The Prevalence of Comorbidities and Associated Factors among Patients with Dementia in the Indian Setting: Meta-analysis of Observational Studies.

Background: Patients with dementia usually have multiple comorbidities. The presence of comorbidities may exacerbate the progression of dementia and decreases the patient's ability to participate in health maintenance activities. However, there is hardly any meta-analysis estimating the magnitude of comorbidities among patients with dementia in the Indian context. Methods: We searched PubMed, Scopus, and Google Scholar, and relevant studies conducted in India were included. The risk of bias was assessed and a random-effects meta-analysis model was used in which I2 statistics were calculated to measure heterogeneity among studies. Results: Fourteen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Altogether, we found the coexistence of comorbid conditions such as hypertension (51.10%), diabetes (27.58%), stroke (15.99%), and factors like tobacco use (26.81 %) and alcohol use (9.19%) among patients with dementia in this setting. The level of heterogeneity was high due to differences in the methodologies in the included studies. Conclusions: Our study found hypertension as the most common comorbid condition among patients with dementia in India. The observed lacuna of methodological limitations in the studies included in the current meta-analysis provides the urgent need for good quality research to successfully meet the challenges ahead while devising appropriate strategies to treat the comorbidities among patients with dementia.

A peer support program results in greater health benefits for peer leaders than other participants: evidence from the Kerala diabetes prevention program.

BACKGROUND: Peer support programs are promising approaches to diabetes prevention. However, there is still limited evidence on the health benefits of peer support programs for lay peer leaders. PURPOSE: To examine whether a peer support program designed for diabetes prevention resulted in greater improvements in health behaviors and outcomes for peer leaders as compared to other participants. METHODS: 51 lay peer leaders and 437 participants from the Kerala Diabetes Prevention Program were included. Data were collected at baseline, 12 months, and 24 months. We compared behavioral, clinical, biochemical, and health-related quality of life parameters between peer leaders and their peers at the three time-points. RESULTS: After 12 months, peer leaders showed significant improvements in leisure time physical activity (+ 17.7% vs. + 3.4%, P = 0.001) and health-related quality of life (0.0 vs. + 0.1, P = 0.004); and a significant reduction in alcohol use (-13.6% vs. -6.6%, P = 0.012) and 2-hour plasma glucose (-4.1 vs. + 9.9, P = 0.006), as compared to participants. After 24 months, relative to baseline, peer leaders had significant improvements in fruit and vegetable intake (+ 34.5% vs. + 26.5%, P = 0.017) and leisure time physical activity (+ 7.9% vs. -0.9%, P = 0.009); and a greater reduction in alcohol use (-13.6% vs. -4.9%, P = 0.008), and waist-to-hip ratio (-0.04 vs. -0.02, P = 0.014), as compared to participants. However, only the changes in fruit and vegetable intake and waist-to-hip ratio were maintained between 12 and 24 months. CONCLUSION: Being a peer leader in a diabetes prevention program was associated with greater health benefits during and after the intervention period. Further studies are needed to examine the long-term sustainability of these benefits.

The Distribution of Lifestyle Risk Factors Among Patients with Stroke in the Indian Setting: Systematic Review and Meta-Analysis.

Background: The burden of stroke is increasing in India, but there is limited understanding of the distribution of reported risk factors in the Indian setting. It is vital to generate robust data on these modifiable risk factors to scale up appropriate strategies for the prevention of cerebrovascular diseases in this setting. Summary: The objective of this study is to estimate the overall proportion of life style risk factors of patients with stroke in the Indian setting. We searched PubMed and Google Scholar and relevant studies published till February 2022 were included. The risk of bias assessment was considered for the study selection criterion in the meta-analysis. The publication bias was evaluated by funnel plots and Egger's test. We identified 61 studies in the systematic review and after quality assessment, 36 studies were included for meta-analysis. Random effect model was used due to the significant inconsistency among the included studies (I2 > 97%). The mean age of the participants was 53.84±9.3 years and patients with stroke were predominantly males (64%). Hypertension (56.69%; 95% CI: - 48.45 - 64.58), obesity (36.61%; 95% CI: - 19.31 - 58.23), dyslipidemia (30.6%; 95% CI: - 22 - 40.81) and diabetes mellitus (23.8%; 95% CI: - 18.79 - 29.83) are the leading intermediate conditions associated with stroke. The Physical inactivity - 29.9% (95% CI: - 22.9 - 37.1), history of tobacco use (28.59 %; 95% CI: - 22.22 - 32.94) and alcohol use (28.15 %; 95% CI: - 20.49 - 37.33) were reported as the behavioral risk factors for stroke in this setting. Key Messages: The current meta-analysis provides robust estimates of the life style related risk-factor of stroke in India based on the observational studies conducted from 1994 to 2019. Estimating the pooled analysis of stroke risk factors is crucial to predict the imposed burden of the illness and ascertain the treatment and prevention strategies for controlling the modifiable risk factors in this setting.

Body composition of type 2 diabetes patients in Uganda: A case-control study.

Introduction: The prevalence of obesity among people diagnosed with Type 2 Diabetes Mellitus (T2DM) has been widely documented. However, the specific composition of this bodyweight remains largely unknown. The study aimed to understand the body composition of T2DM patients using the bioelectric impedance analysis technique, comparing findings to sex and agematched controls. Materials and Methods: A comparative case-control study was carried out among 139 known cases of Type 2 diabetes aged 18 to 78 years randomly sampled from the diabetic clinic of Mbarara Regional Referral Hospital. We matched them to 139 hospital controls who were healthy non-diabetic attendants. Body composition parameters were computed and summarized as medians and interquartile ranges. Differences in the medians of body composition parameters were further assessed using the Mann- Whitney U test. Fat-free and fat mass indices were derived to offer a precise estimation of body composition parameters adjusted for height differences among study participants. Results: Cases had significantly higher median systolic blood pressure, pulse rate, weight, Body Mass Index (BMI), Waist-Hip Ratio (WHR), total fat percentage, fat mass amount, Fat Mass Index, visceral fat, and metabolic age than their counterparts, whereas controls had significantly higher median total body water percentage versus cases. The highest significant differences occurred in fat percentage composition (Cases: ß: 6.9 (95% C.I: 4.4, 9.4); Controls: Ref) followed by visceral fat (Cases: ß: 3.5 (95% C.I: 2.5, 4.4); controls: Ref) and Fat Mass Index (Cases: 95% C.I: 2.6 (95% C.I: 1.6, 3.7). Cases had significantly higher Fat Mass Index, visceral fat and fat percentage (all p<0.05) than controls. Conclusions: Routine assessment of body composition of T2DM patients needs to be done to assess the amount, type and pattern of weight gain to prevent increases in adiposity.

The prevalence and correlates of comorbidities among patients with cancer attending a tertiary care cancer center in South India: An analytical cross-sectional study.

Background: Comorbidities in patients with cancer can affect treatment, and should, therefore, be prioritized and managed. Objectives: Our primary aim was to assess the prevalence of comorbidities among patients with cancer. The secondary objective was to identify the association of comorbidities with various sociodemographic and clinical variables. Materials and Methods: This was a cross-sectional study conducted between December 2019 and March 2020 among patients with cancer, seeking treatment at Malabar Cancer Center, in Kannur District of northern Kerala in South India. Semi-structured interviews were conducted, and comorbidities were assessed using the Charlson Comorbidity Index. The anthropometric measurements were recorded using a standardized instrument and protocol. Results: We enrolled 242 patients in this study. There were 148 (61.2%) female patients; 106 (43.8%) were aged between 41 and 50 years. Cancers of the head-and-neck and breast accounted for the majority of cases (23.1% each, n = 56), followed by the digestive system (18.6%, n = 45) and female reproductive system (11.2%, n = 27). The most common primary cancers in the head-and-neck, digestive, and female reproductive systems were oral, colorectal, and cervical, respectively. The prevalence of comorbidities among patients with cancer was 70.2% (n = 170). Common comorbidities were hypertension (n = 82 ; 33.9%), arthritis (n = 57; 23.6%), and diabetes (n = 53; 21.6%). After controlling for potential confounders, the factors noted to be independently associated with the presence of comorbidities were advanced age, family history of comorbidity, normal weight or underweight, and cancer treatment for more than 6 months' duration. Conclusions: The high prevalence of comorbidities among patients with cancer suggests the need for an integrated system of care and management as the comorbidities affect the overall management of cancer treatment and care.

Association of symptom characteristics and comorbid conditions with viral RNA positivity of Covid-19 patients in Kasaragod district in Kerala, India: A retrospective cohort study.

Background Symptoms of Covid-19 are known to be non-specific ranging from asymptomatic cases to severe illness affecting multiple organ systems. The duration of viral RNA positivity and transmission varies in individuals. We describe the association between symptom characteristics and comorbid conditions with viral RNA positivity of SARSCoV-2 affected individuals. Methods We conducted a record-based retrospective cohort study of 179 patients found to be positive for Covid-19 in Kasaragod district in Kerala. We included details of all patients found positive during the initial phases of the pandemic and recorded details regarding symptoms, duration of viral RNA positivity and the occurrence of transmission. The data were analysed using SPSS. Results Any symptom was present in 68%. Fever (43%) was the most common symptom while 50% had at least one respiratory symptom. Increased duration of viral RNA positivity was found to be associated with presence of comorbid conditions. The majority of individuals who transmitted disease (75%) had some symptom, predominantly a respiratory symptom. Conclusion Respiratory symptoms are seen in half of the patients and viral RNA positivity was for a longer duration in patients with comorbid conditions.

Lived Experiences of Newly Diagnosed Type 1 Diabetes Mellitus Children and Adolescents in Uganda.

Introduction: The first-year post-diagnosis is the most challenging and stressful period in the lifetime of a young child and adolescent living with diabetes, given the adjustments that are meant to be adopted. Therefore, psychosocial factors affecting newly diagnosed children and adolescents need to be well understood and children supported to improve treatment adherence. However, evidence concerning psychosocial experiences among young patients with diabetes is scant in Uganda. This study explores the perceptions and experiences of newly diagnosed children and adolescents in Uganda. Methods: A qualitative exploratory design was employed. We recruited participants aged 6 to <18 years diagnosed within twelve months from three study sites: Mulago National Referral Hospital, Wakiso HCIV, and St Francis Nsambya Hospital. Twenty in-depth interviews were conducted, and textual data were analysed thematically using a framework approach. Results: We identified five themes: battling with symptoms, emotions at diagnosis, challenges in coping with diabetes management, changes I have made, and positive outcomes registered. The analysis found that young people living with diabetes experience a new world of adjustments, including insulin therapy, routine blood glucose monitoring, and dietary changes that are often difficult to deal with, especially in the first year after diagnosis. Discussion: Continuous psychosocial support to newly diagnosed young children and adolescents with T1DM is vital. Addressing psychosocial challenges may improve adherence to treatment regimens. Conclusion: Our findings have demonstrated the mixed experiences of newly diagnosed young children and adolescents living with diabetes, from anxiety and stigmatization to independence.

Body Composition Characteristics of Type 1 Diabetes Children and Adolescents: A Hospital-Based Case-Control Study in Uganda.

Background: Changes in body composition have been suggested as an intractable effect of Type 1 Diabetes Mellitus and its management. This study aims to compare body composition characteristics in a sample of young children and adolescents with Type 1 Diabetes Mellitus with healthy controls. Methods: In this case−control study, body composition was assessed using bioelectrical impedance among 328 participants. Anthropometric measurements included weight, height, upper arm, hip, and waist, circumferences; biceps; triceps; and subscapular and suprailiac skinfolds. From raw Bioelectrical impedance data, we calculated the impedance, phase angle, and height normalised resistance and reactance to assess body composition. Analysis of variance accounting for paired blocks was used to compare the two matched groups, while an independent Student's t-test was used for intragroup comparisons among cases. Results: Waist Hip Ratio, biceps, triceps, subscapular and suprailiac skinfolds were higher among cases than in controls. Cases showed a higher Fat Mass Index, higher fasting blood glucose and higher glycated haemoglobin. Cases also had a higher mean value of resistance (p = 0.0133), and a lower mean value of reactance (p = 0.0329). Phase angle was lower among cases than in controls (p < 0.001). Conclusion: Our diabetic children showed higher levels of adiposity than controls. The observed differences in body composition are explained by differences in the fat-mass index. Abdominal fat accumulation was associated with poor glycaemic control and a lower phase angle.

The suitability, acceptability, and feasibility of a culturally contextualized low-calorie diet among women at high risk for diabetes mellitus in Kerala: a mixed-methods study.

Background: Nutritional therapy has been conventionally recommended for people with prediabetes as a method to delay or halt progression to type 2 diabetes mellitus (T2DM). The extensive diversity in food culture and habits in India pose a challenge in devising a uniform low-calorie diet plan. Though there are a number of studies related to different diet therapies, there exists limited evidence on culturally contextualized low-calorie diet plans and their process in India. The objective of the study is to test the suitability, acceptability, and feasibility of a culturally contextualized low-calorie diet among women with high risk for T2DM in Kerala. Method: We employed a four-stage equal-status sequential design for this study. Firstly, in-depth interviews (n = 10) were conducted to understand the modifiable and non-modifiable components of the usual diet for diabetes prevention. Secondly, we developed a low-calorie diet plan (1500 kcal per day) based on the local preferences and availability. Thirdly, we piloted the diet plan among 18 individuals in the community to know its acceptability. Fourthly, in-depth interviews were done (n = 4) among pilot participants to understand the feasibility of pursuing it through facilitators and barriers to implementing the diet plan. Results: Low-calorie diet plan was suitable for this setting as the burden of diabetes is very high and the diet plan had dietary components similar to the usual diet. Though participants had an intrinsic motivation to follow a healthy lifestyle, several systemic challenges such as the high cost of healthy foods options (fruits and vegetables), rice addiction, and food preferences driven by peer pressure act as hurdles. Conclusion: Apart from culturally contextualizing the low-calorie diet, it is important that complementary strategic measures such as reorientation of the public distribution system and subsidizing fruit and vegetable production and cost are required for the suitability, acceptability, and feasibility of implementation. Supplementary Information: The online version contains supplementary material available at 10.1007/s13410-022-01134-8.

COVID-19 and Psychological Distress among the General Population of India: Meta-Analysis of Observational Studies.

Background: There is scanty evidence regarding the magnitude of COVID-19-related psychological distress (PD) among the general population of India. Objectives: This study aimed to estimate the pooled prevalence of PD among the general public of India during the COVID-19 pandemic. Material and Methods: We conducted a meta-analysis of 21 online surveys conducted across the Indian subcontinent and published between 2020 and 2021. Results: Overall estimates of PD among the general public during the COVID-19 pandemic by the random-effects model is 33.3% (95% confidence interval: 23.8%-42.8%; n = 21 studies). The level of heterogeneity was high among the included studies (I2 = 99.67%). In subgroup analysis, it was found that the survey tool and the methodological quality had a significant effect on the overall prevalence estimates. Approximately 33% of the general public reported to have PD during the COVID-19 pandemic in India, although the overall prevalence varied based on survey tools and quality of studies. Conclusion: As the pandemic crisis seems to be ebbing across the world, the current findings are a wake-up call to devise pragmatic strategies to curtail the burden of similar pandemics and to successfully meet the challenges ahead.

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2 [version 2; peer review: 1 approved].

Background: Data on prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in last 12 months, (5) no intention to quit at all or in the next 12 months, (6) lack of knowledge of harmful effect of smoking, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS deceased from 2.5% in GATS 1 to 1.9% in GATS 2: males from 6.2% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education, early initiation of smoking and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups particularly in the high prevalence Indian states.

Genetics of type 2 diabetes mellitus in Indian and Global Population: A Review.

Background: Non-communicable diseases such as cardiovascular diseases, respiratory diseases and diabetes contribute to the majority of deaths in India. Public health programmes on non-communicable diseases (NCD) prevention primarily target the behavioural risk factors of the population. Hereditary is known as a risk factor for most NCDs, specifically, type 2 diabetes mellitus (T2DM), and hence, understanding of the genetic markers of T2DM may facilitate prevention, early case detection and management. Main body: We reviewed the studies that explored marker-trait association with type 2 diabetes mellitus globally, with emphasis on India. Globally, single nucleotide polymorphisms (SNPs) rs7903146 of Transcription Factor 7-like 2 (TCF7L2) gene was common, though there were alleles that were unique to specific populations. Within India, the state-wise data were also taken to foresee the distribution of risk/susceptible alleles. The findings from India showcased the common and unique alleles for each region. Conclusion: Exploring the known and unknown genetic determinants might assist in risk prediction before the onset of behavioural risk factors and deploy prevention measures. Most studies were conducted in non-representative groups with inherent limitations such as smaller sample size or looking into only specific marker-trait associations. Genome-wide association studies using data from extensive prospective studies are required in highly prevalent regions worldwide. Further research is required to understand the singular effect and the interaction of genes in predicting diabetes mellitus and other comorbidities.

Insulin dependent diabetes and anthropometric assessment: Understanding the rationale for body composition measurement.

The purpose of the review is to explore the interlinkages between diabetes, insulin therapy, and body composition and discuss the need for body composition assessment as part of the routine nutrition and health assessment of children living with diabetes especially in resource limited contexts with a case study of Uganda. Changes in body composition have an intractable effect of Insulin Dependent Diabetes Mellitus and its management. The association between diabetes and body composition has the potential to lead to adverse health outcomes, especially in later years of life. Health practitioners shall devise strategies to efficiently monitor the body composition of young diabetics at an early stage to revert the life threatening complications among young diabetic patients.

Effectiveness and implementation of a lifestyle modification intervention for women with isolated impaired fasting glucose: Study protocol for a hybrid type 2 study in Kerala, India.

Background: Isolated impaired fasting glucose (i-IFG) constitutes a major group in the prediabetic spectrum among Indians, and thus it is imperative to identify effective diabetes prevention strategies. This study aims to evaluate the effects of an intensive community-based lifestyle modification program on regression to normoglycemia among women with i-IFG, compared to a control group at 24 months. The study also aims to evaluate the implementation of the intervention, via both process and implementation outcomes. Methods: We will use a hybrid design (Effectiveness-implementation hybrid type 2 trial) to test the effectiveness and implementation of the lifestyle modification intervention. Effectiveness is evaluated using a randomized controlled trial among 950 overweight or obese women, aged 30 to 60 years, with i-IFG on an oral glucose tolerance test in the Indian state of Kerala. The intervention involves an intensive lifestyle modification program through group and individually mentored sessions using behavioural determinants and behavioural change techniques.  The intervention group will receive the intervention for a period of 12 months and the control group will receive general health advice through a health education booklet. Data on behavioural, clinical, and biochemical measures will be collected using standard methods at 12 and 24 months. The primary outcome will be regression to normoglycemia at 24 months, as defined by the American Diabetes Association criteria. Discussion: This study will provide the first evidence on the effects of lifestyle interventions on regression to normoglycemia in people with i-IFG among Indians. CTRI registration: CTRI/2021/07/035289 (30/07/2021).

Prevalence of anxiety and depressive symptoms during COVID-19 pandemic among the general population in India: A systematic review and meta-analysis.

Objective: The novel coronavirus (n COVID-19) has affected every walk of life across the world including India. Several studies have been available on the COVID-19-related anxiety and depressive symptoms in the public health context. However, there is a dearth of evidence of a meta-analysis regarding the pooled estimates of anxiety and depressive symptoms related to this pandemic based on the existing studies conducted among the general population of India. The aim of the study was to estimate the pooled prevalence of COVID-19-related anxiety and depressive symptoms among the general population in India. Material and Methods: We searched the following electronic bibliographic databases: PubMed, Ovid, Science Direct, and Wiley online library for studies conducted from the onset of the COVID-19 pandemic and until September 25, 2021. We separately analyzed the outcome measures based on the risk of bias assessment. The publication bias was evaluated by funnel plots and Egger's test. Results: We used a random-effect model due to the significant heterogeneity between the studies (Anxiety symptoms - I2 = 99.40% and Depressive symptoms - I2 = 95.3%). According to the index meta-analysis, the pooled estimates of anxiety and depressive symptoms among general population of India during COVID-19 pandemic are 23.5% (95% CI: 17.4-29.6%; n = 21 studies) and 20.2% (95% CI: 17.2-23.2%; n = 17 studies), respectively. In subgroup analyses, good-quality studies (Score ≥7/9) had a significant effect on the pooled prevalence. Conclusion: About one-fifth of the general population of India reported having anxiety and depressive symptoms during the COVID-19 pandemic. The pooled estimates varied with the methodological quality of included studies. The present study provides a comprehensive picture of the overall magnitude of anxiety and depressive symptoms due to the COVID-19 outbreak which will guide the policy makers to measure the burden of similar pandemics more judiciously in the future.

Effectiveness of a physical activity intervention program using peer support among sedentary women in Thiruvananthapuram City, India: results of a non-randomized quasi experimental study.

Background: Interventions to promote physical activity are very limited in India. The objective of this study was to assess the effectiveness and sustainability of a peer support based physical activity (PA) intervention targeting sedentary women in Thiruvananthapuram City, India . Methods: We used a non-randomized quasi-experimental study design with a comparison group. Using the Global Physical Activity Questionnaire (GPAQ) classifications, 401 sedentary women aged 18-64 years were selected by multistage cluster sampling and enrolled into the intervention (n=200) and control (n=201) arms. For the intervention arm, a culturally relevant intervention was delivered to the community stakeholders, participants and peer leaders at three subsequent intensities: intense (three months), less intense (three months) and no intervention (six months). The intervention consisted of a non-communicable disease (NCD) risk assessment, educational workshop, group counselling sessions, goal setting, handbook and peer support. The control participants received printed information on NCDs and their risk factors. PA assessments and anthropometric measurements were made at baseline, 4 th, 7 th and 13 th months. Mixed model analysis was done to assess the difference in PA levels between groups at various time points. Results: The proportion of women who were physically active (≥600 MET minutes per week) was significantly higher in the intervention arm compared to the control arm at 4 th (58.5 % vs 10%, p= 0.001), 7 th (48.5% vs 6%, p= 0.001)) and 13 th  month (29.6 % vs 0.6%, p =0.001), respectively. Improvements from baseline PA expended by the intervention arm compared to the control arm in MET-min / week were 990, 575, and 466 at 4 th, 7 th and 13 th months, respectively. Conclusions: A PA intervention using peer support was found to be effective among women in India. Improvements in PA in the intervention arm decreased over time particularly after the no-intervention phase indicating the need for integrating it with community organizations.

Quarantine practices and COVID-19 transmission in a low-resource setting: Experience of Kerala, India.

INTRODUCTION: Disease transmission patterns of COVID-19 have shown that masking, social distancing, contact tracing and quarantine measures are important strategies for reducing transmission. The effective implementation of quarantine is determined by the commitment of the people and monitoring by the State. The aim of the study was to find out the effectiveness of home quarantine practises and its role in determining SARS CoV2 transmission. METHODS: Record-based retrospective cohort study was conducted among expatriates of Kerala who were on quarantine at their homes and later tested positive for SARS -CoV-2. Quarantine practises were categorised as strict room quarantine, incomplete room quarantine, home quarantine and no quarantine. Risk of transmission was assessed using risk ratios. Multiple logistic regression analysis was performed to find out the determinants of SARS CoV2 transmission. RESULTS: The median (IQR) age and duration of quarantine of 95 study participants were found to be 35 (29, 44) years and 7 (3,13) days, respectively. Majority of the participants practised strict room quarantine (57%), whereas 11.6%, 16.8% and 14.7% practiced incomplete room, home and no quarantine, respectively. Home quarantine without room quarantine had 24 times odds for transmitting disease [OR (95%CI)): 24.14 (4.87--119.75), P < 0.001] and not being in quarantine for any duration before being diagnosed was found to be 14 times riskier when compared with strict room quarantine [OR (95%CI)): 14.44 (2.42-86.17), P = 0.003]. DISCUSSION: Low-resource settings successful in the initial phases of COVID-19 pandemic should make periodic revisions in the quarantine guidelines while continually promoting physical distancing strategies.

Prevalence, awareness, treatment and control of hypertension among adults aged 30 years and above in Barmer district, Rajasthan, India.

We studied awareness, treatment and control of hypertension and factors associated with hypertension prevalence in Barmer district, Rajasthan. A cross-sectional study was conducted among 300 adults aged ≥ 30 years. Data were collected using a modified World Health Organization STEPs tool. Bivariate and multivariate analyses were done to find the factors associated with hypertension prevalence. Hypertension and pre-hypertension prevalence were 22.0% and 50.7% respectively. A quarter (27%) was aware, 25% were on treatment and 9% achieved adequate control of hypertension. Hypertension prevalence was significantly higher among men, older adults, overweight adults and those reported higher income compared to their counterparts.

Bullying victimization and its associated factors among adolescents in Kozhikode district, Kerala, India: a mixed-methods study [version 1; peer review: 1 approved].

Background: Bullying victimization among adolescents is a serious concern as it leads to poor psycho-social adjustments in the future. Literature on bullying at schools in Kerala is limited. This study aimed to investigate the magnitude of bullying and the factors associated with it among adolescents. Methods: A sequential explanatory study design was used. A cross-sectional study among 764 adolescents (mean age 13.3 years, males 58.5%) selected through multistage cluster sampling was done. We used the Olweus Bully-Victim Questionnaire, Global School Health Survey, and Patient Health Questionnaire 9 for data collection. Binary logistic regression was performed to identify predictors of bullying victimization. After this, in-depth interviews were carried out among key stakeholders. Results: About 117 (15.3%) respondents reported being bullied at least twice a month. Verbal bullying was reported by 30% (n=229), physical bullying by 23.3% (n=178), sexual bullying by 11% (n=89) and cyber-bullying by 3.3% (n=25). Adolescents aged 14 years and above (OR 2.09, 95% CI: 1.34-3.26), being male (OR 3.50, 95% CI: 1.97-5.87), the parent's response to bullying (OR 5.27, 95% CI: 2.44-11.36), the victim's reaction to being bullied (OR 8.101, CI: 4.53-14.36) and the teacher's action against the bully (OR 3.59, CI: 1.91-6.73) were major predictors of bullying. Qualitative exploration of pathways of bullying phenomena revealed the influence of parenting on a child being a victim or a bully, and a lack of competence and training among teachers to address bullying at school. Conclusions: Bullying is highly prevalent among adolescents in schools and has short- and long-term implications. Targeted interventions for bullying prevention should focus on older adolescent boys and those who report being bullied. Anti-bullying policies at school are vital to sensitize teachers, parents, and students to bullying.

Clustering of noncommunicable disease risk factors among adolescents attending higher secondary schools in Kasaragod District, Kerala, India [version 2; peer review: 1 approved with reservations].

Background: Limited evidence exists on the presence of collective non-communicable disease (NCD) risk factors among adolescents in Kerala, India. We aimed to assess the prevalence and factors associated with multiple NCD risk factors and the clustering of these risk factors among adolescents in Kasaragod District, Kerala. Methods: We selected 470 adolescents (mean age 16.6 years, male 53.8%) through multi-stage cluster sampling from higher secondary schools of Kasaragod district. Self-administered questionnaires were used, and anthropometric measurements were taken using standard techniques and protocols. Tobacco use, alcohol consumption, low fruits and vegetable consumption, inadequate physical activity, extra salt intake, overweight, consumption of soft drinks and packed foods were the eight NCD risk factors included.The factors associated with one, two and three or more NCD risk factors were analysed using multinomial logistic regression and the standard errors were adjusted for the four clusters. Results: Risk factor clusters with two risk factors (dyads) and three risk factors (triads) were observed in 163 (34.7%) and 102 (21.7%) of the sample, respectively. Adolescents residing in urban areas (odds ratio (OR) = 3.55; 95% confidence interval (CI) = 1.45-8.73), whose father's education level was lower (OR = 3.54; 95% CI = 1.24-10.10), whose mother's education was lower (OR= 4.13; 95% CI = 1.27-13.51), who had restrictions on physical activity (OR = 5.41; 95% CI = 1.20-24.30) and who did not have a kitchen garden (an area where fruits and vegetables are grown for domestic use) (OR=4.51;95% CI = 1.44-14.12) were more likely to have three or more NCD risk factors compared to their counterparts. Conclusions: Clustering of NCD risk factors was prevalent in more than half of the adolescents. Efforts are warranted to reduce multiple risk factors, focussing on children of low educated parents and urban residents.