Prevalence of Selected Cardiovascular Risk Factors and Their Associated Factors among People Living with HIV/AIDS in India

Background

Low- and middle-income countries face the dual problem of infectious and non-infectious diseases. Persons living with HIV/AIDS (PLHIV) are also at risk of cardiovascular diseases. Hence, we did this study to determine the prevalence of cardiovascular risk factors (CVRF) among PLHIV and to find the factors associated with it.

Methods

We carried out a cross-sectional analytical study among all adults aged ≥18 years registered at a facility-integrated anti-retroviral therapy center in Puducherry, India, from September 2016 to February 2018. After obtaining informed consent, we interviewed the participants to assess physical activity, alcohol, and tobacco use. We measured weight, height, abdominal circumference, and blood pressure, with biochemical investigations such as blood glucose and lipid profile.

Results

Of the total 316 adults PLHIV studied, the most common cardiovascular risk factor found was dyslipidemia (82.7%), followed by inadequate physical activity (74.4%). Other behavioral risk factors studied, such as current tobacco use and current alcohol use, showed a prevalence of 12.8% and 5.4%, respectively, among male participants. The prevalence of hypertension among adult PLHIV studied was 15.8%, and diabetes was 12.3%. In the multivariate analysis, diabetes, and hypertension were significantly associated with age and literacy. Obesity was found to be associated with diabetes and abdominal obesity with dyslipidemia.

Conclusion

Dyslipidemia was the most common cardiovascular risk factor, followed by inadequate physical inactivity among PLHIV. Regular screening with blood glucose, blood pressure, and lipid profile, and timely cross-referrals can help in the early detection of CVRF among PLHIV and hence improve their quality of life through appropriate treatment.

Utilization of modern temporary contraceptive methods and its predictors among reproductive-aged women in India: insights from NFHS-5 (2019-21)

Evidence from various studies on modern contraceptive methods shows that the utilization varies greatly. The present study aimed to estimate the magnitude and determinants for temporary modern contraceptive utilization among reproductive-aged (15-49 years) women in India. We analysed National Family Health Survey-5 data using the "svyset" command in STATA software. Modern contraception utilization was estimated using the weighted prevalence, and its correlates were assessed by multivariable regression by reporting an adjusted prevalence ratio (aPR) with 95% confidence interval (CI). QGIS 3.2.1 software was used for spatial analysis of different temporary modern contraceptives. The mean (SD) age of 359,825 respondents was 31.6 (8.5) years with 75.1% (n = 270,311) and 49.2% (n = 177,165) of them being from rural area and having completed education up to secondary school, respectively. The overall utilization of modern temporary contraception was 66.1% [95%CI: 65.90-66.35, n = 237,953]. Multigravida (vs. nulligravida) [aPR = 2.13 (1.98-2.30)], higher education of husband (vs. not educated) [aPR = 1.20 (1.14-1.27)], urban (vs. rural) [aPR = 1.06 (1.03-1.10)], watching television less than once a week (vs. not at all) [aPR = 1.04 (1.01-1.08)], divorced (vs. married) [aPR = 0.65 (0.45-0.94)], and Scheduled Tribe (ST) (vs. unreserved) [aPR = 0.92 (0.88-0.96)] were significant independent determinants. The highest utilization of male condoms, IUCDs, pills and injections were in Himachal Pradesh (86%), Nagaland (64%), Tripura (85%), and Ladakh (20%), respectively. Out of every ten reproductive-aged (15-49 years) women in India, six are using temporary modern contraceptive methods. More intervention strategies should be planned, considering factors like gravida, education, residence, health promotion and caste to attain replacement fertility level.

Effect of life skills education on socio-emotional functioning of adolescents in urban Puducherry, India: A mixed-methods study

BACKGROUND

We wanted to assess the effect of life skills education (LSE) and regular curriculum on the self-esteem, self-efficacy, adjustment, and psychosocial functioning of students from co-educational government schools, compared to those receiving only the regular curriculum. The secondary objectives were to study the feasibility of such sessions and identify the factors affecting the effectiveness of the sessions.

MATERIALS AND METHODS

We conducted a mixed-methods study in government schools of urban Puducherry, India in 2018-2019. The quantitative component was a cluster-randomized trial with activity-based learning methods delivered over 10 sessions in the intervention arm (IA). Differences in outcome variables (self-esteem, self-efficacy, adjustment, psychosocial behavior) between baseline and after intervention in each of the groups were calculated, and the difference-in-differences (DID) technique was applied to account for any natural change in scores over time. Qualitative data were collected through focused group discussions (FGDs) among students and teachers. Analysis was founded on a positivist paradigm with inducto-deductive methodology.

RESULTS

The mean (SD) age of 258 participants was 13 (1) years in both arms. The mean (SD) difference between baseline and end-line for IA and control arm (CA) was 0.3 (4.4) and - 0.1 (4.0), for self-esteem (P = 0.38), 0.03 (6.0) and - 1.1 (6.1) for self-efficacy (P = 0.12), and - 0.04 (3.5) and - 0.05 (4.3) for adjustment (P = 0.73), respectively. Similarly, the median (interquartile range [IQR]) difference in the conduct problems scale of the Strengths and Difficulties Questionnaire was - 1 (-2, 1) and 0 (-1, 1) (P < 0.01). Five FGDs revealed multiple positive effects on anger management, conduct, self-awareness, and responsible behavior. All 10 teachers viewed life skills education (LSE) positively.

CONCLUSIONS

LSE positively affects adolescents' socio-emotional functioning, but more extended periods of exposure are needed to demonstrate discernible change. The feasibility of implementation depends on the syllabus and based on health policies.

Myths, beliefs, and attitude toward cancer among the family caregivers of cancer patients: A community-based, mixed-method study in rural Tamil Nadu

Background and Aim

Family support is one of the most crucial components of cancer care. The familial beliefs and myths associated with cancer can seriously affect the quality of life and treatment outcome of cancer patients. This study intends to explore the prevailing myths, beliefs, and attitude toward cancer among the family caregivers of cancer patients.

Materials and Methods

A community-based, exploratory, mixed-method study was conducted among family caregivers of cancer patients in Cuddalore and Villupuram districts of Tamil Nadu. Content analysis method was used for in-depth interviews. Sociodemographic characteristics and attitude of the study participants were described using proportions.

Results

A common myth about causation of cancer was that it was contagious or of infective origin. Disbelief in tobacco's causation of cancer was found among the study participants. Family members' support was viewed as an essential component for cancer patients. Majority of the participants in the quantitative survey showed favorable attitude toward cancer patients. The common misconception about cancer treatment was that surgery/biopsy can spread cancer and herbal products can cure cancer.

Conclusion

Even though a majority of the participants showed favorable attitude toward their cancer patients, false beliefs and myths regarding causation and treatment of cancer are prevalent in the community.

Menstrual Hygiene Practices and Constraints in Availing Government Sanitary Pad Provision among Adolescents in Rural Puducherry: A Mixed Method Study

Context

Although free and subsidized sanitary pads are provided by the government, proportion of adolescents availing this service remains low.

Aims

The aim of the study was to determine the proportion of adolescent girls availing supply of sanitary napkins from a rural health training center (RHTC) in Puducherry; to assess the level of satisfaction with government supply; and to identify reasons for not accessing the same.

Subjects and Methods

The mixed-method cross-sectional study done in July 2017 included 240 adolescent girls living in the RHTC service area of a tertiary care institute. Quantitative data were collected house to house with a pretested semi-structured questionnaire and qualitative data from a focused group discussion.

Results

Sanitary pads were used by all of the participants who achieved menarche. Of them, 87 (40.2%) used pads purchased outside and 127 (58.8%) used both government supply and private purchase. Reasons for not availing government supply were insufficient quantity and low quality, lack of information about the government provision, and accessibility issues.

Conclusions

Ensuring better quality and adequate quantity of sanitary pads supplied by the government along with increased awareness about the government provision can increase the utilization of the same by rural adolescents.

An initiative to limit screen-time in children aged between 6 and 18 years in an urban area in Puducherry: a qualitative study

Background Recently television viewing and use of computers have increased considerably and has become a necessary evil in the society. The amount of Screen Time (ST) exposure of a child largely depends on the views of their parents. Screen time among adolescents have resulted in multiple problems Objective To explore the perceptions of parents of children aged 6-10 years and adolescents of 11-18 years residing in an area of urban Puducherry regarding screen-time and develop health education material to decrease ST. Materials and methods A community-based, Qualitative study was conducted during April 2018 in Urban Puducherry. Two FGDs among the adolescents t and one FGD among the mothers of 6-10 years old children to capture their perceptions on ST Results and conclusion The three FGD included 30 participants. The main categories that evolved among the adolescents were Benefits, barriers and influencing factors of ST and ways to reduce them. Mothers expressed their concerns regarding screen time and efforts taken to reduce it. Our study showed that curtailing ST is possible by friendly parenting.

The burden of the probable polycystic ovarian syndrome and its associated factor among college going late adolescents and young adults: a cross sectional analytical study in urban Puducherry, South India

Objectives Polycystic Ovarian Syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. In low income and developing countries like India, there are very high chances of developing PCOS due to marked variation between culture, ethnic groups, diet, lifestyle and genetic factors. This study aims to determine the burden of probable PCOS among college going students in Puducherry. Methods A cross sectional study was carried out among students aged 18 years and above in a Government College for Women located in urban Puducherry. A total of 610 students were selected through a cluster random sampling technique. A pretested validated proforma was administered after obtaining informed consent. Results 25.1% (21.8-28.7) of women were having probable PCOS, 18.7% (15.8-22.0) had irregular menstrual history, 8.4% (6.4-10.8) had Hirsutism and 2% (1.8-3.3) had both the symptoms. Regarding food habits, 43.1% were vegetarians and were having probable PCOS and this association was found to be statistically significant. No significant association was found between prevalence of probable PCOS and factors such as higher age, parental income, higher BMI and physical inactivity. Conclusions The present study found a high prevalence of probable PCOS among college going students, especially among study respondents who were obese, physically inactive and vegetarians compared to the counterpart. Earlier detection and proper management of the symptoms can avoid some major co-morbidity in the future. Therefore, screening is an important part in the diagnosis and management of PCOS among adolescent girls.

Worldwide trend in measles incidence from 1980 to 2016: A pooled analysis of evidence from 194 WHO Member States

Background

Decline in measles cases has not been uniform across countries and regions. Hence, we assessed the trend of measles from 1980 to 2016 with respect to WHO regions, World Bank income groups, and globally.

Methods

We have conducted secondary data analysis by using the data on measles incidence from Global Health Observatory. For clustering adjustment, random intercept modeling with negative binomial distribution was used.

Results

Globally, there was decline in the measles incidence from 4211,431 in 1980 to 132,325 in 2016. This accounts for around 8% decline in the measles cases every year (IRR - 0.92, P < 0.001). The results showed that there was a true declining trend after adjusting for clustering at regional (IRR - 0.90, P < 0.001) and income group level (IRR - 0.91, P < 0.001).

Conclusion

Current study showed that there was significant decline in the incident number of measles cases based on worldwide, regional, and income group estimates, but insufficient to achieve the measles elimination target by 2020.

Costs incurred and determinants of out-of-pocket payments for child delivery care in India: Evidence from a nationally representative household survey

In India, out-of-pocket (OOP) expenditure on health care services has been showing an increasing trend. The cost and willingness to pay determines the use of facility-based maternal health services. Hence, the current study was done to find the costs and determinants of OOP payments on childbirth care in India. We analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from the Demographic Health Survey (DHS) program. Stratification and clustering in the sample design were accounted for by using the "svyset" command. Out of 43 507 women, 26 916 (61.9%) had incurred OOP expenditure during their most recent institutional delivery. The average OOP expenditure for delivery care was INR 5985 ($93.3) with median cost being INR 1000 ($15.6). About 80% of women who had OOP expenditure reported that they handled the financial situation by utilizing the money in their bank/savings account. Determinants of OOP expenses were the age of mother, education, religion, state of residence, number of antenatal visits place of delivery, and mode of delivery (P < .05). Out-of-pocket expenditure for accessing care is one of the key determinants of service utilization which, if not addressed by the health system, can deter women from having institutional deliveries in the future.

Worldwide trend in measles incidence from 1980 to 2016: A pooled analysis of evidence from 194 WHO Member States

BACKGROUND

Decline in measles cases has not been uniform across countries and regions. Hence, we assessed the trend of measles from 1980 to 2016 with respect to WHO regions, World Bank income groups, and globally.

METHODS

We have conducted secondary data analysis by using the data on measles incidence from Global Health Observatory. For clustering adjustment, random intercept modeling with negative binomial distribution was used.

RESULTS

Globally, there was decline in the measles incidence from 4211,431 in 1980 to 132,325 in 2016. This accounts for around 8% decline in the measles cases every year (IRR - 0.92, P < 0.001). The results showed that there was a true declining trend after adjusting for clustering at regional (IRR - 0.90, P < 0.001) and income group level (IRR - 0.91, P < 0.001).

CONCLUSION

Current study showed that there was significant decline in the incident number of measles cases based on worldwide, regional, and income group estimates, but insufficient to achieve the measles elimination target by 2020.

Prevalence of medication adherence and its associated factors among patients with noncommunicable disease in rural Puducherry, South India - A facility-based cross-sectional study

Background:

Trends in morbidity and mortality due to noncommunicable diseases (NCDs) are rising because of poor control status. Medication nonadherence is one of the most common and modifiable causes of inadequate control status.

Objectives:

To determine the prevalence of drug adherence among patients with NCD in rural Puducherry.

Methods:

A facility-based cross-sectional study was done among 260 patients with NCD receiving treatment from rural primary health center in Puducherry during February and March 2018. Information regarding sociodemographic profile and household was collected using pretested semi-structured questionnaire. Morisky Medication Adherence Scale was done to assess the adherence. We calculated adjusted prevalence ratios (aPRs) to identify the factors associated with medication adherence.

Results:

Among the 260 participants, 42.7% belonged to elderly age group; 66.2% were females; 44% did not have any formal education; 70% were unemployed. The majority were suffering from hypertension (71.2%) followed by diabetes (56.2%). This study found that almost one-third (32.7%) of the study participants were not properly adherent to medications. Elderly [aPR 2.51 95% confidence interval (CI): 1.70–3.70] and female participants (aPR 1.64 95% CI: 1.04–2.58) were found to have more chance being nonadherent to medications after adjusting for possible confounding variables.

Conclusion:

This study reported that almost one-third of the study participants were nonadherent to medications. Elderly age group and female gender were found to be the determinants of nonadherence. Corrective measures need to be started at patient level first by motivating and educating them regarding the importance of drug intake.