Assessment of Isoniazid Preventive Therapy and Incidence of Tuberculosis among People Living with Human Immunodeficiency Virus Seeking Care in an Anti-retroviral Therapy Center, Puducherry.

BACKGROUND: One in three deaths among people living with human immunodeficiency virus (PLHIV) is due to Tuberculosis. Isoniazid preventive therapy (IPT) was implemented in antiretroviral therapy (ART) center Puducherry in July 2017. OBJECTIVES: We have determined the proportion of PLHIV who were eligible, initiated, completed IPT and also the incidence of tuberculosis before and after implementation of IPT. MATERIALS AND METHODS: It was a facility based longitudinal descriptive study. All PLHIV, aged 10 years and above, seeking care in ART Centers was included. The number of PLHIV eligible, initiated and completed IPT was summarized as proportion with 95% CI. RESULTS: Among the registered PLHIV (999), the proportion of PLHIV those were found eligible for IPT was 93% [95% CI (91.24%-94.67%)] and initiated on IPT was 92% [95% CI (90.20%-93.95%)]. Completion rate of IPT was 96.3% [95% CI (94.59%-97.63%)]. CONCLUSION: Initiation of IPT was relatively less among newly registered PLHIV as compared to older cohort of PLHIV.

Management of diabetes mellitus through teleconsultation during COVID-19 and similar scenarios - Guidelines from Indian Council of Medical Research (ICMR) expert group.

INTRODUCTION: Emergence of COVID-19 pandemic has led to increased use of telemedicine in health care delivery. Telemedicine facilitates long-term clinical care for monitoring and prevention of complications of diabetes mellitus. GUIDELINES: Precise indications for teleconsultation, clinical care services which can be provided, and good clinical practices to be followed during teleconsultation are explained. Guidance on risk assessment and health education for diabetes risk factors, counselling for blood glucose monitoring, treatment compliance, and prevention of complications are described. CONCLUSION: The guidelines will help physicians in adopting teleconsultation for management of diabetes mellitus, facilitate access to diabetes care and improve health outcomes.

Perceived Stress and Its Determinants among Postmenopausal Women in Urban Puducherry.

BACKGROUND: Menopause characterized by a gradual decline in ovarian hormones takes its toll on the women both physically and mentally. These health problems can negatively impact the mental status. Hence, the current study was done to determine the level of stress and its associated factors among postmenopausal women in urban Puducherry, India. MATERIALS AND METHODS: A facility-based cross-sectional study was done among 219 postmenopausal women attending the outpatient department in urban primary health center during May 2017-June 2017. Information regarding sociodemographic profile was collected using pretested semi-structured questionnaire and Cohen's Perceived Stress Scale was used to assess the stress level. We calculated adjusted prevalence ratios (aPRs) to identify the determinants of stress. RESULTS: Among 219 participants, 46.6% were in the age group of 60-74 years; 32.9% had primary to secondary level of education; 56.2% were unemployed; 42.5% belonged to lower socioeconomic class; and 32.9% had both diabetes mellitus and hypertension. The prevalence of stress among the postmenopausal women was 26.0% (95% confidence interval: 20.7-32.2). Postmenopausal woman with higher education (aPR - 2.18), belonging to nuclear family (aPR - 1.93), lesser parity (aPR - 1.18), and current alcohol/tobacco users (aPR-2.32) were found to have a significant association with stress among the study participants. CONCLUSION: The current study showed that more than one-fourth of the postmenopausal women had high to very high level of stress. Education, religion, parity, and substance abuse were the significant determinants of stress. However, further longitudinal research needs to be done to determine whether the factors informed in the current study are truly associated with stress and develop interventions accordingly.

Prevalence of Food Insecurity at Household Level and Its Associated Factors in Rural Puducherry: A Cross-Sectional Study.

BACKGROUND: Malnutrition is a consequence of food insecurity. Food insecurity in India became a public health problem due to explosive population growth and widening gap between rich and poor. It also has a detrimental effect on factors related to health and social well-being of the family. OBJECTIVES: The study was conducted to determine the prevalence of food insecurity at household level in rural population and factors associated with it. SUBJECTS AND METHODS: A community-based cross-sectional study was conducted among the households of rural Puducherry. The adult females in the households were interviewed with a pretested semi-structured questionnaire in which, along with sociodemographic factors, food insecurity was assessed using the Household Food Insecurity Access Scale. Univariate and multivariate logistic regression analysis was done to identify the factors associated with food insecurity. RESULTS: Out of 299 households that were assessed for food insecurity, 31.7% (95% confidence interval [CI]: 26.6-37.4) had food insecurity. Out of 95 households with food insecurity, 51 (17%), 37 (13%), and 7 (2%) had severe, moderate, and mild food insecurity, respectively. In univariate analysis, the presence of children in the family, using below poverty line ration card, and socioeconomic status were significantly associated with food insecurity. In multivariate analysis, socioeconomic status was significantly associated with food insecurity (rate ratio: 3.59; P < 0.001 [95% CI: 1.68-7.67]). CONCLUSIONS: One in three families experienced the food insecurity, and it was more among households with children. It has to be addressed to prevent nutrition-related disorders in community, particularly in children.

Clustering of noncommunicable disease risk factors among adults (18-69 years) in rural population, South-India.

BACKGROUND AND AIMS: Non-communicable diseases (NCDs) and its risk factors are increasing worldwide and in India. Controlling the rise in risk factors at present is crucial to prevent NCD surge in future. Current study was conducted to estimate the burden of clustering of NCD risk factors among adult population (18-69 years) residing in selected villages of rural Bengaluru, Karnataka METHODS: Population based screening for NCD risk factors were carried out among adults in rural Bengaluru during May to October 2019. NCD risk factors were screened using WHO STEPwise approach to chronic disease risk factor surveillance (STEPs) instrument and Integrated Disease Surveillance Project (IDSP) NCD risk factor tool. Presence of three or more risk factors in same individual was considered as presence of clustering of NCD risk factors. Additional analysis was done for clustering of NCD risk factors with different number of risk factors. RESULTS: Prevalence of clustering of NCD risk factors in rural adult population was as follows; ≥2 risk factors 81.0%, ≥3 risk factors 56.3%, ≥4 risk factors 33.6%, ≥5 risk factors 14.5% and ≥6 risk factors 4.8%. The most common NCD risk factors were inadequate intake of fruits and vegetables (82.3%), physical inactivity (46.8%) and central obesity (46.4%). Clustering NCD risk factors were significantly associated with increased age, males and lower levels of education. CONCLUSIONS: High burden of clustering of risk factor indicates the need for health policies with integrated NCD risk factors prevention strategies than targeted approach. Awareness regarding the effect of clustering needs to be increased among the primary care physicians practising in rural areas.

Burden of diabetic kidney disease among persons with type 2 diabetes mellitus registered in a tertiary care center, Puducherry.

BACKGROUND & AIMS: To determine burden of diabetic kidney disease (DKD) and estimate yield and number needed to screen (NNS) in a tertiary diabetes care center. METHODS: DKD was diagnosed if estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73 m2 or Urinary Albumin Creatinine Ratio (UACR) ≥30 mg/g in two urine samples. RESULTS: Of 511 participants, 206 (40%) had DKD. Using both UACR and eGFR, yield and NNS were 39% and three, respectively. CONCLUSION: Using eGFR alone, yield and NNS to find a case of DKD among consecutive adult (≥18 years age) patients with type 2 diabetes mellitus were 26.4% and 4, respectively.

Prevalence and predictors of positive mental health among adolescents in rural Puducherry, South India.

OBJECTIVES: Most of the adult mental health disorder occurs either during childhood or adolescent stage. Assessment of positive mental health among adolescents will help in predicting the future physical and mental health outcome. Hence, this study was done to determine the prevalence and factors associated with positive mental health among adolescents in rural Puducherry. METHODS: A cross-sectional study was conducted among adolescents (10-19 years) during April and May 2018. Mental Health Continuum-Short Form (MHC-SF), a validated questionnaire was used for the assessment of positive mental health. Prevalence of positive mental health was expressed as proportion with 95% confidence interval. RESULTS: Of the total 245 adolescents interviewed, almost half of them belonged to the age group of mid-adolescence (14-16 years). Majority (66.5%) were boys and more than one third were studying in secondary class.Prevalence of positive mental health was 51.8% (95% CI: 45.6-58.1). Mother's education between primary and secondary (aPR-0.77 95% CI: 0.60-0.98), upper middle (aPR-1.74 95% CI: 1.03-2.94) and middle socioeconomic status (aPR-1.80 95% CI: 1.11-2.87) were significantly associated with positive mental health. CONCLUSION: Current study found that more than half of the rural adolescents had positive mental health. Maternal education and upper socioeconomic status were found to be significant predictors of positive mental health. Our findings on the burden and risk factors as well as protective factors of mental health can contribute to the mental health strategy in public health action.

Prevalence and factors related to second hand smoking exposure, knowledge and response among adolescents in rural Puducherry.

OBJECTIVES: To determine the prevalence of Second Hand Smoking (SHS) and assess the factors related to exposure, knowledge and response to SHS among adolescents in rural Puducherry, South India. METHODS: A community based cross-sectional study was conducted among adolescents during March and April 2018. Two out of four villages were selected randomly and all the adolescents were contacted through household visit and questionnaire was administered. Semi structured questionnaire contained three sections: sociodemographic details, environmental assessment and third section contained knowledge about SHS, COTPA and response towards being exposed to SHS, as well as exposure history. Continuous variables like age were summarized as mean (SD). Categorical variables such as awareness, attitude and practise towards SHS were summarized as proportions with 95% confidence interval. RESULTS: Total number of adolescents interviewed was 789. The mean age of the study participants were 14.1 (2.4) years and majority, 440 (55.8%) were boys and 684 (86.7%) belonged to nuclear family. More than one fourth, 210 (26.6%) belonged to middle class of socio-economic status. Environmental assessment of household showed more than half, 456 (57.8%) were staying in pucca house and majority 642 (81.4%) had adequate cross ventilation. It was found that about 70.1% had adequate knowledge about SHS and its harmful effects. Prevalence of exposure to SHS was 49%. Majority (40.5%) told that they will scold or advice the family member to stop smoking if they are exposed to SHS in the living place. However, almost 80% of adolescents mentioned that they will no't react if they see someone smoking in a public place. CONCLUSIONS: Current study found that almost half of the adolescents were exposed to SHS. Even though, almost three fourth had adequate knowledge, attitude towards preventing SHS in public place was found to be poor. Hence, adolescents need to be motivated enough to address the problem in the public place through motivational counselling in adolescent clinics by health care workers.

Factors related to vaccine hesitancy during the implementation of Measles-Rubella campaign 2017 in rural Puducherry-A mixed-method study.

BACKGROUND: Measles is one the leading cause of morbidity, mortality, and disability among under-five children worldwide with India contributing to half of the burden. Hence, Measles-Rubella (MR) campaign was launched to vaccinate all the children between 9 months and 15 years. The current study was done to find the prevalence and factors related to vaccine hesitancy in the MR campaign 2017 in rural Puducherry. METHODS: This was a mixed-method study conducted with a quantitative part involving cross-sectional survey done among parents of children aged between 9 months and 15 years to determine the proportion of MR vaccine hesitancy and qualitative part involved in-depth interviews to explore the barriers and facilitating factors for the MR vaccine hesitancy. RESULTS: Among 461 participants, the prevalence of vaccine hesitancy for the MR campaign was 14.1% (95%CI: 11-17.6%). In adjusted analysis, only mother's age (aPR-2.27) was the significant predictor of vaccine hesitancy. In qualitative analysis, major facilitating factor for campaign was the role played by the doctors in spreading awareness regarding the importance of vaccine and trust by parents on doctors. Major hindering factors were inadequate knowledge regarding campaign, rumors spread about the safety of vaccine, sudden planning, and under preparedness at health system level. CONCLUSION: The current study found that almost one-fifth of the parents were hesitant to give vaccination to children. Social media rumors, lack of knowledge among parents, and inadequate time in planning were major reasons for vaccine hesitancy. Hence, countries should undertake training and education of healthcare workers to empower them to address the vaccine hesitancy.

Level of neighborhood environmental factors related to noncommunicable diseases in selected wards of urban Puducherry, South India.

BACKGROUND: Noncommunicable diseases (NCDs) are the leading causes of mortality worldwide. Environmental factors play an important role in development of risk factors. Hence, the study was done to assess the neighborhood environmental factors related to NCDs in urban area. METHODOLOGY: This community-based cross-sectional study was carried out among three selected wards of urban Puducherry. All shops/establishments related to the risk of NCDs within the study area were study units. Information regarding tobacco, alcohol, diet, and physical activity-related establishments was assessed using pretested semi-structured pro forma. Shops/establishments were labeled either as "favorable" (prevents the risk of NCDs) or "unfavorable" (increases the risk of NCDs). RESULTS: Among 655 establishments, 372 (56.8%) belonged to favorable and 283 (43.2%) to unfavorable category, respectively. Tobacco-related establishments amount to 15.1% (95% confidence interval: 12.6-18.1) of the total establishments. Among these tobacco establishments, almost one-third were selling tobacco to minor and located within 100 m of school. Fruits and vegetable markets contributed to 21.8% of the total establishments. About 22% of the establishments were fast-food outlets. Public health sports facilities were only 6.8% of the total establishments. CONCLUSION: The current study reported almost equal distribution of favorable and unfavorable establishments. However, among unfavorable establishments, tobacco establishments raised concern as one-third of those were selling tobacco to minors. Healthy diet and physical activity related establishments were also found to be less. Hence, corrective measures are to be implemented which will reduce the burden of behavioral risk factors.

Prevalence and determinants of poor quality of sleep among adolescents in rural Puducherry, South India.

BACKGROUND: Adolescence is a critical stage of life which is characterized by rapid biological, social and emotional development. India has the highest adolescent population, however, there is paucity of literature reporting the sleep quality among adolescents. OBJECTIVE: To determine the sleep quality and its associated factors among adolescents residing in selected villages of rural Puducherry. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among adolescents during March and April 2018. Two out of four villages were randomly selected and all the adolescents were contacted through a household visit and a questionnaire was administered. The semi-structured questionnaire contained socio-demographic details of adolescents and details on living environment. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale. Sleep quality is expressed as a proportion with a 95% confidence interval (CI). The association of socio-demographic characteristics with poor sleep quality is reported as a prevalence ratio. RESULTS: The total number of adolescents interviewed was 789. The mean age of the study participants was 14.1 (±2.4) years and the majority, 440 (55.8%) were boys and 684 (86.7%) belonged to a nuclear family. More than a quarter, 210 (26.6%) belonged to the middle class as regards socio-economic status. Environmental assessment of households showed more than half, 456 (57.8%) were staying in a "pucca" house and the majority, 642 (81.4%) had adequate cross ventilation. The prevalence of poor quality of sleep among the adolescents was 2.5% (95% CI: 1.6%-3.9%). It was found that higher educational level [adjusted prevalence ratio (aPR) - 3.43] and belonging to higher socio-economic class (aPR - 5.48) were found to be significant determinants for poor quality of sleep among adolescents. CONCLUSION: The current study found that only 2.5% of the adolescents have poor sleep quality. Adolescents with higher educational level and higher socio-economic status were more prone to have poor quality of sleep.

A longitudinal study on high risk pregnancy and its outcome among antenatal women attending rural primary health centre in Puducherry, South India.

BACKGROUND: Almost 15% of all pregnant women can develop potentially life-threatening complications. As a result, identification of high-risk pregnancy at earliest stage will be useful in directing appropriate intervention. Hence, the current study was done to determine the prevalence and outcome of high-risk pregnancy among antenatal women in rural Puducherry. MATERIALS AND METHODS: A record-based longitudinal study was done during March 2018 among 569 antenatal women who have attended rural health center of tertiary care institute. High-risk pregnancy was classified based on the guidelines from Pradhan Mantri Surakshit Matritva Abhiyan and outcome assessment based on the obstetric and neonatal outcomes. RESULTS: Among 569 antenatal case record reviewed, 315 (55.3%) were in the age group of 20-25 years and majority (463, 81.4%) belonged to below poverty line families; 410 (74.3%) registered their current pregnancy within the first trimester. The prevalence of high-risk pregnancy among study participants was 18.3% (95% confidence interval: 15.3%-21.7%). Majority (81.9%) had term delivery. Regarding obstetric and neonatal outcomes, majority had spontaneous vaginal delivery (73.9%); about 10.4% gave birth to low-birth weight baby, and only 1.7% had stillbirth. Parity, socioeconomic status, and unfavorable outcomes such as low-birth weight, preterm, and postterm delivery were associated with high-risk pregnancy. CONCLUSION: The current study found that almost one-fifth of the pregnant women in rural area have high-risk pregnancy. Unfavorable obstetric and neonatal outcomes were common among high-risk cases. Hence, early detection of high-risk pregnancy needs to be done at primary health-care level to improve the maternal, obstetric, and neonatal outcomes.

Construct Validation and Reliability Assessment of Tamil Version of Epworth Sleepiness Scale to Evaluate Daytime Sleepiness among Adolescents in Rural Puducherry, South India.

BACKGROUND: Epworth sleepiness scale (ESS) has been used widely in the assessment of daytime sleepiness for research and clinical purposes. Hence, this study was done to translate the ESS in Tamil and to assess the construct validity and reliability of the Tamil version among adolescents in rural Puducherry, South India. MATERIALS AND METHODS: Translation of the ESS by native language experts and pilot tested with subsample of adolescents. Final Tamil version was administered among 789 Tamil-speaking adolescents in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis through principal component method. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient. RESULTS: Two factor structures were obtained with Eigenvalues of 3.49 and 1.09, respectively. Both factors accounted for about 57.4% of the variance. Two-factor model assessed by confirmatory factor method found Chi-square value of 215.57 (P < 0.001). Goodness-of-fit revealed acceptable comparative fit indices (0.91). The reliability coefficient (Cronbach's alpha) for complete ESS was 0.81. Factor-based analysis showed that the Cronbach's reliability coefficient was 0.83 and 0.75 for the first and second factor, respectively. CONCLUSION: Our study concludes that the ESS questionnaire is internally valid and consistent with good reliability coefficient for application in Tamil-speaking rural adolescents. However, further research can be done to content validate the questionnaire with standard diagnostic tool.

Preference for Private Sector for Vaccination of Under-Five Children in India and Its Associated Factors: Findings from a Nationally Representative Sample.

BACKGROUND: Understanding the factors associated with private sector preference for vaccination will help in understanding the barriers in seeking public facility and also the steps to improve public-private partnership (PPP) model. METHODS: We analysed the recent National Family Health Survey-4 data (NFHS-4; 2015-16) gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. RESULTS: Weighted proportion of children receiving private vaccination was 10.0% (95% CI: 9.7-10.3). Children belonging to highest wealth quantile (adjusted Prevalence ratio; aPR-1.58), male child (aPR-1.07) urban area (aPR-1.11), not receiving anganwadi/Integrated Childhood Development Services (aPR-1.71) and receiving antenatal care in private sector was significantly associated with higher proportion of private vaccination. CONCLUSION: Current study showed that 1 in 10 <5 years child in India received vaccination from private health facility. Preference for private health facility was found to be influenced by higher socio-economic strata, urban area residence and seeking private health facility for antenatal and delivery services.

Effectiveness of peer led intervention in improvement of clinical outcomes among diabetes mellitus and hypertension patients-A systematic review and meta-analysis.

Peer-led intervention allows the patients to develop knowledge, skills and confidence in managing their own conditions. Hence this review was done to assess the effectiveness of peer-led intervention in improving the clinical outcomes of DM and HTN patients. We conducted systematic search in Medline, CENTRAL, Sciencedirect and Google-Scholar from inception till May 2018 and retrieved 3654 citations. Meta-analysis was performed using random-effects model and pooled mean difference (MD) was reported with 95% CI. Publication bias was assessed using Egger's test. 29 trials (26 DM and 3 HTN) with 6363 participants were included. There was positive effect of peer led intervention on DM and HTN with pooled MD of -0.28% [95%CI: -0.45 to -0.11] and -7.52mmHg [95%CI: -14.39 to -0.66]. There was significant heterogeneity and publication bias in both DM and HTN trials. Sensitivity analysis showed only little improvement in the final estimate. Peer support intervention is effective and causes statistically significant reduction in HbA1C and systolic blood pressure among DM and HTN patients.

Impact and cost effectiveness of pneumococcal conjugate vaccine in India.

BACKGROUND: World Health Organization has recommended the introduction of pneumococcal conjugate vaccine (PCV) in the childhood immunisation programme of all the countries in the world. In lieu of its introduction in India, there is a need to generate evidence on cost-effectiveness of this vaccine. The current study looks into the impact and cost-effectiveness of PCV vaccine in India. METHODS: We evaluated the cost effectiveness of implementation of PCV 13 vaccination program at national level by comparing with no vaccination program for a period of 10 birth cohorts from 2018 to 2027. UNIVAC, a deterministic static cohort model is developed by giving the conservative estimates of vaccine program related to mortality, disease event rates, vaccine efficacy and coverage projections, system and health care costs for the first five years of life. Cost effectiveness is reported as Incremental Cost Effectiveness Ratio (ICER). Further scenario and sensitivity analysis were done. Probability of PCV intervention to be cost effective at a willingness to pay (WTP) threshold equal to per capita gross domestic product (GDP) is calculated using the government perspective. RESULTS: We found that the introduction of PCV vaccination program can cost an additional $467 (INR 31,666) for averting per DALY which is less than one time GDP per capita of India. Even with the most unfavourable scenario for PCV vaccine, cost per DALY averted is found to be $2323 (INR 1,57,520) which is still a cost effective intervention in India. Probabilistic sensitivity analysis found the ICER for PCV to be $649 (INR 44,008) with 95% CI: $374-$1161. CONCLUSION: This study shows that the PCV program is a highly cost effective intervention and justifies the introduction of PCV into routine immunisation schedule in some of the states and recommends introducing it throughout the country to reduce morbidity and mortality among the under-five children.

Association between Indoor Air Pollution and Cognitive Impairment among Adults in Rural Puducherry, South India.

BACKGROUND: Recent evidences showed that outdoor air pollution had significant influence on cognitive functioning of adults. However, little is known regarding the association of indoor air pollution with cognitive dysfunction. Hence, the current study was done to assess the association between indoor air pollution and cognitive impairment among adults in rural Puducherry. METHODOLOGY: A community-based cross-sectional study was done among 295 adults residing in rural field practice area of tertiary care institute in Puducherry during February and March 2018. Information regarding sociodemographic profile and household was collected using pretested semi-structured questionnaire. Mini-Mental State Examination was done to assess cognitive function. We calculated adjusted prevalence ratios (aPR) to identify the factors associated with cognitive impairment. RESULTS: Among 295 participants, 173 (58.6) were in 30-59 years; 154 (52.2%) were female; and 59 (20.0%) were exposed to indoor air pollution. Prevalence of cognitive impairment in the general population was 11.9% (95% confidence interval [CI]: 8.7-16.1). Prevalence of cognitive impairment among those who were exposed to indoor air pollution was 27.1% (95% CI: 17.4-39.6). Individuals exposed to indoor air pollution (aPR = 2.18, P = 0.003) were found to have two times more chance of having cognitive impairment. CONCLUSION: About one-fourth of the participants were exposed to indoor air pollution, out of which more than one-fourth was found to have cognitive impairment which is twice that of the general population. Hence, prevention of exposure to indoor air pollution needs to be done through increased availability to cleaner fuels for household usage.

Knowledge, attitude, and practice regarding organ donation among adult population of urban Puducherry, South India.

BACKGROUND: India is currently having a deceased donation rate of 0.05-0.08 per million population. The National Organ and Tissue Transplant Programme have planned strategies to improve organ donation by creating awareness and capacity building. There is great need to assess the knowledge regarding organ donation among general population. OBJECTIVE S: Among the adult population (≥18 years) residing in urban slum of Puducherry to determine the knowledge, attitude, and practice regarding organ donation. MATERIALS AND METHODS: Community-based cross-sectional study was conducted during April to May 2017 among 257 randomly selected participants in selected wards of urban Puducherry. Data regarding knowledge, attitude, and practice were collected through pretested semi-structured questionnaire. RESULTS: Mean (standard deviation) age of the study participants was 45 (15) years and majority (57%) were female, 41% of them were educated more than secondary. Almost 90% of the study participants have heard about organ donation. However, only 28% (95% confidence interval [CI]: 22.9-33.8) had adequate knowledge regarding organ donation. 58% (95% CI: 51.5-63.5) had positive attitude toward organ donation. Practice regarding registration for organ donation was only 2.3%. Knowledge regarding organ donation was more among joint family (odds ratio [OR] = 1.86, P = 0.02) and middle socioeconomic status (OR = 2.40, P = 0.01). Positive attitude was more among those who were educated above secondary (OR = 3.47, P = 0.001) and less among Muslim/Christian religion (OR = 0.49, P = 0.03). CONCLUSION: Less than one-third of the study population had adequate knowledge regarding organ donation. Even though more than half of them had positive attitude toward organ donation only six individuals registered for organ donation.

Tobacco use, exposure to second-hand smoke among pregnant women and their association with birth weight: A retrospective cohort study.

BACKGROUND: There is paucity of studies on prevalence of SHS among pregnant women and its association with low birth weight (LBW). OBJECTIVES: The study was designed to determine the proportion of tobacco use, exposure to second hand smoke among pregnant women and their association with LBW. MATERIALS AND METHODS: A Retrospective cohort study was conducted from March-June 2017 among 1043 pregnant women admitted for delivery in the Department of Obstetrics and Gynecology, JIPMER. Socio-demographic and obstetric characteristics, tobacco use and exposure to SHS during pregnancy were assessed by interviews. Birth weight of the baby was also extracted. Data was analysed using STATA v12. Univariate analysis was used to assess the association of socio-demographic, obstetric characteristics and exposure to SHS with LBW. RESULTS: Out of 1043 pregnant women, the mean age was 25 (±3.9) years. More than half (57.4%) of women were primigravida. The proportion of women exposed to SHS during pregnancy was 69.9% (95% CI: 67.0-72.6) among which 24% of the women belonged to family, where family members were smokers. Only four had ever used tobacco in the past. However, none used any form of tobacco during pregnancy. LBW was present in 21.4% of the babies. There was no association between exposure to SHS and LBW [PR:0.98 (95% CI:0.71-1.35)]. CONCLUSION: The study shows that there was no significant association between the SHS exposure of pregnant women and low birth weight.

Emerging public health threat of e-waste management: global and Indian perspective.

Background Electrical and electronic waste or e-waste is emerging as a major public health threat worldwide because of rapid advances in technology leading to the generation of large amount of wastes and a lack of knowledge in handling of these wastes. Objective The current review discusses the current e-waste problem worldwide, as a public health concern, with a specific focus on India and recommendations to have effective e-waste management. Methods This is a traditional review study. The burden of e-waste, regulations and its impact on health and the environment at the global and country level were identified using various search engines such as PubMed, Google Scholar, Scopus and ScienceDirect. Books, case studies, legislation documents, reports, original articles and other documents from international organizations and specific governmental agency websites were retrieved. In total, 33 original articles, reports, case studies and documents were used for this review. Results In 2016, 44.7 million tonnes of e-waste was generated with 2 million tonnes produced in India alone. Out of this, only 20% of the e-waste generated globally was handled properly. The situation is worse in India where more than 90% of the e-waste was handled by informal sector workers. An important problem with the process is that they do not take necessary precautionary measures before handling e-waste. Components which are not suitable for reuse are burnt openly or disposed of through open dumping. Most of the informal sector workers are illiterate making them unaware of the hazardous chemicals that can be released later into the water sources and the environment. Conclusion The current review shows that the e-waste poses a serious global public health threat leading to significant environmental and health risks. Most of the developing countries including India were found to be lagging behind in the implementation of environmentally sound formal recycling processes. Hence, a better life cycle assessment model which have been successfully implemented in other developing countries should be introduced in India.