Impact of COVID-19 Pandemic on Routine Immunization Among Tribal Children in Odisha: A Rapid Epidemiological Survey.

OBJECTIVES: To assess the impact of COVID-19 on immunization coverage and delayed vaccination among tribal children in the Khordha district of Odisha state. METHODS: A cross-sectional rapid epidemiological survey was conducted using a standard WHO (30 x 7) cluster survey with 30 tribal villages under the Community Health Centre (CHC), Mendhasala, Odisha, as clusters and seven children from each cluster. A total of 14 children from each cluster; seven each born in 2019 (2019 cohort) and 2020 (2020 cohort), amounting to 420 children were included. The dates of vaccination and related details were obtained from the mother and child protection cards alongside a pretested, semi-structured questionnaires administered to the mothers or primary caregivers. Immunization coverage and delayed vaccination rates were compared between the two cohorts. RESULTS: Full immunization coverage was 81.9% and 77.6% in the 2019 and 2020 cohorts, respectively. A significant decline in full immunization coverage was seen for 14 weeks vaccine in 2020 cohort (p value =0.01). The proportion of delayed vaccination for scheduled vaccines at birth, 6 weeks, 10 weeks, 14 weeks, and 9-12 months for 2019 cohort and 2020 cohort were 8.6%, 6.7%, 18.1%, 19.5%, 22.4%, and 21.9%, 26.7%, 30.5%, 19%, 16.2%, respectively. However, delayed vaccination rates among the 2019 and 2020 cohorts were not statistically significant. CONCLUSION: Our study findings showed a little decline in immunization coverage in tribal areas during the pandemic.

Socioeconomic gradient of lean diabetes in India: Evidence from National Family Health Survey, 2019-21.

Diabetes is a global public health challenge, particularly in India, affecting millions. Among diabetic patients, lean type 2 diabetes is a severe subtype with higher microvascular complication risks. While studies on the prevalence, variations and risk factors of diabetes are increasingly available, there has been limited research on the prevalence, variations, and socioeconomic disparities of lean diabetes in India. This study used NFHS-5 microdata, and lean diabetes is defined as those with a BMI level of under 25 and random blood glucose levels of over 200 or under diabetic medication. Descriptive and multivariate analyses were conducted to understand lean diabetes variations and related factors. Socioeconomic disparities were measured using concentration curves and the concentration index. The study unveiled important insights into lean diabetes in India. 8.2% of men and 6.0% of women had elevated blood glucose levels, indicating a significant diabetes burden. Notably, 2.9% of men and 2.4% of women were diagnosed with lean diabetes. Among type 2 diabetics, 52.56% of males and 43.57% of females had lean type 2 diabetes. Lean diabetes prevalence varied from 11.6% in the poorest quintile to 1.1% in the richest. The odds of lean type 2 diabetes among those in the poorest quintile was 6.7 compared to the richest quintile. The concentration index of lean type 2 diabetes was -0.42 for men and -0.39 for women, suggesting a disproportionate impact on lower socioeconomic groups. This study advances our understanding of the complex interplay between socioeconomic factors and lean type 2 diabetes in India. To address the rising burden of lean diabetes among lower socioeconomic strata, policymakers and healthcare professionals must prioritise initiatives enhancing healthcare access, promoting healthy lifestyles, and ensuring effective diabetes management. By addressing socioeconomic disparities and implementing interventions for vulnerable populations, India can reduce diabetes-related mortality and enhance its citizens' overall health.

The Quality of Life of Older Adults in Rural Eastern India and Its Influencing Factors: A Cross-Sectional Study.

Aims This study aimed to assess the quality of life (QoL) of older adults in rural Odisha, India, exploring its multidimensional nature across physical, psychological, social, and environmental domains. The impact of depression and various sociodemographic factors on QoL was also investigated. Methods The research was conducted in the Tangi block of Khordha district, Odisha, encompassing 468 older adults. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire, Geriatric Depression Scale (GDS-15), and sociodemographic questionnaire were used in data collection. Sampling employed a multistage approach, with statistical analysis utilizing Statistical Package for the Social Sciences (SPSS) version 20 (IBM SPSS Statistics, Armonk, NY), including t-tests for normally distributed data and the Mann-Whitney U test for non-normally distributed data. Results The QoL of older adults in rural Odisha showed variability, with physical and social domains exhibiting relatively positive scores compared to psychological and environmental domains. Depression significantly impacted all QoL dimensions, with the most profound effect observed in global QoL and global health. Sociodemographic factors such as employment, substance use, elder abuse, adverse life events, and poverty were identified as significant determinants of global QoL. Additionally, recreational activity, elder abuse, education, and employment significantly affected all QoL domains. Conclusions This study reveals the complex landscape of QoL of older adults in rural Odisha. The findings emphasize the need for comprehensive interventions targeting mental health, social support, and environmental conditions to enhance the overall well-being of this population. Policymakers and healthcare professionals should consider these multidimensional factors to develop effective strategies for improving the QoL of older adults in similar contexts.

Prevalence of common mental disorders and treatment gap among patients with non-communicable diseases in the rural areas of East India.

BACKGROUND: Mental and physical non-communicable diseases (NCDs) coexist, because they share common environmental and behavioral risk factors. The treatment gap for common mental disorders, such as depression, anxiety, and substance use, is large compared to other NCDs. OBJECTIVE: To determine the prevalence and treatment gap of common mental disorders among patients with non-communicable diseases. METHODOLOGY: The community-based cross-sectional study was conducted in the rural parts of East India, in people aged 30 years and older with NCDs. A simple random sample was chosen to select the villages and participants. Eligible participants administered with screening and diagnostic questionnaire for depression, anxiety, and substance use. Those diagnosed with mental disorders were again assessed for treatment status in the last 12 months. Non-receipt of treatment was considered as treatment gap. RESULTS: A total of 515 participants were included in the analysis. The overall prevalence of common mental disorders among the study population was 46.4% (95% CI 42.0-50.8), and excluding substance use, the prevalence was 11.7% (95% CI 9.0-14.7). The treatment gap for common mental disorders among patients with non-communicable diseases, including and excluding substance use, was 98.3% (95% CI 95.8-99.5) and 93.3% (95% CI 83.8-98.2), respectively. CONCLUSION: The prevalence and treatment gap of common mental disorders among persons with NCDs was high. Public health interventions need to be emphasized for the integration of mental health care into NCD care.

Burden of alcohol use and inclusion of alcohol use disorder medications in the essential medicine lists across 132 countries: An observational study.

Harmful use of alcohol effects the health of the population. The treatment coverage of alcohol use disorders (AUD) varies among countries. The study aimed to determine the inclusion of AUD medicines in various national Essential Medicine Lists (EMLs) and its association with alcohol consumption. It was a secondary data analysis of alcohol consumptions and AUD related medicines in EML. Data were extracted from the WHO Global Essential Medicines database and the WHO Global Status Report on Alcohol and Health 2018. Data were extracted for 194 countries. Only 132 of 194 countries (68.0%) had EML, and among the 132 countries only 27.3% had included AUD medicines in their EML. Only 36 countries had included any of the AUD medicines in their EML. Disulfiram was included by 23 countries, while Acamprosate and Naltrexone was included by only four and 19 countries, respectively. Among the countries, 36.1% were from upper-middle income countries and 16.65 from low-income countries. The inclusion of AUD medicines in national EML was neither associated with alcohol consumption parameters nor the alcohol consumption related policy parameters. Considering the high prevalence of AUD and its complications, there is an urgent need to focus on including AUD medicines in national EML for making AUD treatment available and accessible across the world.

Effectiveness of peer-led intervention in control of non-communicable diseases in rural areas of Khordha district: study protocol for a cluster randomized controlled trial.

BACKGROUND: The main contributors to death and disability from chronic illnesses in developing nations are elevated blood pressure (hypertension), blood sugar (diabetes mellitus), and blood cholesterol (dyslipidaemia). Even though there are affordable treatments, the treatment gap for these conditions is still significant. Few pilot studies from industrialized nations discuss the value of peer-led interventions for achieving community-level management of blood pressure and blood sugar. This study aims to evaluate the effectiveness of peer-led intervention compared to standard care in achieving control of selected non-communicable diseases (NCDs) in Indian context at 1 year of intervention among people of 30-60 years with hypertension and/or diabetes mellitus and/or dyslipidaemia. METHODS: A cluster-randomized controlled trial will be conducted in villages of two rural blocks of the Khordha district of Odisha from August 2023 to December 2024. A total of 720 eligible participants (360 in the intervention group and 360 in the control group) will be recruited and randomized into two study arms. The participants in the intervention arm will receive a peer-led intervention model for 6 months in addition to standard care. The sessions will be based on the six domains of NCDs - self-care, follow-up care, medication, physical activity, diet, limiting substance use, mental health and co-morbidities. The mean reduction in blood pressure, HbA1C, and blood cholesterol in the intervention arm compared to the standard care arm will be the main outcome. DISCUSSION: The increasing burden of NCDs demands for newer strategies for management. Peer-led interventions have proven to be useful at the international level. Incorporating it in India will have remarkable results in controlling NCDs. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI) CTRI/2023/02/050022. Registered on 23 February 2023.

Health system factors related to COVID-19 mortality in Eastern India: Hospital-based cross-sectional study.

Introduction: Mortality from coronavirus disease 2019 (COVID-19) pandemic has left footprints across all ages and socio-economic strata. The deaths because of COVID-19 are usually multi-factorial. The study aimed to assess the health system factors related to COVID-19-related deaths. Materials and Methods: A hospital-based retrospective study was conducted at a tertiary care hospital of eastern India. A total of 272 COVID-19 deaths that occurred between April and November 2020 were investigated. Data were extracted from Medical Record Department, and telephonic interviews were conducted to assess the different delays related to death. Data were analysed using Statistical Package for Social Sciences. Travel time, travel distance, delay in testing, and delay in receiving quality care were presented as median with inter-quartile range. Results: Complete information could be collected from 243 COVID deaths of the 272 deaths (89.3%). The duration of hospital stay was 1-7 days for 42% of the deceased. The median travel time was 120 min, and the median distance travelled was 60 km. The median time to receive first attention of health care workers was 10 minutes. There was hardly any delay in reporting of test results, whereas the median time from symptoms to test and the median time from symptoms to admission were 4 days each. Conclusion: Health system factors related to death of COVID-19 need to be addressed to avoid the avoidable deaths during the pandemic situation. The resilience of the health system can be helpful in reducing death toll in a low-resource country like India.

The top 100 cited articles in menstrual health among adolescent girls: a citation analysis.

BACKGROUND: Menstrual health is an important public health concern where it is still considered a taboo, and adolescent girls often lack knowledge about menstrual health, face limited access to sanitation facilities, and struggle with the affordability of sanitary materials. Every year numerous articles are published; however, only a few of them would be influential in the evolution of a particular field. The number of citations received by an article serves as a quality factor for the impact of the article in a particular field. Citation analysis analyses the relationship between citations received by articles. From the literature search, no citation analysis was conducted on menstrual health. Hence the objective of the study was to identify the articles which received hundred or more citations and also to identify the leading countries, journals, study designs, and departments conducting research on menstrual health. METHODS: Citation analysis was done with search terms pertaining to adolescent and menstrual health using Google Scholar as a database in Publish or Perish software. The articles retrieved were exported to Microsoft Excel. Articles that received a hundred or more citations were screened for the type of article, department, and country where the study was conducted. A descriptive analysis of the hundred or more cited articles was done in Microsoft Excel. RESULTS: A total of 982 articles pertaining to menstrual health among adolescent girls were retrieved. There were hundred articles with hundred and more citations pertaining to the menstrual health of adolescent girls. Cross-sectional study design, Obstetrics and Gynaecology department, India and USA countries, and PLOS ONE journal had the most citations in research on menstrual health among adolescent girls. The top ten articles were on menorrhagia, menstrual hygiene practices, Water, Sanitation and hygiene (WASH), stigma on menstruation, and education on menstrual health. CONCLUSION: The hundred cited articles on menstrual health among adolescent girls were mainly from high-income countries and were of more observational in nature than interventional. Thus, highlighting the need to strengthen experimental studies on the menstrual health of adolescent girls in Lower-middle-income countries.

Menstrual health is an important public health entity where menstrual health management remains poor among adolescent girls in lower-middle-income countries. From the literature, it has been observed that there is a lack of research pertaining to menstrual health. Research-related performances are evaluated through various objective measures; one of them is the number of citations received by the articles, which implicates the impact of the article in a particular field. Hence the objective of our study was to enlist the articles pertaining to menstrual health on adolescent health, which received hundred and more citations. The most common study design, department, country, and journal were determined from articles that received hundred and more citations. The study results showed that the Cross-sectional study design, Obstetrics and Gynaecology department, India and USA countries, and PLOS ONE journal conducted research with the highest number of articles having hundred and more citations. The top ten articles included research pertaining to domains such as menorrhagia, menstrual hygiene practices, Water, Sanitation, and hygiene (WASH), stigma on menstrual health, and education on menstrual health, which are imperative with respect to adolescent girls' menstrual health. From the current citation analysis, it is evident that there is a need for strengthening research on menstrual health, which will generate evidence-based interventions and help policymakers implement necessary policies for adolescent health.

Development and Validation of the ScAbIeS Tool for Diagnosing Scabies by Community Healthcare Workers in Resource-Limited Settings.

Introduction Scabies can lead to community outbreaks if not diagnosed early. Developing and validating a relevant tool for diagnosing scabies at the community level is essential to bridging the early diagnosis and treatment gap. Objective The objective of this study is to develop and validate a newer tool to diagnose scabies at the community level by Community Healthcare Workers (CHWs) in resource-limited settings. Methods The developed "ScAbIeS" tool comprised five items divided into two major and three minor criteria. After its development, a longitudinal descriptive study validated the "ScAbIeS" tool. The eligible participants were included in the study through active screening in villages under the Rural Health Training Center (RHTC) Mendhasala. Those villages' Accredited Social Health Activists (ASHS) were included as CHWs for diagnosing scabies using the "ScAbIeS" tool. The participants with skin lesions and/or itching were diagnosed with scabies by CHWs using the "ScAbIeS" tool. The diagnosis of CHWs using the "ScAbIeS" tool was compared with those of physicians, including expert dermatologists, to determine the sensitivity and specificity. Results Kappa's agreement is found to be 0.896 for CHWs and trained physicians regarding the diagnosis of scabies by the "ScAbIeS" tool. Cronbach's alpha is 0.738 for major criteria and 0.565 for minor criteria. 0.778 is found to be Cronbach's alpha for the total scale. The "ScAbIeS" tool is 85% sensitive and 100% specific to diagnose scabies when used by CHWs. Conclusion The "ScAbIeS" tool can be used to diagnose scabies at the community level by CHWs with appropriate training. It will lead to the prevention of complications and community outbreaks of scabies.

Geriatric depression: prevalence and its associated factors in rural Odisha.

The world's population is aging rapidly, and the epidemiological transition has led to increased mental disorders worldwide. Geriatric depression is masked by multiple comorbidities or the natural process of aging. Our study aims to estimate the prevalence of geriatric depression and find the risk factors associated with geriatric depression in rural Odisha. The study was a multistage cross-sectional study conducted in the Tangi block, district Khordha, Odisha, from August 2020 to September 2022, among 520 participants selected by probability proportional to size sampling. From the selected participants, eligible 479 older adults were interviewed using a semi-structured interview schedule, Hindi Mini Mental Scale, Geriatric Depression Scale-15, and Hamilton Depression Rating Scale. The step forward multivariable logistic regression was used to assess the associated factors of depression among older adults. Among our participants, 44.4% (213) of older adults were depressed. Substance abuse in family members [AOR: 16.7 (9.1-30.9)], history of elder abuse [AOR: 3.7 (2.1-6.7)], physical dependency [AOR: 2.2 (1.3-3.6)], and financial dependency [AOR: 2.2 (1.3-3.6)] are significant independent risk factors associated with geriatric depression. Living with children [AOR: 0.33 (0.18-0.59)] and recreational activity [AOR: 0.54 (0.34-0.85)] are significant protective factors of geriatric depression. Our study found that geriatric depression is highly prevalent in rural Odisha. Poor quality of family life and physical and financial dependency was found to be the most significant risk factor for geriatric depression.

Effectiveness of BBV152/Covaxin and AZD1222/Covishield vaccines against severe COVID-19 and B.1.617.2/Delta variant in India, 2021: a multi-centric hospital-based case-control study.

OBJECTIVES: India introduced BBV152/Covaxin and AZD1222/Covishield vaccines in January 2021. We estimated the effectiveness of these vaccines against severe COVID-19 among individuals aged ≥45 years. METHODS: We did a multi-centric, hospital-based, case-control study between May and July 2021. Cases were severe COVID-19 patients, and controls were COVID-19 negative individuals from 11 hospitals. Vaccine effectiveness (VE) was estimated for complete (2 doses ≥ 14 days) and partial (1 dose ≥ 21 days) vaccination; interval between two vaccine doses and vaccination against the Delta variant. We used the random effects logistic regression model to calculate the adjusted odds ratios (aOR) with a 95% confidence interval (CI) after adjusting for relevant known confounders. RESULTS: We enrolled 1143 cases and 2541 control patients. The VE of complete vaccination was 85% (95% CI: 79-89%) with AZD1222/Covishield and 71% (95% CI: 57-81%) with BBV152/Covaxin. The VE was highest for 6-8 weeks between two doses of AZD1222/Covishield (94%, 95% CI: 86-97%) and BBV152/Covaxin (93%, 95% CI: 34-99%). The VE estimates were similar against the Delta strain and sub-lineages. CONCLUSION: BBV152/Covaxin and AZD1222/Covishield were effective against severe COVID-19 among the Indian population during the period of dominance of the highly transmissible Delta variant in the second wave of the pandemic. An escalation of two-dose coverage with COVID-19 vaccines is critical to reduce severe COVID-19 and further mitigate the pandemic in the country.

Effectiveness of COVID-19 vaccine (Covaxin) against breakthrough SARS-CoV-2 infection in India.

India approved COVID-19 vaccine called Covaxin, developed by the Indian Council of Medical Research and Bharat Biotech Ltd. The primary objective of the study was to estimate the effectiveness of Covaxin in preventing breakthrough SARS-CoV-2 infection in healthcare workers (HCWs). A test-negative matched case-control study was conducted among HCWs of tertiary care hospital in Eastern India. Any HCW who tested positive for COVID-19 using RT-PCR during April and May 2021 was taken as the case. The HCWs who tested negative for COVID-19 by RT-PCR were considered as controls after matching with the date of testing and profession of the cases. Vaccination data were collected from the institution's vaccine database and recall. In case of discrepancy, it was confirmed from the CoWIN portal (cowin.gov.in). The sample size was 670 participants (335 pairs). Conditional logistic regression models were used to calculate the adjusted odds ratio for breakthrough SARS-CoV-2 infection. Vaccine effectiveness was calculated using the following formula: VE = (1-aOR) × 100%. Sensitivity analysis was done for effectiveness of Covaxin, excluding Covishield vaccination. The mean age of participants was 29.1 years (SD = 7.1), and the majority were males (55.2%). Among the study participants, 60% were completely vaccinated, 18.51% were partially vaccinated, and 21.49% were unvaccinated. After adjusting for age, gender, type of household and past history of COVID-19 disease in conditional logistic models, the vaccine effectiveness was 22% (aOR 0.78, 95% CI: 0.52-1.17; p = .233). Sensitivity analysis with Covaxin showed an effectiveness of 29% (aOR 0.71, 95% CI: 0.47-1.08; p = .114) for preventing breakthrough SARS-CoV-2 infection.

Prophylactic Role of Ivermectin in Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Workers.

Introduction Healthcare workers (HCWs) are vulnerable to getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Preventing HCWs from getting infected is a priority to maintain healthcare services. The therapeutic and preventive role of ivermectin in coronavirus disease 2019 (COVID-19) is being investigated. Based on promising results of in vitro studies of oral ivermectin, this study was conducted with the aim to demonstrate the prophylactic role of oral ivermectin in preventing SARS-CoV-2 infection among HCWs at the All India Institute of Medical Sciences (AIIMS) Bhubaneswar. Methods A prospective cohort study was conducted at AIIMS Bhubaneswar, which has been providing both COVID and non-COVID care since March 2020. All employees and students of the institute who provided written informed consent participated in the study. The uptake of two doses of oral ivermectin (300 µg/kg/dose at a gap of 72 hours) was considered as exposure. The primary outcome of the study was COVID-19 infection in the following month of ivermectin consumption, diagnosed as per Government of India testing criteria (real-time reverse transcriptase polymerase chain reaction [RT-PCR]) guidelines. The log-binomial model was used to estimate adjusted relative risk (ARR), and the Kaplan-Meier failure plot was used to estimate the probability of COVID-19 infection with follow-up time. Results Of 3892 employees, 3532 (90.8%) participated in the study. The ivermectin uptake was 62.5% and 5.3% for two doses and single dose, respectively. Participants who took ivermectin prophylaxis had a lower risk of getting symptoms suggestive of SARS-CoV-2 infection (6% vs 15%). HCWs who had taken two doses of oral ivermectin had a significantly lower risk of contracting COVID-19 infection during the following month (ARR 0.17; 95% CI, 0.12-0.23). Females had a lower risk of contracting COVID-19 than males (ARR 0.70; 95% CI, 0.52-0.93). The absolute risk reduction of SARS-CoV-2 infection was 9.7%. Only 1.8% of the participants reported adverse events, which were mild and self-limiting. Conclusion Two doses of oral ivermectin (300 µg/kg/dose given 72 hours apart) as chemoprophylaxis among HCWs reduced the risk of COVID-19 infection by 83% in the following month. Safe, effective, and low-cost chemoprophylaxis has relevance in the containment of pandemic alongside vaccine.

Control of scabies in a tribal community using mass screening and treatment with oral ivermectin -A cluster randomized controlled trial in Gadchiroli, India.

BACKGROUND: Scabies is often endemic in tribal communities and difficult to control. We assessed the efficacy of a community-based intervention using mass screening and treatment with oral ivermectin in controlling scabies. METHODS/ FINDINGS: In this cluster randomised controlled trial, 12 villages were randomly selected from a cluster of 42 tribal villages in Gadchiroli district. In these villages, trained community health workers (CHWs) conducted mass screening for scabies. The diagnosis was confirmed by a physician. Six villages each were randomly allocated to the intervention and usual care arm (control arm). In the intervention arm (population 1184) CHWs provided directly observed oral ivermectin to scabies cases and their household contacts. In the usual care arm (population 1567) scabies cases were referred to the nearest clinic for topical treatment as per the standard practice. The primary outcome was prevalence of scabies two months after the treatment. Secondary outcomes were prevalence of scabies after twelve months of treatment and prevalence of impetigo after two and twelve months of treatment. Outcomes were measured by the team in a similar way as the baseline. The trial was registered with the clinical trial registry of India, number CTRI/2017/01/007704. In the baseline, 2 months and 12 months assessments 92.4%, 96% and 94% of the eligible individuals were screened in intervention villages and 91.4%, 91.3% and 95% in the usual care villages. The prevalence of scabies in the intervention and usual care arm was 8.4% vs 8.1% at the baseline, 2.8% vs 8.8% at two months [adjusted relative risk (ARR) 0.21, 95% CI 0.11-0.38] and 7.3% vs 14.1% (ARR 0.49, 95% CI 0.25-0.98) at twelve months The prevalence of impetigo in the intervention and usual care arm was 1.7% vs 0.6% at baseline, 0.6% vs 1% at two months (ARR 0.55, 95% CI 0.22-1.37) and 0.3% vs 0.7% at 12 months (ARR 0.42, 95% CI 0.06-2.74). Adverse effects due to ivermectin occurred in 12.1% of patients and were mild. CONCLUSIONS: Mass screening and treatment in the community with oral ivermectin delivered by the CHWs is superior to mass screening followed by usual care involving referral to clinic for topical treatment in controlling scabies in this tribal community in Gadchiroli.

Adherence of Doctors to Standard Diarrhoeal Management Guideline During Treatment of Under-Five Diarrhoeal Episodes: A Study From Eastern India.

Introduction Diarrhoea is one of the major preventable causes of childhood death in tribal areas of India. Most acute diarrhoea in childhood can be managed with oral rehydration salt (ORS) and zinc. This study aimed to assess the adherence of doctors to standard diarrheal management guidelines while treating under-five diarrhoeal episodes. Methods The cross-sectional study was conducted in 10 blocks of Kandhamal district in southern Odisha, India. The under-five childhood diarrhoea prescriptions from July to August 2018 were audited during September 2018. One health facility from each block and 15 prescriptions from each health facility were selected randomly. Data were collected and entered in Epicollect5 and analyzed using Statistical Packages for Social Sciences Version 22.0 (IBM Corp., Armonk, NY). Categorical variables were presented as proportions. Results A total of 150 under-five acute diarrhoea prescriptions were audited from 10 health facilities. One hundred ten prescriptions were from the out-patient department and 40 prescriptions were from the admitted diarrhoeal patients. The majority of them included ORS (77.3%) and zinc (75.3%) in the prescription, however, only half of the prescriptions (52.7%) had recommended dose and duration of zinc. All admitted patients received intravenous fluids. Most prescriptions (89.3%) did not document the hydration status of the patient. All prescriptions were silent about the severe acute malnutrition status of the children before administering fluid therapy. Antibiotics were prescribed in 80% of the prescriptions. Prebiotics, probiotics and anti-spasmodic were prescribed in 37.3% of the prescriptions. Conclusion Adherence of doctors to acute diarrheal management guidelines for the management of under-five diarrhoea was poor in our study. Further researches and training are required to improve childhood diarrhoea management in health facilities of tribal areas of India.

Role of ivermectin in the prevention of SARS-CoV-2 infection among healthcare workers in India: A matched case-control study.

BACKGROUND: Ivermectin is one among several potential drugs explored for its therapeutic and preventive role in SARS-CoV-2 infection. The study was aimed to explore the association between ivermectin prophylaxis and the development of SARS-CoV-2 infection among healthcare workers. METHODS: A hospital-based matched case-control study was conducted among healthcare workers of AIIMS Bhubaneswar, India, from September to October 2020. Profession, gender, age and date of diagnosis were matched for 186 case-control pairs. Cases and controls were healthcare workers who tested positive and negative, respectively, for COVID-19 by RT-PCR. Exposure was defined as the intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19. Data collection and entry was done in Epicollect5, and analysis was performed using STATA version 13. Conditional logistic regression models were used to describe the associated factors for SARS-CoV-2 infection. RESULTS: Ivermectin prophylaxis was taken by 76 controls and 41 cases. Two-dose ivermectin prophylaxis (AOR 0.27, 95% CI, 0.15-0.51) was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Those involved in physical activity (AOR 3.06 95% CI, 1.18-7.93) for more than an hour/day were more likely to contract SARS-CoV-2 infection. Type of household, COVID duty, single-dose ivermectin prophylaxis, vitamin-C prophylaxis and hydroxychloroquine prophylaxis were not associated with SARS-CoV-2 infection. CONCLUSION: Two-dose ivermectin prophylaxis at a dose of 300 µg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Chemoprophylaxis has relevance in the containment of pandemic.

Morbidity compression or expansion? A temporal analysis of the age at onset of non-communicable diseases in India.

While there is evidence of morbidity compression in many countries, temporal patterns of non-communicable diseases (NCDs) in developing countries, such as India, are less clear. Age at onset of disease offers insights to understanding epidemiologic trends and is a key input for public health programs. Changes in age at onset and duration of major NCDs were estimated for 2004 (n = 38,044) and 2018 (n = 43,239) using health surveys from the India National Sample Survey (NSS). Survival regression models were used to compare trends by sociodemographic characteristics. Comparing 2004 to 2018, there were reductions in age at onset and increases in duration for overall and cause-specific NCDs. Median age at onset decreased for NCDs overall (57 to 53 years) and for diabetes, hypertension, heart disease, asthma, mental diseases, eye disease, and bone disease in the range of 2-7 years and increased for cancer, neurological disorders, some genitourinary disorders, and injuries/accidents in the range of 2-14 years. Hazards of NCDs were higher among females for cancers (HR 1.51, 95% CI 1.19-1.90) and neurological disorders (HR 1.18, 95% CI 1.06-1.32) but lower for heart diseases (HR 0.88, 95% CI 0.79-0.97) and injuries/accidents (HR 0.87, 95% CI 0.77-0.99). Hazards were greater among those with lower educational attainment at younger ages and higher educational attainment later in life. Unlike many countries, chronic disease morbidity may be expanding in India for many chronic diseases, indicating excess strain on the health system. Public health programs should focus on early diagnosis and prevention of NCDs.

Community perception regarding diarrhoea management practices in a tribal predominant aspirational district of Odisha: A mixed-method study.

CONTEXT: Childhood diarrhea is still a major problem in developing countries, and the condition is worse in tribal areas. AIMS: The study aims to assess the community perception related to diarrhea management in an aspirational district of Odisha, India. SUBJECTS AND METHODS: A mixed-method study was conducted in Kandhamal, an aspirational district of Odisha, Eastern India, from June to October 2018. An in-depth interview was conducted among community health workers, and a cross-sectional survey was done for the household interview. The data were collected in a mobile-based application, Epicollect5, and in-depth interviews were recorded digitally. STATISTICAL ANALYSIS USED: The data were analyzed in the Statistical Package for Social Sciences (SPSS) version 22.0. Categorical variables are presented in proportions. Force-field analysis was conducted to assess the driving and restraining forces of diarrhea. Content analysis was done for the digitally recorded data. RESULTS: Nine out of ten people were aware of the benefit of breastfeeding during diarrheal episodes in children aged under 5 years, and <50% were aware of zinc benefit. Poor sanitation, lack of safe water, poor hygiene practices, socioeconomic status, and illiteracy are the major challenges in diarrheal control in the tribal area. CONCLUSIONS: Improving the demand by creating community awareness regarding management of diarrhea, availability of essential drugs (ORS and zinc) at the community level, and capacity building of community health workers for management of diarrhea can reduce diarrhea-related morbidity and mortality in tribal areas of India. Handwashing, hygiene practices, and availability of safe water need to be promoted in the tribal region. In the long term, the socioeconomic determinants have to be addressed.

Transmission dynamics of the COVID-19 epidemic in India and modeling optimal lockdown exit strategies.

India imposed one of the world's strictest population-wide lockdowns on March 25, 2020 for COVID-19. We estimated epidemiological parameters, evaluated the effect of control measures on the epidemic in India, and explored strategies to exit lockdown. We obtained patient-level data to estimate the delay from onset to confirmation and the asymptomatic proportion. We estimated the basic and time-varying reproduction number (R0 and Rt) after adjusting for imported cases and delay to confirmation using incidence data from March 4 to April 25, 2020. Using a SEIR-QDPA model, we simulated lockdown relaxation scenarios and increased testing to evaluate lockdown exit strategies. R0 for India was estimated to be 2·08, and the Rt decreased from 1·67 on March 30 to 1·16 on April 22. We observed that the delay from the date of lockdown relaxation to the start of the second wave increases as lockdown is extended farther after the first wave peak-this delay is longer if lockdown is relaxed gradually. Aggressive measures such as lockdowns may be inherently enough to suppress an outbreak; however, other measures need to be scaled up as lockdowns are relaxed. Lower levels of social distancing when coupled with a testing ramp-up could achieve similar outbreak control as an aggressive social distancing regime where testing was not increased.