Recent Amendment in the Medical Termination of Pregnancy Act in India: Empowering Women's Health.

SUMMARY: In 1971, the Medical Termination of Pregnancy (MTP) Act was implemented to deal with unsafe abortions, fetal complications, and maternal mortality. In India, it is estimated that more than half of all abortions are unsafe leading to infection, hemorrhages, injury to internal organs, and sometimes maternal death. To address these issues, the MTP Act was amended in 2021 to promote uniformity, accessibility, availability, affordability, and quality of MTP services with appropriate management in case of any adverse event.

Geographical altitude and stunting among children aged under 5 years in India.

Introduction: Previous studies have found positive associations between higher geographical altitude and increased risk of stunting in children under 5 years old, but little evidence exists on this relationship in the Indian context specifically. Chronic exposure to high altitudes can impair food security, healthcare access, oxygen delivery and nutrient absorption, potentially increasing malnutrition. Objective: To investigate the association between geographical altitude and stunting among children aged under 5 years in India. Methods: Using data from the 2015-2016 National Family Health Survey, logistic regression was conducted to estimate the relationship between altitude and stunting, adjusting for child, maternal and household characteristics. The analysis included over 167 555 children under 5 years old. Results: Children at higher altitudes had a significantly greater risk of stunting. Those at >2000+ metres had 40% higher adjusted odds of stunting than children below 1000 metres. The altitude-stunting association was stronger among rural children. Conclusions: This study provides robust evidence that higher geographical altitude is an important risk factor for stunting among young children in India, especially those in rural areas. Targeted interventions to improve food security, healthcare access and nutrition in high-altitude regions could help to mitigate the higher burden of stunting in these areas.

Correlates of diabetes mellitus and hypertension in India: Change as evidenced from NFHS- 4 and 5 during 2015-2021.

Both diabetes mellitus (DM) and hypertension (HTN) have been on the rise in recent decades all over the world more remarkably in developing countries like India. We intend to measure the prevalence of DM and HTN in the Indian population and to compare the trends and various correlates of these diseases in NFHS (National Family Health Survey)-4 and 5. Data of NFHS-4 and 5 were accessed from dhs program website. All statistical analyses were done in SAS (version 9.4). Mixed effects survey logistic regression models were used for estimating odds ratio (OR).p-values <0.05 were considered significant .1,637,762 individual case entries were evaluated. Both the diseases showed an increasing trend as per the advancing age in both sexes. The highest prevalence of DM is seen in the age group of 45-49 years (7.8%) in females and > 50 years (11.9%) in males as per NFHS-5. Similarly, the highest prevalence of HTN was seen in the age group of45-49 years (31.2%) in females and > 50 years (41.4%) in males as per NFHS-5. The OR (95% CI) of prevalence of DM, HTN and both the diseases in age group >50 years was 14.46 (13.14-15.7), 16.65 (15.78-17.6), 79.5 (64.76-97.73) respectively when compared to reference age group15-19 years. Highest odds for having both DM, HTN concurrently was in age >50 years with aOR(95% CI) 65.32 (52.26-72.63) in NFHS 4 and 35.57 (97.47-45.53) in NFHS 5.Rise in prevalence of DM, HTN and concurrent presence is noted with an apparent increase in cases.

Development and Validation of a Questionnaire to Measure a Medical Student's Interest in the Subject of Community Medicine.

Background: Lack of interest has been cited by many studies as the predominant cause for students undervaluing the subject of Community Medicine. However, there are few valid and reliable tools that could measure this interest. To develop and validate a questionnaire to measure a medical student's interest in the subject of Community Medicine. Material and Methods: Cross-sectional study conducted at MTMC Jamshedpur. The Community Medicine Interest Questionnaire (CMIQ) was developed in two phases: item generation and item reduction. Items were generated through a review of the literature, focused group discussions, and in-depth interviews. In the item reduction phase, the content and construct validity of the questionnaire were ascertained. Content validity was carried out by a group of experts based on three parameters: the interrater agreement on the representativeness of the item, the interrater agreement on the clarity of the items, and the content validity index. The construct validity was ascertained through pilot testing of 480 responses from undergraduate medical students. Exploratory factor analysis through principal axis factoring and Promax rotation. Results: Twenty-five items were generated. Three of these items were removed following expert validation. Furthermore, three items were removed after pilot testing. The resulting CMIQ consisted of 19 items distributed over three dimensions: feeling, value, and predisposition to reengage toward the subject. The internal consistency of each of the subscales was ascertained. Conclusions: CMIQ is a valid and reliable tool that can be used to measure such interest for providing educational interventions.

Prevalence of diabetes distress among type 2 diabetes mellitus patients in India: a systematic review and meta-analysis.

Introduction: The burden of type 2 diabetes mellitus (T2DM) in India is on the rise, with projections indicating a staggering 134 million cases by 2045. Managing T2DM demands strict adherence, often resulting in mental strain and burnout. Diabetes distress (DD), a unique psychological burden, significantly affects motivation and self-care, contributing to increased morbidity and mortality. Material and Methods: This study was conducted by doing a comprehensive literature search using PubMed (MEDLINE) and EMBASE databases for studies published from their inception to 14th August 2023 by using relevant keywords. The protocol is registered in PROSPERO and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Selected articles were meticulously screened based on predetermined inclusion and exclusion criteria. Joanna Briggs Institute (JBI) Critical Appraisal scale for cross-sectional study was used for assessing the study quality. Data analysis was done by using Jamovi 2.3.24 software. Results: Following the systematic search and screening process, 10 cross-sectional studies were identified, comprising a total of 2,107 Type 2 Diabetes Mellitus patients. All studies employed the Diabetes Distress Scale-17 (DDS-17) for measurement. The prevalence of DD varied, ranging from 8.45% to 61.48%. The pooled prevalence of DD in T2DM patients in India was estimated at 33% (95% CI: 21%-45%) with substantial heterogeneity observed (I2 = 97.33%, P < 0.001). While an asymmetric funnel plot suggested potential publication bias, sensitivity analysis reinforced the robustness of our findings. Conclusion: Policymakers, clinicians, and researchers can leverage these insights to prioritize the psychological well-being of T2DM patients, ultimately improving their overall health outcomes. This study aligns with the Sustainable Development Goals (SDGs) and India's national health policy, emphasizing the urgency of screening and treating diabetes-related distress by 2025.

Barriers to healthcare utilization among married women in Afghanistan: the role of asset ownership and women's autonomy.

Women face multiple socio-economic, cultural, contextual, and perceived barriers in health service utilization. Moreover, poor autonomy and financial constraints act as crucial factors to their healthcare accessibility. Therefore, the objective of the present study is to study the association between health care utilization barriers and women empowerment, including asset ownership among currently married women in Afghanistan. Data of 28,661 currently married women from Afghanistan demographic health survey (2015) was used to carry out this study. Barriers to access healthcare were computed based on problems related to permission, money, distance, and companionship, whereas women empowerment and asset ownership were computed as potential covariates along with other socio-economic risk factors. Bivariate and logistic analysis was carried out to study the association and odds of explanatory variables. Our results confirm the significant and strong association between the barriers to access healthcare and various explanatory variables. Women having any decision-making autonomy are less likely to face any odds [(AOR = 0.56, p < 0.001), CI: 0.51-0.61] among the currently married women than those who don't have any decision-making authority. Similarly, women who justify their beating for some specific reasons face the greater difficulty of accessing health care [(AOR = 1.76, p < 0.001), CI: 1.61-1.93]. In terms of asset ownership, women having any asset ownership (land or household) are less likely to face any barriers in health services utilization given the lower odds [(AOR = 0.91, p < 0.001), CI: 0.90-0.98]. Accessing maternal health is a crucial policy challenge in Afghanistan. A substantial proportion of women face barriers related to approval, money, distance, and companionship while accessing the health services utilization in Afghanistan. Similarly, women empowerment and asset ownership are significantly associated with health service accessibility. This paper therefore suggests for some policy interventions to strengthen the healthcare needs of women and ensure healthcare accessibility by scaling down these potential barriers like poor autonomy, asset ownership and domestic violence.

Trends of Private Drugs' Sales and Costs Incurred by Patients on Anti-tuberculosis Drugs in Selected Districts of Jharkhand (2022): Results From Sub-national TB-Free Certification.

BACKGROUND: The government of India is committed to eliminating tuberculosis (TB) by 2025 under the National Tuberculosis Elimination Programme which provides free investigations and treatment as well as incentives for nutritional support during their treatment course. Many TB patients prefer to seek treatment from the private sector which sometimes leads to financial constraints for the patients. Our study aims to find the burden of TB patients in the private sector and the expenses borne by them for their treatment. METHODOLOGY: Sales data of rifampicin-containing formulation drug consumption in the private sector of six districts of Jharkhand was collected from Clearing and Forwarding agencies. Based on the drug sales data, the total incurring costs of the drugs, total number of patients, and cost per patient seeking treatment from the private sector were calculated for the year 2015-2021. ANOVA and the post hoc test (Tukey honestly significant difference (HSD)) were applied for analysis. RESULTS:  There was a marked difference amongst all the districts in relation to all the variables namely total costs, cost per patient, and total private patients seeking treatment from the private sector which was statistically significant (p < 0.001). East Singhbhum had the highest out-of-pocket expense and private patients as compared to all six districts. Lohardaga showed the sharpest decline in total private patients from 2015 to 2021. The average cost borne by private patients in 2015 was INR 1821 (95% CI 1086 - 2556) which decreased to INR 1033 (95% CI 507 - 1559) in 2021. CONCLUSION: From the study, it was concluded that the purchase of medicines for TB treatment from the private sector is one of the essential elements in out-of-pocket expenditure (OOPE) borne by TB patients. Hence, newer initiatives should be explored to foresee the future OOPE borne by the patients and decrease OOPE-induced poverty.

Risk of Silico-Tuberculosis in Miners: A Systematic Review and Meta-Analysis.

Context: Tuberculosis (TB) and Silicosis are public health problems with high morbidity and mortality. They also exist as comorbidities and are highly prevalent among mine workers. Aims: This study aims to estimate the risk of TB in miners with silicosis than in miners not having silicosis. Methods and Material: This systematic review was conducted by literature search using PubMed, and EMBASE for studies published from 1st Jan 2017 till 20th July 2022. From the data obtained using relevant keywords for the search, a total of 345 articles were selected for screening after applying our inclusion-exclusion criteria and removing duplicates. PRISMA guidelines were followed. items JBI critical appraisal checklist for cross-sectional studies was used for assessment of the risk of bias. The odds ratio was used to estimate the strength of the association. Results: After extensive screening, four studies have met our selection criteria. The meta-analysis of those studies revealed that the prevalence of TB in miners with silicosis is 27.11% while the prevalence of TB in miners with non-silicosis is 16.75%. The estimated pooled odds ratio (fixed effect model) is 1.34 (95% CI 1.01 - 1.76). Conclusions: The present study reveals that there is an increased risk of TB in miners with Silicosis. Newer initiatives must be taken to prevent TB in miners.