Process evaluation of a complex, multilevel, multicomponent scheme for the prevention and control of non-communicable diseases in Tamil Nadu, India: A mixed-methods protocol.

Background: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in India, necessitating development of multilevel and multicomponent interventions. Makkalai Thedi Maruthuvam (MTM) is a complex multilevel, multicomponent intervention developed and implemented by the south Indian State of Tamil Nadu. The scheme aims to deliver services for preventing and controlling diabetes, and hypertension at doorstep. This paper describes the protocol for planning and conducting the process evaluation of the MTM scheme. Methods and analysis: The process evaluation uses mixed methods (secondary data analysis, key informant interviews, in-depth interviews, conceptual content analysis of documents, facility-based survey and non-participant observation) to evaluate the implementation of the MTM scheme. The broad evaluation questions addressed the fidelity, contexts, mechanisms of impact and challenges encountered by the scheme using the Consolidated Framework for Implementation Research (CFIR) framework. The specific evaluation questions addressed selected inputs and processes identified as critical to implementation by the stakeholders. The CFIR framework will guide the thematic analysis of the qualitative interviews to explore the adaptations and deviations introduced during implementation in various contexts. The quantitative data on the indicators developed for the specific evaluation questions will be cleaned and descriptively analysed.

Face mask use in the city of Chennai, India: Results from three serial cross-sectional surveys, 2021.

INTRODUCTION: The Government of Tamil Nadu, India, mandated wearing face masks in public places to combat the COVID-19 pandemic. We established face mask surveillance and estimated the prevalence of appropriate mask use (covering the nose, mouth, and chin) in the slums and non-slums of Chennai at different time points in 2021. METHODS: We conducted three serial cross-sectional surveys in the outdoors and indoors of Chennai in March, July, and October 2021. We observed the mask wearing among 3200 individuals in the outdoors and 1280 in the indoors. We divided the outdoor and indoor locations into slums and non-slums. In October 2021, we also surveyed 150 individuals from each of the 11 shopping malls in the city. We calculated the proportions and 95% confidence interval (95%CI) for the appropriate mask use in the outdoor, indoor, and malls by age, gender, region, and setting (slum and non-slum). RESULTS: We observed 3200 individuals in the outdoor and 1280 individuals in the indoor setting, each from a slum and non-slum, during the three rounds of the study. In outdoor and indoors, males comprised three-fourths and middle-aged individuals were half the study population. Mask compliance changed significantly with time (p-value <0.001). Males consistently demonstrated better compliance in all rounds. The south region had the highest mask compliance in slums indoors and outdoors in rounds 4 and 5. Young adults had the highest mask compliance in both outdoor slums and non-slums in all rounds. Overall mask compliance in shopping malls was 57% (95% CI: 48-65). CONCLUSION: The mask compliance in Chennai outdoors during the COVID-19 pandemic was less than 50%, with variations across time points by gender, age groups, and geographical locations. We must develop more effective communication strategies for older age groups and crowded indoor settings.

Presence of heavy metals in over the counter teeth whitening products- An evaluative study.

Background: Dentistry plays a crucial role in shaping the facial aesthetics of a person and thus boosts self-esteem. Tooth discolouration is one of the significant cosmetic problems and hence, many teeth whitening products are widely used for discolouration. However, these products may have heavy metals or chemicals that can affect the tooth and other organs. Aim: The aim is to estimate the amount of heavy metals present in teeth whitening products available for purchase over-the-counter in the pharmacies. Materials and Method: A cross-sectional study of teeth whitening products available Over the Counter (OTC) in pharmacies in Chennai and adjoining districts of Tamil Nadu was conducted during the period from December 2019 to February 2020. The Flame Atomic Absorption Spectrometry (FAAS) method was used to measure the heavy metals such as inorganic lead, chromium, cobalt, arsenic, cadmium, nickel and mercury in the products. Results: We collected 39 products and finalized nine for analysis. These products were available as tablet (n = 1), liquids (n = 2) and powders (n = 6). All products were mentioned as herbal or natural. Three products contained inorganic lead levels in parts per million (ppm) of 759 (product 2); 39.4 (product 3) and 28.1 (product 7), way above the permitted levels. None of the other heavy metals were detected from these products. Conclusion: After analysis with the FAAS method, inorganic lead over and above the permissible levels was observed. Dental professionals and community need to be aware of the availability of such products and its detrimental effects on oral and general health.

Syndromic surveillance system during mass gathering of Panchkroshi Yatra festival, Ujjain, Madhya Pradesh, India.

Background: The health implications surrounding a mass gathering pose significant challenges to public health officials. The use of syndromic surveillance provides an ideal method for achieving the public health goals and objectives at such events. In the absence of published reports of systematic documentation of public health preparedness in mass gatherings in the local context, we describe the public health preparedness and demonstrate the operational feasibility of a tablet-based participatory syndromic surveillance among pilgrims during the annual ritual circumambulation- Panchkroshi Yatra. Methods: A real-time surveillance system was established from 2017-2019 to capture all the health consultations done at the designated points (medical camps) in the Panchkroshi yatra area of the city Ujjain in Madhya Pradesh. We also surveyed a subset of pilgrims in 2017 to gauge satisfaction with the public health measures such as sanitation, water, safety, food, and cleanliness. Results: In 2019, injuries were reported in the highest proportion (16.7%; 794/4744); most numbers of fever cases (10.6%; 598/5600) were reported in 2018, while 2017 saw the highest number of patient presentations of abdominal pain (7.73%; 498/6435). Conclusion: Public health and safety measures were satisfactory except for the need for setting up urinals along the fixed route of the circumambulation. A systematic data collection of selected symptoms among yatris and their surveillance through tablet could be established during the panchkroshi yatra, which can complement the existing surveillance for detecting early warning signals. We recommend the implementation of such tablet-based surveillance during such mass gathering events.

Syndromic surveillance during religious mass gatherings, southern India 2015-2018.

BACKGROUND: Mass gathering events carry a risk of public health emergencies such as outbreaks of infectious diseases, stampedes, and injuries and pose an increased risk for individuals with non-communicable diseases. India celebrates many festivals mass gatherings. However, operational research on syndromic surveillance during such events is limited. In this context, we documented the use of information technology tools for syndromic surveillance during selected mass gatherings in South India during 2015-2018. METHOD: We collaborated with health systems for syndromic surveillance during selected religious mass gatherings. We finalized priority syndromes and their surveillance definitions through stakeholder meetings. We used open-source software for surveillance data collection and trained the health care professionals and volunteers for data capture and collation. We consolidated, analyzed, generated near-real-time daily reports and shared them with health authorities for action. RESULTS: The number of participants in these mass gatherings ranged from 100 thousand to 3 million, and recorded out-patients seeking care for syndromic illness ranged from 4,000 to 25,000 per event. We used more than five platforms and captured information on 17 syndromes. We captured a total of 61,523 patient details during syndromic surveillance. The most frequently reported syndromes were injuries, fever, and diarrhea of the reported illness. CONCLUSIONS: These cost-effective open-source technologies are intuitive, adaptable, and inexpensive to maintain and operate in real-time. Therefore, enhanced syndromic surveillance could detect diseases early in mass gatherings.

Transdisciplinarity of India's master's level public health programmes: evidence from admission criteria of the programmes offered since 1995.

INTRODUCTION: In the Indian subcontinent, Master's-level Public Health (MlPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MlPH admissibility criteria 1995 to 2021. METHODS: Using a search strategy, we abstracted information available in the public domain on MlPH programmes and their admissibility criteria. We categorized the admission criteria based on specified disciplines into Health science, Non-health science and Non-health non-science categories. We described the MlPH programmes by location, type of institution, course duration, curriculum, pedagogical methods, specializations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for MlPH admission. RESULTS: Overall, 76 Indian institutions (Medical colleges-21 and Non-medical coleges-55) offered 92 MlPH programmes (Private-58 and Public-34). We included 89 for review. These programmes represent a 51% increase (n = 47) from 2016 to 2021. They are mostly concentrated in 21 Indian provinces. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "3-year bachelor's degree in any discipline", "graduation from any Indian universities", and "graduation in any discipline". Among the health science disciplines, Modern medicine (n = 89; 100%), Occupational therapy (n = 57; 64%) is the least eligible. Among the non-health science disciplines, life sciences and behavioural sciences (n = 53; 59%) and non-health non-science disciplines, humanities and social sciences (n = 62; 72%) are the topmost eligible disciplines for admission in the MPH programmes. CONCLUSION: Our review suggests that India's MlPH programmes are less transdisciplinary. Relatively, non-medical institutions offer admission to various academic disciplines than the medical institutions in their MlPH programmes. India's Master's level public health programmes could be more inclusive by opening to graduates from trans-disciplinary backgrounds.

Morbidity profile of patients attended Siddha Regional Research Institute, Puducherry in 2017-A cross-sectional study.

BACKGROUND: In India, understanding the patterns of utilization of AYUSH care has been considered vital for increased focus on its mainstreaming and integration with prevailing biomedical systems. This paper aims to evaluate the morbidity profiling of the patients attended Siddha Regional Research Institute (SRRI), Puducherry in 2017. METHODS: A cross-sectional study in the patients conducted from January to December 2017. Data was collected for variables including age, gender, and clinical diagnosis from the records maintained in the unit. The data are presented as frequencies and proportions. RESULTS: We have collected 48,204 patients' data from the out-patient facility of SRRI from January to December 2017. The important patient were women (51.3%), 13 - 59 years of age (adults 75.5 %), and re-visitation cases (83.5 %). Osteoarthritis (15 %), sinusitis (6 %), respiratory illness (6 %), psoriasis (5 %), and diabetes (5 %) were the top reported diseases. According to the Siddha, Vatha diseases are reported higher than Pitha and Kabha diseases. CONCLUSION: Overall, in the year 2017 the SRRI OPD has more revisited cases than new ones, and women were slightly higher in proportion compared to males. The most frequently treated disease in both adults and the geriatric population was the musculoskeletal diseases, precisely osteoarthritis. More respiratory diseases were treated in children. These data could be used to analyze the people's perspective in the effective management of certain diseases through Siddha. The establishment of an integrative health facility with a cross-referral system would fetch more credulous among the public.

AYUSH digital initiatives: Harnessing the power of digital technology for India's traditional medical systems.

The incorporation of digital technologies is recognized as one of the inevitable factors to achieve better health care services. Recently, Indian Ministry of AYUSH (MoA) embraced digitalization extensively for development, education and research in AYUSH. In this context, we describe India's digital initiatives for AYUSH systems of medicine for information, research, and academia at various levels. We reviewed the websites and documents available from the MoA and its research councils/institutes along with the plan documents. We described the identified digital initiatives under categories of (1) Health information system (2) Research database/library (3) Academic (4) Information Education and Communication (IEC). We specified the purpose and target group of the identified digital initiatives. We identified 19 key digital initiatives. The AYUSH hospital management information system (A-HMIS), National AYUSH Morbidity and Standardized Terminologies Electronic Portal (NAMASTE), AYUSH Suraksha, e-Aushadhi, e-Charak, Triskandha Kosha, SiddAR APP were categorized under health information system. The Traditional Knowledge Digital Library (TKDL), AYUSH research portal, DHARA, e-CHLAS, Research Management Information system (RMIS), e-Granthasamuccaya and AYUSH Sanjivani App were categorized under research database/library. The Ayurveda e-learning and Ayurvedic Inheritance of India were categorized as the academic initiatives. The Siddha-NIS App, Yoga locator, and Naturopathy-NIN App were categorized as Information, education and communication (IEC) initiatives. The digital initiatives from the MoA were a key to reform the traditional systems of medicines and could improve the education, quality of research and accessibility of the AYUSH healthcare services.

Epidemiology of hospital-based COVID- 19 cluster in a tertiary care cancer hospital, Chennai, India 2020.

OBJECTIVES: To identify risk factors associated with Coronavirus disease 2019 (COVID-19) in a Tertiary care cancer hospital-based cluster and recommend control measures. METHODS: We conducted tracing and confirmation among hospital and community contacts. We telephonically interviewed and abstracted information from hospital records and registers. We described the cluster by time, place and person. We conducted unmatched case-control study to compare risk factors and computed Odds Ratio (OR) and 95% confidence interval. RESULTS: We confirmed COVID-19 in 21 of 1478 tested (1.4%). Secondary attack (%) of COVID-19 among 824 contacts was higher among in-patients of block A (18), household contacts (3.4), housekeeping staff (3.3) and nurses (1.7). The cluster started on April 22 with two successive peaks five days apart and lasted until May 8. Being male, patients aged >33 years [OR = 30·7; 95% CI = 3·6 to 264], having hypertension [OR = 4·3; 95% CI = 1·1 to 16·7] or diabetes [OR = 3·8; 95% CI = 1·0 to 14·1] were associated with COVID-19. Mask compliance was poor (20%) among hospital workers. DISCUSSION: We recommended screening of all patients for diabetes and hypertension and isolation/testing of anyone with influenza-like illness for preventing COVID-19 clusters in hospital settings.

Promoting health economic evaluation studies in the AYUSH system of medicine: the need of the hour.

The double burden of communicable and noncommunicable diseases is a major threat to the Indian public health system. AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homeopathy, represents the Indian system of medicine recognized by the Government of India. Mainstreaming of AYUSH is one of the key strategies of the Indian government for tackling increasing disease burden through initiatives such as AYUSH wellness centers, telemedicine, and quality control measures for medications in the AYUSH system of medicine. Such investment of resources in health systems may require economic evaluations. However, such evaluations are lacking in the AYUSH system, except for a few in homeopathy and yoga. In the absence of evidence from economic evaluations, researchers and decision makers are guided mostly by clinical efficacy while formulating healthcare strategies. In view of the increasing use of AYUSH across the country, economic evaluations of the AYUSH system are the need of the hour to aid healthcare decision making.

Self-reported and clinically identified loss of smell and taste among persons tested for COVID-19 in Chennai, southern India, July-August 2020: A cross sectional study.

BACKGROUND: Early detection of symptoms of loss of smell and taste lately added for Coronavirus disease 2019 (COVID-19) has the potential for improving pandemic response. In the Indian context, we compared proportion experiencing new loss of smell or taste among COVID-19 positive and negative individuals in Chennai city, Southern India. METHODS: We did an analytical cross-sectional study among individuals aged 18-80 years undergoing testing at COVID-19 sample collection centres. We ascertained loss of smell and taste using standardised self-reporting and clinical examination procedures. We administered Sino Nasal Outcome (SNOT 22) questionnaire for comprehensive understanding of these symptoms. We compared proportion having symptoms between COVID-19 positive and negative persons. We compared the two assessment methods to compute diagnostic validity indicators. RESULTS: Of the 277 participants, 169 (61%) were men and mean age of 40.7 years [SD = 13.3]. Fifty eight (21%) had COVID-19 and 12 (36%) of them were asymptomatic. Predominantly reported symptoms were fever (30%), headache (18%) and cough (18%). Self-reported or clinically identified new loss of smell or taste was higher among COVID-19 positive (n = 13; 22%) than negative persons (n = 23; 11%) [p = 0.02]. Sensitivity was higher for self-reported or clinically identified loss of smell (17.2%) than that of loss of taste (6.9%). Negative predictive value for loss of smell or taste, self-reported or clinically identified was 81%. Likelihood ratio of positive test was 2.13. CONCLUSION: Loss of smell or taste are predominantly reported by COVID-19 confirmed individuals. Objective and subjective assessments of smell and taste may be required to identify those requiring COVID-19 testing.

Effect of Remote and Local Acupuncture Points on Periarthritis of Shoulder: A Comparative Study.

Background: Periarthritis of shoulder is a painful condition of the shoulder, affecting 2-3% of the general population and 20% of diabetic patients. Acupuncture is a widely practiced traditional Chinese medicine. Recent evidence shows that it alleviates shoulder pain with different needling techniques. Objectives: The present study is to compare the efficacy of remote and local points on PAS. Methods: 60 subjects were randomly assigned into two groups, remote acupuncture group (n = 30) and local acupuncture group (n = 30). Both groups were assessed at baseline and at the end of 12 sessions. Shoulder pain and its disability index (SPADI) and (ROM) were measured using goniometer. The intervention was given weekly thrice on alternate days for four weeks with 20 min for each session. Results: The result shows that both remote and local acupuncture points were beneficial in the pain management and rage of motion when compared within the group. The effects of acupuncture at remote acupoints were better than those at local acupoints in SPADI and ROM when compared between two groups. Conclusion: In treatment of periarthritis of shoulder remote acupuncture points may have higher therapeutic value when compared to local points.