Recalibrating the Non-Communicable Diseases risk prediction tools for the rural population of Western India.

BACKGROUND: The aim of the present study was to recalibrate the effectiveness of Indian Diabetes Risk Score (IDRS) and Community-Based Assessment Checklist (CBAC) by opportunistic screening of Diabetes Mellitus (DM) and Hypertension (HT) among the people attending health centres, and estimating the risk of fatal and non-fatal Cardio-Vascular Diseases (CVDs) among them using WHO/ISH charts. METHODS: All the people aged ≥ 30 years attending the health centers were screened for DM and HT. Weight, height, waist circumference, and hip circumferences were measured, and BMI and Waist-Hip Ratio (WHR) were calculated. Risk categorization of all participants was done using IDRS, CBAC, and WHO/ISH risk prediction charts. Individuals diagnosed with DM or HT were started on treatment. The data was recorded using Epicollect5 and was analyzed using SPSS v.23 and MedCalc v.19.8. ROC curves were plotted for DM and HT with the IDRS, CBAC score, and anthropometric parameters. Sensitivity (SN), specificity (SP), Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy and Youden's index were calculated for different cut-offs of IDRS and CBAC scores. RESULTS: A total of 942 participants were included for the screening, out of them, 9.2% (95% CI: 7.45-11.31) were diagnosed with DM for the first time. Hypertension was detected among 25.7% (95% CI: 22.9-28.5) of the participants. A total of 447 (47.3%) participants were found with IDRS score ≥ 60, and 276 (29.3%) with CBAC score > 4. As much as 26.1% were at moderate to higher risk (≥ 10%) of developing CVDs. Area Under the Curve (AUC) for IDRS in predicting DM was 0.64 (0.58-0.70), with 67.1% SN and 55.2% SP (Youden's Index 0.22). While the AUC for CBAC was 0.59 (0.53-0.65). For hypertension both the AUCs were 0.66 (0.62-0.71) and 0.63 (0.59-0.67), respectively. CONCLUSIONS: IDRS was found to have the maximum AUC and sensitivity thereby demonstrating its usefulness as compared to other tools for screening of both diabetes and hypertension. It thus has the potential to expose the hidden NCD iceberg. Hence, we propose IDRS as a useful tool in screening of Diabetes and Hypertension in rural India.

Identifying psychological antecedents and predictors of vaccine hesitancy through machine learning: A cross sectional study among chronic disease patients of deprived urban neighbourhood, India.

COVID-19 vaccine hesitancy among chronic disease patients can severely impact individual health with the potential to impede mass vaccination essential for containing the pandemic. The present study was done to assess the COVID-19 vaccine antecedents and its predictors among chronic disease patients. This cross-sectional study was conducted among chronic disease patients availing care from a primary health facility in urban Jodhpur, Rajasthan. Factor and reliability analysis was done for the vaccine hesitancy scale to validate the 5 C scale. Predictors assessed for vaccine hesitancy were modelled with help of machine learning (ML). Out of 520 patients, the majority of participants were female (54.81%). Exploratory factor analysis revealed four psychological antecedents' "calculation"; "confidence"; "constraint" and "collective responsibility" determining 72.9% of the cumulative variance of vaccine hesitancy scale. The trained ML algorithm yielded an R2 of 0.33. Higher scores for COVID-19 health literacy and preventive behaviour, along with family support, monthly income, past COVID-19 screening, adherence to medications and age were associated with lower vaccine hesitancy. Behaviour changes communication strategies targeting COVID-19 health literacy and preventive behaviour especially among population sub-groups with poor family support, low income, higher age groups and low adherence to medicines may prove instrumental in this regard.

Prevalence and determinants of musculoskeletal pain among school-going children carrying schoolbags: A cross-sectional study from Central India.

Musculoskeletal disorders constitute 1,194 prevalent cases per 1,00,000 among children aged 5 to 19 years in India. School bags with a weight exceeding 10% of the bodyweight is a common cause of backache in school children. Methods: School children aged 8-15 years from four private schools of Bhopal were included, resulting in a sample of 934 participants. An author-assisted questionnaire was used for data collection. Results: The school bags were 16.5% of the average weight of students. 55.9% of the students experienced pain in the last 12 months, 41.6% in the last ten days and 21.3% had visited a doctor for the same. On analysis, bags with ³ three compartments (AOR: 3.7), using both shoulders to carry bags (AOR: 0.10), and the absence of lockers in schools (AOR: 17.80) were significant predictors of pain in the last ten days (P < 0.05). Conclusion: Massive advocacy and orientation are required at all levels for educational administrators, teachers, parents and students.

Nutritional Status of Under-five Siblings of Severely Wasted Children in Bhopal.

OBJECTIVE: To study the prevalence and associated factors of undernutrition in siblings of children with severe acute malnutrition (SAM). METHOD: It was a community-based cross-sectional study of under-five year siblings of children with SAM. RESULTS: A total of 128 under-five years siblings were studied, 30% had SAM whereas 20% had moderate acute malnutrition (MAM). More than 7 members in a family (OR=4.23, CI 1.9-9.6, P<0.001), underweight mothers (OR=5.2, CI 2.08-13.0, P<0.001), children who received pre-lacteal feeds (OR=3.24, CI 1.33-7.87, P=0.007), and Muslim religion (OR=4.44, CI 1.78-11.1, P<0.001) were significantly associated with finding of another child with SAM in the family. CONCLUSION: There was high proportion of severe malnutrition in siblings of children with SAM. Consideration should be given to actively screen all under-5 children in the family of a newly diagnosed child with SAM for undernutrition.

Pattern of pediatric emergency visits during lockdown -Impact of COVID-19 pandemic in Jodhpur City, India.

Objectives: To study the impact of lockdown during novel coronavirus disease-19 (COVID-19) pandemic on Pediatric Emergency visits. Methods: In this retrospective study, we compared the data regarding demographic details, triage category, underlying primary organ system involvement and outcomes among pediatric emergency visits of April-May 2019 and 2020. Results are expressed in means and proportions. Chi-square test was applied to compare the proportion in two groups. Results: We observed decrease in number of patients during lockdown period as compared to previous year (792 vs 506, decrease by 36%). There was significant increase in respiratory (P = 0.001, CI 2.66-11.6), and hematological emergencies (P < 0.001, CI 2.96-9.23) Road traffic accident (RTA) were decreased significantly (P = 0.005, CI 0.6-3.06). Unintentional injuries were comparable to previous year (P = 0.14, CI -0.86-6.19), though children being at home. Conclusion: During lockdown, number of pediatric emergency visits was reduced and also lead to delayed presentation. Parents should be informed about utilizing telemedicine services available during this period and avoid delaying in going to hospitals in emergency conditions.

Adherence to healthy behavioral practices promotes COVID 19 preventive behavior among chronic disease patients: A cross-sectional study from urban Rajasthan, India.

Background: The coronavirus disease-19 (COVID-19) pandemic has led to unprecedented morbidity and mortality across the world. Chronic disease patients of urban poor neighbourhoods are one of the most vulnerable population subgroups as the number of cases and deaths increase exponentially in India. The study aims to explore the factors associated with desirable health behaviours among chronic disease patients availing care from a primary health facility and examine their association with the COVID-19 preventive behaviour. Material and Methods: A cross-sectional study was conducted among chronic disease patients attending a health centre in an urban area of Jodhpur, Rajasthan. A interviewer administered semi-structured questionnaire was pilot tested and validated prior to initiation of data collection. A total of 520 patients were enrolled for the study. Results: Poor adherence to health behaviour was observed among a majority of the respondents (infrequent physical activity: 72.0%, one or less fruit serving per day: 96.5%, one or less vegetable serving per day: 88.8%). A factor analysis revealed three domains of COVID-19 preventive behaviour: sanitisation, preventive hygiene and social distancing. Multiple regression revealed respondents opting for COVID-19 screening and those with lower salt intake followed the overall and individual COVID-19 preventive behaviour. Conclusion: The health behaviour assessment and inter-personal counselling by the health care providers at the primary health facilities may contribute to the increasing adherence for the COVID-19 preventive behaviour among chronic disease patients.