Experiences and Beliefs on Tobacco Use, Cessation in India: A Qualitative Study.

Background: Almost 80% of global tobacco usage is concentrated in low- and-middle-income countries (LMICs) like India. Added to this, there is dearth of dedicated tobacco cessation specialist services in healthcare settings in these regions. Identification of challenges in the delivery of cessation interventions and understanding the experiences of tobacco users will aid in formulating successful quit strategies. Objectives: This qualitative study in India aimed to understand the perspectives of tobacco-using patients in healthcare facilities regarding tobacco use and cessation. Methods: This qualitative study was conducted in urban and rural areas of four study sites, two each in the North and South India. Using purposive sampling, patients who were tobacco users were selected from healthcare facilities. The interviews were transcribed, coded and organised into themes. Analysis was done using NVivo 10 software. Results: A total of 22 in-depth interviews were conducted on participants aged 23 to 80 years who were either current or past tobacco users. A majority of the participants were aware of their increased health risks associated with tobacco consumption and had attempted quitting; however, barriers such as peer influence, formed habit, certain cultural barriers and the addictive nature of nicotine prevented them from successfully quitting. Familial and peer support, the government's role in spreading public awareness, and limiting the sale of tobacco were stated as facilitators for tobacco cessation. Conclusions: The findings of this study point out that despite awareness of the perils of tobacco among smokers, there are various barriers and beliefs related to tobacco use and cessation. These findings would prove advantageous for policy-makers to implement and promote addiction treatment programmes for successful tobacco cessation efforts. In order to optimise strategies, policies must be well informed by ongoing dialogue between the public, service providers and policy-makers.

Glycemic control and its determinants among people with type 2 diabetes mellitus in Ernakulam district, Kerala.

Background: Diabetes is a public health problem of colossal proportions. The National Family Health Survey 5 (2019-2020) has found high blood sugar levels among 13.5% of women and 15.6% of men in India. The high morbidity and mortality in diabetes mellitus are due to uncontrolled hyperglycemia resulting in micro- and macrovascular changes affecting multiple organs in the body. The objectives of this study were to estimate glycemic control and its determinants among type 2 diabetics in the Ernakulam district. Methods: A community-based cross-sectional study was conducted among 364 type 2 diabetics who had the disease for at least 5 years duration in the Ernakulam district of Kerala. Probability proportional to size cluster sampling technique was adopted. A semi-structured questionnaire was used to collect sociodemographic and behavioral profiles. Participants' HbA1c levels were assessed to determine glycemic control. Results: The proportion of people with good glycemic control was 21.4%. Determinants such as female gender adjusted odds ratio (aOR = 2.36, P = 0.005), body mass index >23 kg/m2 (aOR = 2.71, P = 0.002), combined drug treatment with Oral Hypoglycaemic agents (OHA) and insulin (aOR = 3.76, P = 0.004), and poor compliance with medications (aOR = 1.93, P = 0.030) were found to be significantly associated with poor glycemic control. Conclusions: Poor compliance with medications and unhealthy lifestyle choices has resulted in a high proportion of diabetics with poor glycemic control in the district. Women are particularly more vulnerable to uncontrolled hyperglycemia than males. Type 2 diabetes mellitus people should be encouraged to maintain strict glycemic control, which is an important measure for secondary prevention of complications.

Smegma Pearl in a Circumcised Patient: A Case Report.

Smegma pearls, also called smegmomas, are a natural secretion composed of epithelial cells, protein, and fat. Smegma pearls are not carcinogenic and do not induce damage or irritation. Despite the frequent occurrence of smegma pearls in uncircumcised children, no case among circumcised patients was reported. Here, we are presenting, for the first time, a case of smegma pearl in a circumcised patient. A 36-year-old circumcised male patient presented with a smegma pearl. The purpose of the present case report is to describe the diagnosis of this benign condition in circumcised patients, yet not described in the literature, and help physicians to enhance patient management and avoid needless investigations or treatments.

Experiences and challenges faced by the working population during COVID-19 Lockdown: A qualitative study.

Background: The largest COVID-19 national lockdown was declared on 25 March 2020 in India with a total shutdown of workplaces and transport sectors. A complete lockdown deemed the entire population of the country to stay wherever they were residing at that point of time with no entry or exit movements being permitted thereafter. This unique situation betwixt a menacing health crisis rolled out a scenario uncustomary to the nation`s citizens. The varied responses of the masses to the lockdown need to be captured in order to understand the difficulties and dilemmas faced by them. Hence, this qualitative analysis aimed to capture the immediate challenges and experiences faced by the working population during the first-ever declared nationwide lockdown. Methodology: After obtaining institutional ethical committee clearance, a qualitative study was conducted using grounded theory approach. Using purposive sampling, people representative of the working-class population in Kerala were selected from three districts of the state. Equal representation of males and females were maintained. In-depth interviews were conducted via telephone using an interview guide till data saturation was obtained. The audio recorded data were later transcribed verbatim and translated to English. The transcripts were then manually coded to identify the emerging themes and subthemes and conclusions were drawn after triangulation. Results: The age of the study participants ranged from 32 to 71 years, they were occupied in different vocations and belonged to middle-class families across three districts of Kerala. All of them were aware and were mentally prepared for a national lockdown. They also made arrangements such as purchase of food, drinking water, medicines, etc., for home but also for office as well. Even though most of them were initially excited about the lockdown it was then followed by fear of contracting the disease, worries about loss of work and financial security. The study participants identified the advantages of lockdown as having more time for self & for family, use of the online/digital medium for routine activities and many also appreciated the support provided by the government in the form of food kits and loans. The lockdown was found to have increased the workload especially for women who had to manage not only family but also online work from home. Conclusion: The study was able to capture the different experiences and challenges faced by the middle-class working population. Even though they went through a cascade of initial excitement followed by fear of contracting the disease, it eventually turned into concerns of job and financial insecurities. The united frontline work of various sectors like police, health sector, local self-government, Kudumbashree and voluntary groups collectively aided in building community resilience enabling the southern state of Kerala to overcome the devastating effects of the pandemic and lockdown.

Pattern of contraceptive use, determinants and fertility intentions among tribal women in Kerala, India: a cross-sectional study.

OBJECTIVES: To assess the pattern of contraceptive use and its determinants, knowledge regarding contraceptives including oral contraceptive pills and fertility intentions among tribal women in the reproductive age group. DESIGN: Community-based cross-sectional study. SETTING: Community development blocks in a predominantly tribal district of Wayanad in Kerala, India. PARTICIPANTS: Women in the reproductive age group (15-49 years) from the tribal groups in the district numbering 2495. OUTCOME MEASURES: PRIMARY: Prevalence of contraceptive use and its determinants. SECONDARY: Knowledge regarding contraceptives in general, oral contraceptives and fertility intentions. RESULTS: The mean age of the study participants was 30.8 years (SD=9.8) and belonged to various tribal groups such as Paniya (59.2%), Kurichiyar (13.6%) and Adiya (10.9%). Current use of contraceptive was reported by about a fourth, 658 (26.4%) (95% CI 27.9 to 24.9) of women. Following logistic regression, belonging to Paniya tribe (adjusted OR (aOR) 2.67, 95% CI 1.49 to 4.77; p<0.001) and age at menarche >13 years (aOR 1.69, 95% CI 1.14 to 2.52; p<0.009) had significantly higher use of contraceptives whereas social vulnerability as indicated by staying in a kutcha house had a lesser likelihood of use of contraceptive (aOR 0.55, 95% CI 0.31 to 0.95; p<0.03). Oral contraceptive use was low (4.8%) among this population and no abuse was observed.Less than half (47%) of the respondents had an above average knowledge on contraception. Multivariable logistic regression indicated that above average knowledge was 2.2 times more likely with higher education (95% CI 1.2 to 3.9), lesser among those who desired more than two children (aOR 0.59; 95% CI 0.38 to 0.94; p<0.02).Two children per family was the preferred choice for 1060 (42.5%) women. No gender bias in favour of the male child was observed. CONCLUSION: Awareness and use of contraceptives are poor though the fertility is not commensurately high. Along with developing targeted responses to contraceptive use among Indigenous people with indigenous data, awareness also requires attention. Ethnographic studies are also necessary to determine the differences in contraceptive use including traditional methods among the various Indigenous groups.