Association of pain and quality of life among middle-aged and older adults of India

BACKGROUND

India is passing through a phase of demographic and epidemiological transition where ageing and chronic morbidities are being more common. Though studies have examined the prevalence and risk factors of pain and other chronic morbidities, nationally representative research examining the association of pain and quality of life (QoL) is limited in India. This study examines the association between pain and QoL among middle-aged and older adults in India.

METHODS

This study uses the data from wave 1 of the Longitudinal Ageing Study in India (LASI) conducted in 2017-18. This study is restricted to 58,328 individuals from all states (except Sikkim), aged 45 years and above. The quality of life is measured in 6 domains (physical, psychological, social, environment, general health and life satisfaction) with 21 variables that range from 0 to 100. The principal component analysis was used to generate a composite score of QoL and the multiple linear regression was used to show the association between pain and quality of life.

RESULTS

It is estimated that approximately 37% of Indian middle-aged and older populations were often troubled with pain. Pain prevalence increase with age and is more common among older adults aged 75 + years (43.37%; 95% CI, 40.95-45.80), and female (41.38%; 95% CI, 39.36-43.39). The average QoL score among those with pain was 81.6 compared to 85.2 among those without pain. QoL was lower among elderly age 75 and above, females, rural residents and illiterates. Controlling for socio-demographic factors, pain reduces the QoL by 2.57 points (β= -2.57; 95% CI, -3.02 - -2.11).

CONCLUSION

Pain reduces the quality of life among middle-aged adults and older adults in India. This evidence could potentially help the policymakers to consider pain as a significant determinant of quality of life in India.

Quality of anthropometric data in India's National Family Health Survey: Disentangling interviewer and area effect using a cross-classified multilevel model

India has adopted a target-based approach to reduce the scourge of child malnourishment. Because the monitoring and evaluation required by this approach relies primarily on large-scale data, a data quality assessment is essential. As field teams are the primary mode of data collection in large-scale surveys, this study attempts to understand their contribution to variations in child anthropometric measures. This research can help disentangle the confounding effects of regions/districts and field teams on the quality of child anthropometric data. The anthropometric z-scores of 2,25,002 children below five years were obtained from the fourth round of India's National Family and Health Survey (NFHS-4), 2015–16. Unadjusted and adjusted standard deviations (SD) of the anthropometric measures were estimated to assess the variations in measurements. In addition, a cross-classified multilevel model (CCMM) approach was adopted to estimate the contribution of geographical regions/districts and teams to variations in anthropometric measures. The unadjusted SDs of the measures of stunting, wasting, and underweight were 1.7, 1.4, and 1.2, respectively. The SD of stunting was above the World Health Organisation threshold (0.8–1.2), as well as the Demographic and Health Survey mark. After adjusting for team-level characteristics, the SDs of all three measures reduced marginally, indicating that team-level workload had a marginal but significant role in explaining the variations in anthropometric z-scores. The CCMM showed that the maximum contribution to variations in anthropometric z-scores came from community-level (Primary Sampling Unit (PSU)) characteristics. Team-level characteristics had a higher contribution to variations in anthropometric z-scores than district-level attributes. Variations in measurement were higher for child height than weight. The present study decomposes the effects of district- and team-level factors and highlights the nuances of introducing teams as a level of analysis in multilevel modelling. Population size, density, and terrain variations between PSUs should be considered when allocating field teams in large-scale surveys.

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Unadjusted standard deviation for child malnourishment indicators are above the recommended level of DHS data quality standards.

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Variation in stunting is directly proportional to workload measured by number of eligible children in the PSUs.

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Cross-classified multilevel models show significant team-level contribution in explaining variations in anthropometric scores.

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Team-level contribution to explaining variations in child anthropometric measures is larger than district-level factors.

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The number of days assigned to gather anthropometric measurements should be dependent on the number of eligible respondents in a PSU, which may be identified at the time of mapping & listing, rather than being a fixed number of days across all the states of India.

Inconsistency in prevalence of hypertension based on self-reports and use of standard tests: Implications for large scale surveys

Objective

Biomarkers are increasingly integrated into population-based surveys to provide reliable estimates of the prevalence of specific diseases. The Demographic and Health Surveys have recently incorporated blood pressure measurements; however, little is known about the extent of agreement between measured and reported levels of hypertension in India. The objective of this study was to examine the extent of agreement between self-reported hypertension and the results of standard blood pressure measurements, as well as to explore the risk groups and factors associated with inconsistencies in self-reported and biomedically measured hypertension.

Methods

Reliability measures such as sensitivity, specificity, and kappa statistics were used to examine inconsistencies in self-reported and biomedically measured hypertension in the National Family Health Survey-4 data. Multilevel logistic models were adopted to analyse the respondent characteristics related to both false-positive and false-negative responses in the survey.

Results

Compared to biomedically measured hypertension, self-reported hypertension was inconsistent and disproportionate at disaggregated levels in India. While self-reports severely underestimated hypertension among men aged 15-54 years and women aged 35-49 years, it overestimated hypertension among women below the age of 35 years. The inconsistency in self-reported and biomedically examined hypertension had deviations from a sex standpoint. Women aged <35 years reported a false-positive prevalence of hypertension. False-negative responses were elucidated among women aged ≥35 years and men aged 15-54 years. The likelihood of false-positive responses was higher among pregnant and obese respondents, and those who consumed alcohol.

Conclusion

The significant deviance of self-reporting of hypertension from the prevalence derived based on standard tests further indicates the need for adopting standard tests in all emerging future large-scale surveys. A back-check survey is recommended to understand and differentiate the excessive false-positive reporting of hypertension among women aged 15-35 years.

Can water composition and weather factors predict fecal indicator bacteria removal in retention ponds in variable weather conditions?

Retention ponds provide benefits including flood control, groundwater recharge, and water quality improvement, but changes in weather conditions could limit the effectiveness in improving microbial water quality metrics. The concentration of fecal indicator bacteria (FIB), which is used as regulatory standards to assess microbial water quality in retention ponds, could vary widely based on many factors including local weather and influent water chemistry and composition. In this critical review, we analyzed 7421 data collected from 19 retention ponds across North America listed in the International Stormwater BMP Database to examine if variable FIB removal in the field conditions can be predicted based on changes in these weather and water composition factors. Our analysis confirms that FIB removal in retention ponds is sensitive to weather conditions or seasons, but temperature and precipitation data may not describe the variable FIB removal. These weather conditions affect suspended solid and nutrient concentrations, which in turn could affect FIB concentration in the ponds. Removal of total suspended solids and total P only explained 5% and 12% of FIB removal data, respectively, and TN removal had no correlation with FIB removal. These results indicate that regression-based modeling with a single parameter as input has limited use to predict FIB removal due to the interactive nature of their effects on FIB removal. In contrast, machine learning algorithms such as the random forest method were able to predict 65% of the data. The overall analysis indicates that the machine learning model could play a critical role in predicting microbial water quality of surface waters under complex conditions where the variation of both water composition and weather conditions could deem regression-based modeling less effective.

Transport of microplastics in stormwater treatment systems under freeze-thaw cycles: Critical role of plastic density

Stormwater treatment systems remove and accumulate microplastics from surface runoff, but some of them can be moved downward to groundwater by natural freeze-thaw cycles. Yet, it is unclear whether or how microplastic properties such as density could affect the extent to which freeze-thaw cycles would move microplastics in the subsurface. To examine the transport and redistribution of microplastics in the subsurface by freeze-thaw cycles, three types of microplastics, with density smaller than (polypropylene or PP), similar to (polystyrene or PS), or greater than (polyethylene terephthalate or PET) water, were first deposited on the top of packed sand-the most common filter media used in infiltration-based stormwater treatment systems. Then the columns were subjected to either 23 h of drying at 22 ⁰C (control) or freeze-thaw treatment (freezing at -20 ⁰C for 6 h and thawing at 22 ⁰C for 17 h) followed by a wetting event. The cycle was repeated 36 times, and the effluents were analyzed for microplastics. Microplastics were observed in effluents from the columns that were contaminated with PET and subjected to freeze-thaw cycles. Comparison of the distribution of microplastics in sand columns at the end of 36 cycles confirmed that freeze-thaw cycles could disproportionally accelerate the downward mobility of denser microplastics. Using a force balance model, we show that smaller microplastics (<50 µm) can be pushed at higher velocity by the ice-water interface, irrespective of the density of microplastics. However, plastic density becomes critical when the size of microplastics is larger than 50 µm. The coupled experimental studies and theoretical framework improved the understanding of why denser microplastics such as PET and PVC may move deeper into the subsurface in the stormwater treatment systems and consequently elevate groundwater pollution risk.

Old-age dependency and catastrophic health expenditure: Evidence from Longitudinal Ageing Study in India

BACKGROUND

Out-of-pocket (OOP) payments and catastrophic health expenditure (CHE) have a strong age gradient. Though studies have examined the socio-demographic and geographic inequality in OOP payments and CHE in India, the role of old-age dependency in financial catastrophe remains unclear. Disaggregated estimates of CHE by the level of old-age dependency of households may help identify the most vulnerable sub-group and provide evidence for specific policies for the financial protection and health care of the elderly. The present study aims to estimate the incidence and intensity of CHE by the old-age dependency of households among middle-aged adults and the elderly in India.

METHODS

A total of 42,949 households from the Longitudinal Aging Study in India (LASI), 2017-18, covering households with at least one-member aged 45+ years, were included in the analysis. Households were classified into three mutually exclusive groups: no old-age dependency, low old-age dependency, and high old-age dependency. The incidence and intensity of CHE were estimated using the capacity-to-pay (CTP) approach. Concentration indices and concentration curves examine the extent of socioeconomic inequality in CHE. Binary logistic regression helps to understand the potential predictors of CHE across each type of old-age-dependent household.

RESULTS

We estimated the overall incidence of CHE at 24.6% (95% CI: 23.3-25.8) among middle-aged adults and the elderly in India. The incidence was 33.2% (95% CI: 31.4-35.1) among households with high old-age dependency, 23.1% (95% CI: 20.8-25.5) among those with low old-age dependency, and 20.4% (95% CI: 19.0-21.7) among no old-age dependency households. CHE intensity was highest among households with low old-age dependency compared to those no old-age dependents. Catastrophic health expenditure was higher among the poorer households in each type of old-age dependency. Among all households, the odds of incurring CHE were higher among households with high old-age dependency (AOR: 1.52; 95% CI: 1.36-1.69) than those with no old-age dependency. Lower-income households, households with pensions as the main source of income, households belonging to scheduled castes, and households residing in rural areas had higher odds of incurring CHE. The co-variates of CHE varied significantly across the type of old-age dependency households. A household's enrolment into a health insurance scheme did not necessarily lower its CHE.

CONCLUSION

Households with high old-age dependency had a higher probability of incurring CHE in India. Providing preventive and curative geriatric care in primary health centres (PHC) is recommended.

Use of unclean cooking fuels and visual impairment of older adults in India: A nationally representative population-based study

Despite widespread use of unclean cooking fuels (UCF) in India, evidence from nationally representative data on its association with visual impairment was lacking. We used a population-based nationwide survey of adults aged 45 years and older that included reported UCF and measured visual impairment. We estimated that 44.8% (95% CI: 42.6, 47.1) of older adults in India lived in households that used UCF. Age- and sex-adjusted prevalence of visual impairment was estimated to be 33.0% (95% CI: 31.0, 34.9) in the older population that did not use UCF and 9.0 percentage points (pp) (95% CI: 8.9, 9.1) higher among those who did. Among those who used UCF, age- and sex-adjusted prevalence of low distance vision was 4.3 pp (95% CI: 4.2, 4.4) higher, prevalence of low near vision was 8.0 pp (95% CI: 7.9, 8.1) higher, and prevalence of blindness was 1.0 pp (95% CI: 0.9, 1.0) higher. After controlling for a rich array of sociodemographic characteristics and state fixed effects, we estimated that use of UCF was associated with higher prevalence of visual impairment by 3.2 pp (95% CI: 1.4, 5.0), low distance vision by 1.8 pp (95% CI: 0.7, 2.9), and low near vision by 3.2 pp (95% CI: 1.3, 5.0). Doubly robust estimates of these differences were slightly larger. Blindness was not significantly partially associated with use of UCF (95% CI: -0.4, 0.6). We did not find support for the hypotheses that the visual impairment risk associated with use of UCF was even larger for females and in households without a separate kitchen or ventilation. The older population of India is highly reliant on UCF that is very strongly associated with visual impairment. Impaired vision should not be overlooked among the harms associated with UCF.

Highly variable removal of pathogens, antibiotic resistance genes, conventional fecal indicators and human-associated fecal source markers in a pilot-scale stormwater biofilter operated under realistic stormflow conditions

Green stormwater infrastructure systems, such as biofilters, provide many water quality and other environmental benefits, but their ability to remove human pathogens and antibiotic resistance genes (ARGs) from stormwater runoff is not well documented. In this study, a field scale biofilter in Southern California (USA) was simultaneously evaluated for the breakthrough of a conservative tracer (bromide), conventional fecal indicators, bacterial and viral human-associated fecal source markers (HF183, crAssphage, and PMMoV), ARGs, and bacterial and viral pathogens. When challenged with a 50:50 mixture of untreated sewage and stormwater (to mimic highly contaminated storm flow) the biofilter significantly removed (p < 0.05) 14 of 17 microbial markers and ARGsin descending order of concentration reduction: ermB (2.5 log(base 10) reduction) > Salmonella (2.3) > adenovirus (1.9) > coliphage (1.5) > crAssphage (1.2) > E. coli (1.0) ∼ 16S rRNA genes (1.0) ∼ fecal coliform (1.0) ∼ intl1 (1.0) > Enterococcus (0.9) ∼ MRSA (0.9) ∼ sul1 (0.9) > PMMoV (0.7) > Entero1A (0.5). No significant removal was observed for GenBac3, Campylobacter, and HF183. From the bromide data, we infer that 0.5 log-units of attenuation can be attributed to the dilution of incoming stormwater with water stored in the biofilter; removal above this threshold is presumably associated with non-conservative processes, such as physicochemical filtration, die-off, and predation. Our study documents high variability (>100-fold) in the removal of different microbial contaminants and ARGs by a field-scale stormwater biofilter operated under transient flow and raises further questions about the utility of human-associated fecal source markers as surrogates for pathogen removal.

Are cesarean deliveries equitable in India: assessment using benefit incidence analysis

BACKGROUND

In the last two decades, cesarean section (CS) deliveries in India have increased by six-fold and created economic hardship for families and households. Although several schemes and policies under the National Health Mission (NHM) have reduced the inequality in the use of maternal care services in India, the distributive effect of public health subsidies on CS deliveries remains unclear. In this context, this paper examines the usage patterns of CS delivery and estimates the share of public health subsidies on CS deliveries among mothers by different background characteristics in India.

DATA

Data from the fourth round of the National Family Health Survey (NFHS-4) was used for the study. Out-of-pocket (OOP) payment for CS delivery was used as a dependent variable and was analyzed by level of care that is, primary (PHC, UHC, other) and secondary (government/municipal, rural hospital). Descriptive statistics, binary logistic regression, benefit incidence analysis, concentration curve and concentration index were used for the analysis.

RESULTS

A strong economic gradient was observed in the utilization of CS delivery from public health facilities. Among mothers using any public health facility, 23% from the richest quintile did not pay for CS delivery compared to 13% from the poorest quintile. The use of the public subsidy among mothers using any type of public health facility for CS delivery was pro-rich in nature; 9% in the poorest quintile, 16.1% in the poorer, 24.5% in the middle, 27.5% among richer and 23% in the richest quintile. The pattern of utilization and distribution of public subsidy was similar across the primary and secondary health facilities but the magnitude varied. The findings from the benefit-incidence analysis are supported by those obtained from the inequality analysis. The concentration index of CS was 0.124 for public health centers and 0.291 for private health centers. The extent of inequality in the use of CS delivery in public health centers was highest in the state of Mizoram (0.436), followed by Assam (0.336), and the lowest in Tamil Nadu (0.060), followed by Kerala (0.066).

CONCLUSION

The utilization of CS services from public health centers in India is pro-rich. Periodically monitoring and evaluating of the cash incentive schemes for CS delivery and generating awareness among the poor would increase the use of CS delivery services in public health centers and reduce the inequality in CS delivery in India.

Natural aging of expanded shale, clay, and slate (ESCS) amendment with heavy metals in stormwater increases its antibacterial properties: Implications on biofilter design

Aging is often expected to decrease the pathogen removal capacity of media because of exhaustion of attachment sites by adsorption of co-contaminants and dissolved organics. In contrast, the adsorption of metals naturally present in stormwater during aging could have a positive impact on pathogen removal. To examine the effect of adsorbed metals on pathogen removal, biofilter media amended with expanded clay, shale, and slate (ESCS) aggregates, a lightweight aggregate, were exposed to metals by intermittently injecting natural stormwater spiked with Cu, Pb, and Zn, and the capacity of aged and unaged media to remove Escherichia coli (E. coli), a pathogen indicator, were compared. Metal adsorption on ESCS media decreased their net negative surface charge and altered the surface properties as confirmed by zeta potential measurement and Fourier-Transform Infrared Spectroscopy (FTIR) analysis. These changes increased the E. coli adsorption capacity of aged media compared with unaged media and decreased overall remobilization of attached E. coli during intermittent infiltration of stormwater. A live-dead analysis confirmed that the adsorbed metals inactivated attached E. coli, thereby replenishing the adsorption capacity. Overall, the results confirmed that natural aging of biofilter media with adsorbed metals could indeed have a net positive effect on E. coli removal in biofilters and therefore should be included in the conceptual model predicting long-term removal of pathogens from stormwater containing mixed pollutants.

Comparative analysis of contraceptive use in Punjab and Manipur: exploring beyond women's education and empowerment

Background

Women’s education and empowerment are important predictors of contraceptive use across countries. However, two of the Indian states, namely, Punjab and Manipur, showed large variations in contraceptive use, despite the similar level of women’s educational attainment and empowerment. Therefore, this paper attempts to understand variation in contraceptive use between these states, despite having similar level of educational attainment and empowerment among the married women.

Methods

This study primarily used cross-sectional data of the National Family Health Survey (NFHS) 2015–16 and to some extent the District Level Household Survey (DLHS) 2012–13 data. The analytical sample includes 13,730 currently married women in Punjab and 8,872 in Manipur. Modern contraceptive prevalence rate (mCPR) is the key outcome variable of this study. Bivariate, multivariate, and multilevel regression analysis are applied to understand the differences in mCPR between these states and its determinants.

Results

Mean years of schooling was about 8 years among women of both the states, and about 34% of the women in Punjab and 27% of the women in Manipur have high level of autonomy. Despite this, use of modern method was 66% in Punjab and only 13% in Manipur. Coverage of family planning program indicators were significantly lower in Manipur than Punjab – frontline workers’ (FLWs) outreach for family planning was only 18% in Manipur compared to 52% in Punjab. Similarly, only 11% of the public health facilities in Manipur compared to 50% of the health facilities in Punjab were ready to provide at least one clinical method of family planning.

Conclusion

Despite the similar level of individual level characteristics across the two states, poor coverage of family planning programs – low outreach of FLWs, low level of facility readiness, as well as sociocultural norms discouraging contraceptive use – might be responsible for lower contraceptive use in Manipur than Punjab. This implies for strengthening the health system for family planning in Manipur to meet the contraception needs of women by addressing sociocultural barriers in the state.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13147-3.

Air quality monitoring and measurement in an urban airshed: Contextualizing datasets from the Detroit Michigan area from 1952 to 2020

With urban air quality being a pressing public health concern, community members are becoming increasingly engaged in determining the links between air quality and human health. Although new measurement tools such as low-cost sensors make local data more accessible, a better understanding of gaps in regional datasets is needed to develop effective metropolitan-scale solutions. Using scoping review methodology, we compiled 214 published journal articles and grey literature reports of air quality data from the Detroit, Michigan area from 1952 through 2020. This critical scoping review focuses on air quality datasets, but related topics such as health studies and community-based participatory science studies were examined from the included articles. Most of these publications were peer-reviewed journal articles published after 2001. Particulate matter, nitrous oxides, and sulfur dioxide were the most commonly studied air pollutants, and asthma was the most frequently associated health outcome paired with air pollution datasets. Few publications reported methods for community-based participatory science. This critical scoping review establishes a foundation of historical air quality data for the Detroit metropolitan area and a set of evaluation criteria that can be replicated in other urban centers. This foundation enables future detailed analysis of air quality datasets and showcases strategies for implementing effective community science programs and monitoring efforts.

Microplastics retained in stormwater control measures: Where do they come from and where do they go?

Stormwater control measures (SCM) can remove and accumulate microplastics and may serve as a long-term source of microplastics for groundwater pollution because of their potential for downward mobility in subsurface. Furthermore, the number of microplastics accumulated in SCM may have been underestimated as the calculation typically only accounts for microplastics accumulated via episodic stormwater loading and ignores microplastic accumuation via continuous atmospheric deposition. To evaluate the source pathways of accumulated microplastics and their potential for downward mobility to groundwater, we analyzed spatial distributions of microplastics above ground on the canopy around SCM and below ground in the subsurface in and outside the boundaries of fourteen SCM in Los Angeles. Using an exponential model, we link subsurface retardation of microplastics to the median particle size of soil (D₅₀) and land use. Despite receiving significantly more stormwater, microplastic concentrations in SCM at surface depth or subsurface depth were not significantly different from the concentration at the same depth outside the SCM. Similar concentration in and outside of SCM indicates that stormwater is not the sole source of microplastics accumulated in SCM. The high concentration of microplastics on leaves of vegetation in SCM confirms that the contribution of atmospheric deposition is significant. Within and outside the SCM boundary, microplastics are removed within the top 5 cm of the subsurface, and their concentration decreases exponentially with depth, indicating limited potential for groundwater pollution from the microplastics accumulated in SCM. Outside the SCM boundary, the subsurface retardation coefficient decreases with increases in D₅₀, indicating straining of microplastics as the dominant removal mechanism. Inside the boundary of SCM, however, the retardation coefficient was independent of D₅₀, implying that microplastics could have either moved deeper into the filter layer in SCM or that compost, mulch, or organic amendments used in the filter media were pre-contaminated with microplastics. Overall, these results provide insights on microplastics source, accumulation, and downward mobility in SCM.

Enhanced removal of per- and polyfluoroalkyl substances in complex matrices by polyDADMAC-coated regenerable granular activated carbon

Granular activated carbon (GAC) has been used to remove per- and polyfluoroalkyl substances (PFASs) from industrial or AFFF-impacted waters, but its effectiveness can be low because adsorption of short-chained PFASs is ineffective and its sites are exhausted rapidly by co-contaminants. To increase adsorption of anionic PFASs on GAC by electrostatic attractions, we modified GAC's surface with the cationic polymer poly diallyldimethylammonium chloride (polyDADMAC) and tested its capacity in complex water matrices containing dissolved salts and humic acid. Amending with concentrations of polyDADMAC as low as 0.00025% enhanced GAC's adsorption capacity for PFASs, even in the presence of competing ions. This suggests that electrostatic interactions with polyDADMAC's quaternary ammonium functional groups helped bind organic and inorganic ions as well as the headgroup of short-chain PFASs, allowing more overall PFAS removal by GAC. Evaluating the effect of polymer dose is important because excessive addition can block pores and reduce overall PFAS removal rather than increase it. To decrease the waste associated with this adsorption strategy by making the adsorbent viable for more than one saturation cycle, a regeneration method is proposed which uses low-power ultrasound to enhance the desorption of PFASs from the polyDADMAC-GAC with minimum disruption to the adsorbent's structure. Re-modification with the polymer after sonication resulted in a negligible decrease in the sorbent's capacity over four saturation rounds. These results support consideration of polyDADMAC-modified GAC as an effective regenerable adsorbent for ex-situ concentration step of both short and long-chain PFASs from real waters with high concentrations of competing ions and low PFAS loads.

Missed opportunities for hypertension screening: a cross-sectional study, India

Objective

To assess missed opportunities for hypertension screening at health facilities in India and describe systematic differences in these missed opportunities across states and sociodemographic groups.

Methods

We used nationally representative survey data from the 2017-2018 Longitudinal Ageing Study in India to estimate the proportion of adults aged 45 years or older identified with hypertension and who had not been diagnosed with hypertension despite having visited a health facility during the previous 12 months. We estimated age-sex adjusted proportions of missed opportunities to diagnose hypertension, as well as actual and potential proportions of diagnosis, by sociodemographic characteristics and for each state.

Findings

Among those identified as having hypertension, 22.6% (95% confidence interval, CI: 21.3 to 23.8) had not been diagnosed despite having recently visited a health facility. If these opportunities had been realized, the prevalence of diagnosed hypertension would have increased from 54.8% (95% CI: 53.5 to 56.1) to 77.3% (95% CI: 76.2 to 78.5). Missed opportunities for diagnosis were more common among individuals who were poorer (P = 0.001), less educated (P < 0.001), male (P < 0.001), rural (P < 0.001), Hindu (P = 0.001), living alone (P = 0.028) and working (P < 0.001). Missed opportunities for diagnosis were more common at private than at public health facilities (P < 0.001) and varied widely across states (P < 0.001).

Conclusion

Opportunistic screening for hypertension has the potential to significantly increase detection of the condition and reduce sociodemographic and geographic inequalities in its diagnosis. Such screening could be a first step towards more effective and equitable hypertension treatment and control.

Drudgery assessment and ergonomic evaluation of pedal operated Ragi (Eleusine Coracana) thresher

BACKGROUND

Ragi (Eleusine Coracana) is a major food crop for the tribal population of India.

OBJECTIVE

This study emphasizes the need to consider ergonomics aspects in the design and development of a pedal operated ragi thresher (PORT) for tribal people, and assesses the drudgery as well as ergonomic evaluation of a developed thresher against the conventional practice.

METHODS

Thirty subjects (male = 15 and female = 15) from the tribal region were evaluated ergonomically. The physiological responses of the subjects were studied and their performance was compared.

RESULTS

The results revealed that the working heart rate, oxygen consumption rate and overall discomfort rating were significantly higher in case of traditional threshing as compared to those in case of PORT. Postural analysis identified the traditional method as the most fatigue one as the person has to lift the hand above shoulder level repeatedly and has to sit in a squatting posture for long period.

CONCLUSION

The drudgery and occupational hazards to public health involved in the traditional method of threshing was reduced by using the PORT. Furthermore, the traditional method involved continuous stressed actions across the entire body, whereas the PORT involved only the lower limbs.

Association of multidimensional poverty and tuberculosis in India

Background

Reduction of multidimensional poverty and tuberculosis are priority development agenda worldwide. The SDGs aims to eradicate poverty in all forms (SDG 1.2) and to end tuberculosis (SDG 3.3.2) by 2030. While poverty is increasingly being measured across multiple domains, reduction of tuberculosis has been an integral part of public health programmes. Though literature suggests a higher prevalence of tuberculosis among the economically poor, no attempt has been made to understand the association between multidimensional poverty and tuberculosis in India. The objective of this paper is to examine the association of multidimensional poverty and tuberculosis in India.

Methods

The unit data from the National Family Health Survey-4, conducted in 2015–16 covering 628,900 households and 2,869,043 individuals across 36 states and union territories of India was used in the analysis. The survey collected information on the self-reported tuberculosis infection of each member of a sample household at the time of the survey. Multidimensional poverty was measured in the domains of education, health, and standard of living, with a set of 10 indicators. The prevalence of tuberculosis was estimated among the multidimensional poor and non-poor populations across the states of India. A binary logistic regression model was used to understand the association of tuberculosis and multidimensional poverty.

Results

Results suggest that about 29.3% population of India was multidimensional poor and that the multidimensional poverty index was 0.128. The prevalence of tuberculosis among the multidimensional poor was 480 (95% CI: 464–496) per 100,000 population compared to 250 (95% CI: 238–262) among the multidimensional non-poor. The prevalence of tuberculosis among the multidimensional poor was the highest in the state of Kerala (1590) and the lowest in the state of Himachal Pradesh (220). Our findings suggest a significantly higher prevalence of tuberculosis among the multidimensional poor compared to the multidimensional non-poor in most of the states in India. The odds of having tuberculosis among the multidimensional poor were 1.82 times higher (95% CI, 1.73–1.90) compared to the non-poor. Age, sex, smoking, crowded living conditions, caste, religion, and place of residence are significant socio-demographic risk factors of tuberculosis.

Conclusion

The prevalence of tuberculosis is significantly higher among the multidimensional poor compared to the multidimensional non-poor in India.

Release of soil colloids during flow interruption increases the pore-water PFAS concentration in saturated soil

Groundwater flow through aquifer soils or packed bed systems can fluctuate for various reasons, which could affect the concentration of natural colloids and per- and polyfluoroalkyl substances (PFAS) in the pore water. In such cases, PFAS concentration could either decrease due to matrix diffusion of PFAS or increase by the detachment of colloids carrying PFAS. Yet, the effect of flow fluctuation on PFAS transport or release in porous media has not been examined. To examine the relative importance of either process, we interrupted the flow during an injection of groundwater spiked with perfluorobutanoic acid (PFBA), perfluorooctanoic acid (PFOA), and bromide as conservative tracer through clay-rich soil, so that diffusive transport would be prominent during flow interruption. After flow interruption, the PFAS concentration did not decrease indicating an insignificant contribution of matrix diffusion. The concentration increased, potentially due to enhanced release of colloid-associated PFAS. Analysis of samples before and after flow interruption by particle size analysis and SEM confirmed an increase in soil colloid concentration after the flow interruption. XRD analysis of soil and the colloids proved that PFAS were associated with specific sites of the colloids. Due to a higher affinity of PFOA to soil colloids, the total PFOA concentration in the effluent samples increased more than PFBA after the flow interruption process. The results indicate that colloids may have a disproportionally higher role in the transport of PFAS in conditions that release colloids from porous media. Thus, fluctuations in groundwater flow can increase this colloid facilitated mobility of PFAS.

Perfluoroalkyl acids on suspended particles: Significant transport pathways in surface runoff, surface waters, and subsurface soils

Eroded particles from the source zone could transport a high concentration of perfluoroalkyl acids (PFAAs) to sediments and water bodies. Yet, the contribution of suspended particles has not been systematically reviewed. Analyzing reported studies, we quantitatively demonstrate that suspended particles in surface water can contain significantly higher concentrations of PFAAs than the sediment below, indicating the source of suspended particles are not the sediment but particles eroded and carried from the source zone upstream. The affinity of PFAAs to particles depends on the particle composition, including organic carbon fraction and iron or aluminum oxide content. In soils, most PFAAs are retained within the top 5 m below the ground surface. The distribution of PFAAs in the subsurface varies based on site properties and local weather conditions. The depth corresponding to the maximum concentration of PFAA in soil decreases with an increase in soil organic carbon or rainfall amount received in the catchment areas. We attribute a greater accumulation of PFAAs near the upper layer of the subsurface to an increase in the accumulation of particles eroded from source zones upstream receiving heavy rainfall. Precursor transformation in the aerobic zone is significantly higher than in the anaerobic zone, thereby making the aerobic subsurface zone serve as a long-term source of groundwater pollution. Collectively, these results suggest that suspended particles, often an overlooked vector for PFAAs, can be a dominant pathway for the transport of PFAAs in environments.

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

BACKGROUND

Lack of nationwide evidence on awareness, treatment, and control (ATC) of hypertension among older adults in India impeded targeted management of this condition. We aimed to estimate rates of hypertension ATC in the older population and to assess differences in these rates across sociodemographic groups and states in India.

METHODS AND FINDINGS

We used a nationally representative survey of individuals aged 45 years and over and their spouses in all Indian states (except one) in 2017 to 2018. We identified hypertension by blood pressure (BP) measurement ≥140/90 mm Hg or self-reported diagnosis if also taking medication or observing salt/diet restriction to control BP. We distinguished those who (i) reported diagnosis ("aware"); (ii) reported taking medication or being under salt/diet restriction to control BP ("treated"); and (iii) had measured systolic BP <140 and diastolic BP <90 ("controlled"). We estimated age-sex adjusted hypertension prevalence and rates of ATC by consumption quintile, education, age, sex, urban-rural, caste, religion, marital status, living arrangement, employment status, health insurance, and state. We used concentration indices to measure socioeconomic inequalities and multivariable logistic regression to estimate fully adjusted differences in these outcomes. Study limitations included reliance on BP measurement on a single occasion, missing measurements of BP for some participants, and lack of data on nonadherence to medication. The 64,427 participants in the analysis sample had a median age of 57 years: 58% were female, and 70% were rural dwellers. We estimated hypertension prevalence to be 41.9% (95% CI 41.0 to 42.9). Among those with hypertension, we estimated that 54.4% (95% CI 53.1 to 55.7), 50.8% (95% CI 49.5 to 52.0), and 28.8% (95% CI 27.4 to 30.1) were aware, treated, and controlled, respectively. Across states, adjusted rates of ATC ranged from 27.5% (95% CI 22.2 to 32.8) to 75.9% (95% CI 70.8 to 81.1), from 23.8% (95% CI 17.6 to 30.1) to 74.9% (95% CI 69.8 to 79.9), and from 4.6% (95% CI 1.1 to 8.1) to 41.9% (95% CI 36.8 to 46.9), respectively. Age-sex adjusted rates were lower (p < 0.001) in poorer, less educated, and socially disadvantaged groups, as well as for males, rural residents, and the employed. Among individuals with hypertension, the richest fifth were 8.5 percentage points (pp) (95% CI 5.3 to 11.7; p < 0.001), 8.9 pp (95% CI 5.7 to 12.0; p < 0.001), and 7.1 pp (95% CI 4.2 to 10.1; p < 0.001) more likely to be aware, treated, and controlled, respectively, than the poorest fifth.

CONCLUSIONS

Hypertension prevalence was high, and ATC of the condition were low among older adults in India. Inequalities in these indicators pointed to opportunities to target hypertension management more effectively and equitably on socially disadvantaged groups.

Iron amendments minimize the first-flush release of pathogens from stormwater biofilters

First flush or the first pore volume of effluent eluted from biofilters at the start of rainfall contributes to most pollution downstream because it typically contains a high concentration of bacterial pathogens. Thus, it is critical to evaluate designs that could minimize the release of bacteria during a period of high risk. In this study, we test the hypothesis of whether an addition of iron-based media to biofilter could limit the leaching of Escherichia coli (E. coli), a pathogen indicator, during the first flush. We applied E. coli-contaminated stormwater intermittently in columns packed with a mixture of sand and compost (70:30 by volume, respectively) and iron filings at three concentrations: 0% (control), 3%, and 10% by weight. Columns packed with a mixture of sand and iron (3% or 10%) without compost were used to examine the maximum capacity of iron to remove E. coli. In columns with iron, particularly 10% by weight, the leaching of E. coli during the first flush was 32% lower than the leaching from compost columns, indicating that the addition of iron amendments could decrease first-flush leaching of E. coli. We attribute this result to the ability of iron to increase adsorption and decrease growth during antecedent drying periods. Although the addition of iron filings increased E. coli removal, the presence of compost decreased the adsorption capacity: exposure of 1 g of iron filings to 1 mg of DOC reduces E. coli removal by 8%. The result was attributed to the alteration of the surface charge of iron and blocking of adsorption sites shared by E. coli and DOC. Collectively, these results indicate that the addition of sufficient amounts of iron media could decrease pathogen leaching in the first flush effluent and increase the overall biofilter performance and protect downstream water quality.