Cardiovascular disease risk factor prevalence among police officials: findings from a cross-sectional study in Kerala, India.

OBJECTIVES: Police officials' stressful and physically demanding activities reportedly increase the risk of cardiovascular disease (CVD). This study explored the prevalence of CVD risk factors such as hypertension, diabetes, tobacco use, alcohol consumption, and overweight among police officials in Kerala, India. METHODS: A cross-sectional study was conducted among 255 police officials in selected police stations in the Thiruvananthapuram district, Kerala. The World Health Organization STEPs questionnaire for noncommunicable disease risk factor surveillance was used to collect information. We collected STEP 1 (demographics, tobacco use, alcohol consumption, physical activity, and diet) and STEP 2 (weight, height, and blood pressure) data. Multivariable analysis was done to identify factors associated with hypertension. RESULTS: The mean age of participants was 42 years (range: 30-55 years) and the majority were men (83.5%). Current use of tobacco or alcohol was reported by 22.7% of the participants. The prevalence of overweight was 64.7% and physical inactivity was 35.1%. Self-reported prevalence of diabetes was 7.5% and of hyperlipidemia was 11.4%. Hypertension prevalence was 40.4%. Among hypertensives, 35.9% were aware, 20.4% were treated, and 5.8% had controlled blood pressure. The control rate was 28.6% among treated hypertensives. When controlling for age, diabetes (odds ratio [OR]: 3.57; 95% CI: 1.16-10.90), and overweight (OR: 1.88; 95% CI: 1.06-3.35) participants were more likely to have hypertension compared with their counterparts. CONCLUSIONS: Police officers have a high prevalence of significant CVD risk factors such as hypertension, physical inactivity, and being overweight. These findings reinforce the need for interventions addressing the above risk factors to prevent CVD in this population.

Strengthening research capacity of early-mid career researchers: Implementation and evaluation of the Excellence in Non-COmmunicable disease REsearch (ENCORE) program.

High-quality training and networking are pivotal for enhancing the research capacity of early- to mid-career researchers in the prevention and control of non-communicable diseases. Beyond building research skills, these professionals gain valuable insights from interdisciplinary mentorship, networking opportunities, and exposure to diverse cultures and health systems. Despite the significance of such initiatives, their implementation remains underexplored. Here, we describe the implementation and evaluation of the Excellence in Non-COommunicable disease REsearch (ENCORE) program, a collaborative initiative between Australia and India that was launched in 2016 and spanned a duration of 3 years. Led by a consortium that included the University of Melbourne and leading Indian research and medical institutions, ENCORE involved 15 faculty members and 20 early-mid career researchers. The program comprised various elements, including face-to-face forums, masterclasses, webinars, a health-technology conference, and roundtable events. ENCORE successfully trained the early-career researchers, resulting in over 30 peer-reviewed articles, 36 conference presentations, and the submission of seven grant applications, three of which received funding. Beyond individual achievements, ENCORE fostered robust research collaboration between Australian and Indian institutions, showcasing its broader impact on strengthening research capacities across borders.

Factors Influencing Tobacco Cessation in India: Findings from the Global Adult Tobacco Survey-2.

OBJECTIVE: The study aimed to assess the socio-demographic and other correlates of cessation behavior across tobacco products among the adult population in India. METHODS: We used data of adults (aged ≥15 years) who were current or former tobacco users (smoking and/or smokeless tobacco) from the Global Adult Tobacco Survey (GATS) India, conducted during 2016-17. The detailed analysis was done for current daily smokers (N=7,647), former daily smokers (N=1,353), and current daily smokeless tobacco users (N=1,2721). Multivariate logistic regression was separately performed to find the associated factors with attempts to quit, successful quitting, different cessation methods of smoking, and smokeless tobacco use. RESULTS: The findings of the study indicated that daily smokers, higher educated, urban residents and employed were more likely to quit smoking compared to their counterparts. Successful quitting of smoking was higher for employed, higher educated, current users of smokeless tobacco and older adults.  For smokeless tobacco users, non-daily users, highly educated, urban residents, and employed were more likely to attempt to quit compared to their counterparts. Successful quitting of smokeless tobacco was higher for unemployed, highly educated, urban residents and current non-smokers, and higher age group adults. CONCLUSION: The findings of this study suggest a need for professionally channelized cessation interventions to reduce the prevalence and relapse of tobacco use and increase the quit rate. Well-designed, large-scale research into specific tobacco cessation methods is needed to establish the association between different tobacco cessation methods and increased quit rates.

Non-communicable disease management: Access to healthcare during COVID-19 pandemic in rural Kerala, India.

Background: Globally, data on the coronavirus disease (COVID-19) pandemic showed a higher risk of infection and complications in people with non-communicable diseases (NCDs). In India, the prevalence of NCDs and their risk factors vary significantly between states. Compared to other states, Kerala has the highest prevalence of non-communicable diseases in the country, along with the highest proportion of the elderly population. The study evaluates the disease management patterns and changes in healthcare behaviors among adults with NCDs in Kerala during the COVID-19 pandemic. Methods: A cross-sectional study was conducted among 410 adult NCD patients in rural Thiruvananthapuram district, Kerala. Using a semi-structured interview schedule, the present study gathered information on socio-demographic characteristics, disease patterns, healthcare utilization, and behavioral change during the pandemic. Results: Mean age of the participants was 62 years (range: 37-88; women: 64%). The most prevalent NCD was hypertension (74%) and diabetes (65%) followed by chronic respiratory disease (12%), cardiovascular disease (11%), and cancer (2%). Nearly 76% had difficulty in obtaining consultation/medical follow-up. Around 10% relied on telecommunication and 32% reported increased stress during the pandemic. Those with low socio-economic status and with a single NCD were more vulnerable to the challenges faced during the pandemic. Conclusion: A higher proportion of adults with NCDs faced difficulties in healthcare access and had negative healthcare behaviors during the pandemic. The findings highlight the need to ensure better healthcare for people living with NCDs during the times of pandemic.

Clinico-epidemiological profile and outcomes of adults with COVID-19: A hospital-based retrospective study in Kerala, India.

Introduction: The clinical and epidemiological presentations of patients with coronavirus disease 2019 (COVID-19) in India is still not well explored. We studied the epidemiological and clinical profile and outcomes of COVID-19 patients admitted to a tertiary care private hospital in Kerala, India. Methods: In this retrospective study, we analyzed data of 476 adult (≥18 years) COVID-19 patients admitted to a tertiary care hospital in Kerala from September 1, 2020 to March 31, 2021. The patients were categorized into mild, moderate, and severe cases and followed till discharge or death. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 with a significance set at P < 0.05. Results: The median age was 57 years (56% men). Mild, moderate, and severe cases accounted for 17%, 65%, and 18%, respectively. Around 75% had at least one comorbidity, and 51% had multiple comorbidities. The most common comorbidities were diabetes (45%), hypertension (44%), dyslipidemia (15%), and cardiac problems (12%). The elevated D-dimer values among patients in different categories were significantly different, with 74% in severe, 46% in moderate, and 19% in mild category patients. Serum ferritin, C-reactive protein, lactic acid dehydrogenase, and neutrophil to lymphocyte ratio values were significantly higher for severely ill patients. Thirty deaths (67% men) occurred during the study period, with a case fatality rate of 6.3%. Mortality mainly happened in the older age group (80%) and those with multimorbidity (90%). Conclusion: Age and multimorbidity are the major contributing factors for death in hospitalized COVID-19 patients. Generalization of the findings necessitates well-designed large-scale studies.

Prevalence, Awareness, Treatment, and Control of Hypertension in Young Adults (20-39 Years) in Kerala, South India.

Objective: We sought to study the prevalence of hypertension and the levels of awareness, treatment and control of hypertension in the young adults in Kerala, India compared to older adults. Methods: We identified 1,221 young adults (men 36.7%) in the age group 20-39 years from the 5,150 participants of the Cardiological Society of India Kerala Coronary artery disease (CAD) and its Risk factors Prevalence (CSI Kerala CRP) Study. We determined prevalence and levels of awareness, treatment and control of hypertension among them compared to older adults. Results: We found that among the young adults, 11.2% had hypertension and 33.3% had prehypertension. Hypertension was nearly three times more prevalent among men than women (20.5 vs. 7.5% p < 0.001) while in older adults there was no difference between men and women in its prevalence. Male sex (OR 3.36, 95% CI 2.15-5.25 p-value <0.001), urban residence (OR 2.21, 95% CI 1.52-3.22 p-value <0.001), abdominal obesity (OR 1.74, 95% CI 1.06-2.87 p-value 0.028) and hypercholesterolemia (OR 1.64 95% CI 1.12-2.40 p-value 0.011) were significant factors favoring hypertension in the young adults. Awareness and treatment of hypertension were significantly poor among younger adults compared to older adults. In young adults, awareness, treatment and control of hypertension were significantly lower among men compared to women (23.9 vs. 51.7% p-value 0.001, 12.0 vs. 25.9% p-value 0.045, and 18.5 vs. 37.9% p-value 0.012, respectively). Participants who had checked blood pressure at least once during the previous year had significantly better awareness and treatment (58.7 vs. 24.0% and 41.3 vs. 19.2%, respectively). Conclusions: We found that one eighth of young subjects had hypertension with three times higher prevalence of hypertension among men compared to women. Awareness, treatment and control of hypertension were less among young adults and worse in young men compared to young women. Identifying hypertension and measures to control it are important and should be specifically targeted to young men.

Effectiveness of a School-Based Educational Intervention to Improve Hypertension Control Among Schoolteachers: A Cluster-Randomized Controlled Trial.

Background The control of hypertension is low in low- and middle-income countries like India. We evaluated the effects of a nurse-facilitated educational intervention in improving the control rate of hypertension among school teachers in India. Methods and Results This was a cluster-randomized controlled trial involving 92 schools in Kerala, which were randomly assigned equally into a usual care group and an intervention group. Participants were 402 school teachers (mean age, 47 years; men, 29%) identified with hypertension. Participants in both study groups received a leaflet containing details of a healthy lifestyle and the importance of regular intake of antihypertensive medication. In addition, the intervention participants received a nurse-facilitated educational intervention on hypertension control for 3 months. The primary outcome was hypertension control. Key secondary outcomes included systolic blood pressure, diastolic blood pressure, and the proportion of participants taking antihypertensive medications. For the primary outcome, we used mixed-effects logistic regression models. Two months after a 3-month educational intervention, a greater proportion of intervention participants (49.0%) achieved hypertension control than the usual care participants (38.2%), with an odds ratio of 1.89 (95% CI, 1.06-3.35), after adjusting for baseline hypertension control. The odds of taking antihypertensive medications were 1.6 times higher in the intervention group compared with the usual care group (odds ratio, 1.62; 95% CI, 1.08-2.45). The reduction in mean systolic blood pressure was significantly greater in the intervention group by 4.2 mm Hg (95% CI, -7.2 to -1.1) than in the usual care group. Conclusions A nurse-facilitated educational intervention was effective in improving the control and treatment rates of hypertension as well as reducing systolic blood pressure among schoolteachers with hypertension. Registration URL: https://www.ctri.nic.in; Unique Identifier: CTRI/2018/01/011402.

Health-Related Quality of Life and Associated Factors Among Adults with Type-2 Diabetes Mellitus: A Community-Based Cross-Sectional Study in Rural Kerala, India.

Background: India is the second-largest country in the world with an estimated 77 million people living with diabetes. Persons with diabetes reported lower quality of life when compared to non-diabetes persons. There are significant associations between poor health-related quality of life (HRQoL) and adverse health outcomes among diabetes people. However, evidence documenting the same in India is scarce. Aims: To assess the health-related quality of life and its determinants among diabetic patients in rural Kerala, India. Methods: We conducted a community-based cross-sectional study among 425 adults type-2 diabetic patients from rural Kerala. The World Health Organization Quality of Life questionnaire was used to measure HRQoL. Multiple logistic regression analysis was used to study the association between HRQoL and independent variables. Results: More than half of the respondents were men (52%), and 45% were older adults (≥60 years). Poor quality of life was reported by 38% of the respondents. Medium [Odds ratio (OR):4.70, 95%CI: 2.61-8.46] and low socio-economic status (SES) group (OR: 4.59, CI: 2.43-8.66) had poorer HRQoL compared to the higher SES group. Those with multi-morbidity (OR: 2.91, CI: 1.63-5.19), unemployed (OR: 2.54, CI: 1.46-4.42), and less educated (OR: 2.28, CI: 1.34-3.88) and older adults (OR: 2.11, CI: 1.28-3.45) were more likely to have poor HRQoL compared to their counterparts. Conclusion: More than one-third of the diabetes patients in rural Kerala reported poor HRQoL. The study also identified age, socio-economic status, education, and occupation as the important predictors of HRQoL among diabetes patients. The findings highlighted the need for assessing HRQoL as part of the routine management of diabetes care in similar settings.

ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable.

Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability. Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact. Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision. Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up. Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].

Multi-morbidity and blood pressure control: Results of a cross-sectional study among school teachers in Kerala, India.

The patterns of concordant and discordant comorbidities of hypertension and their association with hypertension control were ascertained in this cross-sectional study. A total of 402 adults with hypertension were identified from the baseline survey of a randomized controlled trial for hypertension control among school teachers in Kerala. Chronic conditions were captured and categorized into concordant and discordant comorbidities. Nearly 57% of teachers with hypertension reported multimorbidity. Concordant morbidity was reported by 44% and discordant by 21% of participants. The odds of hypertension control was higher among those who reported at least one discordant morbidity (odds ratio [OR]: 2.76, 95% confidence interval [CI]:1.69-4.49) and those who reported at least one concordant morbidity (OR: 2.08, CI: 1.37-3.16), compared to their counterparts. Hypertension control was higher for those who reported any comorbidity (OR: 2.37, CI: 1.51-3.71) compared to those who did not report any. Well-designed large-scale mixed methods studies are required to thoroughly explore multimorbidity and its relationship with hypertension control in India.

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.

One-year clinical outcome of patients with nonvalvular atrial fibrillation: Insights from KERALA-AF registry.

BACKGROUND: We report patient characteristics, treatment pattern and one-year clinical outcome of nonvalvular atrial fibrillation (NVAF) from Kerala, India. This cohort forms part of Kerala Atrial Fibrillation (KERALA-AF) registry which is an ongoing large prospective study. METHODS: KERALA-AF registry collected data of adults with previously or newly diagnosed atrial fibrillation (AF) during April 2016 to April 2017. A total of 3421 patients were recruited from 53 hospitals across Kerala state. We analysed one-year follow-up outcome of 2507 patients with NVAF. RESULTS: Mean age at recruitment was 67.2 years (range 18-98) and 54.8% were males. Main co-morbidities were hypertension (61.2%), hyperlipidaemia (46.2%) and diabetes mellitus (37.2%). Major co-existing diseases were chronic kidney disease (42.1%), coronary artery disease (41.6%), and chronic heart failure (26.4%). Mean CHA2DS2-VASc score was 3.18 (SD ± 1.7) and HAS-BLED score, 1.84 (SD ± 1.3). At baseline, use of oral anticoagulants (OAC) was 38.6% and antiplatelets 32.7%. On one-month follow-up use of OAC increased to 65.8% and antiplatelets to 48.3%. One-year all-cause mortality was 16.48 and hospitalization 20.65 per 100 person years. The main causes of death were cardiovascular (75.0%), stroke (13.1%) and others (11.9%). The major causes of hospitalizations were acute coronary syndrome (35.0%), followed by arrhythmia (29.5%) and heart failure (8.4%). CONCLUSIONS: Despite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry.

Multimorbidity patterns among rural adults with Type-2 diabetes mellitus: A cross-sectional study in Kerala, India.

OBJECTIVES: The study evaluated the prevalence and pattern of multi-morbidity among rural adults with type-2 diabetes mellitus and explored the factors associated with multi-morbidity among 400 adult diabetic patients from rural areas of Thiruvananthapuram district in the Kerala state of India. MATERIALS AND METHODS: The presence of multi-morbidity was assessed using a semi-structured interview schedule based on the physician's confirmation. The reported chronic diseases were classified as concordant (conditions with a similar pathophysiologic risk profile as diabetes) and discordant (conditions whose treatments are not directly related to the pathogenesis for diabetes) co-morbidity. Multivariate analysis was done to find the factors associated with multi-morbidity. RESULTS: Prevalence of multi-morbidity among diabetic patients was 74% (95% Confidence Interval (CI): 69-77), around 66% reported at least one concordant co-morbidity, 30% reported at least one discordant co-morbidity and 21% reported both concordant and discordant co-morbidity with diabetes. Hypertension (59%) was the most frequent co-morbidity. Older adults (above 60 years of age) [Odds Ratio (OR):3.42, 95% CI:1.97-5.94] and women (OR:2.16, CI:1.13-3.51) were more likely to have multi-morbidity compared to their counterparts. Those using insulin and/or oral medication were more likely to have multi-morbidity compared to those using oral medication only (OR: 2.19, CI: 1.07-4.09). CONCLUSION: Multi-morbidity among diabetic patients needs to be addressed by a comprehensive and integrated approach rather than a diabetes specific approach.

Control of hypertension among teachers in schools in Kerala (CHATS-K), India.

OBJECTIVE: We investigated the prevalence, awareness, treatment, control of hypertension and the factors associated with hypertension prevalence and control among school teachers in Kerala, India. METHODS: We surveyed 2216 school teachers in Thiruvananthapuram district of Kerala as part of the control of hypertension among teachers in schools in Kerala (CHATS-K), India. We used World Health Organization STEPS tools for non-communicable diseases risk factor surveillance. Blood pressure, weight and height were measured using standard protocols. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current antihypertensive medication. Controlled hypertension was defined as SBP<140 and DBP<90 mmHg. Separate multivariate analysis was done for finding the associated factors with prevalence and control of hypertension. RESULTS: Age adjusted hypertension prevalence was 14.6%. Men, those with self-reported diabetes, having family history of hypertension and overweight were more likely to have higher prevalence of hypertension compared to their counterparts. Among hypertensives 62% were aware, 49% on treatment and 34% achieved adequate control. Hypertension control was significantly higher among women, diabetics and overweight individuals compared to their counterparts. CONCLUSIONS: A higher level of hypertension control among school teachers in this study indicates an attainable level of hypertension control in the general population of the state. Teachers, with their highly regarded place in the social construct of the country and the state, could thus be used as role models for hypertension control for the general population in the state.

Hypertension in Rural India: The Contribution of Socioeconomic Position.

Background Various indicators of socioeconomic position (SEP) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP, including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP, had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high-income countries. Why this effect is absent in rural India merits investigation.

The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017.

BACKGROUND: Falls can lead to severe health loss including death. Past research has shown that falls are an important cause of death and disability worldwide. The Global Burden of Disease Study 2017 (GBD 2017) provides a comprehensive assessment of morbidity and mortality from falls. METHODS: Estimates for mortality, years of life lost (YLLs), incidence, prevalence, years lived with disability (YLDs) and disability-adjusted life years (DALYs) were produced for 195 countries and territories from 1990 to 2017 for all ages using the GBD 2017 framework. Distributions of the bodily injury (eg, hip fracture) were estimated using hospital records. RESULTS: Globally, the age-standardised incidence of falls was 2238 (1990-2532) per 100 000 in 2017, representing a decline of 3.7% (7.4 to 0.3) from 1990 to 2017. Age-standardised prevalence was 5186 (4622-5849) per 100 000 in 2017, representing a decline of 6.5% (7.6 to 5.4) from 1990 to 2017. Age-standardised mortality rate was 9.2 (8.5-9.8) per 100 000 which equated to 695 771 (644 927-741 720) deaths in 2017. Globally, falls resulted in 16 688 088 (15 101 897-17 636 830) YLLs, 19 252 699 (13 725 429-26 140 433) YLDs and 35 940 787 (30 185 695-42 903 289) DALYs across all ages. The most common injury sustained by fall victims is fracture of patella, tibia or fibula, or ankle. Globally, age-specific YLD rates increased with age. CONCLUSIONS: This study shows that the burden of falls is substantial. Investing in further research, fall prevention strategies and access to care is critical.

Cluster randomised controlled trial of behavioural intervention program: a study protocol for control of hypertension among teachers in schools in Kerala (CHATS-K), India.

BACKGROUND: Control of blood pressure among hypertensives is a major challenge around the world. Interventions for improving hypertension control in India are very limited. This paper describes the protocol for a cluster randomized controlled trial of efficacy of behavioural intervention on control of hypertension among school teachers in Kerala. METHODS: A total of 92 schools are randomised to intervention and control group in Kerala. A baseline survey was conducted in all schools to assess the prevalence of hypertension and its risk factors among school teachers in Thiruvananthapuram district of Kerala state, India. Teachers in both sets of schools will receive a leaflet containing details on the importance of controlling hypertension. With the objective of improving control of hypertension, the intervention schools will additionally receive self-management education and behavioural intervention programs delivered by trained intervention managers along with measurement of weight, waist circumference and blood pressure. This intervention program will be developed based on the findings of the baseline survey and selected components of successful models of hypertension control from previous research done in similar settings. The intervention will be given for 3 months after which a post-survey will be conducted among teachers of both control and intervention schools. The primary outcome is change in control of hypertension and secondary outcome is the change in behavioural risk factors of hypertension both in the control and intervention groups. DISCUSSION: This is the first comprehensive study looking at the efficacy of behavioural intervention on hypertension control among school teachers in Kerala, India. This study is likely to provide an upper estimate of behavioural intervention on hypertension control since teachers are reported to have one of the highest compliance rates of behavioural intervention. TRIAL REGISTRATION: This trial was prospectively registered with the Clinical Trials Registry of India [CTRI/2018/01/011402] on 18 January 2018.

Evidence based interventions and implementation gaps in control of tuberculosis: A systematic review in low and middle-income countries with special focus on India.

We synthesised the findings of intervention studies on Tuberculosis control (TC) in low- and middle-income countries with specific reference to India through a systematic review during the period 2000-2017 in order to identify the implementation gap. The research questions were framed using PICOS (population, intervention, comparison, outcomes and study design) framework and PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were used for study selection. The search was mainly carried out in MEDLINE/PubMed, Web of Knowledge and Cochrane libraries. DOTS was found to be the most effective intervention program for control of Tuberculosis. Lack of utilization of the capacity of various level health staff, accessibility in utilizing health facilities and insufficient community involvement was identified as the major gaps for TC. In the case of India, each state has its own priority and applicability for different TC interventions. Most of the studies on implementation of the TC program supported the encouraging effect of the intervention in the control of Tuberculosis. The specific need of each country is clearly reflected in many of the selected studies. In order to establish the association of intervention and its implementation gaps on TB control, more rigorous evaluation methods are needed including meta-analysis. REGISTRATION: PROSPERO registration number: CRD42018070406.