Health and Lifestyle Issues among Youth: A Record Analysis of Contributing Factors among Beneficiaries Attending Youth Mental Health Promotion Clinics (Yuva Spandana Kendras) in Karnataka, India.

Background: Youth are consideren to be most vulnerable to health and lifestyle issues (HLS) in India. The current study aims to investigate the factors that contribute to health and lifestyle issues among youth attending mental health promotion clinics (YMHP) in Karnataka. Method: Three-year first-visit data from beneficiaries (aged 15-35 years) attending YMHP clinics in Karnataka between 2017 and 2020 were analyzed. Multivariable logistic regression analysis included beneficiaries reporting any HLS issue as the outcome and a host of 57 hypothesized variables as exposures. Results: Overall, 2,615 (25%) beneficiaries reported HLS issues. Years of schooling (AOR 5-7 years = 0.89; 95% confidence interval [CI] =0.60-1.31), (AOR 8-10 years = 0.65; 95% CI = 0.46-0.91), (AOR >10 years = 0.67; 95% CI = 0.49-0.93)], unemployed youth (AOR = 0.52; 95% CI = 0.45-0.61) business and salaried workers (AOR = 1.69; 95% CI = 1.33-2.13), and other occupations (AOR = 2.11; 95% CI = 1.73-2.56), junk food consumption (AOR = 0.76;95% CI = 0.68-0.84), having issues related to relationships with parents (AOR = 3.01; 95% CI = 2.47-3.68) and intergenerational issues (AOR = 1.71; 95% CI = 1.19-2.45), self-development issues (AOR low-self-awareness = 1.57; 95% CI = 1.33-1.85), (AOR low-self-esteem = 1.29; 95% CI = 1.062-1.57), (AOR emotional issues = 1.57; 95% CI = 1.31-1.89), education and academics (AOR = 1.23; 95% CI = 1.09-1.39), safety issues (AOR = 4.11; 95% CI = 3.07-5.50), gender sex and sexuality issues (AOR = 2.44; 95% CI = 1.43-4.15), suicidal ideation (AOR = 1.91; 95% CI = 1.44-2.54), substance use (AOR tobacco chewing = 1.45; 95% CI = 1.09-1.93), (AOR tobacco-smoking = 1.66; 95% CI = 1.18-2.32), (AOR smoking = 4.94; 95% CI = 3.52-6.93) and experiencing emotions (AOR feel anxious = 1.63; 95% CI = 1.41-1.88), (AOR forgetfulness = 1.50; 95% CI = 1.41-1.98), (AOR difficulty in concentration = 1.37; 95% CI = 1.035-1.81), (AOR anger = 1.61; 95% CI = 1.25-2.07), (AOR feel worthless = 2.21; 95% CI = 1.71-2.86) were associated with HLS issues among beneficiaries. Conclusion: This analysis addresses an important but neglected component of HLS issues among youth highlighting the importance of early intervention among youth to prevent the development of diseases later in life. The study has important implications for youth health promotion in India and countries such as India. Health and Lifestyle Issues Among Youth: A record analysis of contributing factors among beneficiaries attending Youth Mental Health promotion clinics (Yuva Spandana Kendras) in Karnataka, India.

Identifying health priorities among workers from occupational health clinic visit records: Experience from automobile industry in India.

CONTEXT: Occupational health surveillance in India, focused on notifiable diseases, relies heavily on periodic medical examination, and isolated surveys. The opportunities to identify changes in morbidity patterns utilizing data available in workplace on-site clinics is less explored in India context. AIMS: Present paper describes longitudinal assessment of morbidity patterns and trends among employees seeking care in occupation health clinic (OHC). The study also intends to explore associations between work department, clinic visits and morbidity pattern. MATERIALS AND METHODS: Record-based analysis was undertaken on data available (for the period 2010-2014) from two OHCs in a leading automobile industry in India. The doctor, examining every employee, documented the provisional diagnosis in specific software which in turn provides summary diagnosis based on affected body organ system as per ICD-10 categories. This information was used to assess the morbidity pattern and trend among workers. Chi-square test of significance and Extended Mantel-Haenszel chi square test was used assess the association and its linear trend. RESULTS: Respiratory, musculoskeletal and digestive system related diseases were the top three reasons for employees visit to OHC. The nature of morbidity varied across different departments in the industry. There was a significant increase in proportion of employees visiting OHC during 2010-2014. CONCLUSION: A clinic visit record, with its own strengths and limitations, provides information on morbidity pattern and its trends among workers. Such information will help plan, implement and evaluate health preventive, promotive, and curative services.

Health-seeking behavior and compliance to post exposure prophylaxis among animal bite victims in India.

BACKGROUND: In rabies endemic countries, where every animal bite is potentially a suspected rabid exposure, the exposed individuals should seek early and proper health care. It is also essential to complete the full course of postexposure vaccination to protect against rabies. OBJECTIVES: The study aimed at determining the health-seeking behavior of animal bite victims; assessing the perceived risk of rabies transmission from different animals and knowledge on its prevention and finding out the compliance to complete course of rabies vaccination and associated factors. METHODS: A multi-centric, health facility-based survey was conducted during May 2017 to January 2018 in six regional-representative states involving 18 health facilities. Study participants were animal bite victims attending the health facilities. The data from all the study participants across the country were compiled and analyzed using descriptive statistics and Chi-square test to find out the association of factors influencing compliance. RESULTS: Among a total of 529 animal bite victims, 83.6% sought postexposure prophylaxis coming directly to health facility; others visited nonallopathic/traditional healers/veterinarians/Auxiliary Nursing Midwifery before coming to health facility. The perceived risk of disease transmission and knowledge on the prevention of rabies was insufficient among the exposed victims. All participants were started with anti-rabies vaccination; the compliance rate for the full course of intramuscular rabies vaccination was 65.9% and for intra-dermal rabies vaccination, it was 85.1%. Among Category III exposures, only 46.2% received rabies immunoglobulin. CONCLUSIONS: Health-seeking behavior and compliance to complete course of anti-rabies vaccination is unsatisfactory, which has to be improved to prevent rabies.

Quality of a life skills training program in Karnataka, India - a quasi experimental study.

BACKGROUND: Youth focused Life Skills Education and Counseling Services (YLSECS) program, trained teachers/National Service Scheme (NSS) officers to deliver Life Skills Education (LSE) and counseling services to college going youth in the state of Karnataka in India. Available evaluation of life-skills training program have neglected the recording and or reporting of outcome among those trained to implement life-skills training program. Present paper highlights the quality of YLSECS training program and change in perception among teachers/NSS-officers trained in-terms of improvement in their cognitive/affective domains. METHODS: YLSECS program focused on World Health Organization identified ten essential domains of life-skills. Participants of the YLSECS program were trained by adopting facilitatory approach based on the principles of Kolb's learning theory. Quasi experimental study design was used to evaluate the outcome of training among participants. Quality of the training was assessed using scoring system and change in perception was assessed using Likert scale. Statistical significance of change in perception before and after training was assessed by paired't' test for proportion. RESULTS: Overall, 792 participants rated the quality of training as either "good" or "excellent". Post-training, significant (p < 0.001) proportion of the participants reported improved awareness about life-skills (before training 49.9 to 74.4% vs post-training range from 91.6 to 95.1% for various domains). There was statistically significant (p < 0.001) increase in participants reporting "very confident" in teaching various life skill domains (before training from 22.7 to 34.2% for various domains and post-training it ranged from 65.2 to 74.7% for various domains). There was modest increase in participants reporting perceived ability to conduct life-skills workshop "without assistance" post-training (before training from 16.8 to 22.9% for various domains vs post-training ranged from 29.8 to 36.8% for various domains). Interestingly, considerable proportion of participants who prior to training reported being confident in providing life skills training (without any assistance), later (i.e post training) reported they need some/more assistance for the same. CONCLUSION: YLSECS training program significantly improved participants knowledge and confidence in imparting life-skills and highlight the need for continued handholding of participants for effective implementation of LSE and counseling service program.

National Mental Health Survey of India, 2016 - Rationale, design and methods.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Impact of an intensive HIV prevention programme for female sex workers on HIV prevalence among antenatal clinic attenders in Karnataka state, south India: an ecological analysis.

OBJECTIVES: To examine the impact of an intensive HIV preventive intervention (IPI) among female sex workers (FSW) on community HIV transmission, as represented by HIV prevalence among young antenatal clinic (ANC) attenders in Karnataka state, south India. METHODS: The IPI was initiated in 18 of the 27 districts in Karnataka in 2003, and was generally at scale by mid-2005, covering over 80% of the urban FSW population. We examined trends over time in HIV prevalence from annual HIV surveillance conducted among ANC attenders in Karnataka under the age of 25 years from 2003 to 2007, comparing the IPI with the other districts. RESULTS: Overall, HIV prevalence among ANC attenders under 25 years of age declined from 1.40% to 0.77%. In a multivariate model, the decline in HIV prevalence in the IPI districts compared to the other districts was statistically significant (P = 0.01), with an adjusted annual odds ratio of 0.88 (95% CI 0.79-0.97). The decline in standardized HIV prevalence in the IPI districts over the period was 56%, compared to 5% in the non-IPI districts. CONCLUSIONS: Although this analysis is limited by lack of precise comparative data on intervention coverage and intensity, it supports the notion that scaled-up, intensive, targeted HIV preventive interventions among high-risk groups can have a measurable and relatively rapid impact on HIV transmission in the general population, particularly young sexually active populations as represented by ANC attenders. Such focused intervention programmes should be rapidly taken to scale in all HIV epidemics, and especially in concentrated epidemics such as in India.

Prevalence and determinants of HIV and sexually transmitted infections in a general population-based sample in Mysore district, Karnataka state, southern India.

OBJECTIVES: To estimate HIV and sexually transmitted infection (STI) prevalence within the general population of Mysore district, and to examine differences in the distribution of risk factors associated with HIV prevalence stratified by sex. METHODS: A community-based study was conducted in Mysore, Karnataka state, southern India, between October 2005 and November 2006; final sample size 4653. A face-to-face interview was conducted, and blood and urine specimens collected to measure HIV and STI prevalences. Risk factors for HIV among men and women were examined using weighted and clustered logistic regression. RESULTS: Weighted HIV prevalence was 0.8% [95% confidence interval (CI) 0.52-1.09] overall and 0.7% (0.35-1.08) and 0.9% (0.51-1.37) in rural and urban populations, respectively. The prevalence of syphilis, gonorrhoea and chlamydial infection was 2.8% for men and 1.8% for women. In multivariate analysis, higher HIV prevalence was associated with ever having used a condom [odds ratio (OR) 2.75, 95% CI 1.01-7.47] and number of lifetime partners for men (OR 6.9, 95% CI 2.18-21.91). For women, HIV infection was associated with condom use at last sexual intercourse (OR 10.51, 95% CI 2.05-53.79), number of lifetime partners and reporting 'don't know' for whether ever had anal sex (OR 9.10, 95% CI 1.14-72.34). CONCLUSIONS: HIV prevalence in the general population of Mysore was found to be comparable to recent prevalence estimates for Karnataka state, and also similar to recent prevalence estimates from antenatal clinic attenders for the district. Few modifiable risk factors for HIV infection were identified. There is evidence from this study that high-risk behaviour may have been underreported, but the prevalence of STI was generally low.