Acceptance and hesitancy towards COVID-19 vaccines in rural and tribal areas of Maharashtra (India).

INTRODUCTION: Hesitancy towards COVID-19 vaccines may be a major hindrance to a successful vaccination program. We assessed the vaccine uptake, facilitators, and barriers for the COVID-19 vaccine in tribal and rural populations in Maharashtra, India. METHODOLOGY: The present study is a cross-sectional analysis of data collected from 373 individuals from six villages (three tribal and three rural) from August 2022 to September 2022. Demographic information, COVID-19 history, details about vaccination, and reasons for taking/not taking the vaccine were collected. RESULTS: In these individuals, 236 (63.3%) had taken two doses, 85 (22.8%) had taken one dose, and 52 (13.9%) had not taken the vaccine. Tribal villagers were less likely to have completed vaccination (50.7% vs 79.3%; p < 0.001). Males were more likely to state 'compulsory at my workplace' (27.7% vs 7.7%; p < 0.001), whereas females were more likely to report 'could not get ration food without it' (52.7% vs 31.5%; p < 0.001) as the reason for vaccination. Common reasons for not taking the vaccine were: fear of side effects (56%); no need for vaccination (41.2%); do not trust the vaccines (40%); and 'there is no such thing as COVID-19'(16%). A majority (94.7%) had completed COVID-19 vaccination at government vaccination centers. CONCLUSIONS: Tribal villagers, women, and those from lower socioeconomic status were less likely to have taken the vaccine. Fear about side effects and mistrust about vaccines were the main reasons for not having taken the vaccine. Addressing these issues in mass information campaigns may help improve vaccination coverage.

Hypertension in men - An emerging public health challenge for India: Evidence from national family health survey-4.

Background: Men in the 25-54 year age group form the major workforce in developing countries like India. The rising trend of hypertension in this age group is a growing matter of concern. Objectives: This study analyzed secondary data analysis from the National Family Health Survey-4. Methods: Men in the 25-54 age group (n = 76,410) from 640 districts of the country were included in the study. State and district-wise trends in hypertension in men along with selected individual lifestyle characteristics were displayed using a geographic information system. Results: The prevalence of hypertension among men in the age group of 25-54 was found to be 35.6% for the entire country. In urban India, the prevalence of hypertension was 38.4% (uncorrected - 40.2%) compared with 33.8% (uncorrected - 34.9%) in rural India. Among the 27,973 hypertensives, 6984 (25%) were the known hypertensives prior to the survey. Out of these only 2403 (34.4%) were taking medicines. The prevalence of tobacco use in any form among the men in this age group was 45.7% (uncorrected - 49%). Conclusion: In conclusion, the study highlights the burden of hypertension in men in the prime age group along with the alarming burden of tobacco consumption and recommends public health and policy interventions targeting both hypertension and tobacco control. It requires urgent attention and specialized strategies in tiding over this epidemic brewing in the workforce of the country.

Pilot implementation of rural rehabilitation services, India.

Objective: To implement rehabilitation services in a rural area of Raigad district, Maharashtra, India. Methods: We piloted a rehabilitation service delivery model through the Mahatma Gandhi Mission Institute of Health Sciences, in five villages. The institute performed participatory rural appraisal and focus group discussions with stakeholders to identify general issues in village life that could affect delivery. To integrate rehabilitation service delivery into the existing primary care system, a team from the institute developed a strategic plan through multidisciplinary clinical meetings. A rehabilitation team conducted a door-to-door survey and referred people needing rehabilitation services to the outreach visits the team was making to the primary health centre twice a week. If needed, patients could be referred to a university teaching hospital for tertiary-level care. Findings: The rural appraisal identified lack of awareness, inadequate workforce and infrastructure as key issues for rehabilitation services delivery. In response, we conducted awareness campaigns and formed a rehabilitation team consisting of personnel and students from the institute. Between 2018 and 2021, the team provided care to 1800 patients, of which half (900 patients) had musculoskeletal disorders. After rehabilitation, 360 (40%) of these 900 patients performed daily-living activities and continued to work with reduced pain within 2-3 days after rehabilitation. The team provided antenatal care to 1629 pregnant women with musculoskeletal pain or stress urinary incontinence. Conclusion: Provision of rehabilitation services built awareness about physiotherapy, developed a rehabilitation care pathway and established a need for regular services. Using existing resources of the institute and involving students rendered the model sustainable.

Assessment of compliance to treatment of hypertension and diabetes among previously diagnosed patients in urban slums of Belapur, Navi Mumbai, India.

BACKGROUND: Nonadherence to treatment is a challenge in managing the increasing burden of chronic noncommunicable diseases in India. The issue is not limited only to people having limited access to health-care services, but for a variety of reasons, a typical pattern of nonadherence is being seen. OBJECTIVE: The objective was to assess the compliance and to find out the reasons of noncompliance to treatment of diabetes/hypertension among previously diagnosed patients from urban slums. METHODS: This is a community-based, cross-sectional study conducted during October 2017-February 2018 in urban slums of Belapur, Navi Mumbai, selecting all cases of diabetes and hypertension diagnosed for >1 year by house-to-house survey, covering a population of 4125. A structured and pretested questionnaire including sociodemographic details, treatment details, and compliance pattern was administered. RESULTS: The study included 208 individuals, of which 164 were under treatment for hypertension and 85 for diabetes. All the patients revealed discontinuation of medication for a significant period at some point since diagnosis. The most common reasons of noncompliance were lack of money (50.58% patients with diabetes, 73.78% patients with hypertension) and difficulty to remember to take daily medication due to work or forgetfulness (49.41% patients with diabetes, 26.21% patients with hypertension). Only 56.5% of patients with diabetes and 64.6% of patients with hypertension were aware that discontinuation of treatment can cause complications, whereas 95.3% of patients with diabetes and 99.4% of patients with hypertension feel that remembering medication at work is difficult. CONCLUSIONS: As the nonadherence is too high, there is an urgent need of attention to this aspect, and remedial measures such as proper counseling to the patient, involvement of family members, and use of low-cost drugs for treatment should be sought.

Assessment of Compliance to Treatment of Diabetes and Hypertension amongst Previously Diagnosed Patients from Rural Community of Raigad District of Maharashtra.

INTRODUCTION: Substantial burden of diabetes and hypertension is on rise in India, leading to a twin epidemic. India, being a rural country, has unique problems regarding the treatment compliance which is a serious risk for morbidity and mortality. OBJECTIVE: To assess the compliance to treatment of hypertension and diabetes amongst the diagnosed patients from rural area and to study reasons of non-compliance and knowledge and attitude. MATERIAL AND METHODS: Community based, cross sectional, observational study conducted in the rural communities of Tara and Barapada villages of Raigad district of Maharashtra. Survey was conducted covering population of 2115 across 360 families, 250 at Barapada and 110 at Tara. All the cases of diabetes and hypertension diagnosed for more than one year were included. A structured and pre-tested questionnaire was administered including details on demography, medical documentation, treatment details and factors assessing the compliance, knowledge and attitude towards the diseases. RESULTS: When reviewed the treatment adherence pattern based on documentary evidence and interview of the patient, on history of taking medication strictly since the detection illness, it was found that more than 70% of the Diabetics and more than 75% of the Hypertensive have discontinued the treatment in between. The most common reasons of non-compliance is the lack of sufficient motivation for treatment adherence as many mentioned (61.4% diabetics, 55.8% hypertensives) difficulty to remember to take daily medication due to work or forgetfulness. This is followed by lack of money (50%diabetics, 55.8% hypertensives) and living far away from doctor in city (43% diabetics and 46% hypertensives). CONCLUSIONS: The study findings are only tip of iceberg and the non-adherence to the treatment of diabetes and hypertension in rural population is at alarmingly high. Illiteracy, lack of faith in treatment and motivation, unawareness and self-neglect as well as financial constraints and lack of specialist care in rural area is playing important role.