Measuring the Effect of Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) on Health Expenditure among Poor Admitted in a Tertiary Care Hospital in the Northern State of India.

Background: Ayushman Bharat-Pradhan Mantri Jan Aarogya Yojna (AB-PMJAY) as a financial risk protection scheme intends to reduce catastrophic health expenditure (CHE), especially among poor. The current study was carried out to assess the utility of AB-PMJAY in terms of reduction in CHE from before and after admission in a tertiary hospital in the northern state of India. Methodology: It was a hospital-based cross-sectional study carried out from August 2020 to October 2021 at a public tertiary hospital of Himachal Pradesh, India. Data were collected from surgery- and medicine-allied (SA and MA) specialties. Along with socio-demographic details, information for total monthly family expenditure (TMFE), out-of-pocket expenditure (OOPE), and indirect illness-related expenditure (IIE) was recorded before and after hospital admission. CHE was considered as more than 10.0% OOPE of THFE and more than 40.0% of capacity to pay (CTP). Results: A total of 336 participants with a mean age of 46 years were recruited (MA: 54.6%). The majority (~93.0%) of participants had illness of fewer than 6 months. The mean TMFE was observed to be INR 4213.1 (standard deviation: 2483.7) and found to be similar across specialties. The OOPE share of TMFE declined from 76.1% (before admission) to 30.0% (after admission). Before admission, CHE was found among 65.5% (10.0% of THFE) and 54.2% (40.0% of CTP) participants. It reduced to about 29.0% (based on both THE and CTP) after admission to hospital. Conclusion: AB-PMJAY scheme found to be useful in reducing CHE in a tertiary hospital.

Hypertension Prevalence, Awareness, Treatment, Control and Risk Factors in Tribal Population of India: a Multi-Centric Cross-Sectional Study.

The prevalence of hypertension is increasing in the tribal population of India. Lifestyle modifications, including dietary changes and acculturation, are the main reasons for the high prevalence of hypertension among the Indian indigenous (tribal) population. This paper reports hypertension prevalence, awareness, treatment, control and risk factors among tribes in five districts of different geographical zones of India. A cross-sectional study was conducted among the adult tribal population of 7590 from these states. Data related to blood pressure, anthropometry, demographic and behavioural variables were collected with prior consent from the participants. The prevalence of hypertension is 34.0% and 28.3% among men and women, respectively. Of the total hypertensives, 27.5% were aware of their hypertension status; of them, 83.9% were receiving treatment, and blood pressure was in control among 33.5% of patients who were receiving treatment. Age, alcohol intake, sedentary lifestyle, Particularly Vulnerable Tribal Groups status and body mass index are found to be significantly associated with the prevalence of hypertension. The prevalence of hypertension is high among these tribal populations, which could be due to modernization and acculturation. Awareness and treatment-seeking behaviour are poor. Hence, early screening, awareness campaigns for seeking treatment, and health promotion are immediately required. Comprehensive health promotion programs need to promote lifestyle modification and re-orientation of the primary health care system to improve availability and accessibility to hypertension screening and treatment.

Democracy, economics, or health-Time to look to the east for leadership.

While the capabilities of the low and middle-income countries (LMIC) have always been defined as "doubtful" to deal with public health crises of Covid pandemic magnitude, a flip-flop and incoherent response by the high-income countries (HIC) was unexpected. In the unprecedented moment of the pandemic, it is that we are beginning to find among ourselves, across the globe a search for stronger, resilient, scalable, and economy-efficient foundations in health systems that are capable of delivering healthcare to all. The apparently underperforming international health bodies have only increased this willingness of individual nations to look towards multilateralism as the foundational principle for not just the exchange of ideas but to deliver on these. India, a vibrant and the largest democracy, has showed her willingness to overcome, for example, the limitation of the vaccines during COVID to a few by making availability and possible delivery of a safe and effective vaccine to populations across the world. This has not only been seen as a hope to surmount challenges through help from others but also as a show of human resilience in the face of adversity.

Development, standardization, and contextualization of qualitative tools for possible use in the assessment and valuation of snakebite envenomation.

Background: Snakebite envenoming, a neglected tropical disease (NTD), is an important public health problem that is responsible for more than 1 lakh deaths annually across the world. However, the majority of the data in this regard is from health institutions and data from community settings are scarce. The aim of the current study was to develop valid and reliable qualitative tools for assessing the burden of snakebites and the health-seeking behavior of the community. The tools developed thus will serve in creating a community connection and thereby strengthen primary care teams engaged in managing snakebites at the primary care level. Methods: A four-step design was used; (a) review of the available literature on the burden of disease, tools used to assess the burden, and the guidelines on snakebite (b) development, laying out, and contextualization of questions/items for the tools (c) pilot testing and establishment of validity. Results: A focus group discussion guide, key informant interview schedule for health professionals, community leaders, and traditional faith healers were matured for the implementation. Conclusion: A reliable and valid qualitative tool was developed to discern the speculations related to snakebites and its management in rural field settings.

A multinational Delphi consensus to end the COVID-19 public health threat.

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

To evaluate the utility of 10 warning signs questionnaire in assessment of cognitive function among elderly people.

INTRODUCTION: Routine screening of high-risk elderly people for early cognitive impairment using mini-mental state examination (MMSE) and its modifications may be constrained by demographic and other variables. Warning signs (as reported by family/caregivers) may be a useful alternative. The present data analysis was carried out with the aim to identify the role of 10 warning signs screen as an alternative tool for screening for cognitive impairment among elderly. MATERIALS AND METHODS: For the purpose of this analysis (correlation), data available with us from a study conducted on the elderly population (60 years and above) from selected geographical areas (Migrant, Urban, Rural, and Tribal) of Himachal Pradesh was used. RESULTS: A high statistically significant was found between scores on 10 warning signs screen and Hindi mental state examination/Bharmouri mental state examination (modifications of MMSE). CONCLUSIONS: Ten warning signs screen can be an important screening total for assessment of cognitive impairment in the elderly Indians.

Assessment of clinical profile of the patients treated at ayurvedic health facilities in north India.

Since a very long time, a significant number of patients have been seeking treatment at Complementary and Alternative Medicine health facilities, but the disease burden at these facilities has never been assessed and documented. Present cross-sectional study was carried out at Ayurvedic tertiary care hospital to document and to assess the rationale of disease reporting at Ayurvedic institutions of the northern state of India from January 2011 to October 2011. Almost half of the patients' morbidities were not classified at all into any of the disease categories. The common reported morbidities at study hospital were: Respiratory (10.5%), neuromuscular (9.5%), digestive (9.2%) and circulatory (9.1%) disorders. As the majority of diseases were unclassified, so mainstreaming of the effective disease surveillance would be required to understand the morbidity pattern and successful treatment practices at health facilities.

Rapid Assessment for Coexistence of Vitamin B12 and Iron Deficiency Anemia among Adolescent Males and Females in Northern Himalayan State of India.

Coexistence of folic acid and vitamin B12 deficiency has been observed among adolescents with iron deficiency anemia, but limited evidence is available from India. So, a rapid assessment was done to study the prevalence of iron, folic acid, and vitamin B12 deficiency among adolescent males and females in northern Himalayan state in India. Methods. Total 885 (female: 60.9%) adolescents (11 to 19 completed years) were surveyed from 30-cluster village from two community development blocks of Himachal Pradesh. Serum ferritin, folic acid, and vitamin B12 were estimated among randomly selected 100 male and 100 female adolescents. Results. Under-nutrition (BMI < 18.5 kg/m(2)) was observed among 68.9% of adolescents (male: 67.1%; female: 70.7; P = 0.29). Anemia was observed to be prevalent among 87.2% males and 96.7% females (P = 0.00). Mild form of anemia was observed to be the most common (53.9%) form followed by moderate (29.7%) anemia. Strikingly, it was found that all the adolescents were deficient in vitamin B12 and none of the adolescents was observed to be deficient in folic acid. Conclusion. Among both male and female adolescents anemia with vitamin B12 deficiency was observed to be a significant public health problem. Folic acid deficiency was not observed as a problem among surveyed adolescents.

Scoring satisfaction among patients, attending ART Centre of a medical college in North-West India.

Patient satisfaction is a measurable concept comprising multidimensional elements such as access to care, quality of the provider patient interpersonal relationship and affordability of care. This further influences the decisions to seek care and outcomes of diseases. Although stigma and discrimination are potential barriers to effective implementation of the antiretroviral therapy (ART) programme, higher satisfaction levels of patients are also crucial for treatment adherence. A hospital-based cross-sectional study was conducted at the ART centre of IG Medical College, Shimla from November 2008 through May 2009. Three hundred and eighty four consecutive adult (≥18 years) patients attending the ART centre and on ART who consented to participate in the study were enrolled. Of the 384 patients, 209 (54.4%) were males. Majority were in the age bracket of 25-44 years. About 61.6% of the patients were satisfied to the services being provided. Mean Patient Satisfaction Questionnaire (PSQ) scores were the highest for technical quality of care and lowest for financial aspects. About 69.4% of the patients were satisfied towards their care provider. Although a majority of the patients were satisfied, several areas of patient care need improvement.

Utility of Consensus Statement in Assessment of Obesity: A Study among Undergraduate Medical Students from Rural Northwest India.

INTRODUCTION: In India, obesity is emerging as an important health problem particularly in the urban areas, paradoxically coexisting with under nutrition. Almost 30-65% of adult Indians are either overweight or obese or have abdominal obesity. MATERIALS AND METHODS: A cross-sectional study design was used to assess the prevalence of obesity among undergraduate medical using consensus statement for obesity in India. RESULTS: The results of the body mass index (BMI) calculations show 26 females and 4 males (29.79% of total students) with a BMI of <18 kg/m(2) as underweight, whereas 13 boys and 4 girls (15.54% of total students) as obese with a BMI of 25 kg/m(2) and above. A total of 18 boys and 6 girls (21.26% of total students) were overweight with a BMI between 23 and 24.9 kg/m(2). DISCUSSION: It is estimated that by application of these guidelines, additional 10-15% of Indian population would be labeled as obese or overweight. We see this very clearly in our study, where we see an increase of 14.53% of students classified as obese and 5.93% students as overweight on using the guidelines of the consensus statement.

Community based assessment of biochemical risk factors for cardiovascular diseases in rural and tribal area of himalayan region, India.

Context. Evident change in nutrition and lifestyle among individuals of urban and rural areas raises suspicion for similar change in tribal area population of India. Aim. To study the biochemical risk factor for CVDs in rural and tribal population of Sub-Himalayan state of India. Settings and Design. Cross-sectional study in rural (low altitude) and tribal (high altitude) area of Himachal Pradesh, India. Methodology. Blood lipid profile using standard laboratory methods. Statistical Analysis. Chi-square test and multiple linear regression analysis. Results. Total of 900 individuals were studied in both areas. As per Asian criteria, obesity (BMI 27.5-30.0 kg/m(2)) was observed to be significantly high (P = 0.00) as 13.7% in tribal area as compared to 5.5% in rural area. Normal level of TC (<200 mg/dL) and LDL (<130 mg/dL) was observed in the majority of the population of both areas, whereas, at risk level of HDL (<40 mg/dL) was present in half of the population of both rural and tribal areas. The prevalence of borderline to high level of TGs was observed to be 60.2% and 55.2% in rural and tribal (P = 0.10) area, respectively. Conclusion. Prevalent abnormal lipid profile in tribal area demands establishment of an effective surveillance system for development of chronic diseases.