Cost-effectiveness of emicizumab prophylaxis for haemophilia A with inhibitors: an adaptive health technology assessment for the Indian setting.

OBJECTIVE: To assess the cost-effectiveness of emicizumab prophylaxis for patients having haemophilia A with inhibitors in the Indian context using an adaptive health technology assessment (aHTA) methodology. DESIGN: Economic evaluation using multiple approaches aimed at adjusting previously generated cost-effectiveness results based on (1) price differences only ('simple') and (2) differences in cost and expected treatment duration ('moderate') and differences in cost, inflation and life expectancy ('complex'). SETTING: Typical haemophilia care in India. PARTICIPANTS: Patients with haemophilia A and inhibitors. INTERVENTION: Emicizumab prophylaxis using two vial strengths (30 or 150 mg/mL) in comparison to no prophylaxis. MAIN OUTCOME MEASURES: Adjusted incremental cost-effectiveness ratio (ICERa), incremental costs and incremental quality-adjusted life years associated with emicizumab prophylaxis from both the health system and societal perspectives. RESULTS: Using the simple ICER adjustment method, emicizumab prophylaxis resulted in potential cost savings from the payers' perspective for both vial strengths in patients aged ≥12 and <12 years. However, from a societal perspective, emicizumab prophylaxis was not cost-effective. Using the moderate adjustment method, emicizumab prophylaxis showed potential cost saving from the health system perspective. The complex adjustment method also revealed cost savings for emicizumab prophylaxis from the health system and societal perspectives across different age groups. CONCLUSION: We found that implementing emicizumab prophylaxis for patients with haemophilia A and inhibitors in India has the potential to result in cost savings. This study highlights the feasibility of using the expanded aHTA methodology for rapid evidence generation in the Indian context. However, it is crucial to address certain research gaps, including data limitations, challenges in translating international evidence to Indian context and associated uncertainties. Additionally, conducting a comprehensive budget impact analysis is necessary. These findings hold significant implications for decision-making regarding the potential provision of emicizumab prophylaxis through federal or/and state government-funded programmes and institutions in India.

Morbidity and Treatment-Seeking Pattern among Low Birth Weight Infants: A Community-based Cohort Study from Puducherry.

Background: To compare the morbidity and treatment-seeking pattern of low birth weight (LBW) and normal birth weight (NBW) infants during the first six months. Material and Methods: A prospective cohort study was conducted in the service areas of eight urban primary health centers of Puducherry from October 2019 to July 2021. Details of LBW and sex-matched NBW infants were obtained from the birth registers of selected PHCs. Data were collected using a structured interview schedule on completion of the first, third, and sixth months at their homes. For comparison, Mid-p exact test was used for incidence rates, t-test/Mann-Whitney for continuous variables and the Chi-square/Fisher's exact test for the categorical variables. Results: Ninety-four pairs of LBWS and NBW infants were recruited. The incidence of morbidity during the first six months among LBW and NBW infants was 37.5 and 33.3 episodes per 100 child months, respectively (P value 0.118). Though the incidence of all-cause morbidity was similar, skin infections were significantly higher among LBW (3.10 vs 1.21 per 100 child months, P = 0.04). The incidence of all-cause morbidity was high in LBW infants with poor weight gain. Conclusion: Birth weight was associated with all-cause morbidity during the first three months. However, this association varied in age points and infants' weight gain.

Prevalence and the factors associated with microalbuminuria among patients with type 2 diabetes mellitus and/or hypertension in the urban areas of Puducherry district: a cross-sectional study.

BACKGROUND: Microalbuminuria is an early indicator for renal and cardiovascular diseases, especially among patients with diabetes mellitus (DM) and hypertension (HTN). We determined the prevalence and the factors associated with microalbuminuria among patients with type 2 DM and/or HTN in the urban areas of the Puducherry district in India. METHODS: We included 225 patients aged 40-69 years with DM and/or HTN from a non-communicable diseases (NCDs) survey conducted during 2019-2020 in the urban areas of Puducherry district. The prevalence of microalbuminuria and various biological risk factors of NCDs were assessed as per the WHO STEPS methodology. The prevalence of microalbuminuria was presented as proportions (95% CI), and the adjusted prevalence ratio (aPR) was estimated using weighted forward stepwise generalized linear modelling. P-value ≤0.05 was considered statistically significant. RESULTS: The mean (SD) age of the patients was 54 (11) years. Over one-third (38.2%) (95% CI: 31.6-44.4) of patients with DM and/or HTN had microalbuminuria. The prevalence was highest among those having both DM and HTN 48% (95% CI: 37-59), followed by those having only DM 40.6% (95% CI: 29-52.2) and only HTN 27.7% (95% CI: 18.1-38.6). The prevalence of microalbuminuria was twice (aPR = 2.1, 95% CI: 1.1-3.9) higher among women and 2.4 times (95% CI: 1.12-5.1) higher among those having both DM and HTN as compared to those with only HTN. CONCLUSION: The prevalence of microalbuminuria among patients with DM and/or HTN is concerningly high. Population-based screening for microalbuminuria, especially among women and those having both DM and HTN, needs to be undertaken in the urban areas of Puducherry district.

Microalbuminuria serves as an early indicator for kidney and cardiovascular diseases, especially among patients with diabetes mellitus (DM) and hypertension (HTN). Our study focussed on determining the prevalence of microalbuminuria among individuals with type 2 DM and/or HTN in the urban areas of the Puducherry district in India. We included 225 patients aged 40­69 years with DM and/or HTN who participated in a non-communicable diseases (NCDs) survey conducted during 2019­2020 in urban Puducherry. We found that over one-third (38.2%) of patients with DM and/or HTN had microalbuminuria. The prevalence was highest among those having both DM and HTN (48%), followed by those having only DM (40.6%) and only HTN (27.7%). The prevalence of microalbuminuria was 2.1 times higher among women than men and 2.4 times higher among individuals with both DM and HTN compared to those with only HTN. These findings highlight the concerningly high prevalence of microalbuminuria among patients with DM and/or HTN in the urban areas of Puducherry district. To address this issue, it is crucial that the public health authorities of Puducherry district implement population-based screening initiatives for microalbuminuria, particularly targeting women and individuals with both DM and HTN in the urban areas of the Puducherry district.

Predictors of Control Status of Hypertension in India: A Systematic Review and Meta-analysis.

Predictors of hypertension (HTN) control status have not been well understood in India. This information is crucial for policymakers and program managers to devise newer HTN control strategies and implement relevant policies and programs. Therefore, we undertook this meta-analysis to estimate the effect of various factors on the control status of HTN in India. We systematically searched PubMed and Embase for observational studies and community-based trials published between April 2013 and March 2021 conducted among people (≥ 15 years) with hypertension in India. Quality of studies was assessed using Newcastle Ottawa (NO) scale. Meta-analysis was performed using random effects model. We reported the effect of various factors on the prevalence of controlled HTN using pooled odds ratio (OR) with 95% confidence interval (CI). Of the 842 studies screened, we analyzed nine studies that included 2,441 individuals. Based on the NO scale, majority (90%) of studies had a low risk of bias. The odds of having controlled HTN were significantly higher among women (OR 1.78, 95% CI 1.62-1.95), those aged > 45 years (OR 1.69, 95% CI 1.44-1.97), and those residing in urban parts of India (OR 1.74; 95% CI 1.48-2.03). These measures varied considerably across different regions of the country. Very few studies reported data on the relationship between behavioural risk factors of non-communicable diseases (NCDs) and HTN control status. We did not find any statistically significant differences between behavioural risk factors of NCDs and HTN control status. To improve HTN control in India, the ongoing/newer HTN control programs need to target men, those aged 15-45, and rural residents. Future studies on HTN control determinants should report disaggregated data and use standardized definitions for behavioral risk factors to enhance reliability and comprehensiveness of findings on the determinants of HTN control in future reviews.

Impact of near-miss event during pregnancy and childbirth on maternal health at 12 months.

OBJECTIVE: To assess the impact of maternal near-miss on late maternal death and the prevalence of hypertension or chronic kidney disease (CKD) and mental health problems at 12 months of follow up. METHODS: This prospective cohort study was conducted in a tertiary hospital in the southeastern region of India from May 2018 to August 2019, enrolling those with maternal near-miss and with follow up for 12 months. The primary outcomes were incidence of late maternal deaths and prevalence of hypertension and CKD during follow up. RESULTS: Incidence of maternal near miss was 6.7 per 1000 live births. Among those who had a near miss, late maternal deaths occurred in 7.2% (95% confidence interval [CI] 3.1%-11.3%); prevalence of CKD was 23.0% (95% CI 16.2%-29.8%), and of hypertension was 56.2% (95% CI 50.5%-66.5%) and only two women had depression on follow up. After adjusting for age, parity, socioeconomic status, gestational age at delivery, hemoglobin levels, and perinatal loss, only serum creatinine was independently associated with late maternal death and CKD on follow up. CONCLUSIONS: Women who survive a life-threatening complication during pregnancy and childbirth are at increased risk of mortality and one or more long-term sequelae contributing to the non-communicable disease burden. A policy shift to increase postpartum follow-up duration, following a high-risk targeted approach after a near-miss event, is needed.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India.

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Association of Social Capital With Tuberculosis: A Community-Based Cross-Sectional Analytical Study in South India.

BACKGROUND: Social capital denotes the relationships, networks, norms and values in the community. A high level of social capital positively improves health through a supportive social system. Illnesses affect health and social relationships. One such disease is tuberculosis (TB), known for its social stigma. India has the highest burden of morbidity and mortality due to TB. The assessment of social capital would highlight the importance of a supportive environment in reducing the disease burden and bringing better treatment outcomes. METHODS: A cross-sectional exploratory analytical study was conducted in two primary health centers in Puducherry between February 2020 and March 2021. Considering the feasibility and resource constraints, we assessed the social capital between 50 newly diagnosed pulmonary tuberculosis (PTB) patients, their age- and gender-matched 50 household contacts (HHCs) and 50 PTB patients who completed treatment a year before. The HHC was either the marital partner or sibling of the newly diagnosed PTB patients selected for comparison as their exposure to infection would be similar to those diseased but did not develop the illness. Social capital and its domains were assessed using the World Bank's social capital questionnaire. Sociodemographic characteristics and social capital domains were compared using a chi-squared test. Mean standardized Z-scores of the domains were compared using one-way analysis of variance (ANOVA). A p-value of <0.05 is taken as significant. RESULTS: Most participants from each group belonged to lower socioeconomic strata and were males (80%). The overall level of social capital was low among the newly diagnosed PTB patients, especially the group and network and trust and solidarity domains. The mean standardized Z-scores of social capital were the highest among the HHCs, followed by the treatment-completed PTB patients. There was no consistent pattern, but the trust and solidarity domain showed a statistically significant difference. CONCLUSION: A low level of social capital and its domains were seen among the newly diagnosed PTB patients. However, better scores among the HHCs and the treatment-completed patients infer a negative association between social capital and TB. Thus, higher social capital preserves and improves health. Therefore, caregivers and disease-cured patients can be utilized as a social support system for current diseased patients and improve their health status.

Cost-effectiveness of population-based screening for microalbuminuria in people with type 2 diabetes mellitus in India.

OBJECTIVES: Patients with diabetes have a higher risk of developing chronic kidney disease (CKD). Early detection of CKD through microalbuminuria screening, followed by treatment, delays the progression of CKD. We evaluated the cost-effectiveness of population-based screening of microalbuminuria among normotensive type 2 diabetes mellitus patients aged >40 years compared with no screening scenario using a decision tree combined with the Markov model. METHODS: We considered two scenarios: Scenario I - dipstick microalbuminuria followed by spot-urine albumin-creatinine ratio (ACR) and serum creatinine in sequence; Scenario II - spot urine ACR plus serum creatinine. A mathematical cohort of the target population was simulated over a lifetime horizon with an annual cycle. Data for the model were obtained from secondary resources. The incremental cost-effectiveness ratios (ICERs) were estimated for screening scenarios compared to nonscreening scenario, along with sensitivity analyses. RESULTS: The discounted ICER per quality-adjusted life years gained for annual microalbuminuria screening in the normotensive diabetic population in India were ₹ 24,114 (US$ 308) and ₹ 13,790 (US$ 176) for scenarios I and II, respectively. Annual screening by scenarios I and II resulted in a reduction of 180 and 193 end-stage renal disease (ESRD) cases per 100,000 population, respectively, resulting in a cost saving of ₹ 12.3 and 13.3 Crore spent on ESRD management over 10 years. Both scenarios were also cost-effective even at the screening frequencies of 5 and 10 yearly. CONCLUSION: Microalbuminuria screening was cost-effective at the threshold of one-time GDP per capita in India.

Hypertension Control Status Among Patients Receiving Treatment From Selected Primary Health Centres in Puducherry: A Cohort-Analysis Approach.

BACKGROUND:  High blood pressure (hypertension) is a major risk factor contributing to 60% of premature deaths caused by non-communicable diseases. In India, a mere 15% of the hypertensive population achieves optimal blood pressure control. Effective monitoring of hypertension is crucial for mitigating the morbidity and mortality associated with cardiovascular diseases. OBJECTIVE: This study employed a cohort analysis approach to determine the control status of hypertension and identify factors associated with hypertension among individuals seeking care at selected primary health centres (PHCs) in Puducherry from January 2019 to December 2022. METHODOLOGY: We assessed treatment records of 1127 patients with hypertension registered at PHCs in both urban and rural areas between 2019 and 2022. Information on socio-demographic details and blood pressure readings was collected to assess the control status of hypertension on a quarterly and six-monthly basis. Additionally, 436 patients were interviewed to identify factors associated with uncontrolled hypertension. RESULTS: Control rates of hypertension varied among PHCs on a quarterly and six-monthly basis. The rural PHC achieved the highest quarterly control rate of 80% in Q4 2020, while the urban PHC had the lowest rate of 44% in Q1 2020. Similarly, the highest six-monthly control rate of 78% was observed in Q3 2019 at both rural and urban PHCs, with the lowest rate of 44% in Q1 2020 at the urban PHC.  Conclusion: Analysing data obtained from regular monitoring of hypertension control status allows healthcare providers to identify patterns, trends, and correlations. It assists providers in making informed decisions regarding treatment adjustments, medication choices, lifestyle recommendations, and policy changes. This approach is expected to improve control status for hypertension, leading to the ultimate goal of better health outcomes for patients.

Haematological screening and its correlation with sociodemographic profile among the indigenous communities in and around Puducherry.

Background: Haemoglobin disorders are unique and important health challenges for tribal populations. Hence, this study was undertaken with the aim to screen for haematological disorders, particularly anaemia and haemoglobinopathies, and to assess the sociodemographic profile in indigenous communities residing in and around Puducherry. Methods: This was a community-based cross-sectional study conducted in both urban and rural areas of Puducherry district. We included 556 participants through convenient sampling. Trained research associates visited community to enrol eligible participants and sought information on sociodemographic parameters, health status, and disease profile, using a structured questionnaire; 2-3 ml of blood was collected in ethylene diamine tetra acid anticoagulant for analysis of haematology parameters. Results: Median age of participants was 28 (17-42) years. Majority (58.8%) of the participants were female, married (52.8%). On thalassemia screening, none of the study participants had any haemoglobinopathy. The burden of anaemia among the study population was 38.7% (95% CI: 34.6-42.8%) and was higher among the female participants in both adolescent (54.5%) and adult (57.8%) age groups. The next common haematological abnormality observed was eosinophilia 21.4% (95% CI: 18-25%), more prevalent among males in the age group of 30-60 years. Conclusion: More than half of the women were anaemic. Multidimensional planning and implementation are needed to improve the socio-economic profile and overall health of this vulnerable population.

Cost-effectiveness of response-adapted therapy (RAT) for advanced Hodgkin's Lymphoma compared with conventional treatment in India: a Markov-model based analysis.

Cost effectiveness analysis of interim positron emission tomography (PET-2, done after 2 cycles of chemotherapy) based response adaptive therapy (RAT) approaches in advanced Hodgkin lymphoma (aHL) are not available from an Indian perspective. We used a five-year decision analytics model to assess the cost-effectiveness of the two RAT approaches [(escalation (RAT-1) or de-escalation (RAT-2)] compared with standard care (SOC) in aHL (mean age:35 years). Modelling data was derived from secondary sources and sensitivity analyses were performed to assess the robustness of the model. Net monetary benefit (NMB) gained from RAT2 in Indian rupees (INR) (INR 2,26,896) was higher than the RAT1 (INR 1,83,138) when compared with SOC. Proportion achieving the complete response after initial treatment (CR1) was the key determining factor for the RAT1/2 dominance over SOC. Despite higher initial input costs, response-adapted therapy of aHL was cost-effective by minimizing the cost incurred and disutility experienced during relapse and salvage.

Despite higher initial costs, response-adapted therapy based on the interim PET scan after 2 cycles of chemotherapy was more cost-effective when compared to standard therapy with 6 cycles of ABVD in patients with advanced Hodgkin's lymphoma. Among the RAT approaches, de-escalation (RAT-2) had better cost-effectiveness than the escalation approach (RAT-1).

Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India.

INTRODUCTION: The World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs. OBJECTIVE: To assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India. METHODS: We developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with ≥10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged ≥40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses. RESULTS: The discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$ 105; ₹ 8,656) and single-stage (US$ 1073; ₹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario. CONCLUSION: In India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels.

Continued tobacco use among tobacco-related head and neck cancer patients seeking care in a tertiary care facility, South India.

INTRODUCTION: Continued tobacco use in cancer patients leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, and an increased risk of cancer recurrence and primary tumours at other sites. OBJECTIVE: To determine the prevalence of continued tobacco usage during the first 6 months of diagnosis among tobacco-related head and neck cancer patients seeking care from a tertiary care centre and the factors associated with it. METHODS: A facility-based cohort study was conducted at a tertiary care centre in Puducherry, India. Newly diagnosed head and neck cancer patients aged > 18 years with a history of tobacco use were interviewed to gather information on their socio-demographic, clinical characteristics, and tobacco usage. All participants were interviewed again at the 3rd month and at the 6th month during their follow-up visit. The data were entered in EpiData v3.1 and analysed using STATA v14. Multivariable logistic regression analysis was done with continued tobacco use as the dependent variable and variables that were found significantly associated with continued tobacco use in univariate analysis. RESULTS: Out of 220 study participants at baseline, 157(71 %; 95 % CI: 65.1-77.1) were using tobacco at the time of diagnosis. Out of these 157 participants, 80(50.9 %; 95 % CI; 43.1-58.7) continued to use tobacco at the 3rd month, 63(40.1 %: 95 % CI: 32.6-47.9) continued to use tobacco at the 6th month. The characteristics significantly associated with continued tobacco use are age (less than 39 years and more than 70 years), primary school education, nuclear family, and living alone, smoking tobacco, and increased duration of tobacco use. CONCLUSION: Two-fifths of head and neck cancer patients with a history of tobacco use continued to use tobacco at the 6th month after diagnosis of cancer. Awareness of effects of tobacco use and the benefits of tobacco cessation needs to be created among cancer patients.

Association of Selected Cardiovascular Markers With Tuberculosis: Community-Based Exploratory Cross-Sectional Analytical Study in Puducherry.

Introduction India accounts for one-fourth of the global tuberculosis (TB) burden and also faces a rising burden of non-communicable diseases. Only a few have studied the association between the infective pathogenesis of TB and cardiovascular diseases (CVD). Methods A cross-sectional exploratory analytical design was used to compare CVD risk factors and immunological and radiological parameters. This was a pilot study conducted in two primary health centers in urban Puducherry between February 2020 and March 2021. Household contacts (HHC) were either spouses or siblings of the newly diagnosed pulmonary tuberculosis (PTB) patients selected for comparison as their exposure to infection would be similar to those who were diseased yet did not develop illness. Assuming a difference of 5% in CVD risk between the general population and TB patients, with a 95% confidence interval, the sample size calculated was 153 in each group by nMaster v2.0. Considering the feasibility and resource constrain, we recruited 50 newly diagnosed PTB patients, their age- and gender-matched 50 HHC and 50 PTB patients who completed treatment a year before. CVD risk factors were compared using chi-square or Fisher exact test. Interleukins-6 (IL-6), interferon-gamma (INF-γ), highly specific - C reactive protein (hs-CRP), and carotid intima-media thickness (CIMT) were compared using ANOVA or Kruskal-Wallis test. Results Most participants from each group belonged to lower socio-economic strata and were males (40/50). Alcohol intake was higher among newly diagnosed and treatment-completed PTB patients (82.5% vs 72.5%). Excess salt intake (58%) was present more in newly diagnosed PTB patients. General and abdominal obesity were seen more among HHC (64% and 84%) and treatment-completed PTB patients (50% and 74%). IL-6 was higher in newly diagnosed PTB patients, whereas INF-γ and hs-CRP were higher in treatment-completed PTB patients. The largest proportion of those having high CIMT values was also in the treatment-completed PTB patients. Conclusion Levels of immune markers hint at the role of inflammation due to TB disease being related to the high CIMT values among the newly diagnosed and treatment-completed PTB patients. CVD risk was higher among TB patients even if they had completed treatment and were declared cured.

Barriers and facilitating factors of postnatal blood glucose monitoring after structured intervention among mothers with gestational diabetes mellitus receiving care from a tertiary health centre, Puducherry - A qualitative study.

BACKGROUND: In India, women with GDM are at an increased risk of developing type 2 diabetes mellitus (T2DM). Despite this, the rate of postnatal blood glucose monitoring is low, and the reasons are not well known. Hence, our study explored the barriers and facilitating factors associated with T2DM postnatal screening six weeks after delivery. MATERIALS AND METHODS: We conducted a qualitative study among 21 mothers with GDM in obstetrics and gynecology department, women and child hospital (WCH), JIPMER, from December 2021 to January 2022. Mothers with GDM were selected purposively between 8 and 12 weeks after delivery to explore the barriers and facilitating factors associated with postnatal screening six weeks after getting mobile call reminders and health information booklet interventions. In-depth interviews were transcribed; manual content analysis with deductive and inductive coding was done. RESULTS: We identified two themes; three categories and subcategories that illustrated barriers and five categories that illustrated facilitators to postnatal blood glucose monitoring. Lack of awareness and misconceptions about GDM, knowledge practice gap, lack of family support, and perception of health system failure by mothers with GDM were barriers to postnatal blood glucose monitoring. Concerns about health, standard advice on postnatal screening, information in health education booklet, mobile reminders, and family support were found to be facilitators. CONCLUSION: We found several barriers and facilitating factors that showed mobile call reminders and booklet interventions had improved postnatal blood glucose monitoring. Our qualitative study has strengthened the findings of the previous RCT, and it would provide more insights to develop further interventions which we must focus on improving postnatal blood glucose monitoring.

The hidden imbalance in neighbourhood nutrition environment: a perspective from lower-middle-income country setting.

Neighbourhood environment plays a pivotal role in determining the individual's nutrition through availability and accessibility of healthy food options. This community-based cross-sectional descriptive study examined neighbourhood spatial attributes using Geographical Information System (GIS) and describe perceived nutrition environment among adult residents in urban Puducherry, India. The density of grocery shops, fruits and vegetable shops, food outlets and restaurants were 64.4, 74.8 and 88.7 per km2, respectively. Out of 200 participants, 191 (95.5%) and 190 (95%) reported easy accessibility to fruits and vegetables shops and restaurants, respectively, while 192 (96%) agreed on availability of unhealthy food options in shops. Current study provides framework for assessment of objective and perceived neighbourhood nutrition environment in lower-middle-income countries with a user-friendly and easily administrable tool.

Effect of a single dose of zoledronic acid on bone mineral density and trabecular bone score in Indian postmenopausal osteoporotic women with and without type 2 diabetes mellitus - A prospective cohort pilot study.

PURPOSE: The objectives were to study the effect of a single dose of intravenous (IV) zoledronic acid (ZA) on changes in bone mineral density (BMD) (lumbar spine (LS), hip, & distal forearm), trabecular bone score (TBS) and bone turnover markers (BTMs) in postmenopausal osteoporotic women with and without diabetes over 12 months. METHODS: Patients were divided into two groups: type 2 diabetes mellitus (T2DM) (n = 40) and non-DM (n = 40). Both groups received a single dose of 4 mg IV ZA at baseline. The BMD with TBS and BTMs (ß-CTX, sclerostin, P1NP) were measured at baseline, six months, and 12 months. RESULTS: At baseline, BMD in all three sites was similar in both groups. T2DM patients were older and had lower BTMs than non-DM patients. The mean increase in LS-BMD (gram/cm2) at 12 months in T2DM and the non-DM group was 3.6 ± 4.7% and 6.2 ± 4.7 %, respectively (P = 0.01). However, the age adjusted mean difference in LS BMD increment between two groups at one year was - 2.86 % (-5.02% to -0.69%), P = 0.01. There was a comparable change in BMD at other two sites, BTMs, and TBS in both the groups over one year follow-up. CONCLUSION: The gain in the LS-BMD was significantly lower in T2DM group compared to non-DM subjects over 12 months after a single IV infusion of 4 mg ZA. The explanation for this could be low bone turnover in diabetes subjects at baseline.

Control status of hypertension in India: systematic review and meta-analysis.

BACKGROUND AND AIMS: Uncontrolled hypertension is a major risk factor for cardiovascular diseases (CVDs). The present study aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of control status of hypertension in India. METHODS AND RESULTS: We carried out systematic search (PROSPERO No.: CRD42021239800) in PubMed and Embase published between April 2013 and March 2021 followed by meta-analysis with random-effects model. The pooled prevalence of controlled hypertension was estimated across geographic regions. The quality, publication bias and heterogeneity of the included studies were also assessed. We included 19 studies with 44 994 hypertensive population, among which 17 studies had low risk of bias. We found statistically significant heterogeneity ( P  ≤ 0.05) and absence of publication bias among the included studies. The pooled prevalence of control status among patients with hypertension was 15% (95% CI: 12-19%) and among those under treatment was 46% (95% CI: 40-52%). The control status among patients with hypertension was significantly higher in Southern India 23% (95% CI: 16-31%) followed by Western 13% (95% CI: 4-16%), Northern 12% (95% CI: 8-16%), and Eastern India 5% (95% CI: 4-5%). Except for Southern India, the control status was lower among the rural areas compared with urban areas. CONCLUSION: We report high prevalence of uncontrolled hypertension in India irrespective of treatment status, geographic regions and urban and rural settings. There is urgent need to improve control status of hypertension in the country.

Protocol for estimating the willingness-to-pay-based value for a quality-adjusted life year to aid health technology assessment in India: a cross-sectional study.

INTRODUCTION: To ensure that the evidence generated by health technology assessment (HTA) is translated to policy, it is important to generate a threshold value against which the outcomes of HTA studies can be compared. In this context, the present study delineates the methods that will be deployed to estimate such a value for India. METHODS AND ANALYSIS: The proposed study will deploy a multistage sampling approach considering economic and health status for selection of states, followed by selection of districts based on Multidimensional Poverty Index (MPI) and identification of primary sampling units (PSUs) using the 30-cluster approach. Further, households within PSU will be identified using systematic random sampling and block randomisation based on gender will be done to select respondent from the household. A total of 5410 respondents will be interviewed for the study. The interview schedule will comprise of three sections including background questionnaire to elicit socioeconomic and demographic characteristics, followed by assessment of health gains, and willingness to pay (WTP). To assess the health gains and corresponding WTP, the respondent will be presented with hypothetical health states. Using time trade off method, the respondent will indicate the amount of time he/she is willing to give up at the end of life to avoid morbidities in the hypothetical health condition. Further, respondents will be interviewed about their WTP for treatment of respective hypothetical conditions using contingent valuation technique. These estimates of health gains and corresponding WTP will then be combined to ascertain the value of WTP per quality-adjusted life year. ETHICS AND DISSEMINATION: The ethical approval has been obtained from the Institutional Ethics Committee (IEC) of Postgraduate Institute of Medical Education and Research, Chandigarh, India. The study outcomes will be made available for general use and interpretation of HTA studies commissioned by India's central HTA Agency.