Preloaded combination nicotine replacement therapy for smoking cessation in Kazakhstan: A randomized controlled trial study protocol.

BACKGROUND: Tobacco use is a major cause of premature death and disease in Kazakhstan, with over 22,500 deaths per year. Although efforts have been made to control tobacco use, smoking-related deaths have continued to increase. One strategy to help smokers quit is to use nicotine replacement therapy (NRT), with combination NRT resulting in higher long-term quit rates than a single form of NRT. A study aims to determine the effectiveness of preloaded combination NRT on smoking cessation, the change in health-related quality of life due to smoking cessation, and explore treatment adherence perceptions. METHODS AND ANALYSIS: The study will be conducted as a randomized, single-blind superiority trial, with 100 participants in each arm. The trial will be carried out at the National Research Cardiac Surgery Center, Astana, Kazakhstan, and will recruit current smokers aged 18 years and above with a motivation to quit. Participants will be randomly allocated to either the intervention group or the control group. The former will receive preloaded combination NRT, while the latter will receive fast-acting NRT alone. The primary outcome measure will be sustained abstinence from smoking after six months. Secondary outcome measures will include health-related quality of life and adherence to the treatment. DISCUSSION: The study may gather further evidence that a combination NRT is more efficient than a fast-acting NRT alone. The findings of this study may help to improve tobacco cessation strategies in Kazakhstan and other countries with high smoking prevalence rates. TRIAL REGISTRATION NUMBER: NCT05484505.

Out-of-pocket expenditure on non-communicable diseases during Covid-19. A cross-sectional study from a semi-urban area of Kannur, Kerala.

Introduction: Non-communicable disease (NCD) care was drastically affected during the COVID-19 pandemic. Therefore, this study aimed to estimate the cost incurred for NCD care during the pandemic and also to compare the cost of care of private and public facility utilizers. Methods: This community-based cross-sectional analytical study was conducted among 316 individuals aged 30 years and above from selected primary care facility service areas in Kannur district, Kerala. The total cost of illness for all NCDs was calculated from the patient's perspective and was estimated using a bottom-up approach. Direct, indirect, and total costs were summarized using the median with IQR. A median regression analysis was done to find the factors associated with total cost. Results: The total median direct medical cost was ₹400.0 (120-2360.0), and the total median direct non-medical cost was ₹720.0 (300.0-1200.0). The total median cost of NCD care was ₹1200.0.0 (200.0-3990.0). There was a significant association between the place of NCD service utilization and cost. The cost of availing care from private [₹2497.5 (455.0-6490.0)] was much higher compared to public facilities [₹120.0 (0-1000.0)]. Conclusion: The expenditure on NCD care during COVID-19 was high and for a private facility utilizer, it was much higher compared to a government facility utilizer. Strengthening the services through subcentres can reduce travel expenses, hence the non-medical cost of NCD care.

Prevalence and factors associated with utilization of ayurvedic drugs during COVID-19. A community-based cross-sectional study.

Background: COVID-19 pandemic emerged as a major public health emergency. Ayurvedic medicines are not generally considered as conventional medicine. Hence, we aimed to assess the prevalence of utilization of Ayurveda as prophylaxis for COVID-19 during the pandemic, factors associated with utilization, and willingness to use Ayurvedic medicines in future prospects. Methods: This cross-sectional analytical study was conducted in urban Bengaluru, India from April to May 2022. The sample size of the study was 427. Systematic random sampling was done and data were collected using a validated semi-structured questionnaire. Results: The mean (SD) age of the participants was 38.9 (±14.08) years. The proportion of utilization of ayurvedic medicines was 22.5% (n = 96, 95% CI 18.6-26.7) and social class was significantly associated with non-utilization (p = 0.042). Among the utilizers, 66% of them used Ayurvedic medicines for prevention/post-COVID ailments. More than half (55%, 95% CI 49.7-59.4) of the individuals were willing to use Ayurvedic medicines in the future and level of education was associated with unwillingness (p=0.010). Conclusion: Nearly three-fourth of the participants were not utilized Ayurvedic medicines during COVID-19 pandemic. Strengthening ayurvedic services and improving awareness may increase the utilization in the community. An integrated health system approach at the policy level is pivotal in mainstreaming Ayurvedic medicines.

Down referral and assessing comprehensive diabetes care in primary care settings: An operational research from India.

BACKGROUND AND AIMS: In this study, we aimed to refer eligible (patients with stable blood sugar and without any history of cardiovascular events or proliferative retinopathy) and willing persons with diabetes (PwDs) to primary healthcare centers (PHCs) from tertiary care and to compare the care indicators. METHODS: This before-after interventional study was conducted among PwDs aged ≥18 years at a tertiary care hospital in South India. Care indicators (regularity to the clinic, waiting time, and blood sugar control status) were assessed before down referral and after three months of follow-ups at PHCs. RESULTS: Of 204 PwDs referred to PHCs. Among them, 88% (n = 180) registered at PHCs for care and 46% (n = 94, 95% CI 39.1-53.2%) were lost to follow-ups at PHCs. The main reason for loss to follow-ups was the unavailability of medicines at PHCs(n = 41, 44%). Among those who were on regular follow-ups at PHCs, there was no significant difference in fasting blood glucose (FBG) control status compared to tertiary (52%-64.6%, p = 0.083). However, there was a significant improvement in the regularity of clinic visits (75% vs. 100%, p < 0.001), consultation waiting time (90 vs. 60 min, p = 0.028), and waiting time at pharmacy queues (120 vs. 30 min, p < 0.001) between tertiary care and PHCs. However, among those registered at PHCs, only 40.6% (n = 73, 95% CI 33.3-48.1) were willing to continue care at PHCs for their diabetes management. CONCLUSION: Primary care was better than tertiary care in terms of PwD's regularity of clinic visits and waiting time for care.

Telemedicine Awareness and the Preferred Digital Healthcare Tools: A Community-based Cross-sectional Study from Rural Karnataka, India.

Background: The Indian government launched national teleconsultation services (eSanjeevani OPD) to provide safe doctor-to-patient consultations. This study aimed to determine the awareness and willingness to seek services from eSanjeevani OPDs. Material and Methods: This is a cross-sectional descriptive study conducted in Nandigudi village, Karnataka. The total sample size was 273, and participants were recruited using a systematic sampling technique. Results: The prevalence of awareness about teleconsultations was 2.2% (n = 6, 95% CI: 0.8-4.7%). None of the participants utilized eSanjeevani services in the last year. Approximately 56.0% (n = 153, 95% CI: 49.9-62.0%) were willing to use eSanjeevani OPD. "Not being familiar" (n = 99, 82.5%) with eSanjeevani OPD was the major reason for unwillingness to use teleconsultation, and 73.8% (n = 113) preferred video calls as the mode of communication. Conclusion: The majority of the participants were not aware of and were unwilling to use eSanjeevani OPD. Therefore, healthcare professionals should focus more on creating awareness of teleconsultations.

A Comparative Analysis of Microscopy, Coproantigen Serology, and Nested Multiplex PCR in the Laboratory Diagnosis of Entamoeba histolytica Infection.

Objectives Amoebiasis is caused by the most common intestinal protozoan parasite Entamoeba histolytica . This parasite causes amoebic colitis, which is manifested by diarrhea, followed by dysentery. The laboratory diagnosis of intestinal amoebiasis in most cases is by microscopic examination of stool samples. Other nonroutine methods include coproantigen enzyme-linked immunosorbent assay (ELISA) from stool samples, serum ELISA for antibodies, stool culture, isoenzyme analysis, and polymerase chain reaction (PCR). The present study aimed to comparatively analyze the different diagnostic modalities used for the detection of E. histolytica from the stool sample of patients with intestinal amoebiasis. Materials and Methods This study was undertaken with 631 patients, during a period of 3 years, from January 2017 to December 2019. Stool specimen obtained from each patient was subjected to direct microscopic wet mount examination, coproantigen ELISA, and nested multiplex PCR, respectively. Results Out of all the patients tested, 5.2% were positive for E. histolytica. Among the positive cases, stool microscopy was positive in 3.17%, coproantigen ELISA was positive in 29 (4.6%) cases, and PCR was positive in 30 (4.75%) cases. Statistical Analysis The prevalence of E. histolytica infection was summarized as percentages. The three diagnostic tests done were statistically analyzed, taking microscopy as the gold standard. The agreement between techniques (microscopy, coproantigen ELISA, and PCR) was analyzed with kappa statistics. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were summarized as percentage with 95% confidence interval. Conclusion In all suspected amoebiasis cases, a combination of stool microscopy, coproantigen testing with molecular detection of the parasite offers the best approach to diagnosis of this parasitic infection.

Alcohol use among adult men and its impact on personal and family life: findings of a community-based cross-sectional survey and focus groups discussions from a low alcohol taxed region, Puducherry, India.

BACKGROUND: There is limited published literature on the impact of alcohol use among alcohol dependents and their family members. OBJECTIVES: To find the factors associated with alcohol use and explore the impact of alcohol use on alcohol dependents and their family members. METHODS: A cross-sectional analytical study was conducted among 316 men aged above 18 years, and four focus group discussions (FGDs) were conducted among alcohol dependents and their family members. A validated semi-structured questionnaire was used. RESULTS: The mean (SD) age of the study participants was 45.2 (15.1) years, and 276 of them (87.3%) were educated. The prevalence of alcohol use was found to be 38% [95% confidence interval (CI) = 32.8-43.4]. Older age [adjusted prevalence (APR) = 2.23 (95% CI = 1.17-4.27)], no formal education [APR = 1.20 (95% CI = 1.20-1.20)], rural residence [APR = 1.05 (95% CI = 1.05-1.05)], self-reported comorbidities [APR = 1.21 (95% CI = 1.21-1.21)], tobacco use [APR = 2.42 (95% CI = 1.98-2.97)] and individuals having a family history of alcohol use [APR = 2.42 (95% CI = 1.73-3.37)] were the factors associated with alcohol use. The family members of alcohol users suffer mainly mental, emotional and physical abuse. Abusive language used by the alcoholic father and family break-ups have an influence on children and in their schooling. CONCLUSIONS: Prevalence of alcohol use in a low alcohol taxed region in India was high. The family members of alcohol users mainly suffer mental, emotional and physical abuse.

Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?

BACKGROUND: In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs). METHODS: We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as 'eligible' for primary care management. RESULTS: Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3-48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR = 1.16), people with diabetes for more than 10 years (APR = 1.23), and the presence of comorbidities (APR = 1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness. CONCLUSIONS: About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.

Determinants of Nutritional Status among Under-Five Children in the Tribal Population of The Nilgiris, Southern India: A Cross-Sectional Study.

BACKGROUND: The tribal populations in The Nilgiris of Tamil Nadu are identified as particularly vulnerable tribal groups (PVTGs) and are "high risk" in terms of health and nutrition. OBJECTIVES: The objective of the study is, among the under-five tribal children, to determine the prevalence of undernutrition and the factors associated with it. MATERIALS AND METHODS: This community-based cross-sectional study was conducted between March and June 2019 among 605 under-five tribal children. The prevalence of underweight, stunting, and wasting was expressed as proportion; the association with determinants was assessed using log-binomial regression model. RESULTS: The prevalence of underweight, stunting, and wasting was 63% (95% confidence interval [CI] 57-70), 62% (95% CI 54-70), and 31% (95% CI 24-38), respectively. Among them, 29%, 35%, and 10% were severely underweight, stunted, and wasted, respectively. Among 605 participants, 80% utilized supplementary nutrition program of the Integrated Child Development Services; only 21% of whom utilized it as per the ICDS recommended quantities prescribed for different category of beneficiaries. Male child, age >2 years, and illiteracy of father were significantly associated with underweight. Age >2 years and illiteracy of mother were significantly associated with stunting. Male child and low family income were significantly associated with wasting. CONCLUSION: Nearly three out of four children in the community were undernourished. Poverty alleviation programs are required to combat undernutrition among backward communities.

Effect of satapushpa churnam with tila tailam in oligomenorrhea associated with polycystic ovarian syndrome.

BACKGROUND: Current medical intervention of Polycystic Ovarian Syndrome (PCOS) mainly includes hormonal therapies which have long-term health consequences. OBJECTIVE: This study aimed to evaluate the effect of natural drug satapushpa (Anethum sowa Kurz.) powder with tilatailam (sesame oil) as anupanam (vehicle) in oligomenorrhoea associated with PCOS. MATERIALS AND METHODS: A single-group, before and after intervention study in the outpatient department and inpatient department of Government Ayurveda teaching hospital for women and children was done among women aged 18-35 years. Individuals diagnosed with oligomenorrhoea for more than three consecutive menstrual cycles and fulfilling Rotterdam's criteria of PCOS were included. Six grams of powder was given morning and evening along with 12 ml of tilatailam for three months. Effectiveness was assessed at 3rd and 6th months. RESULTS: A total of 30 patients were recruited; the mean (SD) age was 22.6 (3.9) years. Majority were students (86.7%), residing in urban areas (60%), and unmarried (80%). Almost one-third of the participants had kapha-vata prakriti. There was no significant change in menstrual duration and amount of bleeding. However, a significant reduction in the menstrual interval was observed after three months of treatment (p = <0.001). Similarly, the median interquartile range (IQR) volume of the right ovary was reduced from 10 (7.2-14.8) to 5.3 (4.7-7.6) cm3 (p=<0.001), and the median (IQR) volume of the left ovary reduced from 9.1 (6.7-11.9) to 5.1 (4.6-7.1) cm3 (p=<0.001). CONCLUSION: Treating PCOS using satapushpa powder and tilatailam for three months effectively regularizes the menstrual interval and reduces ovarian volume.

Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India.

In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.

'I was scared I will end up in another abortion': a mixed-methods study assessing the impact of COVID-19 pandemic and lockdown on the antenatal care of pregnant women in Puducherry, South India.

BACKGROUND: As a mitigation measure for COVID-19 pandemic, lockdown was implemented in India for a period of 2 months (24 March-31 May 2020). Disruption in antenatal care (ANC) provisions during lockdown is expected due to diversion of public health facilities on pandemic. OBJECTIVE: To assess the proportion of pregnant women who had not completed the ideal number of antenatal visits, availability of iron-folic acid (IFA) supplements and challenges in availing health services during the period of lockdown. METHODS: A concurrent mixed-methods study was conducted among pregnant women in Puducherry, India. Information on obstetric characteristics and details regarding antenatal visits were collected through telephonic interviews. In-depth interviews were conducted to understand the perceived challenges in availing health services during the lockdown period. RESULTS: Out of 150 pregnant women, 62 [41.3%; 95% confidence interval (CI) 33.6-49.3] did not complete the ideal number of visits and 61 (40.7%, 95% CI 32.7-49.0) developed health problems. Out of 44 women who received medical care for health problems, 11 (25%) used teleconsultation. Of all the women, 13 (8.7%, 95% CI 4.9-14.0) had not taken the IFA supplements as prescribed by the health provider. Economic hardship, restricted mobility, lack of information about the health system changes and psychological stress due to the fear of COVID were the challenges in accessing care. CONCLUSIONS: Two out of five pregnant women did not complete the ideal number of visits and developed health problems during the lockdown period.

Preference on prenatal sex determination and its associated factors among currently married women of reproductive age group in Puducherry, India.

BACKGROUND: Sex determination refers to knowing the sex of foetus during prenatal period for non-medical reasons. Attitude of married women to sex determination is important to improve the sex ratio at birth. AIM AND OBJECTIVES: This study aimed to assess preference on sex determination and associated factors among currently married reproductive age group women. MATERIALS AND METHODS: This cross-sectional community-based study was done during 2016-2017 among 2228 currently married women of 18-49 years' age group in urban and rural Puducherry, India. Information on the demographic characteristics, level of awareness and preference for sex determination was obtained. Multiple logistic regression was used to identify factors influencing preference for sex determination. Unadjusted and adjusted odds ratio (AOR) as a measure of effects was used. RESULTS: Of 1979 respondents, all were aware that sex determination is possible. Majority of them did not prefer sex determination (95.4%, 1888). About 80 (4.0%) preferred, while 11 (0.6%) were undecided about it. Majority of them were aware that sex determination without medical indication is a crime. Common source of information was healthcare workers (76.4%). After adjusting for confounders, age group (18-24, AOR = 5.334; 25-29, AOR = 3.249; 30-34, AOR = 3.857; 35-39, AOR = 2.279), middle level education (AOR = 2.3), those with unmet need for family planning (AOR = 2.970) and urban area (AOR = 67.679) subjects were preferred more; housewife (AOR = 0.481) and those without living son (AOR = 0.406) had preferred lesser for sex determination compared to their counterparts. CONCLUSION: About one in 25 currently married women preferred sex determination. It is comparatively more in urban areas. High-risk groups should be educated to develop correct awareness and attitude on prenatal sex determination.

Quality of life and its determinants among sewage workers: A cross-sectional study in Puducherry, South India.

BACKGROUND: There is a paucity of information on sewage worker's quality of life (QoL). Hence, we aimed to assess the QoL and its associated factors among sewage workers in Puducherry, coastal south India. MATERIALS AND METHODS: A total of 210 sewage workers were included in the study. QoL was assessed using a validated Tamil version of WHO QoL-BREF. The association of QoL with age, educational status, residence area, self-reported chronic illness, use of protective measures, tobacco and alcohol use was assessed by univariate analysis. Multiple linear regression analysis was used to assess the independent factors associated with QoL. RESULTS: Overall mean (standard deviation) score of QoL was 56.9 (9); mean score of social relationship domain was comparatively lower than physical, psychological and environmental domains. Current tobacco and alcohol uses were 17% and 67%, respectively, while alcohol use during work (entering sump) was 5%. At least one morbidity was present among 94 (45%) subjects. About half (47%) used at least one protective measure while entering the drainage sump. Age group above 50 years, below primary level education, presence of chronic illness, smokers and alcohol users had significantly lower QoL score. CONCLUSIONS: Social relationships' domain of QoL was very low among sewage workers. The majority of them do not use any personal protective devices and almost half had chronic illnesses.

Non-exclusive breastfeeding amongst high-risk children: Factors and barriers associated with non-exclusive breastfeeding at a tertiary care hospital in Southern India.

BACKGROUND: In the first 6 months of life, non-exclusive breastfeeding (NEBF) is estimated to be the cause of 1.4 million deaths worldwide and contributes to 10% of the disease burden in under-five children. AIMS AND OBJECTIVES: The objective of the study was to determine the prevalence of NEBF amongst the high-risk children and the factors associated with NEBF. METHODS: This cross-sectional study was conducted amongst high-risk babies admitted between August 2016 and February 2018 who also attended the high-risk follow-up clinic at the neonatology department. Data were collected using a pre-tested structured questionnaire. Chi-square test was used to determine the factors associated with NEBF and prevalence ratios (PR) with 95% confidence interval (CI) were calculated. RESULTS: Amongst 304 children, 56.3% were male and 87% had birth weight <2500 g. Nearly three-fourth of the mothers were <30 years of age. The prevalence of NEBF was 49.3% (95% CI: 43.7-55.0). There was a significant association of NEBF with employment status of the mother (PR = 1.45; 95% CI: 1.1-1.9), NEBF in previous child (PR = 2.3; 95% CI: 1.4-3.9) and EBF at the point of discharge (PR = 2.3; 95% CI: 2-2.6). The barriers reported by the mothers leading to NEBF were insufficient or less milk secretion, poor breastfeeding attachment, perceived thirst and poor maternal health. CONCLUSION: One out of every two children admitted in neonatal intensive care unit were non-exclusively breastfed before 6 months of age. The employment status of mother, practice of exclusively breastfeeding the previous child and EBF at the time of discharge were significantly associated with NEBF.

Predictors of Suicidal Ideation and Attempt among Patients with Major Depressive Disorder at a Tertiary Care Hospital, Puducherry.

Objectives Mental disorders have a large impact on death by suicide. Hence, this study aims to determine the prevalence of suicidal behaviors among major depressive disorder (MDD) patients and the associated factors. Materials and Methods This cross-sectional analytical study was conducted among individuals aged 18 to 65 years, diagnosed with MDD in the Psychiatry Outpatient Department of a Tertiary Care Center, Puducherry during March to October 2019. Severity of depression was assessed using Hamilton Depression Rating Scale and Columbia-Suicide Severity Rating Scale was used to find the suicidal behaviors. Results For 166 participants in the study, mean (standard deviation) age was 40 (11) years and majority were females (76%). More than one-third (37%) had severe or very severe depression, and the prevalence of suicidal ideation, plan, and attempts were 83, 24, and 35%, respectively. After adjusting the covariates, the severity of depression and unemployment were significantly associated with suicidal attempts (adjusted prevalence ratios [aPR] = 11.4 and 1.9), and very severe depression was associated with suicidal ideation (aPR = 1.6). Among 140 individuals with suicidal ideation, 45 (32%) had an ideation frequency of 2 to 3 times/week, 69 (50%) had ideation for 1 hour, 36 (26%) could control ideation with little difficulty, and 12% had suicidal ideation mostly to end or stop their pain. Conclusion Suicidal ideation and attempts were significantly high in MDD patients, and the severity of depression was significantly associated with it. Early identification of high-risk suicidal behavior and implementation of effective preventive interventions are necessary to reduce death by suicide in these groups.

Current fertility desire and its associated factors among currently married eligible couples in urban and rural area of Puducherry, south India.

BACKGROUND: There are paucity of studies on current fertility desire at community level. OBJECTIVE: To assess current fertility desire and its associated factors among eligible couples of reproductive age group in Puducherry, India. METHODS: A community-based cross-sectional study from 2016 to 2017 among 2228 currently married eligible couples assessed socio-demographic and fertility-related factors associated with fertility desire. Data were collected based on the National Family Health Survey questionnaire. Association of fertility desire was assessed by univariate and generalised linear regression analysis. RESULTS: Out of 1979 respondents, current fertility desire within two years was 13.7% (95% CI, 12.3%-15.3%). Mean number of children (SD) currently living and preferred was 1.77(0.851) and 2.11 (0.528) respectively. After adjusting for confounders, the significant factors positively associated with fertility desire include woman's age of 18-24 (APR = 2.91), 25-29 years (APR=2.48), 30-34 (APR=2.47), 35-39(APR=2.06), high socioeconomic status (APR=2.02), those without child (APR=52.35) and those with one child (APR=35.60). CONCLUSION: The fertility desire is comparatively lesser than other areas. Those without or with a single child and high socioeconomic status group had comparatively more fertility desire.

Time to reach health-care facility and hospital exit outcome among road traffic accident victims attending a tertiary care hospital, Puducherry.

BACKGROUND: In India, most of the deaths due to road traffic accidents (RTAs) occur within 24 h of the accident. Hence, this study aimed to assess the proportion of RTA victims reaching the health-care facilities within the golden hour. MATERIALS AND METHODS: This cross-sectional study was conducted in a tertiary care center in South India between August and September 2017. All RTA victims who were admitted for treatment in the emergency department during the study period were included. Data were collected using structured, pretested, and validated pro forma. Hospital exit outcomes between those who reached within 1 h and those who did not were expressed as proportion with a 95% confidence interval (CI). The factors associated with hospital exit outcomes were analyzed using a Chi-square test. RESULTS: Among 626 RTA victims, the mean (standard deviation) age was 37.4 (2.6) years, and about 83% (n = 521) were male. More than one-third (37%) of the RTAs occurred on urban roads (n = 235, 37.5%). A total of 424 (67.7%) were referred from other hospitals. The mean time taken for RTA victims to reach any health-care facility was 3 h. More than half (n = 346, 55% [95% CI: 51.3-59.2]) of the RTA victims had reached a health-care facility within the golden hour. Among those who reached beyond the golden hour, one-fourth (n = 77, 27.5%) were delayed due to the unavailability of transporting vehicles. Delay in communication (n = 59, 21.1%), prolonged travel (n = 41, 14.6%), lack of knowledge about nearby facilities (n = 39, 13.9%), nonavailability of attenders (n = 35, 12.5%) and financial issues (n = 29, 10.4%) were the other reasons for the delay. CONCLUSION: Almost half of the RTA victims reached the health-care facilities after the golden hour. Unavailability of ambulances or vehicles for transport and delay in communication were the important factors that played a role in the delay.

Prevalence of suicidal ideation, plan, attempts and its associated factors in selected rural and urban areas of Puducherry, India.

BACKGROUND: The Union Territory of Puducherry has a high rate of suicide in India. This study aims to find the prevalence of suicidal ideation, plan and suicide attempts and the risk factors of suicidal behaviours. METHODS: This community-based cross-sectional study was conducted among adults aged 18 years and above in rural and urban areas of Puducherry, India. Columbia Suicide Severity Rating Scale questionnaire was used. Prevalence ratio was estimated to assess the factors associated. RESULTS: The 12-month and lifetime prevalence of suicidal ideation was reported to be 12.5% (95% CI: 10.4-15.0%) and 20% (95% CI: 17.4-22.9%), respectively. About 0.7% (95% CI: 0.3-1.5%) and 2.1% (95% CI: 1.2-3.3%) of the participants had suicide plan in past 12 months and ever in their lifetime, respectively. Around 1% (95% CI: 0.5-2.0%) and 5.7% (95% CI: 4.3-7.6%) of the participants had attempted suicide in past 12 months and ever in their lifetime, respectively. Family issues, physical abuse, unemployment and place of residence were significantly associated with suicidal ideation in multivariable analysis. CONCLUSION: Prevalence of suicidal ideation and suicide attempt were very high in the study area. Unemployment, physical abuse and family issues were significantly associated with suicidal behaviour.

Extent of contraception methods practised by unmet need couples after counselling: a cross-sectional follow-up study in Puducherry, South India.

BACKGROUND: Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling. OBJECTIVE: To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it. METHODS: A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX). RESULTS: The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems. CONCLUSIONS: This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed.