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Abstract Introduction Existing evidence suggests a lower uptake of cervical cancer screening among Indian women. Coverage is lower in rural than urban women, but such disparities are less explored. So, the present study was conducted to explore the self-reported coverage of cervical cancer screening in urban and rural areas stratified by socio-demographic characteristics, determine the spatial patterns and identify any regional variations, ascertain the factors contributing to urban-rural disparities and those influencing the likelihood of screening among women aged 30–49 years factors residing in urban, rural, and overall Indian settings. Methods We did a secondary analysis of the fifth round of the National Family Health Survey in India (2019-21) data with a sample size of 3,48,882 women. The coverage of cervical cancer screening was estimated using sampling weights. Urban-rural differences were compared using the chi-square test. Spatial patterns were analysed using aggregated district-level data, and the contribution of different independent variables to the urban-rural disparities was estimated using multivariate decomposition analysis. Multivariable logistic regression was conducted using STATA 17 to obtain the significant factors of reported screening in urban and rural areas. Results The nationwide coverage of cervical cancer screening was 2.0% (95% CI: 1.9-2.0). The urban (2.4%; 2.3–2.5) participants had higher screening coverage than their rural (1.8%; 1.7–1.8) counterparts. Moran’s I statistic confirmed the presence of spatial dependence and geographical gradient. Decomposition analysis depicted small urban-rural differences in the screening coverage of 0.60% (0.4–0.8). Endowment and coefficient contributed to 88.15% and 11.85% of the disparities. Compositional changes were contributed majorly by regional differences, low education, scheduled tribes, and having living children > 2. Higher odds of having screening were associated with older age (AOR 1.45, 95% CI: 1.03–1.28), higher education (1.32; 1.13–1.55), higher age of first intercourse (1.60; 1.43–1.79), married (1.25; 1.08–1.45) and diabetic (1.39; 1.17–1.65) women, and those from South India (6.76; 5.90–7.75). The odds were lower among Muslims, scheduled tribes and participants using hormonal contraceptives. Conclusion There are significant urban-rural disparities in cervical cancer screening uptake that can be attributed to regional variation, educational inequalities, tribal groups, socio-economic inequalities and parity, necessitating the need to comprehensively design tailor-made advocacy initiatives and simultaneously address the broader determinants of health.

Background and Aim: A better understanding of the complex interplay between socioeconomic determinants and risk factors of high blood pressure (BP) has critical implications. Behavioral characteristics are strong candidates to act as mediators of the observed effects of socioeconomic determinants on BP; therefore, we aimed to investigate the mediating role of smoking and alcohol on the association between education, wealth index, sex, and hypertension using NFHS-5 data. Materials and Methods: We conducted a secondary analysis of the data collected from a nationally representative survey (NFHS-5 data) in India. We included 1,923,504 people aged 18 years and above who had all the necessary information for the analysis. We performed a mediation analysis using linear and logistic regression models to estimate the natural direct effect, total effects, and natural indirect effect of sex, education, and wealth index, and systolic BP (SBP) and diastolic BP (DBP), while maintaining behavioral habits (smoking and alcohol use) as mediator variables. Results: An equal distribution of males (51.4%) and females (48.6%) was seen, about 13.2% consumed alcohol, and 27.6% had used or smoked tobacco. Females had significantly lower SBP (β = −4.59, −4.67) and DBP (β = −2.07, −2.60) compared to males. Lower educational levels significantly influenced systolic (β = −2.89, −2.89) and diastolic (β = −1.15, −1.14) BP; people in the richer and richest quintile had significantly higher systolic (β = 0.60, 0.59) and diastolic (β = 0.43, 0.43) BP. Mediation analysis showed partial mediation by alcohol and tobacco, which was statistically significant (P < 0.001). Conclusion: These results will help in developing targeted interventions to address the unique risk factors and challenges faced by different population subgroups.

Introduction: Gestational diabetes mellitus (GDM) affects 14% of pregnancies globally, with a prevalence of 9–16% in India. Low-glycaemic index (GI) foods like millets may help control glycaemia in GDM. This study compared glycaemic control between GDM patients consuming millets once a day (MOD) and those receiving enhanced medical nutrition therapy (MNT) for 1 month. Methods: A parallel-arm randomized controlled trial was conducted among 224 GDM mothers at a tertiary centre from April 2022 to December 2023. Participants were randomized into two groups: The Enhanced MNT group received standard care with education materials, while the MOD group received 200 g of millets daily for 1 month and recipes. Follow-ups were at 2 weeks and 1 month. The primary outcome was the difference in glycaemic control between groups, analysed with a 95% confidence interval (CI) and P < 0.05 significance. Results: Of the 219 participants who completed the study (97.8%), adherence was 77.6% in the MOD group and 78.5% in the Enhanced MNT group. In an intention-to-treat analysis, an additional 11.6% (95% CI: -1.5% to 24.7%) in the MOD group achieved glycaemic control compared to the Enhanced MNT group, which was not statistically significant (P = 0.083). However, the MOD group had a significant mean post-prandial blood glucose reduction of -4.55 (95% CI: -8.55 to -0.56; P = 0.025). Conclusion: Both interventions effectively controlled glycaemic levels, with the MOD group showing slightly better post-prandial glucose control. Adherence to the protocol was high. Trial Registration: CTRI Registry CTRI/2022/04/042013.

Background: Pharmacological drugs and medications are being widely used for the control of non-communicable diseases like hypertension. Hill-Bone–Compliance to High Blood Pressure Therapy Scale (HB-HBP) is a newly developed specific questionnaire for assessing the anti-hypertensive medication adherence. Hence, this study was done to translate the HB-HBP in Tamil and to assess the construct validity and reliability of the Tamil version. Materials and Methods: Translation of HB-HBP to native language, Tamil was done by experts and piloted with subsample of hypertensive patients from rural Puducherry. Final Tamil-translated HB-HBP was administered among 328 Tamil-speaking hypertensive patients in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis (EFA) through the principal component method. Based on the minimum average partial and parallel analysis, three-factor model was distinguished. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach’s alpha coefficient. Results: Three factor structures were obtained with eigenvalues of 6.5045, 2.8165, and 1.2261, respectively, which accounted for 75.34% of variance. Three-factor model assessed by the confirmatory factor method found Chi-square value of 1055.048 (P value

Introduction: Improper consumption of food leads to various forms of malnutrition such as undernutrition, overnutrition and micronutrient deficiency. The coexistence of various malnutrition forms in the same household is a public health concern in developing countries. Very little research has been done on exploring the burden and risk factors associated with double (DBM) and triple burden of malnutrition (TBM). Methods: Secondary analysis was done using data from India's National Family Health Survey-5 (NFHS-5), 2019-21. Mothers and under-five children were paired at the household level as a unit of analysis. DBM and TBM were interpreted from children's height-for-age, weight-for-height, weight-for-age and anaemia status and mothers' body-mass-index. Stratification and clustering in the sample design were accounted for during the analysis in STATA v14.2. DBM and TBM were summarized as weighted proportions with 95 % confidence interval (CI) and the risk factors associated were reported as adjusted odds ratio (aOR) with 95%CI using mixed effects logistic regression. Results: We included 167,380 mother-child pairs for analysis. In India, the prevalence of DBM was 7.7 % (95 % CI: 7.5–7.9 %) and TBM was 5.1 % (5.0–5.3 %) at the household level among mother-child dyads. Mothers' age, age at first birth, educational levels, current breastfeeding habits, mode of delivery, child's age, gender, twin birth, birth weight, geographical region, residence, caste and religion, and wealth index were associated with both DBM and TBM. Conclusion: Both DBM and TBM are public health concerns in India. Thus, scaling-up of health intervention, effective implementation of nutritional programmes and life-course approach are needed to control malnutrition.

Background: Socioeconomic disparity changed healthcare seeking and management cascade of hypertension due to inequity in hypertension care cascade pathway. Objectives: The inequities in burden and treatment-seeking behavior of hypertension among reproductive age group women were studied from National Family Health Survey-4 (NFHS-4) data. Materials and Methods: We analyzed the data from NFHS-4 of women of reproductive age group between 15 and 49 years among the selected households contributing to 699,686 women. Socioeconomic inequities were assessed by expenditure quintile. Inequities in burden and treatment-seeking behavior were reported using the concentration curve and concentration index. Results: The prevalence of hypertension in India was 15% (95% confidence interval: 14.9%–15.4%). One-third (32%) of the hypertensive population received treatment and only 28% of the women had controlled blood pressure. Wealth and education-based inequalities were more in high wealth index. The inequity in screening and awareness was in the northern and northeastern regions. Conclusion: There was inequity in the overall hypertension care cascade pathway with more inequity in the northern and northeastern region.

Background: Tuberculosis (TB) remains a global health concern, particularly in India, which carries a significant portion of the global burden. The role of sex as a determinant of health is increasingly recognized, impacting various aspects of TB, including treatment compliance and outcomes. This study aimed to determine the mediating role of treatment compliance in the relationship between sex and sputum conversion in newly diagnosed pulmonary TB patients in Chennai, South India. Methods: We conducted a retrospective cohort study among patients newly diagnosed for TB at ESIC Medical College & PGIMSR between April 2020 and April 2022. A causal mediation analysis was performed to identify the direct and indirect effects of sex on sputum conversion via the mediator, treatment compliance. We employed logistic regression models and the “paramed” package for the analysis, with bootstrapping technique for examining the significance of indirect and direct effects. Results: The Marginal Total Effect (MTE) suggested that females were more likely to have sputum positivity compared to males (OR: 6.77; p = 0.003). Direct effect of being female increased the odds of sputum positivity at the end of the intensive phase (OR: 3.42; p = 0.03). The indirect effect of being female via treatment compliance significantly increased the odds of sputum positivity at the end of the intensive phase (OR: 1.98; p = 0.03). Conclusion: The study provides evidence that treatment compliance significantly mediates the relationship between sex and sputum conversion in TB patients, highlighting the necessity to consider gendered dimensions of health in TB control strategies.

Introduction: Severe Haemophilia A patients with inhibitors are currently being treated with bypassing agents like activated prothrombin complex concentrates (aPCC) and recombinant factor VIIa. Emicizumab is a recombinant humanized monoclonal antibody, introduced to reduce the bleeding events, improve treatment adherence, and quality of life. However, cost-effectiveness and long-term sustainability of the intervention is not studied in a low middle income setting like India. Aim: The primary objective of this study was to evaluate the cost-utility of Emicizumab compared to traditional bypassing agents in the treatment of severe haemophilia A patients with inhibitors in India. Secondary objective was to analyze the budgetary impact of introducing Emicizumab for this patient population from the perspective of public health system in India. Methods: Markov model was created to compare the prophylactic emicizumab therapy against bypassing agents for a hypothetical cohort of 10-year-old adolescents in India. The time horizon was 10 years and model built based on health system perspective. Cost utility was expressed as costs per quality-adjusted life-years (QALYs) gained. All costs were expressed as 2021 US dollars. Probabilistic sensitivity analysis was performed to check the robustness of the estimates. Results: Prophylactic emicizumab was a cost saving intervention with negative Incremental Cost Utility Ratio (ICUR) against recombinant factor VIIa of −853,573 USD (INR -63,109,773), and negative ICUR of −211,675 USD (INR -15,650,403) against APCC. The estimated total budget for treating all the severe Haemophilia A patients with inhibitors in India was USD 59,042,000 (INR 4,365,329,312) for 10 years’ time horizon (per patient cost of USD 295,210 [INR 21,826,646.56]). Conclusion: Prophylactic emicizumab therapy is a cost saving intervention when compared to both the bypassing agents as it is less costly and more effective for severe Haemophilia A patients with inhibitors in India.

Background: Women experiencing domestic violence might have restrictions in the pregnancy-related decision-making and care-seeking process leading to adverse pregnancy outcomes. We explored the association between domestic violence and undesirable pregnancy events. Methods: 63,796 women aged 18–49 years covered under the domestic violence module of National Family Health Survey-5, 2019-21. Stratification and clustering in the complex sampling design of the survey were accounted in analysis. Using Poisson regression, prevalence ratio (PR) was reported to provide association of domestic violence with undesirable pregnancy events. Results: Prevalence of undesirable pregnancy events was 25.0% (95%CI: 24.4%–25.7%) amongst women aged 18–49 years. Prevalence of unintended, terminated pregnancy and complications during pregnancy was 3.2%, 5.1% and 20.9%, respectively. Women aged ≥35 years, educated, unemployed, primi or multi parity, intimate partner/husband being uneducated, facing problem with access to healthcare, belonging to large number of household members (≥4) and poorest or poorer quintile had significantly higher chance of having undesirable pregnancy events. Sexual violence (aPR: 1.11, p = 0.02) had higher chance of having undesirable pregnancy events. Conclusion: One-fourth of reproductive-age group women had undesirable pregnancy events. Sexual violence was significantly associated with these events. Effective policy should protect women from domestic violence to promote maternal well-being.

Abstract Background and Aims The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries. Methods We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta‐analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal). Results Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1–60.5) for suicidal behavior, 52.7% (95% CI: 44.5–60.7) for suicides, and 43.1 (95% CI: 32.9–53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2–66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%–62.9%) and Pakistan (45.1%; 95% CI: 30.9–59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633). Conclusion This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause‐and‐effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.

Background: Disrespect and abuse have a negative impact on the quality of care provided in the public health facilities, thereby impacting the public health-care utilization of the patients. Objectives: This study aims to capture the burden and determinants of disrespect and abuse faced by the patients who seek care from public health facilities in Tamil Nadu. Methods: This study was conducted among 4917 participants at outpatient and inpatient levels in 18 public health facilities across six districts in Tamil Nadu. Institutional disrespect and abuse were reported as proportion with 95% confidence interval (CI). Logistic regression model was done to assess the determinants of institutional disrespect and abuse. Results: Overall, the proportion of participants facing some form of institutional disrespect and abuse was 9.8% (95% CI: 9.0%–10.6%). Elderly patients (≥60 years) (adjusted odds ratio [aOR] = 2.71; 95% CI: 1.27–5.76), widowed/separated/divorced (aOR = 1.99; 95% CI: 1.11–3.57), patients with higher educational qualification (aOR = 1.82; 95% CI: 1.25–2.64), patients belonging to the richest quintile in terms of socioeconomic status (aOR = 4.96; 95% CI: 3.59–6.84), and patients having some form of chronic disease (aOR = 1.37; 95% CI: 1.07–1.75) had significantly higher odds of facing institutional disrespect and abuse. Conclusion: Almost one in ten patients visiting secondary and tertiary care public health facilities in Tamil Nadu had faced some form of disrespect during their hospital visit/stay. The findings from our study should be taken up and further qualitative exploration to identify the reasons for such disrespectful care and corrective solutions should be suggested.

Introduction: India depicts a very high prevalence of hypertension. We need to learn more about the effect of wealth-related disparities on the prevalence of hypertension. The primary objective of this study was to assess temporal changes in the epidemiology of hypertension and associated wealth-related disparities among adults using two waves of nationally representative datasets from India. Methods: We did a secondary data analysis of the National Family Health Survey (NFHS) rounds 4 and 5. We included information from the two rounds from 699,686 and 108,791 males and 92,804 and 677,803 females. Weighted analysis and multivariate binomial regression were used to depict the prevalence and predictors of hypertension. Inequalities were estimated using the concentration index (CI) and concentration curves. Results: The weighted prevalence of hypertension among males increased from 14.6% to 16.7% among males, and from 8.8% to 9.9% among females, between NFHS-4 and NFHS-5. Prehypertension rose from 43.3% to 48.3% for males, and females, from 30.2% to 36.2% between the NFHS rounds. Overall, the CI among the males (0.078 and 0.050) and females (0.102 and 0.059) decreased from rounds 4 to 5, depicting a decrease in pro-poor wealth-related inequalities in hypertension prevalence in India. Conclusions: To conclude, the current analysis depicts that inequalities due to which hypertension was more prevalent in the wealthier classes in India are slowly disappearing. Therefore, we need to target the already exhausted poor patients with limited access to health-care resources to prevent them from further shifting beyond the line of poverty before these differences narrow down further.

Background: Acute liver injury (ALI), a complication often seen in COVID-19 patients, can lead to severe liver damage, multi-organ failure, acute vascular events, and can potentially escalate to patient mortality. Given this, we initiated a meta-analysis to investigate the correlation between ALI and adverse outcomes in COVID-19 patients. Methods: We conducted an exhaustive search of databases, including Medline, Embase, PubMed Central, ScienceDirect, Google Scholar, and the Cochrane Library, from the November 2019 until January 2022. The quality of the included studies was evaluated using the Newcastle Ottawa (NO) scale. Our meta-analysis was carried out using a random-effects model and results were presented as pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). Results: Our analysis incorporated 20 studies involving a total of 13,850 participants, predominantly from China and the United States. According to the NO scale, the majority of these studies were categorized as low-quality. Patients with ALI faced approximately 7 times higher odds of severe COVID-19 symptoms (pooled OR = 7.09; 95%CI: 4.97 to 10.12) and over 5 times higher odds of mortality (pooled OR = 5.50; 95%CI: 3.37 to 8.99) when compared to those without ALI. Conclusion: Our findings affirm that ALI is a potent predictor of adverse outcomes, including severity and mortality, among COVID-19 patients. Recognizing and promptly addressing ALI in COVID-19 patients could be pivotal in improving prognosis and tailoring individualized patient management strategies. This underscores the need for clinicians to be vigilant about liver complications in the COVID-19 patients and integrate appropriate interventions in the treatment paradigm.

Catastrophic health expenditure [CHE] in India is on a rise. This situation would worsen even further when resources are disproportionately distributed across various socioeconomic classes. Hence, we conducted this study to determine the equity and extent of out-of-pocket [OOP] payments, Catastrophic health expenditure and impoverishment among rural households during COVID-19 pandemic in Tamil Nadu, India. A cross-sectional survey covering 2409 households was conducted during November 2021 across six districts in rural part of Tamil Nadu. Information on out-of-pocket payments, Catastrophic health expenditure (based on 40% capacity-to-pay [CTP] method) and impoverishment was obtained through World Health Organization standard criteria. Point estimates were reported as proportions with 95% Confidence Interval [CI]. Our results showed that the proportion of households with out-of-pocket payments on health and Catastrophic health expenditure in the month preceding the survey was 82.8% (95%CI: 81.2%–84.3%) and 26.9% (95%CI: 25.1%–28.7%) respectively. Nuclear (couple with dependent children only) and joint family type (extended family), presence of under-five children and lower socioeconomic status were significant determinants of Catastrophic health expenditure. The prevalence of impoverishment was 6.4% (95%CI: 5.4%–7.5%). To conclude, more than three fourth of the rural households in Tamil Nadu has out-of-pocket payments for health with one-fourth having Catastrophic health expenditure. Almost one in fourteen non-poor households faced impoverishment during the COVID-19 pandemic. This shows the disproportionate distribution of health expenses especially in the rural areas. Hence, appropriate financial risk protection measures should be taken in order to progress towards universal healthcare in our country.

BACKGROUND: Self-directed learning (SDL) is an essential aspect of adult education or andragogy, gaining significance in medical education with the introduction of competency-based medical education. The primary objective of this study is to assess the self-directed learning abilities of second-year medical undergraduates in Chennai, South India, and to identify potential challenges and gaps in their learning process. MATERIALS AND METHODS: A cross-sectional study was conducted among 82 second-year medical students attending self-directed learning sessions at a medical college in Chennai. Data were collected using the self-directed learning instrument (SDLI), a standardized questionnaire, administered through Google Forms. Participants’ identities were maintained confidential. Data were analyzed using SPSS version 22.0. Descriptive data were presented as proportions and percentages. Normally distributed quantitative data were expressed as mean and standard deviation. Non-normal continuous data were expressed as median and interquartile range (IQR). RESULTS: The majority of the students (61%) demonstrated a high level of SDL ability, with a median score of 76. Students exhibited strong learning motivation (mean score 4.11) but struggled with planning and implementation (mean score 3.07). The maximum mean score was 4.11 for item 3 (constant improvement and excelling in learning), and the minimum mean score was 3.07 for item 11 (arranging and controlling learning time). The students showed high self-monitoring (mean score 3.76) and interpersonal communication skills (mean score 4.00). CONCLUSIONS: SDL emerges as a boon for medical undergraduates in this study. By providing adequate training to faculty members on SDL implementation and guidance to students on planning and time management, SDL can play a pivotal role in enhancing medical education quality and fostering life-long learning among future medical professionals.

Background: Compliance with appropriate hand hygiene practises is the most efficient and cost-effective intervention that can be implemented in the healthcare setting. Given its importance, we tried to capture the compliance with hand hygiene practises and their appropriateness among healthcare workers during the COVID-19 pandemic in public health facilities in Tamil Nadu. Methods: This cross-sectional study involved doctors, nurses, and allied healthcare professionals from various departments in 18 public healthcare facilities spanning six districts in Tamil Nadu. A random-intercept model was employed for the multivariable logistic regression analysis to evaluate the factors influencing hand hygiene compliance and its adequacy. The effect size was presented as an adjusted odds ratio (aOR) accompanied by a 95% confidence interval (CI). Results: In total, 2733 hand hygiene observations were made. Only during 19.4% (95%CI: 17.9%–20.9%) of these observations, hand washing was done. Only during 37.9% (95%CI: 33.9%–42.1%) of these observations, hand washing was done appropriately by following all the essential steps of hand hygiene. Nurses (aOR = 2.49; 95%CI: 1.90–3.26), healthcare workers in General Surgery (aOR = 2.18; 95%CI: 1.53–3.10) and Obstetrics & Gynaecology departments (aOR = 1.75; 95%CI: 1.26–2.43), working in inpatient departments (aOR = 2.64; 95%CI: 1.38–5.04) had significantly higher compliance to hand hygiene practices. Nurses (aOR = 2.58; 95%CI: 1.33–5.01) and General Medicine department healthcare workers (aOR = 1.98; 95%CI: 1.09–3.61) had significantly higher compliance to appropriate hand hygiene practices. Conclusion: Our study shows that only during one-fifth of the observations did healthcare workers do hand washing, and less than 10% did it appropriately by following all the essential steps of hand hygiene.

Objectives: To estimate the prevalence, pattern, and factors associated with functional impairment among elders. Materials and Methods: A community-based cross-sectional analytical study was conducted among older adults (aged ≥60 years) residing in the urban blocks of West Bengal. An interview was conducted using a structured questionnaire, which included Katz index and half-arm span to measure functional impairment and body mass index (BMI), respectively. Results: The mean (SD) age (in years) of 457 participants was 69.0 (7.3) years and 52% were males, 72% were graduates, 52% were obese, and 55% had hypertension. The prevalence of functional impairment was 7.4% (95% confidence interval [CI]: 5.21–10.24). The most common aid or appliance used was spectacles (93%) followed by a denture (20%). The functional impairment was more common among the oldest-old (≥85 years) (adjusted prevalence ratio (aPR) 8.26, 95% CI: 2.50–27.28), middle-old (75–84 years) age group (aPR 3.85, 95% CI: 1.44–10.31), underweight (BMI < 18.50 kg/m2) (aPR 3.60, 95% CI: 1.44–9.00), and among the individuals using walking sticks (aPR 3.47, 95% CI: 1.60–7.51). Conclusion: The burden of functional impairment is low among older adults in the urban area of West Bengal. Policies need to be framed at the household level to reduce the extent of disability among the oldest-old and elders who are underweight and use walking aids.

Introduction: Perceived Stress Scale (PSS), developed in 1983, is one among the widely used global scales to assess the perceived psychological stress status. Hence, our study aimed at developing a Tamil version of THE 10-item PSS (TPSS-10) and assess its construct validity and internal consistency among patients with diabetes in Puducherry, South India. Methods: We translated the TPSS-10 by language experts and pilot-tested the sample with a subsample of diabetes patients. The finalized version of TPSS-10 was administered to 117 Tamil-speaking diabetic patients availing services from the rural health center in Puducherry, South India. Construct validity was assessed using the exploratory factor analysis (EFA) and the principal component analysis (PCA). A confirmatory factor analysis (CFA) was also done to obtain the goodness-of-fit. Reliability of questionnaire was evaluated by Cronbach's alpha. Results: Two factors were obtained with Eigenvalues of 4.61 and 2.16. Both factors explained 67.8% of the total variance. The two-factor model assessed by CFA found a χ2 value of 714.99 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.93). The reliability coefficient (Cronbach's alpha) for complete TPSS-10 was 0.86, indicating good internal consistency. Discussion: Our study concludes that the TPSS-10 questionnaire is internally valid and consistent with good reliability coefficient after its administration to Tamil-speaking urban diabetic patients in order to measure perceived stress. However, further research is warranted to content-validate the tool with a standard diagnostic instrument.

Background: Formative assessments methods such as objective structured clinical examination (OSCE) are reliable and valid assessment tools employed under the competency-based medical education (CBME) curriculum. However, there was no uniform scale to assess the attributes of OSCE for any of the medical subjects. Hence, this study was done to develop and validate a scale to assess the attributes of OSCE and make sure that the intended objectives of the OSCE are achieved. Methods: The scale was developed using literature review and expert opinion. It consisted of 10 questions and response to these items was based on a 5-point Likert scale ranging from “strongly agree” to “strongly disagree.“ The final version was administered among 30 students undertaking survey community diagnosis (CD) posting during their third semester. Exploratory and confirmatory factor analysis was performed to validate the scale. Results: Two-factor structures were obtained with eigenvalues of 4.32 and 1.90. Factor 1 consisted of seven items (positively faced questions) accounting for 42.84% of the variance, whereas Factor 2 had the remaining three items (negatively faced questions) explaining 19.36% of the variance. Thus, together, the two factors explained 62.20% of the variance. Goodness-of-fit indices revealed good Comparative fit index (CFI) s of 0.90, Tucker Lewis index (TLI) of 0.87, and acceptable Standardized Root Mean Square Residua (SRMR) of 0.13. The reliability coefficient (Cronbach's alpha) for the scale was 0.81. Conclusion: This study develops and validates a scale that can be used universally for assessing the attributes of OSCE across all disciplines and in medical education institutes in India.

The second wave of COVID-19 pandemic has spread rampantly throughout India between April and May 2021, leading to high mortality rates. Identifying any change in the rate of vaccine hesitancy or refusal due to such mass casualty events will provide further insights on developing appropriate risk communication strategy. Hence, this study was undertaken to identify the vaccine hesitancy and refusal before and during the second wave of COVID-19 pandemic. We conducted a longitudinal study among 900 adults to know about their vaccine hesitancy and refusal pattern before (March 2021 – round-1) and during the second wave of COVID-19 pandemic (May 2021 – round-2). Telephonic interview was conducted using the pre-tested semi-structured questionnaire. There was an increase in the vaccine hesitancy (27.8% in round-1 to 32.7% in round-2) and refusal (25.6% in round-1 to 35.6% in round-2) during the second wave of pandemic in Puducherry. In adjusted analysis, vaccine hesitancy was found to increase by 1.19 times during the round-2 survey compared to round-1 survey (aIRR = 1.19; 95%CI: 1.03–1.37). We also found that the vaccine refusal increased by 1.40 times during the round-2 survey compared to round-1 survey (aIRR = 1.40; 95%CI: 1.22–1.62) after adjusting for age, place of residence, and occupation. We found that the confidence in COVID-19 vaccine efficacy and safety has declined over time leading to increase in the vaccine hesitancy and refusal in our study cohort, with more than one-third refusing to get themselves vaccinated during the second wave of pandemic.

Background: Sex determination refers to knowing the sex of foetus during prenatal period for non-medical reasons. Attitude of married women to sex determination is important to improve the sex ratio at birth. Aim and Objectives: This study aimed to assess preference on sex determination and associated factors among currently married reproductive age group women. Materials and Methods: This cross-sectional community-based study was done during 2016–2017 among 2228 currently married women of 18–49 years' age group in urban and rural Puducherry, India. Information on the demographic characteristics, level of awareness and preference for sex determination was obtained. Multiple logistic regression was used to identify factors influencing preference for sex determination. Unadjusted and adjusted odds ratio (AOR) as a measure of effects was used. Results: Of 1979 respondents, all were aware that sex determination is possible. Majority of them did not prefer sex determination (95.4%, 1888). About 80 (4.0%) preferred, while 11 (0.6%) were undecided about it. Majority of them were aware that sex determination without medical indication is a crime. Common source of information was healthcare workers (76.4%). After adjusting for confounders, age group (18–24, AOR = 5.334; 25–29, AOR = 3.249; 30–34, AOR = 3.857; 35–39, AOR = 2.279), middle level education (AOR = 2.3), those with unmet need for family planning (AOR = 2.970) and urban area (AOR = 67.679) subjects were preferred more; housewife (AOR = 0.481) and those without living son (AOR = 0.406) had preferred lesser for sex determination compared to their counterparts. Conclusion: About one in 25 currently married women preferred sex determination. It is comparatively more in urban areas. High-risk groups should be educated to develop correct awareness and attitude on prenatal sex determination.

Background: Nutrition of the elderly affects immunity and functional ability and leads to increased morbidity and mortality. Validation of a short-form (SF) scale will make the assessment easier for primary care physicians. Hence, the study was done to assess the validity and reliability of Mini-Nutritional Assessment–SF (MNA-SF) Questionnaire among elderly in Puducherry. Methods: A cross-sectional study among 279 elderly was conducted in four villages of rural Puducherry. We have used three forms of MNA questionnaire. Diagnostic accuracy of the MNA-SF was assessed and internal consistency was interpreted using Cronbach's alpha. Results: The prevalence of malnutrition by the MNA full-form scale was 17.9%. Similar prevalence was reported by the body mass index (BMI) MNA-SF (16.5%), but calf-circumference (CC) MNA-SF overestimated the prevalence (38%). Sensitivity was higher in CC-MNA-SF (92%) when compared to BMI-MNA-SF (72%), while specificity was higher in BMI-MNA-SF (95.6%) when compared to CC-MNA-SF (73.8%). The positive predictive value was higher in BMI-MNA-SF (78.3%) when compared to CC-MNA-SF (43.4%), while the negative predictive value almost similar in both the scales. Reliability of the questionnaire showed the highest value for MNA full form (alpha = 0.71). Conclusion: This shows that both the forms of MNA-SF (BMI-based, CC-based) were valid and can be recommended as a screening tool for the assessment of nutritional status of the elderly.

Background: Menopause characterized by a gradual decline in ovarian hormones takes its toll on the women both physically and mentally. These health problems can negatively impact the mental status. Hence, the current study was done to determine the level of stress and its associated factors among postmenopausal women in urban Puducherry, India. Materials and Methods: A facility-based cross-sectional study was done among 219 postmenopausal women attending the outpatient department in urban primary health center during May 2017–June 2017. Information regarding sociodemographic profile was collected using pretested semi-structured questionnaire and Cohen's Perceived Stress Scale was used to assess the stress level. We calculated adjusted prevalence ratios (aPRs) to identify the determinants of stress. Results: Among 219 participants, 46.6% were in the age group of 60–74 years; 32.9% had primary to secondary level of education; 56.2% were unemployed; 42.5% belonged to lower socioeconomic class; and 32.9% had both diabetes mellitus and hypertension. The prevalence of stress among the postmenopausal women was 26.0% (95% confidence interval: 20.7–32.2). Postmenopausal woman with higher education (aPR – 2.18), belonging to nuclear family (aPR – 1.93), lesser parity (aPR – 1.18), and current alcohol/tobacco users (aPR-2.32) were found to have a significant association with stress among the study participants. Conclusion: The current study showed that more than one-fourth of the postmenopausal women had high to very high level of stress. Education, religion, parity, and substance abuse were the significant determinants of stress. However, further longitudinal research needs to be done to determine whether the factors informed in the current study are truly associated with stress and develop interventions accordingly.

Objective To explore the various stakeholders’ perspectives on barriers and facilitators for medication adherence among patients with cardiovascular diseases (CVDs) and diabetes mellitus (DM)in India.Design Systematic review of qualitative studies.Data sources A comprehensive systematic search was conducted in Medline, Cochrane Library, Science Direct and Google Scholar from January 2010 to July 2020. We included all qualitative peer-reviewed studies, reporting barriers and facilitators of medication adherence, from India, for our current review.Data extraction and synthesis Data extraction was performed by two independent authors who also assessed the quality of included studies using the Critical Appraisal Skills Programme criteria. This qualitative evidence synthesis adhered to the enhancing transparency in reporting the synthesis of qualitative research checklistResults In total, 18 studies were included. Major barriers reported were lack of understanding about the disease, complications related to non-adherence, followed by forgetfulness, lack of family support and risk communication. Health system-related barriers such as accessibility, affordability and acceptability were also reported by majority of the studies. Creation of peer support groups, digital reminder systems, integration of native Indian systems of India, physiotherapy and geriatric clinics at the primary healthcare level and innovations in patient care were suggested to counter these barriers in medication adherence.Conclusion Such patient-specific targeted interventions need to be developed to achieve better control among patients with CVD and DM.PROSPERO registration numberCRD42020199529.

Objective To determine the prevalence and determinants of diabetes mellitus (DM) among tuberculosis (TB) patients and to assess the additional yield and number needed to screen (NNS) to obtain a newly diagnosed DM among TB patients.Design We undertook a cross-sectional analysis of the cohort data under Regional Prospective Observational Research for Tuberculosis-India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included. Pretested standardised questionnaires and tools were used for data collection. Prevalence of DM among TB patients was summarised as proportion with 95% CI. Type II DM was diagnosed if random blood sugar level was >200 mg/dL or if the participant had a documented history of DM. NNS by blood glucose testing to diagnose one new DM case among TB patients was also calculated.Setting Three districts of South India: Puducherry, Cuddalore and VillupuramSubjects Newly diagnosed sputum smear positive pulmonary TB patients aged ≥16 yearsResults In total, 1188 TB patients were included. Prevalence of DM among TB patients was 39% (95% CI: 36.2% to 41.8%). In unadjusted analysis, elderly TB, marital status, caste, gender, higher education level, household income and obesity had a significant association with DM. However, in adjusted analysis, only marital status (currently married aPR; 3.77 (95 CI: 2.20 to 6.49), widowed/separated/divorced aPR; 3.66 (95 CI: 1.96 to 6.83)) and body mass index category (normal weight aPR; 3.26 (95 CI: 2.55 to 4.16), overweight aPR; 3.86 (95 CI: 2.69 to 5.52), obesity aPR; 4.08 (95 CI: 2.81 to 5.94)) were found to be significant determinants. The number of TB patients needed to be screened to find a new DM case was 12.Conclusion We found that one in three TB patients had coexisting DM. The number of TB patients needed to be screened to obtain a newly diagnosed DM patients was also determined. The study supports and highlights the need of RNTCP’s effort in bidirectional screening of TB and DM.

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.

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.

The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (

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.

Background: Low birth weight (LBW) is a major cause of neonatal morbidity and mortality. In addition to medical/clinical risk factors, various socio-demographic factors also have an impact on birth weight. Objective: The objective of the study is to determine the association of antenatal social support and spouse abuse during pregnancy with LBW in Urban areas of Puducherry. Materials and Methods: A community-based case–control study was conducted in Puducherry. Mothers of 100 LBW infants and normal birth weight infants in 2016 were studied. Functional Social Support Questionnaire and Index of Spouse Abuse scales were used. Conditional logistic regression for matched pair studies was done for multivariate analysis. Results: Mean (± standard deviation) age and education of the study participants was 25.6 (±3.5) and 8.28 (±3.6) years, respectively. The proportion of girl child was 59% and 43% among cases and controls, respectively. Mothers with higher perceived social support (odds ratio [OR] = 0.5; 95% confidence interval [CI]: 0.4–0.7) had lesser odds of LBW. The odds of LBW was 3.6 (adjusted OR [aOR] = 3.6; 95% CI: 1.3–9.9) times and 6.9 (aOR = 6.9; 95% CI: 1.5–31.9) times greater among mothers who experienced nonphysical abuse and had pregnancy-induced hypertension respectively and it was statistically significant after adjusting for child's gender, social support, and parity. Conclusions: The presence of nonphysical abuse during the antenatal period increased the risk of LBW. The awareness should be created in the community to prevent maternal exposure to abuse.

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.

BACKGROUND: Addressing good breastfeeding practices among antenatal and postnatal mothers is important as it helps in bringing about a positive change in the behavior, attitude, and practice with appropriate health education. Hence, this study was done to determine the awareness level of antenatal and postnatal mothers about the breastfeeding practices and benefits and identify the factors associated with it in rural Chengalpattu, Tamil Nadu, India. MATERIALS AND METHODS: We conducted this community-based cross-sectional study among 377 antenatal and postnatal mothers in the selected rural villages of Chengalpattu between October 2019 and September 2020. Details regarding the sociodemographic characteristics and awareness/knowledge about the breastfeeding were collected using pretested semistructured questionnaire. Knowledge adequacy was summarized as proportion with 95% confidence interval (CI), and factors associated with knowledge were interpreted as adjusted prevalence ratio (aPR) with 95% CI using log-binomial regression. RESULTS: About 19.6% (95% CI: 15.7%–24.0%) mothers had inadequate knowledge about breastfeeding. Women who were unemployed (aPR = 1.60; 95% CI: 1.02–2.51), belonging to the lower socioeconomic status (aPR = 2.62; 95% CI: 1.80–3.82), belonging to Muslim religion (aPR = 1.63; 95% CI: 1.14–2.35), and living in joint family (aPR = 1.58; 95% CI: 1.12–2.21) had significant higher risk of inadequate knowledge about breastfeeding practices compared to those who were employed, belonging to upper socioeconomic status, Hindu religion, and living in nuclear family. CONCLUSION: We found that almost one-fifth of the antenatal and/or postnatal mothers had inadequate knowledge about the breastfeeding benefits and practices. Health education sessions are required to promote the awareness about breastfeeding during antenatal and postnatal check-ups.

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.

Background: Adherence to medication and lifestyle modification is an important predictor of positive outcome of diabetes management among adults in which primary caregiver (PCG) plays an important role. Objectives: The objectives of this study were to describe the involvement of PCG in adherence to the drugs, diets, and lifestyle changes among patients with type 2 diabetes mellitus in an urban area of Puducherry. Methodology: A total of 311 type 2 diabetes patients irrespective of their source of diabetes care were included from the service area of an urban health and training center in an urban area of Puducherry. The PCG for each patient was identified, and the PCG and the patient were interviewed separately to obtain the information on adherence and involvement in various aspects of diabetes management, respectively, using an interview schedule. The information on diabetes control status of the patient was obtained from the records available. Results: About 10% of the patients did not have caregiver. Nearly 90% of the PCGs were involved in either of the lifestyle modification, drug adherence, checking type and frequency of medication, accompanying for consultation, or all. About 80% of the PCGs remind the patient to take medicines when out of station mainly by phone call/short message service. Encouragement toward physical activity was proportionately less compared to diet and drugs, and that was reflected in the patient's level of adherence in those domains. Overall involvement of spouse was more than the nonspouse. PCG involvement was found to be significantly associated with adherence to diet (P = 0.027) but not with drug and physical activity (P > 0.05). Conclusion: The PCG should also be considered while designing health education intervention on various aspects of diabetes management, focusing and highlighting the areas of poor involvement and their importance in disease management. The health system should place special focus on patients without PCG.

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.

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.

CONTEXT: Harmful use of alcohol has led to 1.7 million deaths from noncommunicable diseases and 1 million injury deaths including road traffic accidents, self-harm, and interpersonal violence. The opportunistic screening can be used to screen for substance abuse in outpatient department (OPD) attendees of primary health-care (PHC) settings in India. AIMS: This study was conducted to determine the prevalence of willingness to quit alcohol use among alcohol users and factors associated with it. SUBJECTS AND METHODS: A facility-based cross-sectional study was conducted in urban PHCs and willingness to quit alcohol was assessed among the alcohol users. Alcohol Use Disorder Identification Test (AUDIT) scale was used to assess the alcohol use disorder score. Data were entered using Epidata version 3.1 and analyzed using STATA version 14. RESULTS: It is found that two-third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education (adjusted prevalence rate ratio [aPR] = 1.9; 95% confidence interval [CI]: 1.2–2.9), occupation (aPR = 1.4; 95% CI: 1.1–1.8), higher AUDIT scores (aPR = 2.7; 95% CI: 2.2–3.5), frequency of alcohol use (aPR = 1.6; 95% CI: 1.2–2.0), and positive family history of alcohol-related illness times (aPR = 1.6; 95% CI: 1.3–2.0) were significantly associated with willingness to quit alcohol. CONCLUSION: Two-third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education, occupation, higher AUDIT scores, frequency of alcohol use, and positive family history of alcohol-related illness were significantly associated with willingness to quit alcohol.

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: Almost 15% of all pregnant women can develop potentially life-threatening complications. As a result, identification of high-risk pregnancy at earliest stage will be useful in directing appropriate intervention. Hence, the current study was done to determine the prevalence and outcome of high-risk pregnancy among antenatal women in rural Puducherry. MATERIALS AND METHODS: A record-based longitudinal study was done during March 2018 among 569 antenatal women who have attended rural health center of tertiary care institute. High-risk pregnancy was classified based on the guidelines from Pradhan Mantri Surakshit Matritva Abhiyan and outcome assessment based on the obstetric and neonatal outcomes. RESULTS: Among 569 antenatal case record reviewed, 315 (55.3%) were in the age group of 20–25 years and majority (463, 81.4%) belonged to below poverty line families; 410 (74.3%) registered their current pregnancy within the first trimester. The prevalence of high-risk pregnancy among study participants was 18.3% (95% confidence interval: 15.3%–21.7%). Majority (81.9%) had term delivery. Regarding obstetric and neonatal outcomes, majority had spontaneous vaginal delivery (73.9%); about 10.4% gave birth to low-birth weight baby, and only 1.7% had stillbirth. Parity, socioeconomic status, and unfavorable outcomes such as low-birth weight, preterm, and postterm delivery were associated with high-risk pregnancy. CONCLUSION: The current study found that almost one-fifth of the pregnant women in rural area have high-risk pregnancy. Unfavorable obstetric and neonatal outcomes were common among high-risk cases. Hence, early detection of high-risk pregnancy needs to be done at primary health-care level to improve the maternal, obstetric, and neonatal outcomes.

BACKGROUND: Noncommunicable diseases (NCDs) are the leading causes of mortality worldwide. Environmental factors play an important role in development of risk factors. Hence, the study was done to assess the neighborhood environmental factors related to NCDs in urban area. METHODOLOGY: This community-based cross-sectional study was carried out among three selected wards of urban Puducherry. All shops/establishments related to the risk of NCDs within the study area were study units. Information regarding tobacco, alcohol, diet, and physical activity-related establishments was assessed using pretested semi-structured pro forma. Shops/establishments were labeled either as “favorable” (prevents the risk of NCDs) or “unfavorable” (increases the risk of NCDs). RESULTS: Among 655 establishments, 372 (56.8%) belonged to favorable and 283 (43.2%) to unfavorable category, respectively. Tobacco-related establishments amount to 15.1% (95% confidence interval: 12.6–18.1) of the total establishments. Among these tobacco establishments, almost one-third were selling tobacco to minor and located within 100 m of school. Fruits and vegetable markets contributed to 21.8% of the total establishments. About 22% of the establishments were fast-food outlets. Public health sports facilities were only 6.8% of the total establishments. CONCLUSION: The current study reported almost equal distribution of favorable and unfavorable establishments. However, among unfavorable establishments, tobacco establishments raised concern as one-third of those were selling tobacco to minors. Healthy diet and physical activity related establishments were also found to be less. Hence, corrective measures are to be implemented which will reduce the burden of behavioral risk factors.

BACKGROUND: India is currently having a deceased donation rate of 0.05–0.08 per million population. The National Organ and Tissue Transplant Programme have planned strategies to improve organ donation by creating awareness and capacity building. There is great need to assess the knowledge regarding organ donation among general population. OBJECTIVE (S): Among the adult population (≥18 years) residing in urban slum of Puducherry to determine the knowledge, attitude, and practice regarding organ donation. MATERIALS AND METHODS: Community-based cross-sectional study was conducted during April to May 2017 among 257 randomly selected participants in selected wards of urban Puducherry. Data regarding knowledge, attitude, and practice were collected through pretested semi-structured questionnaire. RESULTS: Mean (standard deviation) age of the study participants was 45 (15) years and majority (57%) were female, 41% of them were educated more than secondary. Almost 90% of the study participants have heard about organ donation. However, only 28% (95% confidence interval [CI]: 22.9–33.8) had adequate knowledge regarding organ donation. 58% (95% CI: 51.5–63.5) had positive attitude toward organ donation. Practice regarding registration for organ donation was only 2.3%. Knowledge regarding organ donation was more among joint family (odds ratio [OR] = 1.86, P = 0.02) and middle socioeconomic status (OR = 2.40, P = 0.01). Positive attitude was more among those who were educated above secondary (OR = 3.47, P = 0.001) and less among Muslim/Christian religion (OR = 0.49, P = 0.03). CONCLUSION: Less than one-third of the study population had adequate knowledge regarding organ donation. Even though more than half of them had positive attitude toward organ donation only six individuals registered for organ donation.

BACKGROUND: Patients with cancer often delay seeking medical advice in developing countries. In India, only 20%–30% of cancers are being diagnosed in Stages I and II. Screening for red flag symptoms of cancer can be used to identify high-risk individuals in the community. METHODOLOGY: A community-based cross-sectional study was conducted in February 2017 among 302 participants in one of the service areas of Jawaharlal Institute of Postgraduate Medical Education and Research urban health center selected by universal sampling. Data on the presence of red flag symptoms of cancer (persistent cough, persistent change in bowel/bladder habits, nonhealing ulcer, persistent difficulty in swallowing, unexplained weight loss, unexplained lump, persistent unexplained pain, unexplained bleeding, and change in the appearance of mole) and presence of risk factors were collected through interviews. The collected data were entered using EpiData version 3.0. RESULTS: The mean (standard deviation) age of the study participants was 44 (11) years and 50.6% of them were male. At least one red flag symptom of cancer was present in 22 (7.3%) individuals; 9 (2.8%) had unexplained pain, 4 (1.3%) had change in bowel habits, 4 (1.3%) had change in bladder habits, 3 (1%) had cough, 3 (1%) had nonhealing ulcer, 2 (0.6%) had unexplained bleeding, 1 (0.3%) had difficulty in swallowing, 1 (0.3%) had weight loss, 1 (0.3%) had lump, and 1 (0.3%) had change in the appearance of mole. CONCLUSION: Screening for red flag symptoms of cancer is an easy tool that can be used in the community to identify high-risk individuals, which will facilitate early diagnosis of cancer.

BACKGROUND: Dengue is the most common life-threatening arboviral infection contributing to 92 million infections worldwide. India alone contributes for 34% of the global burden. Success of dengue control depends largely on adequate knowledge and good practices of preventive measures. However, there is a need to find the existing awareness among the general population, especially in rural areas. Thus, our present study was done to determine the awareness, attitude, and practice measures regarding dengue fever in rural Tamil Nadu. MATERIALS AND METHODS: A community-based cross-sectional survey was done among 303 individuals belonging to the selected village in rural Tamil Nadu during November 2016. Information regarding sociodemographic details and awareness, attitude, and practice toward dengue were collected using a semi-structured questionnaire. Adequacy of knowledge and attitude was summarized as proportion with 95% confidence interval. RESULTS: Among 303 participants, 204 (67.3%) were above 30 years of age; 196 (64.6%) were females; 255 (84.1%) were ever married; 149 (49.1%) were employed and most of them 93 (30.6%) were educated up to secondary level; 103 (33.9%) belonged to the Class 4 socioeconomic status. About 33.3% (95% confidence interval [CI]: 28.2–38.8) of the study participants had adequate knowledge and 56.1% (95% CI: 50.5–61.6) had positive attitude toward dengue prevention. About 57.7% (95% CI: 52.1–63.2) were practicing preventive measures. CONCLUSION: The current study found that only one-third of the participants had adequate knowledge regarding dengue but more than half of them had positive attitude toward dengue prevention and practicing mosquito control measures. Hence, large-scale information, education, and communication campaigns need to done at frequent intervals for rural population.