Palliative Care Need in India: A Systematic Review and Meta-analysis.

Background: To achieve sustainable development goal 3.8, countries must prioritise the provision of palliative care. We aimed to estimate the prevalence of palliative care needs in India. Methods: A systematic literature search was conducted in databases of PubMed, Cochrane, Embase, Web of Science, and EBSCO Host. We included community-based studies published in English between inception and April 30, 2023. We excluded hospital-based studies that were conducted solely including diseased patients. Data were extracted independently, and a quality assessment was performed. To estimate the pooled prevalence and 95% confidence intervals (CI), we used the random-effects model. Heterogeneity was assessed using the Q statistic and I2 test. Subgroup analyses were conducted based on the study site, urban-rural distribution, gender, and age groups. Publication bias was evaluated using a funnel plot and Egger test. STATA software was used for data analysis. Results: Out of the 2632 articles identified, 8 cross-sectional studies were included. Using the random-effects model, the pooled estimate of palliative care needs was found to be 6.21/1000 population (95% CI: 2.42-11.64). The southern region showed a prevalence of 10.83/1000 compared to 2.24/1000 in the northern region. Urban areas had a prevalence of 3.34/1000, while rural areas had a prevalence of 7.69/1000. Among females, the prevalence was 9.64/1000, compared to 6.77/1000 among males. Notably, individuals aged over 60 years had a higher prevalence of palliative care needs, with a rate of 37.86/1000 population. Conclusion: This systematic review and meta-analysis highlight a substantial need for palliative care in India, with a prevalence of 6.21 individuals/1000 population.

Perceptions and Attitudes Toward Community Medicine Among Medical Students: A Systematic Review.

Community medicine is yet to become a popular discipline as a choice for postgraduation and career among medical students in India. Our objective is to find the proportion of students opting for community medicine as a choice for a career. We also aim to find out the perceptions and attitudes of medical students about the subject of community medicine. Our inclusion criteria encompassed studies of any design, written or translated into the English language, and published from their inception up to the last date of our search, which was 15th August 2023. Our comprehensive search covered prominent databases, including PubMed, Scopus, and Embase, as well as an extensive screening of the first 10 pages of Google Scholar and Google. The risk of bias in the studies was evaluated by using the quality assessment tools recommended by the Joanna Briggs Institute critical appraisal tool for prevalence studies. In the initial search, 2069 articles were identified, with 1109 duplicates removed. The remaining 960 articles underwent title and abstract screening, leading to the exclusion of 931 articles. After applying eligibility criteria and reviewing the full text of 29 articles, seven studies were excluded. Ultimately, 22 studies were deemed eligible for inclusion in the systematic review. Among the total of 5106 students, 1032 students expressed a willingness to choose community medicine as their career. The pooled estimate, derived through a random effects model, was 0.21, with a 95% CI of 0.14 to 0.27. Studies conducted in India revealed a willingness of 0.23 (95% CI: 0.13- 0.33), whereas studies conducted outside India reported a lower proportion of 0.17 (0.14-0.24). When considering the year of study, a combined willingness of 0.02 (95% CI: 0.00-0.03) was observed among first and second-year students, contrasting with a higher proportion of 0.18 (95% CI: 0.04-0.32) among third-year students. Fourth-year students and interns demonstrated a willingness of 0.03 (95% CI: 0.00-0.06). The factors for disliking the subject included the perceived absence of clinical engagements, concerns about financial rewards, limited prospects for recognition and fame, etc. By actively engaging in the solution of these challenges, medical educators and policymakers can contribute to the vitalization of community medicine as a coveted and attractive specialty.

Burden of Tuberculosis among tribal populations of India: A systematic review and meta-analysis.

ABSTRACT: Tuberculosis (TB) continues to impose a significant burden on tribal populations in India, a high-risk group for the disease. Despite its preventable and curable nature, TB remains a formidable health challenge for these communities. However, a critical knowledge gap exists regarding the population-based prevalence of TB among tribal populations in India. The current systematic review and meta-analysis were carried out to provide a single, population-based estimate. A comprehensive search was conducted on PubMed, Embase, Scopus, and Web of Science databases using the keywords 'tuberculosis', 'TB', and 'tribal' or 'tribes'. This search encompassed articles published between 1 January 2000 and 1 March 2023. The included articles underwent a quality assessment screening to ensure their reliability and relevance. Subsequently, a pooled estimate of TB prevalence among tribal populations was quantified using a random-effects model. To investigate potential sources of heterogeneity in the prevalence estimates, subgroup analyses were performed. We identified 14 studies that encompassed a substantial population of 267,377 individuals from various regions in India belonging to tribal communities. The application of a random-effects model yielded a pooled prevalence estimate of 894.4 per 100,000 population, with a 95% confidence interval ranging from 523.5 to 1361.9. The assessment of heterogeneity using the Cochrane Q test indicated significant variability among the included studies (I2 = 99.17%; P < 0.001). Notably, the prevalence of TB among tribal populations was found to be higher than the national prevalence. The scientific evidence available for the prevalence of TB among tribal populations is restricted to a few tribes only. Conducting further research to estimate the prevalence among other tribes all over the country is the need of the hour and should be addressed accordingly.

Depression and Associated Factors Among Older Adults in a North Indian State: A Cross-Sectional Study.

INTRODUCTION: India is currently experiencing a significant increase in its elderly population, and it is predicted to rise. Depression is prevalent among the elderly population. This study aimed at measuring the prevalence of depression among the elderly population in India. METHODOLOGY: This cross-sectional study was conducted in both urban and rural regions of Delhi, with a total of 230 participants recruited through systematic random sampling. This sampling method involved selecting households from a comprehensive list. The Patient Health Questionnaire 9 (PHQ-9) was used as a screening tool for depression. Participants with a PHQ-9 score above 9 were considered to potentially experience depression. RESULTS: The study findings revealed that 68.2% (95%CI: 61.8%-74.2%) of the total sample of 230 participants screened positive for depression. Gender (p = 0.02), age category (p < 0.01), place of residence (p < 0.01), and diabetes (p < 0.01) were significantly associated with depression. CONCLUSION: The study found a high prevalence of depression among the elderly population, with females, urban dwellers, and those with a history of diabetes being significantly associated with depression. Early detection through screening programs and community-based interventions could help manage depression in this vulnerable group.

The Prevalence of Violence Against Resident Doctors and Its Subsequent Effects on Patient Management in a Tertiary Care Hospital in Delhi, India.

Introduction Workplace violence (WPV) is a significant problem for healthcare professionals across the world, regardless of whether they work in developed or developing countries. Studies have shown that in India, up to 75% of doctors have experienced some form of violence in the workplace. The purpose of the present study was to examine the extent of violence against doctors and its impact on patient management. Methodology This cross-sectional study was conducted in a tertiary care hospital in New Delhi in June 2022. A total of 326 resident doctors from six departments were selected using stratified random sampling. Data were collected using a semi-structured interview schedule and a pre-validated questionnaire. Statistical analysis was done using Stata 17, and ethical clearance was obtained from the Institute Ethical Committee. Result Workplace violence was prevalent among healthcare professionals, with 80.4% (95% confidence interval (CI): 75.6%-84.5%) experiencing verbal abuse and 21.7% (95% CI: 17.4%-84.5%) experiencing physical violence. Perceived delays in treatment and patient deaths were the most common causes of violence. Most participants were hesitant to report WPV due to time-consuming reporting processes and a lack of organisational support. WPV had a negative impact on doctors' mental and personal well-being, with 73.3% reporting its negative impact. WPV has led to a decrease in the provision of surgical and medical interventions. Conclusion The study findings suggest that a significant proportion of doctors in a tertiary care hospital in Delhi encounter some form of workplace violence. Despite the high incidence of WPV, reporting of these events remains low due to inadequate support and deficient reporting procedures within healthcare organisations. The negative impact of WPV is not limited to the physicians' psycho-social well-being but extends to their approach to patient care as well. Therefore, taking appropriate actions to prevent WPV is crucial for ensuring the safety and well-being of healthcare professionals and improving patient outcomes.

Willingness to Quit and Associated Factors Among Tobacco Users Attending Outpatient Departments of a Tertiary Care Hospital in Delhi, India.

Background: Tobacco use has become a modern-day epidemic which significantly impacts health, socioeconomic status, and environmental sustainability. The readiness to quit or stop using tobacco is a crucial first step in changing one's behavior. Hence, the current study sought to assess the prevalence of willingness to quit and associated factors among tobacco users. Methods: This study was conducted on 425 tobacco users selected using multi-stage random sampling from the outpatient departments (OPDs) of a tertiary care hospital in Delhi, India. A pre-designed, interviewer-administered questionnaire was used to elicit information. Logistic regression was performed to assess the effect of independent factors on the willingness to quit. Findings: The mean age of the study participants was 39.37 years (S.D.=±12.99). The majority of the participants were male (400, 94.1%), and 25 (6.9%) were female. Overall, the prevalence of willingness to quit in the current study was 70% among the study participants. The results of the multivariable analysis showed that those belonging to urban areas, tobacco users with a duration of≤10 years, and those who received advice from a doctor to quit had a significantly higher willingness to quit than their counterparts. However, age, gender, marital status, education, religion, age of initiation of tobacco use, and nicotine dependence were not found to have a statistically significant relationship with the willingness to quit tobacco products. Conclusion: Willingness to quit was high among the study participants. The data in this study suggested that belonging to urban areas, duration of tobacco use, and doctor's advice to quit are important factors which need to be considered when framing future tobacco cessation programs.

Prevalence of High and Moderate Risk of Liver Fibrosis Among Patients With Diabetes at a Noncommunicable Diseases (NCD) Clinic in a Primary Healthcare Center in Northern India.

Background Diabetes is a known entity that contributes to increased incidence and progress of liver fibrosis. Despite the integration of nonalcoholic fatty liver disease (NAFLD) into the NP-NCD program (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke [NPCDCS]), screening individuals in primary healthcare settings for liver fibrosis remains uncommon. The objective of this study was to determine the prevalence of the risk of liver fibrosis in individuals with diabetes. Methodology The secondary data analysis was conducted among patients with diabetes attending the noncommunicable diseases (NCD) clinic at the Primary Health Center (PHC) Najafgarh, Delhi, from January 2023 to June 2023. We used the Fibrosis-4 (FIB-4) score to assess the risk of liver fibrosis. The data analysis was carried out using Stata 17.0 software (StataCorp, College Station, TX). Results Out of 394 individuals screened, 158 (39.5%) were male and 236 (60.5%) were female. Among the study participants, 64.9% (95% confidence interval [CI] 60.0%-69.7%) were of low risk, 30.5% (95% CI 25.9%-35.3%) were of intermediate risk, and 4.6% (95% CI 2.7%-7.1%) were of high risk of developing liver fibrosis based on FIB-4 scoring. The increased risk was associated with increased age, duration of diabetes, and dyslipidemia. Conclusions The prevalence of high risk of liver fibrosis among patients with diabetes was 4.6% (95% CI 2.7%-7.1%), whereas an intermediate risk of developing liver fibrosis was observed in 30.5%. The study advocates integrating these screening tools into primary healthcare settings, alleviating the strain on larger healthcare facilities. It also underscores the importance of early detection and management of liver fibrosis in patients with diabetes.

Mapping of mental health care facilities and psychiatrists in a North Indian district of India.

Introduction: Since 1990, the proportional contribution of mental disorders to India's total disease burden has nearly doubled, but the number of psychiatrists has not increased proportionately. Even after two decades of District Mental Health Programme (DMHP) launch, a considerable treatment gap still exists for mental illness. The present study aimed to map all health facilities providing mental health services and all psychiatrists in district Faridabad, Haryana. Methods: The starting point was the information available with the DMHP and district health office. This was supplemented by web search and snowball sampling. All identified facilities were visited to map the mental health services provided. All the mental health care providers and health care facilities were mapped using "Google my Maps". 2011 census data on population were used. Results: In Faridabad, 0.88 psychiatrists per lakh population were present. Most psychiatrists were concentrated in the urban area. The number of psychiatrists per lakh population was 1.1 in urban, compared to 0.54 in rural Faridabad. Clustering of mental health facilities was also observed more in urban areas (8.7 per 100 Sq Km) compared to rural areas (0.95 per 100 Sq Km) of district Faridabad. Conclusion: There was a scarcity of psychiatric manpower and facilities in the district with a distinct urban skew.

Perception and Attitude Towards COVID-19 Vaccination Among the Elderly: A Community-Based Cross-Sectional Study.

Introduction COVID-19 is one of the most formidable obstacles that humanity has encountered in this century. The death rate was high among the elderly in India; therefore, getting the elderly vaccinated was one of the most important things to do. Objective We conducted this study to assess the perception and attitude about the COVID-19 vaccines among the elderly population. Methods This cross-sectional study was conducted at Fatehpur Beri, New Delhi. We selected 108 participants using systematic random sampling. We used a semi-structured questionnaire to collect the data. Results Out of 108 participants, 52.8% were men. Among them, 9.3% of participants had tested positive before. The average number of days of illness among the participants was 5.3 (SD + 3.5). Males had a higher average day of illness (5.5, SD +3.7) than females (4.9, SD +3.3). Among those who had not been vaccinated, 73.3% of participants said they would receive the vaccine, 6.7% were unsure, and 20% were not willing to receive the vaccine. Conclusion COVID vaccination in an elderly population showed a relatively high vaccine acceptance rate, and the willingness to get the vaccine was also high among the unvaccinated.