Perception and Practices Regarding Stubble Burning in Rural Community of Haryana.

Background: Agricultural emissions pose significant health risks, especially in countries like India with abundant agricultural waste. This study focuses on understanding stubble burning perceptions and practices in rural National Capital Region to inform targeted interventions for sustainable farming practices and improved public health. Methods and Material: This community-based cross-sectional study was conducted among the randomly selected households of rural Ballabgarh, Haryana. A pre-tested, semi-structured questionnaire was used to obtain information on perception and practices on stubble burning. Data were collected in Epicollect 5 and analyzed in STATA 14. Results: Of the 2000 households approached, 1813 responded with a response rate of 90.7%. Around 53% of the study participants believed that vehicular pollution is the main reason for air pollution, and 90% of them were unaware of the Government schemes related to stop stubble burning and with respect to the practices of stubble disposal. Around 70% of the participants mentioned that respiratory illness is the most severe effect of air pollution. Conclusion: The public was mostly unaware of the government's efforts to reduce stubble burning. Health promotion initiatives must be carried out to raise community knowledge about the programs available to combat stubble burning, therefore decreasing air pollution and its health implications.

Prevalence of anaemia among adolescent girls (10-19 years) in India: A systematic review and meta-analysis.

Background Anaemia is a serious public health problem. It is the second-commonest contributing factor to years lost by adolescents to disability and death. Targeting adolescent girls will allow a window of opportunity to correct their nutritional health and improve their obstetric outcomes. Studies in India have reported varying prevalence rates of anaemia among adolescent girls. Hence, we did a systematic review and meta-analysis of community-based studies to obtain a comprehensive pooled estimate of the prevalence of anaemia among adolescent girls in India. Methods We did a systematic electronic search in PubMed, Embase, Cochrane Library and Google scholar to retrieve community-based studies that reported the prevalence of anaemia among adolescent girls (10-19 years) in India, without any date or language restriction. To estimate the pooled prevalence and heterogeneity, the random-effects model and I2 statistical methods were used. We did subgroup analyses based on geographical region, study setting, method used to measure haemoglobin concentration, and year of publication. Results We included 35 studies in this meta-analysis comprising 152 640 participants. The pooled prevalence of anaemia among adolescent girls was 65.7% (95% CI 59.3%- 71.9%). There was significant heterogeneity between the studies (I2 99.6%; p<0.001). Conclusion There is a high prevalence of anaemia among adolescent girls in India. While all regions of the country have a high prevalence, tribal areas need special attention. Targeted actions need to focus on the identification of determinants of anaemia apart from iron supplementation.

Is it a challenging task to work with personal protective equipment in a COVID-19 ICU: Findings from a hospital-based cross-sectional study from north India.

Introduction: Amidst the coronavirus disease 2019 (COVID-19) pandemic, the use of personal protective equipment (PPE) is mandatory for healthcare workers to remain protected against infection. The present study was undertaken to evaluate challenges faced by the healthcare workers while using level 3 PPE. Methods: This hospital-based study was conducted among resident doctors selected by convenience sampling method using a pretested, semi-structured, self-administered questionnaire after getting informed consent from the participants to collect data on the somatic, psychological, and technical problems faced while working in PPE. Bivariate and multivariable logistic regression was done between outcome variables and other independent variables to check for the association. Results: Of the total, 252 resident doctors completed the survey, their age ranged from 22 to 36 years with 140 (55.6%) males and 112 (44.4%) females. One-twenty-nine (51.2%) residents were trained to work in ICU, 73 (29%) participants used PPE ≤10 times and the rest 179 (71%) used PPE more than 10 times. The difficulties faced were as follows: visual impairment (n = 244, 96.8%), headache (n = 226, 89.6%), breathing difficulty (n = 216, 85.7%), hearing impairment (n = 201, 79.8%), sweating (n = 242, 96%), and fear of being infected (n = 156,61.9%). Two-thirty-six (93.6%) participants felt that overall work quality reduced due to PPE. Headache, hunger, urge to micturate, anxiety, sleep disturbances, and need to change the timing of medication or diet were higher with increased duration of work with PPE. Conclusion: A longer duration of work is associated with headache, hunger, anxiety, and sleep disturbances. More research has to be done to improve the PPE to reduce problems like visual impairment, skin irritation, sweating, and breathing difficulty.

Prevalence of asthma among children in India: A systematic review and meta-analysis.

There is a lack of national-level estimates on the magnitude of asthma among children in India. Hence, we undertook a systematic review and meta-analysis to estimate the prevalence of asthma among children in India. We searched PubMed, Embase, Cochrane Library, and Google Scholar, and included cross-sectional studies reporting data on the prevalence of asthma among children in India. A random-effects model was used to estimate the pooled prevalence of asthma. In the 33 selected studies (pooled sample of 167,626 children), the estimated prevalence of asthma was 7.9% (95% confidence interval: 6.3-9.6%), I2 = 99.1% (P < 0.001). The prevalence was higher among boys and in urban areas. Appropriate training and resources should be made available at the primary healthcare level for early detection and management of asthma in children. A nationwide population-based survey is indicated to provide reliable estimates of the burden of asthma.

Prevalence and Factors Associated with Hypertension among Community-Dwelling Adolescents in a Rural Area of Haryana, India, Using AAP 2017 and NHBPEP Criteria.

OBJECTIVE: To estimate the prevalence and determinants of hypertension among adolescents in a rural area in North India. METHODS: This was a cross-sectional study conducted among community-dwelling adolescents (10-19 y) and defined blood pressure as per the National High Blood Pressure Education Program (NHBPEP) and American Academy of Pediatrics (AAP) 2017 criteria. A pretested, semistructured questionnaire was used to elicit sociodemographic details and risk factors of hypertension. Association of factors with hypertension, z scores of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were assessed by logistic and linear regression. In multivariable regression model, for both logistic and linear regression, variables with p value < 0.2 were included, excluding collinear variables. RESULTS: Eight hundred sixty-four adolescents participated with mean (SD) age, BMI of 14.0 ± 2.6 y, 18.3 ± 3.5 kg/m2. Hypertension prevalence was 22.5% (95% CI: 19.7, 25.5) as per AAP and 15.2% (95% CI: 12.9, 17.8) as per NHBPEP criteria. Being hypertensive as per the AAP was associated with family history of noncommunicable disease (NCD) (adjusted odds ratio, AOR 1.80, 95% CI: 1.11, 2.86) and BMI (AOR = 1.09, 95% CI: 1.04, 1.14), and as per the NHBPEP, was only associated with BMI (AOR = 1.11, 95% CI: 1.05, 1.17). SBP z score was significantly associated with male sex (adjusted beta coefficient AC = 0.79, 95% CI: 0.69, 0.90), and weight z scores (AC = 2.00, 95% CI: 1.22, 3.28); DBP z score was significantly associated with z scores of height (AC = 0.70, 95% CI: 0.51, 0.96) and waist (AC = 1.15, 95% CI: 1.02, 1.30). CONCLUSION: The prevalence of hypertension among adolescents was high and was associated with BMI and family history of NCD.

Effectiveness of Visual Inspection with Acetic Acid (VIA) Screening on Cervical Cancer Mortality and Incidence - A Systematic Review and Meta-Analysis.

OBJECTIVES: Despite being a cheap, easy, and commonly used technique for screening early development of cervical cancer, collective evidence on the effect of visual inspection with acetic acid (VIA) for reducing cervical cancer mortality and incidence are conflicting. We conducted a systematic review and meta-analysis to determine the effectiveness of VIA screening on cervical cancer mortality and incidence. METHODS: We searched PubMed, Embase, Cochrane library (Cochrane Database of Systematic Reviews & Cochrane Central Register of Controlled Trials), World Health Organization's (WHO) International Clinical Trials Registry Platform, and Google Scholar to identify studies conducted among women with no history of cervical cancer that assessed effectiveness of VIA on the cervical cancer mortality and incidence. Random effects model was used to estimate incident rate ratio and sensitivity analysis was conducted using Bayesian methods. RESULTS: Of the included 4 studies, three were cluster randomized trials from India and one was quasi-experimental study done in Thailand. Duration of follow-up ranged from 7 to 12 years. Based on 3 trials, pooled rate-ratio for cervical cancer mortality and all-cause mortality was 0.68 (95% CI: 0.56-0.81, I2=0%) and 0.91 (0.85-0.97, I2=57%), respectively. Pooled rate-ratio of invasive cervical cancer was 0.94 (95% CI: 0.67 - 1.30, I2=84%). Likewise, there was non-significant reduction in incidence of stage IB, >=stage II, and unknown stage cervical cancer. CONCLUSIONS: VIA screening may lead to reduction in cervical cancer and all-cause mortality in long run. However, the effectiveness of VIA in preventing invasive cervical cancer is inconclusive.

Validating the use of U-tool as a novel method for measuring the corneal diameter in infants screened for congenital glaucoma.

PURPOSE: The Castroviejo caliper is routinely used for measuring the corneal diameter in patients with primary congenital glaucoma, but needs an examination under anesthesia (EUA) or sedation. A simple U-shaped tool was devised to aid in the estimation of the corneal diameters of patients in settings where an ophthalmic caliper is not available or EUA is not feasible. METHODS: Infants presenting to the congenital glaucoma clinic posted for EUA were recruited. The demographic details of the patients such as age, sex, and diagnosis were noted. A simple U-shaped tool was devised using three Schirmer strips or a printable ruler. Before the patient underwent a EUA, the corneal diameters were measured using the U-tool. During EUA, corneal diameters were measured using the Castroviejo caliper. RESULTS: The mean age of infants was 6.7 ± 3.39 months (R = 1-12). The mean corneal diameter measured using the U-tool was 13.29 ± 1.33 mm and with Castroviejo caliper was 13.18 ± 1.39 mm. The difference between the corneal diameters measured using the two techniques was -0.114 mm with the Bland-Altman plot 95% Limits of agreement (LoA) from -0.965 to 0.737 mm. Corneal diameters measured with both instruments had a good correlation (Pearson's correlation coefficient = 0.95, P < 0.001). CONCLUSION: U-tool can be used for screening congenital glaucoma by first-contact physicians or optometrists. It can also be used by ophthalmologists when EUA is delayed.

Prevalence of chronic obstructive pulmonary disease in India: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide. There is a lack of national-level estimates on the magnitude of COPD in India. Hence, we estimated the prevalence of COPD among adults in India. METHODS: We searched PubMed, Embase, Cochrane Library, Google Scholar, and Scopus and included community-based cross-sectional studies reporting data on the prevalence of COPD among adults based on spirometry. A random-effects model was used to estimate the pooled prevalence of COPD. RESULTS: In the eight identified studies, (pooled sample of 8,569 individuals), the estimated prevalence was 7.4% (95% confidence interval: 5.0%-9.8%), I2 = 95.4% (P < 0.001). The prevalence was higher among males, in the urban area, and the northern region. CONCLUSION: Adequate training and resources should be provided to diagnose COPD at primary health care level for early management. A nationwide population-based survey is indicated to provide reliable estimates of the burden to inform evidence-based community-based interventions.

A rapid review of pre-exposure prophylaxis for HIV in the Asia-Pacific region: recommendations for scale up and future directions.

Decline in new HIV infections in the Asia-Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines; for the latter, we also did an expanded Internet search. This review focussed on nine countries contributing >95% of new infections in this region. A total of 36 PrEP-related studies conducted among men who have sex with men, female sex workers, and transgender women were included, of which 29 were quantitative, six were qualitative and one was a mixed-method study. Most of the studies have addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. Limited published information was available about national PrEP policies and guidelines; of the selected nine countries, five have adopted the recommended World Health Organization PrEP policy of which four have integrated it in their national HIV response. HIV risk perception concerns about safety, side-effects, stigma, and affordability were major challenges to PrEP acceptance. Community-based implementation has the potential to address these. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. To stem the epidemic, newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.

Prevalence of hypertension among adolescents (10-19 years) in India: A systematic review and meta-analysis of cross-sectional studies.

BACKGROUND: Despite the well-known short-term and long-term ill effects of elevated blood pressure in children and adolescents, pooled data on its burden among Indian adolescents have not yet been synthesized. OBJECTIVES: We did a systematic review with meta-analysis to calculate the pooled prevalence of hypertension among adolescents (10-19 years) in India. METHODS: We searched PubMed, Embase, Cochrane library, Google Scholar and IndMed, and included cross-sectional studies reporting data on hypertension prevalence among 10 to19 years old and published in English language from their inception till 1st March 2020. Modified New castle Ottawa scale was used to assess risk of bias based on research design, recruitment strategy, response rate and reliability of outcome determination. A random effects model was used to estimate pooled prevalence, and heterogeneity was assessed using Cochrane's Q statistic test of heterogeneity and I2 statistic. To explore the heterogeneity, we did a meta-regression, and sub-group analyses based on region, study setting and number of blood pressure readings. RESULTS: Out of 25 studies (pooled sample of 27,682 participants) six studies were of high, eighteen of moderate, and one was of low quality. The prevalence of hypertension across studies ranged from 2% to 20.5%, with a pooled estimate of 7.6% (95% CI: 6.1 to 9.1%), I2 = 96.6% (p-value <0.001). Sub-group analysis restricted only to the western India demonstrated a smaller heterogeneity (I2 = 18.3%). In univariate model of meta-regression, diagnostic criteria was significantly associated with pooled prevalence (-4.33, 95%CI: -7.532, -1.134). CONCLUSION: The pooled prevalence of hypertension among adolescent in India is 7.6% with substantial heterogeneity between the studies. To tackle the high prevalence of hypertension among adolescents, early detection by screening under school health programme and opportunistic screening at Paediatric OPD should be implemented by Policy makers.