Indian journal of public health最新文献

Introduction: The first case of measles outbreak in Pune was reported on November 14, 2022; since then, there were a total of 266 cases from Pune Municipal Corporation (PMC).

Objective: The objective is to find out risk factors associated with measles during an outbreak in Pune city.

Methods: This was a 1:1 unmatched case-control study conducted from February 2023 to September 2023 in PMC. Cases were immunoglobulin M-positive laboratory-confirmed measles cases and a control was any child who did not have any rash in the study period and not living in the same household with a case. Face-to-face interview of cases and controls were carried out by visiting houses to obtain information on sociodemographic characteristics and immunization history, including Vitamin A supplementation. The sample size was 200.

Results: There was a statistically significant difference among the mean age of cases (53.18 ± 18.08) and controls (30.08 ± 18.08). Father's and mother's education, immunization, and Vitamin A supplementation were also significant. Those who had not received any dose of measles-rubella (MR) vaccine had a higher chance of having infection with an odds ratio of 3.093 (95% confidence interval [CI]: 2.37-4.037) and those who were partially immunized with 1 dose of MR showed odds ratio of 2.027 (95% CI: 1.328-3.096) for having measles infection. COVID-19 lockdown was the reason given by majority (29.3%) for unimmunized of the measles vaccine.

Conclusions: In this study, the main cause of this measles outbreak was under immunization. It is important to maintain high levels of under 5 immunization even during emergencies to prevent future measles outbreaks.

Background: In India, oral cancer ranks as the third most common cancer in men and the fourth in women, largely due to the prevalent use of tobacco. Data on oral cancer screening among tobacco users in India are limited.

Objectives: This study aimed to determine the prevalence of oral cancer screening among tobacco users and to identify factors associated with it.

Materials and methods: This study analyzed data from the National Family Health Survey (NFHS-5), using stratified multistage clustering sampling to ensure national representativeness. The data analysis included estimating weighted proportions to account for the cluster sample design.

Results: The NFHS-5 data include information on oral cavity examinations for oral cancer for 97,000 men and 707,119 women. Among these individuals, 41,669 (40.59%) men and 45,568 (6.44%) women were identified as tobacco users. Among tobacco users, screening rates were low, at 1.07% for men and 0.53% for women, with even lower rates among those using smokeless tobacco. Significant differences in screening rates were observed across different tobacco products and demographic groups. Factors such as gender, age, socioeconomic status, education level, and recent healthcare visits significantly influenced screening rates. Screening rates were highest among individuals in Andhra Pradesh, with 6.28% for men and 5.38% for women, showing significant differences in screening outcomes based on attempts to quit tobacco use and visits to healthcare providers.

Conclusion: The study finds low oral cancer screening rates among tobacco users. Efforts should prioritize overcoming barriers to screening and customizing interventions to enhance screening rates in India.

Background: Cancer patients experience deterioration in their functional status and it is regarded as an important cancer patient outcome metric.

Objectives: (1) To assess the functional status of cancer patients of West Tripura District using the Eastern Cooperative Oncology Group (ECOG) Scale. (2) To study the sociodemographic factors associated with functional status of cancer patients. (3) To study the disease-related factors associated with functional status of cancer patients.

Materials and methods: This was a community-based cross-sectional study conducted among 180 randomly selected cancer patients (≥18 years of age) in West Tripura District. The functional status was assessed using ECOG performance status scale.

Results: The study highlighted that majority of the participants were in the age group of 55-64 years (40.0%), had squamous cell carcinoma (59.40%), and TNM Stage II of cancer (34%). Bivariate analysis showed that age, religion, caste, body mass index, blood pressure, site of cancer, pathological type of cancer, and TNM staging were significantly associated with functional status of cancer patients (P < 0.05). Multiple logistic regression showed factors such as religion, caste, site of cancer, pathological type of cancer, and TNM staging of cancer patients significantly affected the functional status in cancer patients (P < 0.05).

Conclusion: The current study highlighted that majority of the cancer patients had poor functional status with site, type, and TNM staging of the cancer significantly affecting the functional status. Hence, targeted interventions with palliative care should be more focused on certain types and advanced stages of the disease to enhance functional performance and health outcomes.

Background: Persons with substance use disorders (SUDs) who do not recognize their substance use as problematic are less likely to perceive needing treatment and less motivated to seek help. The factors that contribute to cognizance among persons with SUDs are poorly understood. The identification of factors of cognizance and using this to tailor motivational enhancement strategies may be beneficial toward minimum relapse and prolonged drug-free existence.

Objectives: To identify the social and clinical factors which are at play with cognizance of SUD among subjects attending opioid substitution clinic.

Materials and methods: A cross-sectional study of subjects registered more than 3 months who attended opioid substitution therapy were included with a sample size of 62. Pretested questionnaire was used to elicit the information from consenting eligible persons. A translated validated version of Scale of Change Readiness and Treatment Eagerness Scale in Bengali was applied scoring subjects with high or low recognition of SUD.

Results: On regression modeling, predictors which had positive odds of having good cognizance were subjects with family support (adjusted odds ratio [AOR]: 9.4, confidence interval [CI]: 1.77-81.9) and those subjects who were continuing the present spell of therapy for less than a year (AOR 4.03, CI 1.1-19.7). Subjects who were declared clean at least once in their life time had a less chance of being cognizant of their problems. (AOR 0.13 CI 0.03-0.55). Model had an accuracy of 74% and area under the curve as 0.8.

Conclusion: Identifying the factors associated with increased or decreased cognizance can be used while counseling or predicting follow-up treatment for SUD subjects.

Introduction: With epidemiological transition, the prevalence of diabetes and hypertension has significantly increased. Adherence to self-care is crucial to achieve blood glucose and blood pressure (BP) control.

Objectives: The study aimed to understand the impact of a structured community engagement program on blood glucose and BP levels among patients with diabetes and hypertension, respectively.

Methods: Patients receiving treatment at two primary care clinics at Karnataka and Telangana were enrolled after obtaining consent. Peer groups were created and weekly sessions on self-care conducted for 12 weeks. BP, body mass index, and glycosylated hemoglobin were recorded pre- and postintervention.

Results: Out of 284 patients enrolled, 202 underwent baseline investigations, and 142 (70%) completed all sessions. A median 3 mmHg reduction in systolic BP (SBP) was observed among hypertensive patients post intervention.

Conclusion: Community-based engagement sessions contributed to reduction in SBP. Similar model can be considered under the National Programme for Prevention and Control of Noncommunicable Diseases to improve self-care among noncommunicable disease patients by training health workers.

Background: Vision impairment and blindness are major public health challenges, especially in low- and middle-income countries. Although the prevalence of blindness in India has reduced considerably, untreated cataract still remains a public health challenge. The World Report on Vision (2019) emphasizes the need to make eye care an integral aspect of universal health coverage and incorporate integrated people-centred eye care in health systems.

Objective: (1) To describe the setup of an Integrated Primary Eye Care model. (2) To describe the pattern of ocular morbidity among patients attending the primary healthcare clinics across four states in India.

Methods: Retrospective observational study describing the primary eye care services delivered across four states in India between August 2019 and March 2020. The de-identified secondary data were analyzed for the pattern of ocular morbidity.

Results: Seven thousand and twenty-four patients availed the eye care services across the four primary care clinics. Majority of the patients were female (54.7%), most patients belonged to the age groups of 45-60 years (33.2%) and 30-45 years (32.3%). Elderly patients of both genders had equal access to the eye care services. The common presenting complaints were diminished vision (83.1%), redness (9.5%), and pain (6.4%).

Conclusion: Uncorrected presbyopia (35%), refractive error (32.8%), and cataract (12.8%) were the commonly observed ocular morbidities. Integration of primary eye care into primary health care can improve access to eye care services, especially for vulnerable population such as elderly and women, who otherwise face several challenges to access eye care services.

Background: Obesity and chronic inflammation increase metabolic disease risk.

Objectives: This study investigated associations between inflammation, body composition, and dietary patterns in Indian physicians.

Materials and methods: In this cross-sectional study, 550 government doctors aged 25-60 years in Gujarat, India, were recruited through multistage random sampling. Anthropometry, bioelectrical impedance analysis, and food frequency questionnaire data were collected. Dietary Inflammatory Index (DII) scores were calculated.

Results: High obesity prevalence was observed, with 48% classified as obese by body fat percentage (BF%) despite normal body mass index (BMI). Significant positive correlations were found between DII scores and BF% (r = 0.57, P < 0.001) and BMI (r = 0.27, P < 0.001). DII scores were negatively correlated with skeletal muscle percent (r = -0.45, P < 0.001). Higher body fat raised the odds of elevated DII by 1.121 (95% confidence interval [CI] 1.05-1.22, P < 0.001), while higher muscle percent lowered DII odds by 0.910 (95% CI 0.85-0.964, P < 0.001).

Conclusions: Excess adiposity correlated with higher dietary inflammation among Indian physicians, contrasting with lower inflammation linked to greater muscle mass. Evaluating inflammation alongside body composition provides insights beyond BMI alone.

Background: The changing patterns in the incidence of diseases have highlighted the importance of increasing government intervention toward noncommunicable diseases, but a detailed analysis is needed at the specific disease level.

Objectives: This study attempts to look in some detail at the burden of disease and the share of private and public sectors in providing health facilities across some selected ailments.

Materials and methods: Some specific ailments in both communicable and noncommunicable disease segments including infections, respiratory, cardiovascular, diabetes, and gastrointestinal are identified based on high disability index and medical costs. The unit-level data by the National Sample Surveys on Social Consumption related to Health carried out in the 71st and 75th Rounds along with Global Burden of Disease data provided by the Institute for Health Metrics and Evaluation formed the database.

Results: The number of ailments per 1000 persons in the last 15 days of the survey held for the out-patient cases reveal that infections stood at the highest level of 32% followed by cardiovascular at 16.7%. Despite low average annual expenditure on communicable diseases, the high number of hospitalized cases increase the total expenditure on this segment multifold.

Conclusions: In this ailments-based analysis, the rising incidence of non-communicable diseases like cardiovascular diseases, diabetes and neoplasms is observed along with the high incidence of the upper and the lower respiratory tract diseases and other infections which have afflicted Indian population for decades. Both in terms of deaths and disability index, two ailments in the communicable disease segment, namely, chronic respiratory diseases and infections need to be addressed along with rising incidence of cardiovascular diseases and cancer. The disproportionately higher burden of medical expenses on the low-income strata and stark differences between public and private sectors in the costs of providing health facilities needs to be addressed by target allocation of government budget.

Background: The hijra and transgender (H/TG) persons have enhanced risk of HIV infection.

Objectives: We aimed to explore whether there were any associations between stigma, HIV risk behaviors, and HIV seropositivity among H/TG persons in India.

Materials and methods: We analyzed 4966 H/TG participants, from the national integrated biological and behavioral surveillance survey conducted in 2014-2015 focusing on experiences of stigma from family, friends, and healthcare settings. Univariate, bivariate, and multivariate logistic regression were used to calculate the unadjusted and adjusted odds ratios with a 95% confidence interval, to assess the association if any, between stigma, HIV risk behaviors, and HIV seropositivity among H/TG persons in India.

Results: Nearly half of the participants reported experiencing stigma from social circles, whereas a significant proportion faced stigma in healthcare setting. The stigma was associated with HIV risk behaviors such as inconsistent condom use, substance use, and lower HIV knowledge. We did not find a direct association between stigma and HIV seropositivity, suggesting that while stigma influences behaviors, its impact on actual HIV infection rates may be more nuanced.

Conclusions: There was a need for targeted interventions to address stigma faced by H/TG from their social circle and also in healthcare setting.

Background: The global prison population exceeds 11.5 million, with a 3% Human immunodeficiency virus (HIV) infection rate, significant burden of Hepatitis C, and risk of undiagnosed infectious diseases due to limited prior healthcare access. On release, prisoners may reintegrate into society, contributing to the spread of infections.

Objectives: To estimate the burden and correlates of HIV, coinfections, and risk behaviors among prison inmates in three Indian states.

Materials and methods: This study utilizes data from the 17 th round of HIV Sentinel Surveillance Plus 2021, among prison inmates in Chhattisgarh, West Bengal, and Nagaland. Participants were interviewed using a structured questionnaire, and blood specimens were tested for HIV, Syphilis, Hepatitis B virus (HBV), and Hepatitis C virus (HCV). Data were analyzed using STATA version 17. Stratified data analysis was done employing Pearson Chi-square testing. Factors associated with HIV and any infection were assessed with multivariable logistic regression analysis controlling sociodemographic factors as potential confounders.

Results: Nagaland records the highest HIV (4.6%), Syphilis (3.6%), and HCV (1.0%), and West Bengal has the highest HBV burden (1.5%). Logistic regression revealed higher odds of HIV infection among those with a history of imprisonment, undertrial status, and good HIV knowledge. The burden of any infection was higher in the 30-39 age group and those with a prior history of imprisonment.

Conclusion: This study highlighted the interplay between sociodemographics and high-risk behaviors within prison settings and the concentrated HIV epidemic. The findings should drive actionable strategies, guiding strategic planning, intervention prioritization, and resource allocation to enhance overall public health outcomes beyond prison confines.