Indian journal of public health最新文献

Background: Brucellosis, a zoonotic disease, is responsible for multitude of health issues and economic burden in community and is widely studied in high-risk population. The prevalence of disease or exposure to the organism causing brucellosis in a specific community has not been studied widely.

Objectives: This study was conducted to measure community-based seroprevalence of human brucellosis in livestock-rearing villages in three districts of central Gujarat.

Materials and methods: We collected a total of 2561 blood samples of individuals from households of 93 villages. Multistage random sampling techniques were used for sample collection during the study period of 2021-2023. Serum samples were tested for immunoglobulin (Ig) G and IgM by the Novatech enzyme-linked immunosorbent assay Brucella kit.

Results: District-wise seropositivity ranged from 18.35% to 26.81%, and overall, 579 (22.60%) samples were found to be positive for IgG, IgM, or both antibodies to Brucella spp.

Conclusion: The seroprevalence of human brucellosis is high in the community of livestock-rearing villages and requires to be studied in more detail.

Introduction: Noncommunicable diseases (NCDs) are escalating in all gradients of population across globe. India launched a plan in 2017 for prevention and control of NCDs by addressing its social determinants and focusing multisectoral action (MSA). An assessment study of MSA in Uttar Pradesh informed that MSA is still at nascent stage of execution, and more focused efforts are needed to align all nonhealth sectors with health. This research provides inputs for implementing MSA after in-depth exploration of barriers in districts of Uttar Pradesh, India.

Objectives: To understand barriers in implementation of MSA for prevention and control of NCDs.

Materials and methods: A qualitative study was conducted with 29 key informants across various sectors from selected districts of Uttar Pradesh to identify barriers in MSA. Data were transcribed and translated before manual analysis. Codes and emerging themes were categorized into barriers. Content analysis of sector's websites was done to capture content related to MSA in public domain to get comprehensive understanding of barriers through data triangulation.

Results: There is no collaborative platform wherein different sectors could negotiate mandates and collaborate towards implementing MSA. Crucial barriers identified were lack of active participation from nonhealth sectors and frequent change of program nodal officers. The absence of monitoring mechanism for collaborative activities also emerged as an important barrier added by work culture and capacity of officers to implement MSA.

Conclusions: Establishment of functional platforms at districts for collaborative actions between sectors is essential along with extensive use of digital media to enhance coordination.

Background: Breast cancer is the most common cancer among Yemeni women. In this study, we aimed to determine the socioeconomic and lifestyle factors of breast cancer risk and survival among Yemeni women in Thamar.

Objectives: We assessed the association between socioeconomic status, lifestyle factors, and the risk of developing breast cancer; and compared disease-free survival (DFS) and overall survival between urban and rural breast cancer patients.

Materials and methods: We performed a retrospective, case-control study using data from the Thamar cancer registry and household survey. Cases were women with histologically confirmed breast cancer diagnosed from January 1, 2019 to December 31, 2023, and frequency-matched controls included women without breast cancer. Risk determinants were determined using multivariate logistic regression models and survival outcomes were analyzed using Cox regression.

Results: A total of 115 cases and 119 controls were included in the study. Significant breast cancer-associated factors were illiteracy (adjusted odds ratio [aOR] =5.46, P < 0.001), wood fuel for cooking (aOR =15.8, P < 0.001), low monthly income below 200 USD (aOR =12.1, P < 0.001), and postmenopausal status (aOR =2.54, P = 0.035). The comparison of DFS between urban and rural residents showed no statistically significant difference.

Conclusions: The study identified illiteracy, wood fuel for cooking, postmenopausal status, and low monthly income as key associated factor for breast cancer among the cases and controls examined. No significant difference in DFS was observed between urban and rural residents.

Background: The nutritional status of children in South Asian regions is already under threat from rising global temperatures and more unpredictable rainfall and humidity patterns. Child undernutrition based on mid-upper arm circumference has been a major concern for Nepal as it is the highest among children in the world.

Objective: The objective of our study is to determine the climate change and socioeconomic determinants of undernutrition in children under 3 years.

Methods: This study explored the sample of 538 children ranging in age from 3 to <36 months using a binary logistic regression model to determine the climate change and socioeconomic factors associated with child undernutrition.

Results: Our study estimated approximately 24% of children are undernourished. Our analysis in the adjusted multivariable logistic regression model found that children born between 65% and 75% humidity were 3.48 times more likely to be undernutrition as compared to the humidity level at <65% (adjusted odds ratio = 3.48; 95% confidence interval [CI]: 1.08-11.18). The bivariate analysis found that children born at a temperature higher than 30°C were four times more likely to suffer from undernutrition (odds ratio = 4.00; 95% CI: 1.19-13.44). The study revealed that children who had low childbirth weight were eight times more at risk of being undernutrition.

Conclusions: Our study revealed that temperature, precipitation, climate hazard, occupation of the mother, and health facility distance were common climate change and socioeconomic risk factors of child undernutrition in Nepal.

Background: The state of maternal nutrition, denoted by the maternal anthropometric parameters (MAPs), plays a pivotal role in determining the birth outcomes.

Objectives: This study was conducted to determine whether MAPs could predict selected birth outcomes.

Materials and methods: A cross-sectional study was conducted among randomly selected 333 pregnant mothers admitted for delivery after 28 weeks of period of amenorrhea at a tertiary care maternity hospital in Sri Lanka. Pregnant mothers who were having multiple pregnancies, awaiting elective cesarean section due to past section, registered for booking visits after 12 weeks of gestation, and had pre-existing disease conditions that might affect anthropometric parameters were excluded from the sample. Information on MAPs and birth outcomes were extracted from medical records. Data were analysed using ordinal logistic regression.

Results: Mean ± standard deviation of pre-pregnancy weight (PPW), maternal height (MH), pregnancy weight gain (PWG), and pre-pregnancy body mass index (BMI) were 55.1 ± 12.8 kg, 154.7 ± 5.7 cm, 9.6 ± 4.1 kg, and 22.9 ± 4.9 kg/m2, respectively. Nearly half of the mothers had unsatisfactory prepregnancy BMI, while 68.5% of mothers had unsatisfactory PWG. Low birth weight was reported in 24.6%, while 18.3% and 12.1% had prematurity and APGAR scores less than nine at birth, respectively. Higher PPW and PWG predicted better birth weight. Satisfactory PWG was predictive of maturity at birth. Both a satisfactory PPW and MH emerged as predictors of a good APGAR score at birth.

Conclusions: PPW, PWG, and MH can significantly predict selected birth outcomes in singleton pregnancies. These predictions will be useful for the provision of better perinatal care through early identification of high-risk newborns.

Summary: Poor glycemic control is associated with an increased risk of diabetes-related complications, attributable to a wide range of factors. The aim of this study was to determine the prevalence and predictors of poor glycemic control among patients with type 2 diabetes in southern Afghanistan. We conducted a cross-sectional study among diabetes patients randomly recruited from four hospitals in southern Afghanistan during their follow-up visits between August and October 2024. Out of 406 patients, 74.9% (95% confidence interval [CI]: 70.3%-79.1%) had poor glycemic control. Physical inactivity (adjusted odds ratio [AOR] =1.89, 95% CI: 1.04-3.41), irregular monitoring of blood glucose levels (AOR = 8.80, 95% CI: 4.49-17.2), nonadherence to antidiabetic medications (AOR = 2.69, 95% CI: 1.41-5.13), and presence of depression symptoms (AOR = 2.20, 95% CI: 1.25-3.86) were significant predictors of poor glycemic control. The findings highlight an urgent need for targeted health policies and clinical interventions to address the high prevalence of poor glycemic control in Afghanistan.

Background: Vitamin D3 deficiency is linked to various chronic and infectious ailments. While prior studies have explored its prevalence in Indian children, adolescents, and pregnant women, a comprehensive understanding is lacking.

Objective: The D3 PULSE survey aimed to capture doctor perspectives on Vitamin D3 deficiency in Indian outpatient department (OPD) patients.

Methods: This was a cross-sectional survey executed across India, in both urban and rural regions comprising 23 states and 4472 cities. The survey included 20,603 respondent doctors from diverse specialties. An online six-item questionnaire gathered the clinical opinions of respondents based on their routine practice, expertise, and preferences on the prevalence and treatment approaches of Vitamin D3 deficiency. Data were gathered and analyzed based on the responses to a six-item survey questionnaire.

Results: Survey results indicated Vitamin D3 deficiency in 51%-100% of OPD patients, prompting 58% of doctors to prescribe an 8-week course of 60K Vitamin D3 supplements primarily for deficiency and immune support. Sixty-seven percent of doctors clinically assess deficiency through symptoms such as fatigue and depression. Key considerations for doctors in choosing and prescribing Vitamin D3 supplements include desired serum level increase (67%) and patient compliance. Challenges include low patient awareness and therapy costs.

Conclusion: The D3 PULSE study highlights widespread Vitamin D3 deficiency (51%-100%) among Indian OPD patients. Management involves an 8-week course of 60K Vitamin D3 supplements, with considerations for serum level increase and patient compliance. Different formulations (tablets/capsules/sachets/injections) demonstrated similar efficacy. Lack of awareness and high therapy costs pose challenges to effective supplementation.

Background: Evaluation and monitoring of public hospitals across Mizoram, India was conducted using hospital records and administrative data from 2016 to 2023.

Objectives: This study seeks to investigate the opportunity benefits of public health services in Mizoram by conducting a comprehensive economic analysis of their cost-effectiveness and cost-benefit while accounting for inflation.

Materials and methods: This study adapted and modified the inflation adjustment methodology employed in previous research to suit its specific requirements. In addition, relevant data were gathered from various official government documents and organizations to facilitate the analysis. Inflation-adjusted variables, cost-effectiveness, cost-benefit, and time series methods were employed for this study.

Results: The opportunity benefits estimated to be ₹33,462,912,272 in 2023, equivalent to 1,640,107,165 in purchasing power parity terms. A cost-effectiveness analysis revealed that public hospitals in the outpatient department had a cost-effectiveness ratio of 0.1323 (13.23%) or 1:8 compared to private hospitals during the study period. The inpatient department had a cost-effectiveness ratio of 0.3141 (31.4%) or 1:3. Furthermore, the cost-benefit ratio of total budgetary allocation to health care was 0.2835 (28.35%) or 1:4. The total opportunity benefits accounted for 17.9% of the Gross State Domestic Product of ₹190,368,300,000 in 2021-2022.

Conclusion: The expansion and development of public health systems are crucial for delivering essential healthcare services to the broader population, with a particular focus on vulnerable populations who are disproportionately affected by health disparities.

Background: Scrub typhus is an acute febrile illness caused by the Gram-negative cocco-bacillus Orientia tsutsugamushi, accidentally transmitted to humans by the bite of mite chiggers. Its epidemiology in India remains obscure due to under-reporting of cases.

Objectives: This single-hospital study prospectively determined the seropositivity, clinical features and treatment response of scrub typhus over 5 years in the city of Jodhpur, Western Rajasthan, from where no formal seropositivity data were previously available.

Methods: All patients with acute febrile illness of more than 5 days were screened according to the Department of Health Research-Indian Council of Medical Research (DHR-ICMR) 2015 guidelines and enrolled after their signed informed consent. Serological test Orientia tsutsugamushi immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) was performed. All positives were reported to Integrated Diseases Surveillance Programme.

Results: Over the 5-year study (2019-2023), a total of 1497 patients met the DHR-ICMR criteria, and 83 (5.5%) tested Orientia tsutsugamushi IgM ELISA positive. The classical clinical features such as eschar, rash, and lymphadenopathy were less common; and others such as myalgia, headache, malaise, altered sensorium, LFT derangement, thrombocytopenia, and leukocytosis were more commonly reported. More cases occurred during winter and responded well to doxycycline or azithromycin clinically. Three died before initiation of therapy.

Discussion: This is the first study from Jodhpur to describe the occurrence of scrub typhus, by the DHR-ICMR guidelines. Despite being a reportable disease under the Integrated Disease Surveillance programme, the epidemiology of scrub typhus remains obscure in India due to low clinical suspicion, poor availability of diagnostic services and under-reporting of clinical cases.

Background: Women's hypertension (HTN) is often underestimated and goes untreated due to the perception that women have a lesser risk of cardiovascular disease compared to males.

Objectives: The purpose of this study was to assess the prevalence and major risk factors of HTN in adult women of Punjab.

Materials and methods: A community-based cross-sectional study with multistage sampling design was conducted among rural population of Punjab. The survey was designed in accordance with the WHO STEPwise approach for surveillance of noncommunicable disease to provide prevalence estimates of risk factors for three age groups for HTN. Village was considered a primary sampling unit (PSU). From each selected PSU in a rural area, households were selected. The ultimate sampling units were the households.

Results: A total of 2160 females were screened for HTN. Eight hundred and twenty-seven (38.27%) were found to be hypertensive, with 27.9% in stage 1 and 10.4% in stage 2 HTN. Body mass index and reproductive health factors (P = 0.001) were substantially linked with HTN. Significant disparities emerged in nutritional habits: hypertensive subjects exhibited higher average sugar intake (P = 0.006) and salt intake (P = 0.007) and were more likely to add table salt during meals (P = 0.013).

Conclusion: HTN prevalence is alarmingly high in Punjab, posing significant risks for chronic diseases and other health complications among its residents. The findings from this research could provide crucial insights that form the basis for developing tailored public health programs, policies, and awareness campaigns focused on HTN and its risk factors in rural communities.