuse, forgetfulness, lack of family support, and high case load of health facilities. Corrective measures suggested to address the barriers were to provide health education to patients and family members, awareness campaigns in community, and health education sessions at the clinic. Conclusion: Psychological factors such as stress, social isolation, and negligence are major barriers for drug adherence. Health education session at community and health system is needed to improve the adherence.

Background: An average Indian woman spends almost one-third of her lifespan in the postmenopausal phase enduring the consequences of hormonal decline. This can have a significant impact on quality of life (QOL). Hence, this study was conducted to assess the QOL and health problems among postmenopausal women in urban Puducherry, South India. Methods: A cross-sectional study was carried out among postmenopausal women attending urban primary health center between April and May 2017. Information about social, economic, and demographic characteristics was collected using a semi-structured questionnaire, and menopause rating scale was used to assess the QOL. Results: Among 204 participants, 55.4% belonged to elderly age group (≥60 years); 61.3% did not have any formal education; 55.9% of the participants were unemployed; 68.7% were widowed, separated, or divorced; 89.7% belonged to Hindu religion; and 42.2% belonged to lower socioeconomic class. Majority (78%) suffered from psychological problems followed by somatovegetative (62%) and urogenital problems (33%). The prevalence of poor QOL was 37.2% (95% confidence interval: 30.8%–44.0%). Participants belonging to Hindu religion (annual percentage rate [aPR]-4.14), in nuclear family (aPR-2.31), and with chronic comorbidity (aPR-5.52) and alcohol/tobacco users (aPR-6.03) had significantly higher risk of poor QOL. Conclusion: The current study found that more than one-third of the postmenopausal women in urban Puducherry have poor QOL with majority suffering from psychological problems. Hence, more focus needs to be given to this target population to achieve physical, social, and mental well-being among females.

We undertook this review to assess the impact of pricing strategies on brand choice, loyalty and quitting behaviour in Global South countries. We systematically retrieved articles from Medline, CENTRAL, ScienceDirect, Google Scholar from inception up to January 2020. Studies which reported tobacco industry’s pricing strategies were eligible. We summarized the data as themes and codes using the principles of inductive qualitative thematic analysis within structured rational constructivist framework. In total, 13 studies met inclusion criteria were included. Major strategies adopted by tobacco industries to tackle the pricing and taxation changes were increased tax absorption, differential taxation based on price, cigarette length/size which ensures modest increase in the net price of cigarettes. This in turn influences the tobacco users in terms of brand loyalty and switching as they prefer to stay with factory-made cigarettes or shift to a cheaper alternative or illegal product rather than decreasing/quitting tobacco use. Absorption of excise tax and differential taxation are the common pricing strategies adopted by tobacco industries in Global South. These strategies together with external determinants impact the price-related tobacco control interventions.

Background: Measles is one the leading cause of morbidity, mortality, and disability among under-five children worldwide with India contributing to half of the burden. Hence, Measles-Rubella (MR) campaign was launched to vaccinate all the children between 9 months and 15 years. The current study was done to find the prevalence and factors related to vaccine hesitancy in the MR campaign 2017 in rural Puducherry. Methods: This was a mixed-method study conducted with a quantitative part involving cross-sectional survey done among parents of children aged between 9 months and 15 years to determine the proportion of MR vaccine hesitancy and qualitative part involved in-depth interviews to explore the barriers and facilitating factors for the MR vaccine hesitancy. Results: Among 461 participants, the prevalence of vaccine hesitancy for the MR campaign was 14.1% (95%CI: 11–17.6%). In adjusted analysis, only mother's age (aPR–2.27) was the significant predictor of vaccine hesitancy. In qualitative analysis, major facilitating factor for campaign was the role played by the doctors in spreading awareness regarding the importance of vaccine and trust by parents on doctors. Major hindering factors were inadequate knowledge regarding campaign, rumors spread about the safety of vaccine, sudden planning, and under preparedness at health system level. Conclusion: The current study found that almost one-fifth of the parents were hesitant to give vaccination to children. Social media rumors, lack of knowledge among parents, and inadequate time in planning were major reasons for vaccine hesitancy. Hence, countries should undertake training and education of healthcare workers to empower them to address the vaccine hesitancy.

The current study was done to examine the trend of mental health mortality in India using age–period–cohort (APC) analysis. We have conducted a secondary data analysis by using the data on mental health mortality from WHO Global Health Estimates. We performed APC analysis by weighted least squares regression with assumption that data follows Poisson distribution.Annual increase in the age adjusted mortality rate due to mental health problems was 1.52%. Rate ratio (RR) increased consistently across all the age groups from 15–19 to 80–84 years. RR of period effects also showed increase from 2001–2005 to 2011–2015 periods. RR of cohort effects showed consistent increase from 1921–1925 to 1986–1990 cohorts and then decreasing from 1991–1995 to 1996–2000. To summarize, we found that mental health mortality shows increasing trend in India over the past decade with maximum increase among older population.

Background Adolescence is a critical stage of life which is characterized by rapid biological, social and emotional development. India has the highest adolescent population, however, there is paucity of literature reporting the sleep quality among adolescents. Objective To determine the sleep quality and its associated factors among adolescents residing in selected villages of rural Puducherry. Materials and methods A community-based cross-sectional study was conducted among adolescents during March and April 2018. Two out of four villages were randomly selected and all the adolescents were contacted through a household visit and a questionnaire was administered. The semi-structured questionnaire contained socio-demographic details of adolescents and details on living environment. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. Sleep quality is expressed as a proportion with a 95% confidence interval (CI). The association of socio-demographic characteristics with poor sleep quality is reported as a prevalence ratio. Results The total number of adolescents interviewed was 789. The mean age of the study participants was 14.1 (±2.4) years and the majority, 440 (55.8%) were boys and 684 (86.7%) belonged to a nuclear family. More than a quarter, 210 (26.6%) belonged to the middle class as regards socio-economic status. Environmental assessment of households showed more than half, 456 (57.8%) were staying in a “pucca” house and the majority, 642 (81.4%) had adequate cross ventilation. The prevalence of poor quality of sleep among the adolescents was 2.5% (95% CI: 1.6%–3.9%). It was found that higher educational level [adjusted prevalence ratio (aPR) – 3.43] and belonging to higher socio-economic class (aPR – 5.48) were found to be significant determinants for poor quality of sleep among adolescents. Conclusion The current study found that only 2.5% of the adolescents have poor sleep quality. Adolescents with higher educational level and higher socio-economic status were more prone to have poor quality of sleep.

Highlights • This is the first review determining psychological morbidities amidst COVID-19 pandemic. • Almost half of the general public had a significant mental health impact. • Poor sleep quality was the commonest problem followed by stress, psychological distress. • The burden was highest among the COVID-19 patients followed by healthcare workers., This review was done to synthesize the existing evidence on the prevalence of various psychological morbidities among general public, healthcare workers and COVID-19 patients amidst this pandemic situation. Systematic searches were conducted in various databases and search engines such as Medline, Chinese national knowledge infrastructure, Cochrane library, ScienceDirect, and Google Scholar from inception until 22 April 2020. Newcastle Ottawa scale was used to assess the quality of included studies. We carried out a meta-analysis with random-effects model and reported pooled prevalence with 95% confidence intervals (CIs).A total of 50 studies were included in the review. Only seven studies (14%) had low risk of bias. Pooled prevalence rate of psychological morbidities includes poor sleep quality (40%), stress (34%), psychological distress (34%), insomnia (30%), post-traumatic stress symptoms (27%), anxiety (26%), depression (26%). Pooled prevalence rate of psychological morbidities with respect to impact of event due to COVID-19 pandemic was 44% (95%CI-42% to 47%). The burden of these psychological morbidities was highest among the COVID-19 patients followed by healthcare workers and general population.

ObjectiveThis review was done to determine the prevalence of metabolic syndrome (MS) among adult general population in India. We also wanted to find the gender, setting, and region-wide distribution of MS in India.MethodsWe conducted systematic searches in various databases including Medline, ScienceDirect, Cochrane library and Google Scholar from inception until August 2019. We included studies conducted in India reporting the prevalence of MS among adults aged 18 years or more. We used the Newcastle Ottawa scale to assess the quality of included studies. We carried out a meta-analysis with random-effects model and reported pooled prevalence with 95% confidence intervals (CIs). We used the Funnel plot to assess publication biases.ResultsIn total, we analysed 113 data from 111 studies with 133,926 participants. Majority of the included studies (76 out of 111) had low risk of bias. We found significant heterogeneity among the included studies (pConclusionAlmost one in three adults in India suffer from MS. Females, people living in urban areas and in northeast region had higher prevalence of MS. Development and implementation of policies and protocols for the screening of MS would enable us in early diagnosis and treatment with special focus towards the vulnerable and high-risk groups.

ObjectiveThe current study was done to determine the prevalence, determinants, disclosure status and help-seeking behaviour of spousal violence using a nationally representative sample of ever-married women in India.MethodsWe have analysed the most recent National Family Health Survey-4 data (2015–2016) gathered from the Demographic Health Survey programme. Stratification and clustering in the sample design were accounted usingsvysetcommand. Point estimates were reported as proportions with 95% CI.ResultsA total of 66 013 ever-married women aged 15–49 years were included. Lifetime prevalence of spousal violence in India was 31% (95% CI 30.4% to 31.7%). Physical violence was the most common form accounting for 27.4% of victims followed by emotional (12.7%) and sexual violence (6.7%). Higher women’s age, Muslim religion, low education, employed women, lower socioeconomic status, presence of substance use among women and husbands, lower education and unemployed husbands, history of family violence and women in Central and Eastern states had a significant association with one or more forms of spousal violence with significant p value. Prevalence of help-seeking behaviour among women who faced spousal violence in India was 13.5% (95% CI 12.8% to 14.2%). Widowed/separated/divorced women, employed and highly educated women, and women in Northern states had significantly higher prevalence of help-seeking behaviour with respect to all the forms of spousal violence (pConclusionOne in three women in India faces spousal violence. Only 1 in 10 women seeks help following violence. Efforts should be made to ensure people working in formal institutions screen for spousal violence and know how to respond to women facing it.

Background: Nutritional status of the elderly population has become an important issue but often gets neglected. Both undernutrition and over nutrition are important public health priorities in this vulnerable group. Objectives: To determine the prevalence of malnutrition and factors associated with it among elderly population in rural Puducherry using mini-nutritional assessment (MNA) questionnaire. Materials and Methods: A community-based cross-sectional study was conducted among 279 elderly population between November and December 2016 in four villages of rural Puducherry, India. Information on sociodemographic characteristics and nutritional status of the elderlies were collected using validated MNA questionnaire. Body mass index was used to report obesity based on Asia-Pacific guidelines. Results: Among 279 participants, 178 (63.8%) were in the age group of 60–70 years, 190 (68.1%) were females, and 208 (74.6%) had no formal-education. Prevalence of malnutrition among elderly was found to be 17.9% (95% CI: 13.7–22.7) and about 58.8% (95% CI: 52.9–64.4) were at risk of malnutrition which was assessed using MNA questionnaire. Prevalence of obesity was found to be 32.5% (95% CI: 27.3–38.3) and 38.4% had inadequate fruits and vegetables intake. About 250 (89.6%) are living independently according to ADL score. Conclusion: Both undernutrition and over nutrition are important health issues to be considered among elderly population in this area. Primary healthcare strengthening to address and prevent this health issue by balanced dietary practices may improve their nutritional status, thereby enhancing their quality of life.

Background World Health Organization has recommended the introduction of pneumococcal conjugate vaccine (PCV) in the childhood immunisation programme of all the countries in the world. In lieu of its introduction in India, there is a need to generate evidence on cost-effectiveness of this vaccine. The current study looks into the impact and cost-effectiveness of PCV vaccine in India. Methods We evaluated the cost effectiveness of implementation of PCV 13 vaccination program at national level by comparing with no vaccination program for a period of 10 birth cohorts from 2018 to 2027. UNIVAC, a deterministic static cohort model is developed by giving the conservative estimates of vaccine program related to mortality, disease event rates, vaccine efficacy and coverage projections, system and health care costs for the first five years of life. Cost effectiveness is reported as Incremental Cost Effectiveness Ratio (ICER). Further scenario and sensitivity analysis were done. Probability of PCV intervention to be cost effective at a willingness to pay (WTP) threshold equal to per capita gross domestic product (GDP) is calculated using the government perspective. Results We found that the introduction of PCV vaccination program can cost an additional $467 (INR 31,666) for averting per DALY which is less than one time GDP per capita of India. Even with the most unfavourable scenario for PCV vaccine, cost per DALY averted is found to be $2323 (INR 1,57,520) which is still a cost effective intervention in India. Probabilistic sensitivity analysis found the ICER for PCV to be $649 (INR 44,008) with 95% CI: $374-$1161. Conclusion This study shows that the PCV program is a highly cost effective intervention and justifies the introduction of PCV into routine immunisation schedule in some of the states and recommends introducing it throughout the country to reduce morbidity and mortality among the under-five children.

Objectives Most of the adult mental health disorder occurs either during childhood or adolescent stage. Assessment of positive mental health among adolescents will help in predicting the future physical and mental health outcome. Hence, this study was done to determine the prevalence and factors associated with positive mental health among adolescents in rural Puducherry. Methods A cross-sectional study was conducted among adolescents (10–19 years) during April and May 2018. Mental Health Continuum-Short Form (MHC-SF), a validated questionnaire was used for the assessment of positive mental health. Prevalence of positive mental health was expressed as proportion with 95% confidence interval. Results Of the total 245 adolescents interviewed, almost half of them belonged to the age group of mid-adolescence (14–16 years). Majority (66.5%) were boys and more than one third were studying in secondary class. Prevalence of positive mental health was 51.8% (95% CI: 45.6–58.1). Mother’s education between primary and secondary (aPR-0.77 95% CI: 0.60–0.98), upper middle (aPR-1.74 95% CI: 1.03–2.94) and middle socioeconomic status (aPR-1.80 95% CI: 1.11–2.87) were significantly associated with positive mental health. Conclusion Current study found that more than half of the rural adolescents had positive mental health. Maternal education and upper socioeconomic status were found to be significant predictors of positive mental health. Our findings on the burden and risk factors as well as protective factors of mental health can contribute to the mental health strategy in public health action.

Peer-led intervention allows the patients to develop knowledge, skills and confidence in managing their own conditions. Hence this review was done to assess the effectiveness of peer-led intervention in improving the clinical outcomes of DM and HTN patients. We conducted systematic search in Medline, CENTRAL, Sciencedirect and Google-Scholar from inception till May 2018 and retrieved 3654 citations. Meta-analysis was performed using random-effects model and pooled mean difference (MD) was reported with 95% CI. Publication bias was assessed using Egger's test. 29 trials (26 DM and 3 HTN) with 6363 participants were included. There was positive effect of peer led intervention on DM and HTN with pooled MD of -0.28% [95%CI: -0.45 to -0.11] and -7.52mmHg [95%CI: -14.39 to -0.66]. There was significant heterogeneity and publication bias in both DM and HTN trials. Sensitivity analysis showed only little improvement in the final estimate. Peer support intervention is effective and causes statistically significant reduction in HbA1C and systolic blood pressure among DM and HTN patients.

BACKGROUND: First point-of-care (FPC) at the primary health care (PHC) level is an important public health issue at the global level. Patients directly come to tertiary health centers without a referral. AIMS AND OBJECTIVES: Hence, the current study was done to assess the proportion of individuals availing health-care services from rural health center (RHC) as FPC and reasons for not availing it. METHODS: A community-based cross-sectional study was conducted in Puducherry, coastal South India, among 367 households with 1510 individuals. Sociodemographic details, recent FPC during the past 6 months, morbidity profile, and reasons for not seeking were collected from all the individuals. RESULTS: About 44.5% (672/1510) of individuals used any health facilities, of which 70.4% (473/672) used RHC as the FPC. About 33.2% of individuals had a respiratory illness, 22.3% had general signs and symptoms. About 24.6% (32/130) mentioned the reasons for not seeking care as lack of appropriate health facilities. CONCLUSION: More than one-fourth of the study population not utilized services at PHC level. Improving the health facilities may help to increase these services.

Background: Cognitive impairment among noncommunicable disease (NCD) patients causes significant burden to the patients and families by increasing the dependency level and risk of developing Alzheimer's disease in the future. Hence, the current study was done to screen for mild cognitive impairment among NCD patients attending rural primary health center in Puducherry. Materials and Methods: A facility-based cross-sectional study was done among 260 NCD patients attending rural health center of tertiary care center in Puducherry from February to March 2018. Information regarding sociodemographic and behavioral characteristics was done using semi-structured questionnaire, and cognitive function was screened using mini-mental status examination tool. Results: Among the 260 participants, majority were females (66.2%) and belonged to elderly age group (42.7%). About 44% of the participants did not have any formal education and almost three-fourths (70%) were unemployed. The most common NCD was hypertension (71.2%), followed by diabetes (56.2%) and bronchial asthma (15%). Proportion of cognitive impairment was 10.8% (95% confidence interval: 7.4–15.0). Cognitive impairment was three times more prevalent among elderly participants (prevalence ratio [PR] – 3.35, P = 0.002) when compared to the age group of

Background: India contributes to one-third of rabies death globally. Despite the efforts taken by government, Rabies incidence in India has been constant for over a decade. Hence, there is need to assess the awareness and treatment-seeking behaviour which will help to plan strategies to prevent rabies related deaths. The objective of the study was to assess the awareness about rabies among general population and to determine the treatment-seeking behaviour and adherence to anti-rabies vaccine among victims of dog-bite in rural PuducherryMethods: Community based cross-sectional study was conducted during November 2016 in rural Puducherry. 386 individuals were covered in four villages. Information on socio-demographic characteristics and awareness regarding rabies, treatment-seeking behaviour and adherence to anti-rabies vaccine among dog-bite victims was collected using pre-tested questionnaire.Results: Among 386 participants, 244 (63.2%) were in the age group 31-60 years, 259 (67.1%) were females, 103 (26.7%) had no formal-education. About 68% were found to have adequate knowledge regarding rabies but only 49.5% were aware of local wound-management and 237 (61.4%) showed a positive attitude towards vaccination following scratches/lick over abraded skin. Among 27 (6.9%) with history of dog-bite in last one-year, 17 (62.9%) had taken first-aid measures. All 27 (100%) had visited hospital out of which 24 (88.8%) adhered to vaccination schedule.Conclusions: Although two-thirds of the study populations were found to have adequate knowledge regarding rabies, half of them had no knowledge regarding first-aid measures. Although all dog bite victims visited hospital, some did not adhere to the schedule mainly due to negligence. Hence, there is need to create awareness regarding wound management and post-exposure immunization.