Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, ...potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence.
The state of Kerala stands out as having the highest prevalence of diabetes and coronary artery disease in comparison to other states within India. This observation positions India as the global ...epicenter for noncommunicable diseases (NCDs), specifically diabetes, and cardiovascular ailments. Kerala is in a highly advanced stage of epidemiological transition, surpassing other states in India. This transition is characterized by factors such as an aging population, a high incidence of NCDs, and elevated levels of morbidity. Kerala boasts a robust health-care system encompassing a strong public sector, further reinforced by a network of private hospitals spread across the state. Moreover, the population of Kerala possesses a high literacy rate. It is well-informed about their rights, while local self-governance and nongovernmental organizations (NGOs) actively collaborate to promote community health. These factors have collectively contributed to the state's proactive approach toward addressing NCDs. In the domains of surveillance, monitoring, and prevention of NCDs, as well as the prevention of complications arising from these diseases, Kerala has implemented various schemes across the public, private, and NGO sectors. These initiatives encompass activities to raise awareness about NCDs, provide treatment options, and focus on preventive measures. By documenting and highlighting these schemes, Kerala's health-care system and its achievements can serve as a roadmap for the rest of the country, outlining strategies for prevention, monitoring, and therapeutic interventions. It is imperative that other states within India, as well as low- and middle-income countries (LMICs) at large, adopt and adapt the processes and practices established by Kerala to effectively combat the NCDs pandemic. By following this path, the nation and other LMICs can effectively confront the challenges posed by NCDs and work toward improving their populations' overall health and well-being.
Menstrual hygiene products used by women have evolved in the past several decades with comfort, ease of use and cost driving women's choices. In a country like India, where women form nearly 50% of ...the population, the sheer volume of periodic menstrual non-biodegradable waste generated has significant environmental implications. With majority of the country hailing from low-middle class backgrounds, observing healthy menstrual hygiene practices with environmentally friendly products necessitates the consideration of affordable and highly sustainable alternatives. Further, during the COVID-19 pandemic, period poverty is higher than ever, causing women to turn to the reusable product market for affordable and long lasting alternatives. Hence, we studied the Feasibility and Acceptability (FA) of a novel banana fiber based menstrual pad (BFP) amongst women living in rural and urban environments.
The quantitative study of FA of the BFP was conducted amongst 155 rural and 216 urban participants in India. For greater authenticity of the FA study, we considered participants who used BFP for more than 4 months (Rural = 111 and Urban = 186) in the study. The survey data included responses from participants from Bihar, Delhi, Karnataka, Kerala, Maharashtra, Tamil Nadu and West Bengal. A 22-item survey instrument was developed and validated using Exploratory Factor Analysis (EFA) and reliability test (Cronback's Formula: see text). Binomial logistic regression analysis was used to analyse the factors that affect the FA of BFP based on the survey responses. In addition to survey analysis, environmental sustainability through Formula: see text footprint analysis, microbial load, pH and the ability of the BFP to withstand pressure after absorption were also studied.
The results indicated high levels of feasibility (rural Formula: see text, urban Formula: see text and acceptability (rural Formula: see text, urban Formula: see text) of BFPs across both participant groups. Comparing key BFP characteristics such as leakage and comfort to participants' prior practices revealed general satisfaction on the performance of BFP, leading to them recommending BFPs to others. User perception on the reasons for their preference of BFP highlighted their concern for environment, health and cost as decisive factors. The microbial load on a 3 year reused BFP was found to be similar to an unused BFP. Regression analysis showed cost as an important indicator for feasibility (Formula: see text; 95% CI = 1.083-3.248) and acceptability (Formula: see text; 95% CI = 1.203-3.748) amongst rural participants.
Based on feasibility and acceptability results, BFP is a promising consideration as an environmentally sound, non-invasive; yet reusable alternative to fulfil MHM needs in populous countries such as India. Longer term studies in larger samples are necessary to validate these findings.
Background
This study identified the risk factors for severe acute respiratory syndrome coronavirus 2 infection among household contacts of index patients and determined the incubation period (IP), ...serial interval, and estimates of secondary infection rate in Kerala, India.
Methods
We conducted a cohort study in three districts of Kerala among the inhabitants of households of reverse transcriptase polymerase chain reaction‐positive coronavirus disease 2019 patients between January and July 2021. About 147 index patients and 362 household contacts were followed up for 28 days to determine reverse transcriptase polymerase chain reaction positivity and the presence of total antibodies against SARS‐CoV‐2 on days 1, 7, 14, and 28.
Results
The mean IP, serial interval, and generation time were 1.6, 3, and 3.9 days, respectively. The secondary infection rate at 14 days was 43.0%. According to multivariable regression analysis persons who worked outside the home were protected (adjusted odds ratio aOR, 0.45; 95% confidence interval CI, 0.24–0.85), whereas those who had kissed the coronavirus disease 2019‐positive patients during illness were more than twice at risk of infection (aOR, 2.23; 95% CI, 1.01–5.2) than those who had not kissed the patients. Sharing a toilet with the index patient increased the risk by more than twice (aOR, 2.5; 95% CI, 1.42–4.64) than not sharing a toilet. However, the contacts who reported using masks (aOR, 2.5; 95% CI, 1.4–4.4) were at a higher risk of infection in household settings.
Conclusions
Household settings have a high secondary infection rate and the changing transmissibility dynamics such as IP, serial interval should be considered in the prevention and control of SARS‐CoV‐2.
Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial ...infarction (MI). A key reason for poor outcomes is non-adherence to medication. Methods The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4–5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done. Discussion The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment. Trial registration The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095.
Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence ...of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India.
Blood pressure of 5980 adults from 20 randomly selected slums were measured by door to door survey by trained nurses as a part of baseline assessment for a cluster randomised controlled trial.
Prevalence of hypertension was found to be 34.8% (95% CI 33.5–34.9). Among those with hypertension, 66.9% were aware of their hypertensive status, of which 75.8% were initiated on treatment for hypertension. Proportion of hypertensive in the population who had their blood pressure under control was 24.5%. Among hypertensive, 53% were obese, 25.1% had diabetes mellitus, 14% had history of hospitalisation for high blood pressure. Of them, 60.3% had a per capita salt consumption above 8 g/day and 47.5% of them reported sitting for more than 8 h on a usual day. Mean monthly out of pocket expenditure for treatment of hypertension was $9(Median $8, IQR $16).
One in three adults in urban slums of Kochi had hypertension. High rates of obesity, salt intake, physical inactivity prevails among the people with hypertension. Awareness, treatment initiation and control rate of hypertension are lower in urban slums as compared to non-slum urban areas. Slums require additional attention to ensure equitable and universal access to hypertension control.
Introduction: Coronavirus Disease-2019 (COVID-19) is a highly contagious viral illness caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Serological surveys help in ...understanding the burden of past infections. The World Health Organisation (WHO) suggests the need for populationbased sero-epidemiological investigations to acquire data for implementing containment measures. The tribal population, being the most marginalised and vulnerable section, is at a higher risk for COVID-19. However, there is limited literature regarding the seroprevalence of COVID-19 among the tribal population in our country. Aim: To assess the COVID-19 seropositivity, associated factors, and knowledge among adults of tribal origin attending a primary care centre in Wayanad, Kerala. Materials and Methods: A cross-sectional study was conducted among 279 adults of tribal origin, aged between 18 and 95 years, attending a primary tribal healthcare centre at Amrita Institute of Medical Sciences, Kochi, Kerala, India, from August 2021 to October 2021. A semistructured questionnaire was used to collect socio-demographic details, history of COVID-19 infection, vaccination status, and participants’ knowledge and awareness about COVID-19. Antibody presence was tested using the WANTAI test kit. Data analysis was performed using Statistical Package for Social Sciences(SPSS) version 21.0 A multivariable logistic regression was conducted following univariate analysis to identify independent factors associated with COVID-19 seropositivity. Results: The mean age of the study population was 45.34±15.86 years. Among the 279 participants, the proportion of seropositivity to COVID-19 antibodies was found to be 245 (87.8%) with a 95% confidence interval (CI) of 83.98 to 91.62. Regarding knowledge and awareness related to COVID-19, 186 (66.7%) participants were not aware of the common symptoms of COVID19. Individuals aged above 60 years had a five times higher probability of having COVID-19 antibodies compared to those aged 30 years or younger (adjusted odds ratio (aOR) 4.71, 95% CI 0.111 to 20.025). Those who had received atleast one dose of the vaccine were nine times more likely to have seropositivity (aOR 8.58, 95% CI 1.390 to 53.028). Conclusion: The seropositivity of COVID-19 was high at 87.8%. Older people and vaccinated individuals were more likely to be seropositive. Therefore, it is necessary to strengthen vaccination efforts among all age groups. Continued sero-surveillance and vaccination surveys need to be conducted to gain more insights into the antibody kinetics of this novel pathogen.
Background
Exposure to second hand smoke (SHS) is a cause for heart disease and lung cancer among non- smokers. This cluster randomized control trial will evaluate the effectiveness of a tobacco ...smoke free home intervention in reducing exposure to second hand smoke.
Protocol
The intervention will be conducted among 30 clusters in urban and peri-urban areas of Kochi, India. The sample size is 300 per arm and 15 clusters to detect a minimal difference of 0.03ng/ml in cotinine levels between groups, at 80% power with a two-sided alfa of 0.05 considering variable cluster size. A baseline survey will be undertaken to identify smokers. Data related to smoking, indoor smoking, nicotine dependence, blood pressure (BP) of smokers, morbidity experienced, and lung volume Fev1/Fev6 of smokers will be measured. Urine cotinine, morbidity, BP of spouse and child will be assessed. Air quality monitors measuring PM2.5 will be placed in homes. Trained self-help group women and frontline health workers will implement the intervention. The intervention will consist of monthly home visits to educate the smoker on the harms of second-hand smoke using 3 A's. The circle of influencers around the smoking men will also be contacted by the members of self-help group to provide support to stop smoking within homes and to quit. They will then organize two-three meetings of community leaders and heads of women's groups, present data on harms of SHS, and explain the rationale for establishing smoke free homes in their community for a duration of six months. After the intervention a post assessment will be conducted and this will be repeated after six months.
Ethics and dissemination
The trial protocol was approved by the Institutional Ethical Committee of Amrita Institute of Medical Sciences. Results will be submitted to open access peer reviewed journals and shared with other stakeholders.
Trial registration
CTRI/2021/06/034478
ObjectivesTo assess the pattern of contraceptive use and its determinants, knowledge regarding contraceptives including oral contraceptive pills and fertility intentions among tribal women in the ...reproductive age group.DesignCommunity-based cross-sectional study.SettingCommunity development blocks in a predominantly tribal district of Wayanad in Kerala, India.ParticipantsWomen in the reproductive age group (15–49 years) from the tribal groups in the district numbering 2495.Outcome measuresPrimaryPrevalence of contraceptive use and its determinants.SecondaryKnowledge regarding contraceptives in general, oral contraceptives and fertility intentions.ResultsThe mean age of the study participants was 30.8 years (SD=9.8) and belonged to various tribal groups such as Paniya (59.2%), Kurichiyar (13.6%) and Adiya (10.9%). Current use of contraceptive was reported by about a fourth, 658 (26.4%) (95% CI 27.9 to 24.9) of women. Following logistic regression, belonging to Paniya tribe (adjusted OR (aOR) 2.67, 95% CI 1.49 to 4.77; p<0.001) and age at menarche >13 years (aOR 1.69, 95% CI 1.14 to 2.52; p<0.009) had significantly higher use of contraceptives whereas social vulnerability as indicated by staying in a kutcha house had a lesser likelihood of use of contraceptive (aOR 0.55, 95% CI 0.31 to 0.95; p<0.03). Oral contraceptive use was low (4.8%) among this population and no abuse was observed.Less than half (47%) of the respondents had an above average knowledge on contraception. Multivariable logistic regression indicated that above average knowledge was 2.2 times more likely with higher education (95% CI 1.2 to 3.9), lesser among those who desired more than two children (aOR 0.59; 95% CI 0.38 to 0.94; p<0.02).Two children per family was the preferred choice for 1060 (42.5%) women. No gender bias in favour of the male child was observed.ConclusionAwareness and use of contraceptives are poor though the fertility is not commensurately high. Along with developing targeted responses to contraceptive use among Indigenous people with indigenous data, awareness also requires attention. Ethnographic studies are also necessary to determine the differences in contraceptive use including traditional methods among the various Indigenous groups.
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