Association between domestic violence and unintended, terminated pregnancy and complications during pregnancy among Indian women: Findings from nationally representative survey.

Background: Women experiencing domestic violence might have restrictions in the pregnancy-related decision-making and care-seeking process leading to adverse pregnancy outcomes. We explored the association between domestic violence and undesirable pregnancy events. Methods: 63,796 women aged 18-49 years covered under the domestic violence module of National Family Health Survey-5, 2019-21. Stratification and clustering in the complex sampling design of the survey were accounted in analysis. Using Poisson regression, prevalence ratio (PR) was reported to provide association of domestic violence with undesirable pregnancy events. Results: Prevalence of undesirable pregnancy events was 25.0% (95%CI: 24.4%-25.7%) amongst women aged 18-49 years. Prevalence of unintended, terminated pregnancy and complications during pregnancy was 3.2%, 5.1% and 20.9%, respectively. Women aged ≥35 years, educated, unemployed, primi or multi parity, intimate partner/husband being uneducated, facing problem with access to healthcare, belonging to large number of household members (≥4) and poorest or poorer quintile had significantly higher chance of having undesirable pregnancy events. Sexual violence (aPR: 1.11, p = 0.02) had higher chance of having undesirable pregnancy events. Conclusion: One-fourth of reproductive-age group women had undesirable pregnancy events. Sexual violence was significantly associated with these events. Effective policy should protect women from domestic violence to promote maternal well-being.

Association between acute liver injury & severity and mortality of COVID-19 patients: A systematic review and meta-analysis.

Background: Acute liver injury (ALI), a complication often seen in COVID-19 patients, can lead to severe liver damage, multi-organ failure, acute vascular events, and can potentially escalate to patient mortality. Given this, we initiated a meta-analysis to investigate the correlation between ALI and adverse outcomes in COVID-19 patients. Methods: We conducted an exhaustive search of databases, including Medline, Embase, PubMed Central, ScienceDirect, Google Scholar, and the Cochrane Library, from the November 2019 until January 2022. The quality of the included studies was evaluated using the Newcastle Ottawa (NO) scale. Our meta-analysis was carried out using a random-effects model and results were presented as pooled odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). Results: Our analysis incorporated 20 studies involving a total of 13,850 participants, predominantly from China and the United States. According to the NO scale, the majority of these studies were categorized as low-quality. Patients with ALI faced approximately 7 times higher odds of severe COVID-19 symptoms (pooled OR = 7.09; 95%CI: 4.97 to 10.12) and over 5 times higher odds of mortality (pooled OR = 5.50; 95%CI: 3.37 to 8.99) when compared to those without ALI. Conclusion: Our findings affirm that ALI is a potent predictor of adverse outcomes, including severity and mortality, among COVID-19 patients. Recognizing and promptly addressing ALI in COVID-19 patients could be pivotal in improving prognosis and tailoring individualized patient management strategies. This underscores the need for clinicians to be vigilant about liver complications in the COVID-19 patients and integrate appropriate interventions in the treatment paradigm.

Prevalence and Determinants of Physical Violence and Its Impact on Birth Outcomes During Pregnancy in India: Evidence From a Nationally Representative Survey.

Physical violence during pregnancy can have negative impact on health status of mother and fetus. Hence, the current study was done to determine the prevalence and determinants of physical violence and its impact on birth outcomes during pregnancy in India. We have analyzed the most recent National Family Health Survey 4 data (NFHS-4) gathered from Demographic Health Survey (DHS) program. Stratification (urban/rural) and clustering (villages/census enumeration blocks [CEBs]) in the sample design was accounted using svyset command. In total, 62,165 ever pregnant women aged 15 to 49 years were included. Prevalence of physical violence during pregnancy in India was 3.3%. Husband/partner (2.7%) was the person most commonly responsible. Women who were widowed/separated/divorced (aPR = 1.88), belonging to the poorest quantile (aPR = 2.32), women who were employed (aPR = 1.42), women in the Southern states (aPR = 3.24), and women whose husband/partner has lesser educational qualification (adjusted prevalence ratio [aPR] = 2.02) had significantly higher prevalence of physical violence during pregnancy (p < .001). Women who faced physical violence had significantly higher proportion of miscarriage (4.3%), abortion (3.3%), and stillbirth (1.1%) when compared with women who did not face any violence (4.1% had miscarriage, 1.8% had abortion, and 0.5% had stillbirth; p < .001). These findings show the importance of providing general supportive measures and strengthen the existing punitive legislations to prevent the violence during pregnancy.

Prevalence and determinants of breast and cervical cancer screening among women aged between 30 and 49 years in India: Secondary data analysis of National Family Health Survey - 4.

Background: ">Breast and cervical cancers are the two leading causes of cancer-related morbidity and mortality in India. Early diagnosis of these cancers through screening offers the best chance to achieve successful treatment outcomes. Hence, the current study was done to determine the prevalence and predictors of breast and cervical cancer screening among women aged 30-49 years in India. Methods: We have analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from Demographic Health Survey program. Stratification and clustering in the sample design were accounted using svyset command. Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was reported. Results: In total, 336,777 women aged 30-49 years were included. Proportion of women aged 30-49 years with history of breast cancer examination in their lifetime was 12.9% (95% CI: 12.6-13.2%), while it was 29.8% (95% CI: 29.3-30.3%) for cervical cancer. It was found that women aged 45-49 years (aPR=1.09), married (aPR=2.18), higher educational level (aPR=1.28), richest quantile (aPR=1.96), no history of pill use (aPR=1.24), obese (aPR=1.06), and healthy dietary habits (aPR=1.47) were more likely to be screened for breast cancer. Predictors for cervical cancer screening were higher age group (aPR=1.06), married (aPR=2.94), secondary educational level (aPR=1.05), richest quantile (aPR=2.24), nonpill user (aPR=1.24), nontobacco user (aPR=1.07), and lower parity (aPR=1.09). Conclusion: A total of 1 out of 10 women in reproductive age group were screened for breast cancer while less than one in three for cervical cancer. Hence, it is important to spread awareness and increase access to screening services to achieve early diagnosis and better treatment outcomes.

Development and Validation of Scale Assessing the Preparedness of Objective Structured Clinical Examination in Undergraduate Competency based Medical Education.

Background: Formative assessments methods such as objective structured clinical examination (OSCE) are reliable and valid assessment tools employed under the competency-based medical education (CBME) curriculum. However, there was no uniform scale to assess the attributes of OSCE for any of the medical subjects. Hence, this study was done to develop and validate a scale to assess the attributes of OSCE and make sure that the intended objectives of the OSCE are achieved. Methods: The scale was developed using literature review and expert opinion. It consisted of 10 questions and response to these items was based on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree." The final version was administered among 30 students undertaking survey community diagnosis (CD) posting during their third semester. Exploratory and confirmatory factor analysis was performed to validate the scale. Results: Two-factor structures were obtained with eigenvalues of 4.32 and 1.90. Factor 1 consisted of seven items (positively faced questions) accounting for 42.84% of the variance, whereas Factor 2 had the remaining three items (negatively faced questions) explaining 19.36% of the variance. Thus, together, the two factors explained 62.20% of the variance. Goodness-of-fit indices revealed good Comparative fit index (CFI) s of 0.90, Tucker Lewis index (TLI) of 0.87, and acceptable Standardized Root Mean Square Residua (SRMR) of 0.13. The reliability coefficient (Cronbach's alpha) for the scale was 0.81. Conclusion: This study develops and validates a scale that can be used universally for assessing the attributes of OSCE across all disciplines and in medical education institutes in India.

Worldwide trends in breast cancer incidence from 1993 to 2012: Age-period-cohort analysis and joinpoint regression.

BACKGROUND: Breast cancer is the most common cancer accounting for about one-fourth of total cancer cases and 15% of all cancer deaths among women worldwide. It is important to determine its trend across the regions in the world to find the high-focus regions. Hence, the current study was done to assess the global trends and deviations in the incidence of breast cancer. MATERIALS AND METHODS: A descriptive trend analysis was done using the data on breast cancer incidence from the WHO Cancer Incidence Data of Five Continents plus database. Joinpoint regression was performed to determine the average annual percent change (AAPC), and age-period-cohort analysis was done to obtain age-, period-, and cohort-specific deviations and rate ratio. RESULTS: All the regions showed an increasing trend in breast cancer incidence, with an exception of America. Maximum increase was observed in Asia (AAPC = 2.6%; 95% confidence interval [CI]: 2.4%-2.9%) followed by Europe (AAPC = 0.7%; 95% CI: 0.5%-1%). There was consistent rise in the breast cancer incidence across the age groups in all the four continents with maximum burden in elderly (P < 0.001). Except in America, all other regions showed consistent rise in the incidence of breast cancer through the periods 1998-2002 to 2007-2012 (P < 0.001). There was consistent increase across the cohorts from 1923-1927 to 1978-1982 in continents such as Asia and Oceania (P < 0.001). CONCLUSION: To summarize, the incidence of breast cancer shows an increasing trend globally with a maximum increase in the Asian region. This makes a strong need for newer strategies irrespective of current prevention and control interventions.

Spatial Pattern and Determinants of Tobacco Use Among Females in India: Evidence From a Nationally Representative Survey.

INTRODUCTION: Tobacco use has been steadily increasing among the females in developing countries. It has led to rise in tobacco-related morbidity and mortality among females. Knowing the geographic distribution of the habit is essential to identify high-priority areas and direct the healthcare intervention. Hence, this study was done to assess the spatial patterns and determinants of tobacco consumption among females in India. AIMS AND METHODS: Univariate and bivariate Moran's I statistic and local indicators for spatial association maps were generated to determine the spatial clustering of tobacco consumption (smoked and smokeless form). Ordinary least-square regression, spatial-lag and spatial-error models were performed to assess the determinants. Poverty (belonging to poorest and poorer quintile of wealth index), illiteracy (no formal education), marital status, ST population, tobacco use by family members, and alcohol use were the explanatory variables. RESULTS: Univariate Moran's I was .691 suggesting positive spatial autocorrelation. High-prevalence clustering (hotspots) was maximum in the central, eastern, and northeastern states such as Chhattisgarh, Madhya Pradesh, Odisha, Bihar, Manipur, Tripura, Meghalaya, Mizoram, and Assam. This pattern was similar for both smokeless and smoked form. Results of spatial-lag and spatial-error model suggested that alcohol use, scheduled tribes, illiteracy, poverty, marital status, and tobacco use by family members were significant determinants of female tobacco consumption. The coefficient of spatial association was maximum for alcohol use (ß = .20, p < .001) followed by widowed/separated/divorced (ß = .12, p < .001). CONCLUSIONS: Tobacco consumption among females in India is spatially clustered. Multisectoral coordination and targeted interventions are required in the geographical hotspots of tobacco consumption. IMPLICATIONS: This is the first study to explore the geospatial pattern of tobacco consumption among females in India. We found that the pattern of tobacco use among females is spatially clustered in India. Clustering was predominantly found in central, eastern, and northeastern regions of the country. Tribal population in these areas and complementarities between alcohol and tobacco use contributed significantly to the high-prevalence clustering. These findings will be helpful for policymakers and planners to devise specific intervention package targeting the high-risk regions.

Physical, emotional and sexual violence faced by spouses in India: evidence on determinants and help-seeking behaviour from a nationally representative survey.

OBJECTIVE: The current study was done to determine the prevalence, determinants, disclosure status and help-seeking behaviour of spousal violence using a nationally representative sample of ever-married women in India. METHODS: We have analysed the most recent National Family Health Survey-4 data (2015-2016) gathered from the Demographic Health Survey programme. Stratification and clustering in the sample design were accounted using svyset command. Point estimates were reported as proportions with 95% CI. RESULTS: A total of 66 013 ever-married women aged 15-49 years were included. Lifetime prevalence of spousal violence in India was 31% (95% CI 30.4% to 31.7%). Physical violence was the most common form accounting for 27.4% of victims followed by emotional (12.7%) and sexual violence (6.7%). Higher women's age, Muslim religion, low education, employed women, lower socioeconomic status, presence of substance use among women and husbands, lower education and unemployed husbands, history of family violence and women in Central and Eastern states had a significant association with one or more forms of spousal violence with significant p value. Prevalence of help-seeking behaviour among women who faced spousal violence in India was 13.5% (95% CI 12.8% to 14.2%). Widowed/separated/divorced women, employed and highly educated women, and women in Northern states had significantly higher prevalence of help-seeking behaviour with respect to all the forms of spousal violence (p<0.001). CONCLUSION: One in three women in India faces spousal violence. Only 1 in 10 women seeks help following violence. Efforts should be made to ensure people working in formal institutions screen for spousal violence and know how to respond to women facing it.

Fat taxation in India: A critical appraisal of need, public health impact, and challenges in nationwide implementation.

National Nutritional Monitoring Bureau survey (2017) has found that more than half of the adults in India were overweight and obese. To halt this rising epidemic, development of various policy measures has been suggested in National action plan for prevention and control of noncommunicable diseases. One such measure is the introduction of fat tax which is a surcharge or tax placed on food and beverages containing high amounts of fat. Government of India has made various direct budgetary initiatives for boosting the sectors related to the production of items rich in fat, sugars and salt without realizing the potential public health consequences. Hence, increasing the taxes for unhealthy junk foods should encourage the people to take healthier food options which in turn lead to positive impact on health. However, fat taxationfaced several challenges during implementation in countries like Denmark, Hungary, France and United States. Major challenges were the taxation debate, setting tax limit and encroaching into the autonomy rights of people. Evidences have shown that taxation alone cannot bring down the burden of non-communicable diseases but should be combined with measures like subsidies and access to healthy food items, public health education campaigns and programmes.

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.