A district-level geospatial analysis of anaemia prevalence among rural men in India, 2019-21

BACKGROUND

Despite its considerable impact on health and productivity, anemia among men has received limited attention. In a country as diverse as India, characterized by extensive geographic variations, there is a pressing need to investigate the nuanced spatial patterns of anemia prevalence among men. The identification of specific hotspots holds critical implications for policymaking, especially in rural areas, where a substantial portion of India's population resides.

METHODS

The study conducted an analysis on a sample of 61,481 rural men from 707 districts of India, utilizing data from the National Family Health Survey-5 (2019-21). Various analytical techniques, including Moran's I, univariate LISA (Local Indicators of Spatial Association), bivariate LISA, and spatial regression models such as SLM (Spatial Lag Model), and SEM (Spatial Error Model) were employed to examine the geographic patterns and spatial correlates of anaemia prevalence in the study population.

RESULTS

In rural India, three out of every ten men were found to be anemic. The univariate Moran's I value for anaemia was 0.66, indicating a substantial degree of spatial autocorrelation in anaemia prevalence across the districts in India. Cluster and outlier analysis identified five prominent 'hotspots' of anaemia prevalence across 97 districts, primarily concentrated in the eastern region (encompassing West Bengal, Jharkhand, and Odisha), the Dandakaranya region, the Madhya Pradesh-Maharashtra border, lower Assam, and select districts in Jammu and Kashmir. The results of SLM revealed significant positive association between anaemia prevalence at the district-level and several key factors including a higher proportion of Scheduled Tribes, men in the 49-54 years age group, men with limited or no formal education, individuals of the Muslim faith, economically disadvantaged men, and those who reported alcohol consumption.

CONCLUSIONS

Substantial spatial heterogeneity in anaemia prevalence among men in rural India suggests the need for region-specific targeted interventions to reduce the burden of anaemia among men in rural India and enhance the overall health of this population.

Prevalence and Predictors of Risky Sexual Behavior Among Young Men in India: Evidence From National Family Health Survey

Objective

The study examines the prevalence and factors associated with high-risk sexual behavior among sexually active young Indian men.

Methods

This study used samples of 14,584 men aged 15 to 29 from the National Family Health Survey (NFHS-5), 2019-21.

Results

14% of men engaged in early sexual debut (<18 years), 68% had unprotected sex, and 4% had multiple sexual partners in the past 12 months. Age, marital status, educational attainment, occupation, wealth quintile, alcohol consumption, internet use, media exposure, and region were significant predictors of risky sexual behavior.

Conclusions

We suggest a tailored approach for effective policy design considering risk factors of risky sexual behavior.

Local anaesthetic for pain post rubber band ligation of haemorrhoids: a prospective, single-blinded randomised controlled trial

BACKGROUND

Rubber band ligation (RBL) is a widely accepted intervention for the treatment of haemorrhoids. However, post procedure pain is a common complaint. The aim of this study was to determine whether the addition of local anaesthetic (LA) to the haemorrhoid pedicle base, post RBL, aids in reducing early post-procedure pain. Additionally, to compare perceived perianal numbness, oral analgesia usage and total consumption, and adverse events.

METHODS

This study was a prospective, single-blinded randomised controlled trial. Patients were recruited from colorectal clinics in two Australian hospitals between 2018-2019. Patients randomised to the intervention (LA) group received 2mls bupivacaine 0.5% with adrenaline 1:200,000 to each haemorrhoid base. Patients in the control group were not administered LA. Pain scores were recorded over 48 h using visual analogue scales. Analgesia consumption was documented and other secondary objectives were recorded dichotomously (yes/no).

RESULTS

At 1 h post-procedure, patient reported pain scores were significantly lower in the LA group compared to the control group (p = 0.04). There were no significant differences in pain scores between the groups at 4, 24 or 48 h. Additionally, there were no significant differences between groups with respect to oral analgesia usage, perianal numbness or adverse events.

CONCLUSIONS

LA to the haemorrhoid pedicle post RBL may significantly reduce early post procedure pain without any increased risk of adverse effects.

Temperature-controlled radiofrequency device treatment of septal swell bodies for nasal airway obstruction: An open-label, single arm multicenter study

BACKGROUND

Nasal airway obstruction (NAO) is a highly prevalent disorder. Septal swell body (SSB) hypertrophy is an often overlooked contributor to NAO. SSB treatment may relieve symptoms of NAO. The objective of this study was to assess the clinical use of a temperature-controlled radiofrequency (TCRF) device to treat SSBs to improve symptoms in adults with NAO.

METHODS

In this prospective, multicenter, open-label, single arm study, patients with severe or extreme NAO related to SSB hypertrophy received bilateral TCRF treatment in the SSB area. The primary endpoint was improvement in Nasal Obstruction Symptom Evaluation (NOSE) Scale scores from baseline to 3 months postprocedure. A subset of study patients underwent computed tomography (CT) imaging to evaluate posttreatment changes in SSB size.

RESULTS

Mean NOSE Scale scores significantly improved from 73.5 (SD 14.2) at baseline to 27.9 (SD 17.2) at 3 months postprocedure, a reduction of -45.3 (SD 21.4, 95% confidence interval [CI]: -50.4 to -40.1; p < 0.0001); the responder rate was 95.7% (95% CI: 0.88 to 0.99; p < 0.0001). CT evaluation at 3 months showed statistically significant reductions in the SSB with the greatest reduction in the middle thickness (mean change -3.4 [SD 1.8] mL, 95% CI: -4.0 to -2.8; p < 0.0001). Minimal adverse events with any relationship to the device or procedure were reported; none were serious in nature and no septal perforations occurred.

CONCLUSIONS

This study demonstrates that TCRF treatment of SSB hypertrophy is well tolerated and effective at reducing both SSB size and symptoms of NAO at 3 months posttreatment.

Bilateral Longus Colli Abscesses as a Complication of Advanced Bacterial Rhinosinusitis

Known complications of acute bacterial rhinosinusitis include retropharyngeal abscess, cavernous sinus thrombosis, intracranial abscess, and associated sequelae. We describe the case of a patient with longus colli abscess formation resulting from acute pansinusitis, complicated by bilateral cavernous sinus thrombosis in the setting of concurrent viral pneumonitis, severe sepsis, and a large area cerebral infarction. The bilateral longus colli abscesses were drained via stereotactic image-guided endonasal sinus surgery, yielding Staphylococcus hominis in culture. The described disease progressed rapidly over a 2-week course amid the COVID-19 pandemic.

Locating perpetrators of violence against women in India: An analysis of married men's characteristics associated with intimate partner violence

Intimate Partner Violence (IPV) against married women is widely prevalent in India. Using recent data from NFHS-5, we analyzed the association between husbands' characteristics and IPV. Separate logistic regression models were developed for three distinct "husband characteristic groups" namely demographic, social and economic groups, and one final model including only statistically significant variables. IPV has been found to be significantly associated with men's age, age gap between husband and wife, men's educational level, religion, caste, region, number of daughters, wife's decision-making autonomy, men's IPV justifying attitude, alcoholism and substance abuse among men, type of work and wealth. We suggest shifting the policy gaze from women and prioritizing men's education, control on substance abuse and alcoholism among men as well as employment opportunities to tackle the violence against women.

Intra-urban differentials in the exclusive use of hygienic methods during menstruation among young women in India

Menstrual hygiene among women is a critical public health issue in urban India, but it remains understudied and under-researched. However, to our knowledge, no national level study in India has yet examined the differentials in the exclusive use of hygienic methods among young women (aged 15-24) in urban India. This study attempts to fill this gap by analysing biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods among these women. We analysed data on 54561 urban women aged 15-24 from National Family Health Survey-5, 2019-21. We used binary logistic regression to examine differentials in the exclusive use of hygienic methods. To examine spatial variation, we mapped exclusive use of hygienic methods across Indian states and districts. The study found that two-thirds of young women in urban India reported exclusive use of hygienic methods. However, there was significant geographic heterogeneity observed at both state and district levels. In states such as Mizoram and Tamil Nadu, the use of hygienic methods was over 90%, while in Uttar Pradesh, Bihar, Chhattisgarh, and Manipur, it was less than 50%. The district-level variation in exclusive use of hygienic methods was even more striking. In many states, districts with extremely low exclusive use (less than 30%) were located in close proximity to districts with high exclusive use. Being poor, uneducated, Muslim, having no mass media exposure, living in the north and central regions, not having a mobile phone, getting married before 18, and having an early experience of menarche were associated with lower exclusive use of hygienic methods. In conclusion, substantial biodemographic, socioeconomic, and geographic differentials in the exclusive use of hygienic methods suggest the need for context-specific behavioural interventions. Mass media campaigns and targeted distribution of subsidized hygienic methods could help reduce the existing inequities in the exclusive use of hygienic methods.

Wealth-based inequality in the exclusive use of hygienic materials during menstruation among young women in urban India

BACKGROUND

The exclusive use of hygienic materials during menstruation (sanitary napkins, locally made napkins, tampons, and menstrual cups) among urban women in India has been increasing over time. However, little is known about the wealth-based disparity in the exclusive use of hygienic materials during menstruation among these women. This study, therefore, measures wealth-based inequality in the exclusive use of hygienic materials during menstruation among urban women in India. Furthermore, the measured inequality is decomposed to unravel its contributing factors.

DATA AND METHODS

Using data from the National Family Health Survey-5 (2019-21), we calculated the Erreygers normalized concentration index (CI) for India and each of its states to measure wealth-based inequality in the exclusive use of hygienic materials during menstruation among women in urban India. Further, we decomposed the Erreygers CI to estimate the relative contribution of covariates to wealth-based inequality in the exclusive use of hygienic materials during menstruation. The analysis included 54,561 urban women aged 15-24 from 28 states and eight union territories of India.

RESULTS

The Erreygers CI value of 0.302 indicated a pro-rich inequality in the exclusive use of hygienic materials among urban women in India. While all the states and UTs showed pro-rich inequality, the CI varied considerably across the country. Among the bigger states, the inequality was highest in Madhya Pradesh (CI: 0.45), Assam (CI: 0.44), Bihar (CI: 0.41), and West Bengal (CI: 0.37) and the lowest in the south Indian states of Tamil Nadu (CI: 0.10), Andhra Pradesh (CI: 0.15), Telangana (CI: 0.15), and Kerala (CI: 0.20). Erreygers decomposition revealed that wealth-based inequality in women's education and mass media exposure contributed almost 80% of the wealth-based inequality in the exclusive use of hygienic materials during menstruation among urban women in India.

CONCLUSION

Substantial pro-rich inequality in the exclusive use of hygienic materials suggests that the policies and program initiatives should prioritize reaching out to poor women to increase the overall rate of exclusive use of hygienic materials during menstruation in urban India.

Menstrual hygiene practices among adolescent women in rural India: a cross-sectional study

Background

Exclusive use of hygienic methods (sanitary napkins, locally prepared napkins, tampons, and menstrual cups) to prevent the visibility of bloodstains during menstruation is still considerably low among adolescent women in rural India. However, no prior research has explored the prevalence and determinants of exclusive hygienic methods among rural Indian adolescent women. To address this gap, this study examines the factors affecting adolescent women’s exclusive use of hygienic methods in rural India. Additionally, this study explores state- and district-level geographical disparities in the exclusive use of hygienic methods among adolescent women in rural India.

Methods

Information on 95,551 adolescent women from rural India from the latest round of National Family Health Survey (NFHS-5) was analyzed. Bivariate statistics and multilevel logistic regression analysis were used to assess the Individual- and community-level factors associated with exclusive use of hygienic methods among adolescent women in rural India. Choropleth maps were used to discern the geographical disparities in the exclusive use of hygienic methods.

Results

In rural India, only 42% of adolescent women exclusively used hygienic methods, with substantial geographic disparities at the state and district levels. At the state level, the exclusive use of hygienic methods varied from 23% in Uttar Pradesh to 85% in Tamil Nadu. Even greater variation was observed at the district level. There was a clear north-south divide in the exclusive use of hygienic methods among adolescent women in rural India. The results of multilevel logistic regression indicated a considerable amount of variation in the exclusive use of hygienic methods at community level which further reduced when controlled for individual and community-level factors. Rural Indian adolescent women with higher education (AOR:3.20, 95% CI: 2.81–3.64), from general category (AOR: 1.14, 95% CI: 1.07–1.21), with medium mass media exposure (AOR: 1.43, 95% CI: 1.35–1.51), and from richest wealth quintile (AOR: 3.98, 95% CI: 3.69–4.30) were more likely to use hygienic methods exclusively.

Conclusion

Wide differential across biodemographic and socioeconomic groups, and substantial geographic disparities at state- and district-level in the exclusive use of hygienic methods suggests a need to adopt context-specific interventions for adolescent women in rural India. Distribution of subsidized or free menstrual hygiene methods to disadvantaged adolescent women, and in the low-prevalence districts may increase the level of exclusive use of hygienic methods remarkably.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14622-7.

Indications for Absorbable Steroid-Eluting Sinus Implants: Viewpoint via the Delphi Method

Absorbable steroid-eluting sinus implants provide targeted corticosteroid release over a sustained period and are designed to prevent both undesirable adhesion formation and sinus ostia restenosis. Here, we highlight the key evidence of these implants to date and query a group of experts via a Delphi process on the indications and optimal timing for intraoperative or in-office placement of these implants. Six of a total of 12 statements reached consensus and were accepted. Overall, experts largely agree that intraoperative or in-office use of steroid-eluting stents could be considered for patients: (1) who are diabetic or intolerant of oral steroids, (2) undergoing extended frontal sinus surgery, and (3) with recurrent stenosis. Given the lack of expert consensus on other key statements, clinicians should carefully consider these treatment options on a case-by-case basis after shared decision-making.

The Utility of Preoperative Phone Calls for Endoscopic Sinus Surgery Procedures

OBJECTIVE

Perioperative patient education improves patient satisfaction, surgical outcomes, and can reduce postoperative call volume. Here, we investigate whether the use of standardized preoperative phone calls elicits similar results in patients undergoing endoscopic sinus surgery (ESS).

METHODS

Patients undergoing ESS at a tertiary rhinology center were identified prospectively through the electronic medical record (EMR). In the intervention cohort, a standardized preoperative educational phone call was performed. A postoperative survey was utilized to collect self-assessment of satisfaction and understanding in all patients. Postoperative call rates were obtained from the EMR. Wilcoxon rank sum and chi-squared analyses were conducted to compare results. Demographics of the otology and rhinology cohorts were compared with a Mann Whitney U-test.

RESULTS

Data from 43 cases and 58 controls were collected. Patients receiving the intervention were similar to controls with regard to patient-reported understanding (case:9.1 ± 1.1 vs control:9.0 ± 1.4, p = 0.801) and satisfaction (case:9.4 ± 1.1 vs 8.9 ± 1.4, p = 0.155). Both cases and controls called the clinic regarding surgical outcomes more often than for postoperative medications or administrative concerns. Independent of receiving the intervention, patients that did not call clinic postoperatively had significantly better understanding of their procedures (call:8.6 ± 1.6 vs no-call:9.5 ± 1.0, p < 0.015) and satisfaction with their experience (call:8.8 ± 1.4 vs no-call:9.5 ± 1.1, p < 0.028). Patient age may contribute to lack of impact in the rhinology cohort, as compared to the otology group, but socioeconomic status does not seem to differentiate the two samples.

CONCLUSION

Though shown in other settings, a significant impact of educational phone calls prior to surgery was not observed in this sample. Patient education calls prior to endoscopic sinus surgery were not associated with changes in postoperative call volume to the clinic. Patient understanding and satisfaction may be related to other factors, such as patient selection or demographics. Future studies may target such patients prior to ESS.

Efficacy of postoperative oral metronidazole for haemorrhoidectomy pain: a randomized double-blind, placebo-controlled trial

AIM

The aim of this work was to examine the efficacy of oral metronidazole in reducing posthaemorrhoidectomy pain versus placebo.

METHOD

Forty patients were randomized to either metronidazole and standard care or placebo and standard care (21 metronidazole, 19 placebo) in a double-blinded, randomized controlled trial. The main outcome measure was posthaemorrhoidectomy pain scores over 21 days, measured on a 10-point Likert scale.

RESULTS

There were no significant differences between groups with regards to age, gender, smoking status, self-reported general health or quality of life, haemorrhoid-related pain, haemorrhoid-related impact on quality of life, reported satisfaction with surgery, experience of surgery, median overall pain score or likelihood of recommending surgery to others. For reported median worst pain scores and defaecation-related pain, a trend to significance was identified between groups on days 16 and 18-21, with the metronidazole group reporting less pain. However, these differences were not significant when prespecified Bonferroni correction criteria were used. Using multilevel mixed effects modelling, the impact of time on median worst pain score was identified to be highly significant (P < 0.0001) whereas treatment allocation (placebo versus metronidazole) did not significantly affect the improvement in patients' reported pain (P = 0.8837).

CONCLUSION

Our data do not support the hypothesis that postoperative metronidazole has a clinically meaningful effect on posthaemorrhoidectomy pain. This study adds to the previous literature, and implies that it should not be routinely used as an adjunct to analgesia.

Are stage-based health information messages effective and good value for money in improving maternal newborn and child health outcomes in India? Protocol for an individually randomized controlled trial

Background

Evidence is limited on the effectiveness of mobile health programs which provide stage-based health information messages to pregnant and postpartum women. Kilkari is an outbound service that delivers weekly, stage-based audio messages about pregnancy, childbirth, and childcare directly to families in 13 states across India on their mobile phones. In this protocol we outline methods for measuring the effectiveness and cost-effectiveness of Kilkari.

Methods

The study is an individually randomized controlled trial (iRCT) with a parallel, partially concurrent, and unblinded design. Five thousand pregnant women will be enrolled from four districts of Madhya Pradesh and randomized to an intervention or control arm. The women in the intervention arm will receive Kilkari messages while the control group will not receive any Kilkari messages as part of the study. Women in both arms will be followed from enrollment in the second and early third trimesters of pregnancy until one year after delivery. Differences in primary outcomes across study arms including early and exclusive breastfeeding and the adoption of modern contraception at 1 year postpartum will be assessed using intention to treat methodology. Surveys will be administered at baseline and endline containing modules on phone ownership, geographical and demographic characteristics, knowledge, practices, respectful maternity care, and coverage for antenatal care, delivery, and postnatal care. In-depth interviews and focus group discussions will be carried out to understand user perceptions of Kilkari, and more broadly, experiences providing phone numbers and personal health information to health care providers. Costs and consequences will be estimated from a societal perspective for the 2018–2019 analytic time horizon.

Discussion

Kilkari is the largest maternal messaging program, in terms of absolute numbers, currently being implemented globally. Evaluations of similar initiatives elsewhere have been small in scale and focused on summative outcomes, presenting limited evidence on individual exposure to content. Drawing upon system-generated data, we explore linkages between successful receipt of calls, user engagement with calls, and reported outcomes. This is the first study of its kind in India and is anticipated to provide the most robust and comprehensive evidence to date on maternal messaging programs globally.

Trial registration

Clinicaltrials.gov, 90075552, NCT03576157. Registered on 22 June 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3369-5) contains supplementary material, which is available to authorized users.

Headaches and facial pain in rhinology

"Sinus headache" is a common chief complaint that often leads patients to an otolaryngologist's office. Because facial pain may or may not be sinogenic in origin, the otolaryngologist should be equipped to evaluate and treat or to appropriately refer these patients. Analysis of current data indicates that the majority of patients who present with sinus headaches actually have migraines. Furthermore, the downstream effect of the cytokine cascade initiated in migraine physiology can cause rhinologic symptoms, including rhinorrhea, congestion, and lacrimation, which may also confound diagnosis. Other causes of sinus headache include the following: cluster headaches, Sluder neuralgia, trigeminal neuralgia, myofascial trigger point pain (tension headaches, temporomandibular joint dysfunction), and contact point headaches. The diagnostic dilemma for an otolaryngologist occurs when a patient has facial pain and symptoms that may indicate chronic rhinosinusitis but with nondiagnostic endoscopy. Traditionally, these patients have been primarily managed with empiric antibiotics. An alternative strategy is to first screen these patients with an upfront computed tomography. This algorithm may ultimately decrease cost; avert unnecessary antibiotics prescriptions; and prompt more timely referrals to other, more appropriate, disciplines, such as neurology, dentistry, and/or pain management specialists.