Evaluation of the SPIRIT Integrated Suicide Prevention Programme: study protocol for a cluster-randomised controlled trial in rural Gujarat, India.

BACKGROUND: Suicide is a major public health challenge globally and specifically in India where 36.6% and 24.3% of all suicides worldwide occur in women and men, respectively. The United Nations Sustainable Development Goals uses suicide rate as one of two indicators for Target 3.4, aimed at reducing these deaths by one third by 2030. India has no examples of large-scale implementation of evidence-based interventions to prevent suicide; however, there is a sizeable evidence base to draw on for suicide prevention strategies that have been piloted in India or proven to be effective regionally or internationally. METHOD: The SPIRIT study is designed as a cluster-randomized superiority trial and uses mixed methods to evaluate the implementation, effectiveness and costs of an integrated suicide prevention programme consisting of three integrated interventions including (1) a secondary-school-based intervention to reduce suicidal ideation among adolescents, (2) a community storage facility intervention to reduce access to pesticides and (3) training for community health workers in recognition, management, and appropriate referral of people identified with high suicidal risk. DISCUSSION: Combining three evidence-based interventions that tackle suicide among high-risk groups may generate a synergistic impact in reducing suicides at the community level in rural areas in India. Examination of implementation processes throughout the trial will also help to prepare a roadmap for policymakers and researchers looking to implement suicide prevention interventions in other countries and at scale. TRIAL REGISTRATION: Clinical Trial Registry of Indian Council of Medical Research, India: CTRI/2017/04/008313. Registered on 7 April 2017. http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=18256&EncHid=&userName=SPIRIT Trial registry was last modified on 28 June 2019.

Prevalence of Smokeless Tobacco among Low Socioeconomic Populations: A Cross-Sectional Analysis.

BACKGROUND: Cost, social acceptability and non-stringent regulations pertaining to smokeless tobacco (SLT) product sales have made people choose and continue using SLT. If disaggregated data on smokeless forms and smoked practices of tobacco are reviewed, the incidence of SLT remains static. There is a strong positive correlation of SLT intake with the occurrence of adverse cardiovascular disease, particularly in the low socioeconomic populations. AIMS: To investigate the prevalence of smokeless tobacco, its initiation influence and risk factors associated with the practice among lower socioeconomic populations of Bangladesh. In this study, we explore the utilization of SLT among lower socioeconomic populations in industrialized zone of Bangladesh. METHODS: A cross-sectional analysis using both quantitative and categorical approaches was employed. Using systematic random sampling method, four focus group discussions (FGDs) were conducted and 459 participants were interviewed. Multiple logistic regression model was applied to distinguish the significant factors among the SLT users. RESULTS: Almost fifty percent of the respondents initiated SLT usage at the age of 15-24 years and another 22 percent respondents were smoking and using SLT concurrently. The bulk of the women respondents used SLT during their pregnancy. Nearly twenty five percent of the respondents tried to quit the practice of SLT and one-quarter had a plan to quit SLT in the future. More than twenty percent respondents were suffering from dental decay. A noteworthy correlation was found by gender (p<0.01), sufferings from SLT related disease (p<0.05). The multiple logistic regression analysis suggested that, males were 2.7 times more knowledgeable than that of females (p<0.01) about the adversative health condition of SLT usage. The respondents suffering from SLT related diseases were 3.7 times as more knowledgeable about the effect of the practice of SLT than the respondents without diseases (p<0.01). Regarding the knowledge about the health consequences of the practice of SLT, one participant in the FGD session commented that "although the mouth is the gateway to health, we infected our mouth by using Zarda and Gul". Again, informants opined that peer, family, curiosity and hospitality, culture are influencing factors for SLT initiation. CONCLUSION: counselling on tobacco, including SLT, health hazards have to be emphasized through mass media and it is essential for development of relevant policies and communication messages to make people aware of serious health consequences of SLT usages.

Determinants of overweight and obesity among Bangladeshi diabetic women of reproductive age.

BACKGROUND: Several reproductive disorders with overweight and obesity are now known to be associated with insulin resistance. The study was aimed to assess the proportion and determinants of overweight and obesity among diabetic women of reproductive age. METHODS: This cross-sectional analytic study was conducted among 888 diabetic women of reproductive age attending the out-patient department (OPD) of the central hospital of the Diabetic Association. Body Mass Index (BMI) was used to assess the general obesity. Waist Circumference (WC), Waist-Hip Ratio (WHR) and Waist-Height Ratio (WHtR) were used to assess central obesity. RESULTS: The overall prevalence of overweight was 22% (95% CI 19-24) and that of obesity was 48% (95% CI 45-51). Prevalence of central obesity by waist circumference was 77%, by waist-hip ratio was 99.9% and by waist-height ratio was 89%. Overweight and obesity were higher in the age group of 45-49 years (49%) and 35-44 years (24%) respectively. On Pearson's correlation analysis, BMI and WC were significantly correlated with age (r = 0.135, p = 0.001; r = 0.162, p = 0.001) and income (r = 0.151, p = 0.001; r = 0.087, p = 0.009) respectively. WHR was also correlated with income (r = 0.094, p = 0.005). Moreover, WHtR was significantly correlated with age (r = 0.139, p = 0.001), income (r = 0.069, p = 0.04) and duration of diabetes (r = 0.073, p = 0.03).On binary logistic regression analysis, BMI was significantly associated with age, income and management of diabetes by Oral Hypoglycemic Agent (OHA) (p < 0.05). WC was significantly associated with age, income and management of diabetes by OHA and insulin (p < 0.05). Where, WHR was significantly associated only with duration of diabetes (p < 0.05). WHtR was significantly associated with age (p < 0.05), management of diabetes by OHA (p < 0.05) and insulin (p < 0.05) in this analysis. CONCLUSIONS: A high prevalence of both overweight and obesity exists in diabetic women of reproductive age in Bangladesh and it seems to be associated with increasing age, income, duration of diabetes, and use of oral hypoglycemic agents.

Severe acute malnutrition in Asia.

Severe acute malnutrition (SAM) is a common condition that kills children and intellectually maims those who survive. Close to 20 million children under the age of 5 years suffer from SAM globally, and about 1 million of them die each year. Much of this burden takes place in Asia. Six countries in Asia together have more than 12 million children suffering from SAM: 0.6 million in Afghanistan, 0.6 million in Bangladesh, 8.0 million in India, 1.2 million in Indonesia, 1.4 million in Pakistan, and 0.6 million in Yemen. This article is based on a review of SAM burden and intervention programs in Asian countries where, despite the huge numbers of children suffering from the condition, the coverage of interventions is either absent on a national scale or poor. Countries in Asia have to recognize SAM as a major problem and mobilize internal resources for its management. Screening of children in the community for SAM and appropriate referral and back referral require good health systems. Improving grassroots services will not only contribute to improving management of SAM, it will also improve infant and young child feeding and nutrition in general. Ready-to-use therapeutic food (RUTF), the key to home management of SAM without complications, is still not endorsed by many countries because of its unavailability in the countries and its cost. It should preferably be produced locally from locally available food ingredients. Countries in Asia that do not have the capacity to produce RUTF from locally available food ingredients can benefit from other countries in the region that can produce it. Health facilities in all high-burden countries should be staffed and equipped to treat children with SAM. A continuous cascade of training of health staff on management of SAM can offset the damage that results from staff attrition or transfers. The basic nutrition interventions, which include breastfeeding, appropriate complementary feeding, micronutrient supplementation, and management of acute malnutrition, should be scaled up in Asian countries that are plagued with the burden of malnutrition.

Measuring the cost-effectiveness of a national health communication program in rural Bangladesh.

In this article we examine the cost-effectiveness of the Smiling Sun multichannel media campaign, which was undertaken in Bangladesh from 2001 to 2003 and involved a nationally broadcast television serial drama supported by radio, television, newspaper, and billboard advertisements and local promotion activities. The goal was to encourage the use of a package of family health services at NGO (nongovernmental organization) Service Delivery Program (NSDP) providers. This analysis relates the costs of the Smiling Sun campaign at the national and local level to measures of change in the use of health services, namely, antenatal care and childhood immunizations. Effectiveness is measured using data from cross-sectional surveys conducted in 2001 and 2003 in NSDP catchment areas in rural Bangladesh. The statistical approach, bivariate probit estimation, controls for nonrandom exposure to the program's media messages, advertisements, and signs. Using national-level data, we find that the Smiling Sun campaign was both effective and cost-effective, inducing higher levels of service utilization for only $0.05 per additional antenatal care (ANC) user and only $0.30 and $0.36 for each additional child vaccinated for measles and DPT3, respectively. With respect to local promotion activities, the cost per attributable behavior change was considerably higher--nearly $8 per new ANC user, $37 per new DPT3 vaccination, and $32 per new measles vaccination.

Seeking optimal means to address micronutrient deficiencies in food supplements: A case study from the Bangladesh Integrated Nutrition Project.

In seeking to improve the micronutrient contents of a food supplement used in a major community-based nutrition project in Bangladesh, operations research was conducted to compare the provision of needed micronutrients through additional food sources (fresh or dried fruits or vegetables), a micronutrient multi-mix, and a combination of the two. Micronutrient gaps (the difference between micronutrient requirements and actual micronutrient intake) were estimated for four groups of project beneficiaries, with target intakes defined as requirements for iron, calcium, zinc, vitamin A, vitamin C, riboflavin, niacin, and vitamin B12 recommended by the Food and Agriculture Organization/World Health Organization. Primary focus was placed on iron and vitamin A. Cost and bulk constraint analyses, based on cost of supplement, feasibility of delivery, and serving volume needed to achieve micronutrient targets, were used for comparing the supplement options. In terms of these analyses, the micronutrient multimix proved, by far, to be the most advantageous. Food options, however, are arguably desirable in that they provide dietary benefits additional to that of known micronutrients and may increase demand to boost production of domestic fruits and vegetables for the population as a whole. The study concludes that it is cost-effective to use powdered micronutrient mixes for such specific purposes as enrichment of supplementary food and food fortification, but encourages production and consumption of micronutrient-rich foods through programme messages and activities.