Indian journal of public health最新文献

Background: Noise-induced nonauditory effects and hearing loss are increasingly recognized as significant occupational health risks.

Objectives: The study investigates the nonauditory and auditory effects of daily noise exposure on traffic policemen in Chandigarh, focusing on their knowledge, perceptions, and attitudes toward noise pollution.

Methods: A cross-sectional design was employed, comparing 100 traffic policemen exposed to noise pollution with a control group of policemen working in quieter office settings.

Results: The Chi-square test showed a statistically significant association between stress and irritation among traffic policemen compared to their office-based counterparts (P < 0.05). However, no significant differences were found in responses regarding disturbance, headache, loss of sleep, or hypertension (P > 0.05). Self-assessment of auditory effects revealed that 56% of traffic policemen experienced symptoms of tinnitus, compared to 29% of general policemen. Diurnal noise levels at various traffic junctions in Chandigarh showed the highest (Leq) near the airport light point junction (79.9-78.8 dB) and the lowest at the Sukhna Lake entry point (72.0-69.89 dB). Average noise levels across all locations ranged from 76.04 to 75.30 dB, both during peak and nonpeak hours, well above the World Health Organization's recommended limit of 65 dB for traffic areas. Most traffic policemen were unaware of the harmful effects of noise pollution and did not consider it an occupational hazard.

Conclusion: This study highlights the need for stricter enforcement of noise control policies and increased awareness of noise pollution to reduce its impact on public health, particularly regarding noncommunicable diseases.

Background: Raised blood pressure (BP) is an important risk factor for cardiovascular diseases. Research has shown a negative gradient of BP with socioeconomic status (SES) in developed countries. However, studies in India reveal conflicting results.

Objectives: To examine the association between SES and BP among older adults in India and to explore the mediating mechanisms.

Methods: Structural Equation Modeling was employed to investigate the association of SES indicators (monthly per-capita expenditure and education) with systolic and diastolic BP using the cross-sectional data from Longitudinal Aging Study of India- Wave-1 (2017-2019). Separate models were fitted for rural men, rural women, urban men, and urban women to capture the residence- and gender-based variations. Mediating effects of bio-behavioral risk factors and antihypertensive medication use were explored.

Results: The sample size under analysis was 59,333. After adjusting for age, SES was positively associated with systolic and diastolic BP in both rural men and women. A clear pattern was not observed in urban men, while a negative association was observed in urban women. The hypothesized mediators exhibited a harmful mediating effect in all associations, with Body Mass Index being the strongest. There existed a significant protective effect of raising SES on BP in urban women which was not explained by the mediators.

Conclusion: In a country like India undergoing rapid socioeconomic changes, BP complexly interacts with SES, varying between residence and genders. This underscores the need for further exploration to inform effective public health interventions.

Background: India faces unique challenges in tobacco control, with 266.8 million adults using tobacco. Despite these challenges, the country has made progress with the National Tobacco Control Program (NTCP). Effective execution of these policies is crucial to combat the growing tobacco epidemic. This study aims to establish consensus on national and subnational NTCP priorities using a modified Delphi technique.

Methods: A three-stage modified Delphi process involved 21 experts from government, nongovernmental organizations, and academia. In the first stage, experts identified key tobacco control priorities. In the second stage, they rated these priorities on a Likert scale (0-4), and the top 10 were determined using a weighted mean. The final stage included an in-depth discussion and ranking of these top priorities by the expert panel.

Results: In the initial round, experts proposed 20 national and 17 subnational priorities, which were then rated and ranked to achieve consensus on the top 10 for each level. The top three national priorities identified were amending the National Tobacco Control Legislation (COTPA), monitoring NTCP implementation, and protecting health policy from tobacco industry interference. The top three subnational priorities were: enforcing COTPA and the e-cigarette ban (PECA), engaging civil society in tobacco control efforts, and promoting tobacco-free schools and villages.

Conclusions: While national policies and legislation are vital for strengthening the overall tobacco control framework, effective implementation and enforcement at both national and subnational levels are essential for curbing the tobacco menace in India.

Background: Hypertension and tobacco use are significant public health concerns with detrimental effects during pregnancy.

Objectives: This study was conducted to assess the association between tobacco use and hypertension among women of prime childbearing age (20-34 years) in India using a representative survey, the National Family Health Survey (NFHS)-5.

Methods: Secondary data from the NFHS-5 conducted between June 2019 and April 2021 were utilized. Multivariable logistic regression was performed to analyze the association between tobacco use and hypertension, adjusting for sociodemographic factors, illness, physical characteristics, and state-wise data.

Results: Tobacco users had a significantly higher prevalence of hypertension (8.8%) compared to nonusers (6.57%). Women using tobacco were 1.16 times more likely to have hypertension than nonusers (95% confidence interval: 1.05-1.28).

Conclusion: The study highlights the increased risk of hypertension among tobacco-using women of childbearing age in India. Comprehensive interventions addressing both tobacco control and hypertension management are urgently needed.

Background: Double fortified salt (DFS) is an innovative new fortified food product that provides humans with small but critical amounts of iodine and iron through their diet.

Objectives: The present study involved assessing the effectiveness of DFS in improving the status of iron biomarkers and hemoglobin (Hb) concentration among adolescent girls in Chandauli district, Uttar Pradesh.

Materials and methods: A double-blind, randomized controlled trial was conducted in 26 villages of the Chandauli district among 602 adolescent girls (15-19 years). Venous blood samples were collected from anemic adolescent girls, followed by a baseline survey. One group received DFS along with nutrition education, whereas the other group received iodized salt and nutrition education. An end line survey was conducted to compare the outcomes. The Wilcoxon signed-rank test was employed to evaluate the differences in median values of biochemical parameters, and a regression test was used to assess the association of DFS with the change in serum iron levels from baseline to end line.

Results: The Hb levels among girls increased by 1.7 g% from baseline to end line (P < 0.001), and serum iron levels rose by 8.4 µg/dL (P < 0.001). After adjusting for covariates and confounders, the DFS was positively associated with a greater increase in serum iron levels compared to iodized salt (P < 0.05).

Conclusion: The present study identified an easy and economical solution to mitigate iron deficiency without causing side effects such as toxicity or stomach upset as with iron tablets. DFS is shown to be an effective public health strategy for enhancing the nutritional status and overall health among adolescent girls.

Background: An Increased burden of noncommunicable diseases and their association with sleep problems exists.

Objective: The objective of this study was to estimate the prevalence of sleep problems in India.

Materials and methods: A meta-analysis of the studies conducted on Indian data was planned using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. To assess the methodological quality, a 10-point Joanna Briggs Institute (JBI) checklist for prevalence studies was used.

Results: Pooled estimates of 100 eligible studies showed the prevalence was 25.7% for insomnia (95% confidence interval [CI]: 16.3%-38.0%, I2 = 99.4%), for obstructive sleep apnea (OSA), 37.4% (95% CI: 27.8%-48.2%, I2 = 98.3%), and for restless leg syndrome (RLS) was10.6% (95% CI: 7% to 15.9%, I2 = 97.3%). An increased prevalence was seen in patients with diabetes, heart disease, and other conditions. JBI checklist scores ranged from 4 to 9, with a median score of 7. Subgroup analysis showed that both patients and the general population had sleep disorders; prevalence of insomnia 32.3% (95% CI: 18.6%-49.9%, I2 = 99.4%) and 15.1% (95% CI: 8.0%-26.6%, I2 = 99.1%), OSA 48.1% (95% CI: 36.1%-60.3%, I2 = 97.4%) and 14.6% (95% CI: 9.2-22.5%, I2 = 97.4%), and RLS 13.1% (95% CI: 8.7%-19.3%, I2 = 91.9%) and 6.6% (95% CI: 2.4%-16.4%, I2 = 99.1%) in patients and general population, respectively. Excessive daytime sleepiness was a common symptom. Different methodologies and diverse population groups were studied, thus increased heterogeneity was seen.

Conclusion: Increased prevalence of sleep problems existed in noncommunicable diseases and the general population. A need to recognize the allostatic load of sleep problems in noncommunicable diseases is highlighted.

Background: Injection drug use is a global issue with almost one-fifth of them being human immunodeficiency virus (HIV) positive.

Objectives: The present study is aimed at finding out the burden of HIV infection and associated factors among injecting drug users (IDUs) between 18 and 25 years of age of Tripura and to compare with the registered prevalence of infection among them.

Materials and methods: A cross-sectional study was conducted among 80 young IDUs in West and Dhalai district of Tripura. Respondent driven sampling was done identifying hotspots with the help of targeted intervention-NGOs, to interview the respondents.

Results: Most of the respondents were male (92.5% and 85% respectively from West and Dhalai district) and between 22 and 23 years age. The self-reported seroprevalence of HIV among IDUs was 53.8% (in comparison to 38% among Tripura State AIDS Control Society (TSACS) registered seroprevalence) in West district and 57.9% (in comparison to 50.6%) in Dhalai district. Most of them (81% and 91%, respectively) are currently on antiretroviral therapy and socioeconomic status of IDUs from Dhalai district was found to be significant predictor of HIV infection among them.

Conclusion: Self-reported prevalence of HIV among IDUs in both the study districts was higher than TSACS reported HIV prevalence among IDUs in the same districts. Socioeconomic status was a significant predictor of HIV infection among the IDUs with scope for improvement among practice related to regular use of condoms during sexual intercourse.

Background: Southern India has one of the highest prevalence of consanguineous marriages in Asia. Limited research has been conducted to understand the reasons behind this in the rural areas of South India, despite the potential risks associated with consanguinity.

Objectives: The present community-based mixed-methods study was conducted in selected villages of Telangana, with an aim to determine the prevalence and pattern of consanguineous marriages and also to find out why the population native to this region prefer such marriages.

Materials and methods: Two hundred and fifty-two married couples aged 18-75 years, native to this region, were interviewed by doing house to house survey, for achieving the aim, and focused group discussions were conducted, to find out why people of this region prefer or oppose consanguineous marriages, to understand their "mind-set," influencing consanguinity.

Results: The present study found a prevalence of 36.51% consanguinity in this region, with an inbreeding coefficient of 0.014028. The wife's education level is the only sociodemographic factor significantly affecting the prevalence of consanguineous marriages, while factors such as age, socioeconomic status, time spent in the region, religion, employment, husband's education, family structure, and age at first birth show no impact. The continuation of consanguineous marriages in this region is driven by social factors such as marital security and cultural practices, along with economic factors such as inheritance and dowry.

Conclusion: Consanguinity is highly prevalent in this region, and there is an urgent need community-based campaigns to raise the awareness of the general population regarding its negative effects.

Background: The incidence of mortality and cumulative risk of developing cancer has been consistently high in the northeastern Region of India. Cancer is among the leading causes of death in Mizoram. This survey is an approach to implement a baseline monitoring system to drive us in understanding the linkage between exposures to risk factors, other noncommunicable diseases, and cancer incidence.

Methods: A cross-sectional study was conducted among 2880 households from 60 primary sampling units who were selected using a multistage cluster sampling technique. The data were collected using household level interview, adult interview, cancer patient interview, and health facility interview.

Results: Nearly half of the respondents had a clustering of >3 cancer risk factors. The prevalence of current tobacco use (smoked or smokeless) was as high as 77.1%. Over 80% of the respondents consumed fermented products. Nearly half of the respondents were prehypertensive. 35.9% of the respondents were overweight. Nearly 41.3% of the respondents had central obesity. Around 42.8% of the respondents were aware of cancer screening. Less than 25% of the surveyed primary health cares provided cancer screening services.

Conclusion: The high prevalence of cancer risk factors underscores the urgent need for comprehensive and sustained efforts toward prevention, education, and intervention. The challenges posed by a poor health system for cancer prevention are grave and demand urgent attention from all stakeholders involved in health-care delivery.

Background: Private practitioners play a key role in addressing the healthcare needs of a large proportion of the Indian population. While several studies have explored drug prescribing practices in India, a gap exists in understanding the drug prescribing patterns of private practitioners.

Objectives: This study described the drug prescribing patterns of private practitioners using World Health Organization (WHO) prescribing indicators, with a focus on estimating the proportion of antibiotics prescribed based on AWaRe (ACCESS, WATCH, and RESERVE) classification.

Materials and methods: The study used a cross-sectional descriptive design. The prescriptions of private practitioners were collected from customers at 20 pharmacies in Puducherry, South India from September to November 2023.

Results: A total of 600 prescriptions were included in the analysis. About one-third (33.7%) of prescriptions collected were for individuals aged 31-45 years, whereas least (6.3%) were for those <18 years. The antibiotic prescription rate was 38.8%, exceeding WHO standards (20%-26.8%), with 61.4% falling in the WATCH category, below the WHO target of ≥60% ACCESS category. Polypharmacy was observed, averaging 3.6 drugs per prescription, exceeding the WHO standards (1.6-1.8 drugs). Generic name prescription was only 0.2%, deviating from the WHO's 100% standard. Injections were prescribed in only 3.5% of prescriptions, below the WHO standards (13.4%-24.1%). Furthermore, only 52.8% of prescribed drugs were on the National Essential Medicine List (NEML) of India, 2022, below the WHO's 100% NEML prescription standards.

Conclusion: This study has highlighted the practice of polypharmacy, higher preference for branded drugs and antibiotics, and a lesser utilization of NEML-listed medications by the private practitioners in Puducherry.