Excess Screen Time and its Associated Factors among Young Men in a Rural Community of North India.

Screen-based media usage among young people is blooming rapidly due to technological and digital revolution. We conducted community-based cross-sectional study to determine the prevalence of excess screen time and its association with sociodemographic and behavioral patterns in a rural block of Haryana, India. A semi-structured interview schedule was administered by trained physicians to ascertain screen time in a typical day and various socioeconomic and behavioral factors among a random sample of 860 young men aged 18-24 years. The prevalence of excess screen time was 61.8% (95% confidence interval [CI] 58.4-65.1). It was significantly associated with education (adjusted odds ratio [AOR] 1.7, 95% CI 1.1-2.6) and occupation (AOR 2.2, 95% CI 1.2-3.9) of the father and their sleep duration of ≤8 h (AOR 1.6, 95% CI 1.2-2.3). Limiting the screen time as per international standards and behavioral interventions are needed for this young population.

Intravenous ferric carboxymaltose rapidly increases haemoglobin and serum ferritin among pregnant females with moderate-to-severe anaemia: A single-arm, open-label trial.

Background: . Infusion of ferric carboxymaltose (FCM) can correct iron deficiency anaemia in the second or third trimester of pregnancy. However, large-scale public health use of FCM is constrained by two issues. First, there is limited evidence on the efficacy and safety profile of FCM in the Indian context. Second, logistic challenges in administering FCM at a subdistrict healthcare setting have not been assessed. We aimed to measure the mean increase in haemoglobin (Hb) level 2 weeks after infusion of FCM to pregnant females with moderate-to-severe anaemia attending a subdistrict hospital in India. Methods: . During June-December 2016, we did a single-arm, open-label trial among pregnant females with a gestation of 16-32 weeks, Hb 5.0-9.9 g/dl. FCM was infused (per Ganzoni formula) in a single session up to a maximum of 1000 mg of iron. Hb and s-ferritin levels were measured at recruitment, 2 weeks post-infusion and at delivery. Adverse events were noted. Results: Seventy-seven pregnant females were enrolled with mean (SD) age 23.2 (3.1) years, gestation 27.6 (3.8) weeks and Hb 8.4 (0.9) g/dl. At 2 weeks post-infusion (n=63), the mean Hb level increased by 1.9 g/dl (95% confidence interval [CI] 1.6-2.3) and at delivery (n = 64) by 2.9 g/dl (95% CI 2.4-3.4). The median (interquartile range) (in ng/ml) for serum ferritin at baseline (n = 68), 2 weeks post-FCM infusion (n = 61) and at delivery (n = 39) was 6.3 (5.1-11.7), 275.4 (186.4-330.3) and 61.3 (42.5-132.0), respectively. No major adverse effects were reported. Conclusion: Infusion of FCM rapidly corrected anaemia, sustained its effect till delivery and replenished body iron reserves. FCM is safe and effective in treating anaemia in pregnant females in the second and third trimester at the subdistrict healthcare setting in India.

Is Inclusion of informed consent associated with HIV seropositivity rate? findings from 2017 HIV sentinel surveillance among men having sex with men in select states of India.

BACKGROUND: During round 2017 of HIV Sentinel Surveillance (HSS) for men who have sex with men (MSM) in India, sampling strategy was changed from consecutive sampling to random sampling, and recruitment was conditioned on informed written consent. OBJECTIVE: The study aimed to explore whether inclusion of informed consent is associated with HIV seropositivity rates among MSM population in select four states of Central India. METHODS: The cross-sectional study was conducted in four states of Delhi, Jharkhand, Uttar Pradesh, and Uttarakhand that were supervised by All India Institute of Medical Sciences, New Delhi. We did analysis of data collected during 2017 HSS, supplemented with additional program data from targeted intervention (TI) sites. All nine MSM sites in four states were included. Participants were defined as all those MSM who participated in HSS 2017 irrespective of whether they were mentioned in the random list or were selected by the TI partner. The MSM in the random list who either refused to participate or could not be contacted even after three attempts were classified as "nonparticipants." Seropositivity of both groups was compared. Descriptive statistics were derived. RESULTS: Overall nonparticipation rate was 14.7%, the highest being in Jharkhand (26%) and lowest in Uttarakhand (6.8%). Overall HIV positivity rate was significantly higher (P < 0.001) in nonparticipants (4.2%) when compared to participants (1.42%). CONCLUSION: The change in sampling strategy and introduction of written informed consent for recruitment of high-risk groups in HSS 2017 round could have led to an underestimation of HIV seropositivity rate among MSM in the states in Central Zone.

Smokeless Tobacco Use is "Replacing" the Smoking Epidemic in the South-East Asia Region.

Background: The sustained anti-tobacco campaign initiated in response to the mounting evidence against tobacco smoking has driven tobacco companies and smokers to look for alternative choices, such as smokeless tobacco (SLT) products. If this strategy advances, it could undermine several gains made by the campaign over the years. Our objective was to examine the trends in the prevalence of different tobacco types in three countries (Bangladesh, India, and Nepal) of South-East Asia. Methods: Data from national surveys were used to estimate the trends of weighted and age-standardized prevalence (along with 95% CI) of different tobacco products. The share of each tobacco type was then calculated as a percentage of total tobacco use for each time point and country. Results: In all the three countries, smoking prevalence declined (by 6% in Bangladesh, 3% in India, and 7% in Nepal) but SLT use increased (by 3% in Bangladesh, 6% in India, and 4% in Nepal) over the study period. SLT use increased irrespective of whether the total tobacco use increased or decreased. The share of SLT as a percentage of total tobacco use increased from 15% to 19% among Bangladeshi men, from 46% to 61% in India, and from 29% to 41% in Nepal. Conclusions: In South-East Asia, a clear shift in the product preference from smoking to SLT was noted. Misleading advertising by tobacco companies may be responsible for the increase in the SLT prevalence, which is as harmful as smoking. Countries should strengthen policies to restrict SLT usage and prevent the rise of its use. Implications: It has been documented that the smoking prevalence has been declining in most countries of the South-East Asia region where effective anti-tobacco laws have been implemented. But, due to a number of factors, the prevalence of smokeless tobacco has been increasing steadily, making the entire anti-tobacco movement less effective in terms of reducing the tobacco-attributable disease burden. In this context, this study has provided a detailed comparative analysis of the prevalence of smokeless tobacco use and smoking in three countries of the SEAR where such data were available. It can be clearly seen that the preference for smoking has shifted towards the smokeless tobacco in all the three study countries. This study recommends that tobacco control interventions should be aligned with the changing dynamics of the tobacco epidemic, and the need of the hour is placing restrictions of smokeless tobacco use so as to drive forward the gains of the anti-tobacco movement.

Use of spectacles for distance vision: coverage, unmet needs and barriers in a rural area of North India.

BACKGROUND: Uncorrected refractive errors contribute enormously to the burden of avoidable visual impairment worldwide. There is a huge disparity in different parts of the globe in context to spectacle coverage for distance vision. This study was undertaken with objectives of determining prevalence of spectacle coverage, unmet needs and associated factors among adults in a rural community of north India. METHODS: A community-based cross-sectional study was carried out within selected clusters of Jhajjar district of Haryana. All participants aged > 15 years underwent visual acuity assessment by LogMAR "E" screening chart. Participants with presenting visual acuity < 6/12 in any eye and all current spectacle users underwent detailed ophthalmic examination and refraction. Additional details about spectacles, barriers for their use and willingness to pay for them were collected. Participants with met and unmet need for spectacle use at visual acuity > 6/12 was computed. These are reported as proportions with 95% confidence intervals. Associated factors with unmet need were determined using bivariable and multivariable logistic regression analysis. RESULTS: A total of 6910 participants were examined. The current spectacle use was 7.5% (95% Confidence Interval CI: 6.5, 8.7). The spectacle coverage was found in 33.3% (95% CI: 30.0, 36.7) participants among those in need. The unmet need was found in 10.8% of participants (95% CI: 10.1, 11.6). On multivariable analysis, odds of unmet need was associated with age, gender, level of education and marriage status. The most common barrier for refractive correction was lack of perceived need for refraction and its correction. CONCLUSION: There is substantial unmet need for distance vision spectacles in this population. It is imperative that multi-component intervention be implemented to improve spectacle coverage in this rural north Indian setting.

Assessment of implementation status of Cigarettes and Other Tobacco Products Act (COTPA) and its awareness among residents in a block of Haryana.

BACKGROUND: Legislative route is one of the known method to control behaviour of population. Cigarette and Other Tobacco Products Act is one of the laws enacted to control the use of tobacco in India lunched in the year 2003. OBJECTIVE: The objective of this study was to find compliance of COTPA among tobacco stores and to find the knowledge of people regarding COTPA. METHODS: All selected communities were studied by community audit. All stores selling tobacco products were assessed for its compliance to COTPA. Thirty participants from selected communities with in the age range of 18- 65 years were selected and interviewed for knowledge regarding COTPA. RESULTS: A total of 218 stores were found to be selling tobacco. None of the stores were fully compliant to all COTPA clauses. Stores in rural areas were found to be more non-complaint than urban areas. 41% of stores were selling tobacco to minors, 10% were within 100 yards of schools.8% of schools have tobacco advertisement on façade and 24% displayed tobacco products openly. Around half of the participants (n-552) had heard about COTPA whereas only 4% were aware of all 4 provisions of COTPA. CONCLUSION: Although more than a decade passed since the law was enacted poor compliance and knowledge was found among participants.

Assessment of histopathological features of maculopapular viral exanthem and drug-induced exanthem.

BACKGROUND: Viral infections and drug reactions are the commonest causes of exanthems in clinical practice. Clinically, their overlapping features may pose a diagnostic challenge. Hematologic, in vitro, and drug provocation tests are either unreliable or impractical. METHODS: This was a descriptive, prospective study to assess and compare histopathological features of maculopapular viral and drug exanthem. Subjects fulfilling case definition of exanthems were included. Serum C-reactive protein (CRP) and absolute eosinophil count (AEC) were also studied. RESULTS: Skin biopsy slides of 48 cases were evaluated and AEC and CRP were performed. Both median AEC and CRP were lower in viral exanthem compared with drug exanthem. On histopathological evaluation, features such as lymphocytic exocytosis, and dermal infiltrate of eosinophils, lymphocytes and histiocytes were seen in a significantly greater number of drug exanthems. Other findings such as focal spongiosis, acanthosis, keratinocyte necrosis, basal cell damage, papillary dermal edema and atypical lymphocytes in the dermis were also observed in higher though not statistically significant number of drug exanthem biopsies. CONCLUSIONS: Certain histopathological features can help to differentiate between the two exanthems and this modality may be used in situations when there is clinical overlap and when drug rechallenge cannot be undertaken.

Prevalence and gender difference in depression in primary health care in India: A systematic review and meta-analysis.

Background: Depression contributes to the major burden of mental illness in India. Assessment of burden is essential to develop interventions to address the problem at the primary care level. Materials and Methods: We carried out a systematic review and meta-analysis of studies documenting the prevalence of depression in primary care in India. A wide literature search strategy was developed using keywords and Medical Subject Headings. The literature search was done in MEDLINE (via PubMed), IndMed, and major Indian psychiatric journal websites. The protocol was registered at PROSPERO. Bias assessment was carried out using a Cochrane risk of bias tool. Results: A total of 186 studies were identified after an initial search, of which 17 were included in the final analysis using pre-specified inclusion and exclusion criteria. The aggregate point prevalence of depression at the primary care level of the 17 studies using the random-effect model was 23.0% (95% CI: 16.0-30.0%). Significant heterogeneity was reported among the studies attributed majorly to a variety of study tools for assessing depression. Sub-group analysis revealed the higher aggregated prevalence of depression among females as compared to males at the primary care level. Conclusion: The study provided updated evidence of higher and gender differential burden of depression at the primary care level in India.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India.

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Trends in tobacco consumption in India 1987-2016: impact of the World Health Organization Framework Convention on Tobacco Control.

OBJECTIVES: We describe national and subnational trends in tobacco use over three decades in India, assess the impact of the World Health Organization's Framework Convention on Tobacco Control (FCTC) on them and draw inferences for regional tobacco control policy. METHODS: Data from nine cross-sectional surveys conducted between 1987 and 2016 were analysed. Time trends in gender- and state-wise prevalence were derived for different forms of tobacco. To assess Framework Convention's impact, relative changes in tobacco prevalence before and after its implementation were estimated. Progress towards global noncommunicable diseases target was also measured. RESULTS: Post-implementation of the FCTC, smoking and smokeless tobacco use declined by 52.9% and 17.6%, respectively. The tobacco product mix (exclusive smokeless/exclusive smoked/dual) underwent a reversal from 37:52:11 in 1987 to 65:22:13 in 2016. Having achieved 20.5% relative reduction since 2009, India is en route to achieving the global noncommunicable diseases target. CONCLUSIONS: Steep declines in tobacco use have followed the implementation of FCTC in India. However, the impact has been unequal on smokeless and smoked forms. Tobacco-control policies in high smokeless burden countries should take cognizance of this pattern and design comprehensive and flexible policies.

Health behaviors, outcomes and their relationships among young men aged 18-24 years in a rural area of north India: A cross-sectional study.

BACKGROUND: There is limited information related to health behaviors and their related factors among young men in rural setting of India. This study was conducted to investigate multiple health risk behaviors and outcomes among young men aged 18-24 years in rural India. METHODS: This was a community-based cross-sectional survey conducted in the Ballabgarh block of Faridabad district, Haryana, India. Information regarding socio-demographic details, substance use, injury & violence, mental health and sexual behaviors were collected using a semi-structured interview schedule. Age adjusted prevalence estimates of behaviors and outcomes are computed along with 95% Confidence Intervals. Mediation analysis was carried out to examine relationships between socio-demographic variables, select behaviors and outcomes reported in the study. RESULTS: A total of 836 young men participated in the study, with mean (SD) age of 20.6 (1.9) years. The age-adjusted prevalence (with 95% Confidence Interval) for ever use of tobacco, alcohol, and other substances was 34.2% (33.9, 34.5), 23.4% (23.2, 23.6), and 4.5% (4.4, 4.5), respectively. Loneliness and suicidal thoughts were reported by 237 and 35 youth men with age adjusted prevalence as 28.6%, 95% CI: 28.4-28.8 and 4.3%, 95% CI: 4.23-4.31, respectively. A total of 330 young men met serious injury in past one year (prevalence 39.3%, 95%CI: 39.01-39.67). Almost one-third of men (prevalence 30.6%, 95%CI: 30.34-30.85) had engaged in pre-marital sexual intercourse. Current substance use was found to be significant mediator for associations with socio-demographic variables studied for dependent variables viz. pre-marital sexual intercourse and serious injury. CONCLUSION: High prevalence of various risk behaviors and outcomes was found in young men aged 18-24 years in our rural setting. It is imperative that multi-component health intervention package be rolled out to address these.

Correction: Health behaviors, outcomes and their relationships among young men aged 18-24 years in a rural area of north India: A cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0220285.].

Prevalence and causes of visual impairment among adults aged 15-49 years in a rural area of north India - A population-based study.

Purpose: Very few studies have been conducted in India and other parts of the world on visual impairment among individuals aged 15-49 years. This study was conducted to determine the prevalence, causes, and associated factors of visual impairment among adults aged 15-49 years in a rural population of Jhajjar district, Haryana, north India. Methods: A population-based cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 15-49 years were selected using compact segment cluster sampling approach. As part of the house-to-house survey, presenting visual acuity using screening chart corresponding to five "E" 6/12 optotypes was measured along with collection of other demographic details. The optometrists performed detailed eye assessment including repeat measurement of visual acuity using retro-illuminated conventional logMAR tumbling "E" charts, torch light examination, and non-cycloplegic refraction at a clinic site within the village to ascertain visual impairment and its cause. Results: Of 5,470 enumerated adults, 5,117 (94%) completed all study procedures. The age- and sex-adjusted prevalence of visual impairment was found to be 1.85% [95% confidence interval (CI): 1.48, 2.23] and blindness was 0.09% (95% CI: 0.01, 0.18). The age- and sex-adjusted prevalence of unilateral visual impairment was 1.11% (95% CI: 0.81, 1.41). Uncorrected refractive errors (84%) contributed maximum to visual impairment in this age group. The visual impairment in study participants was found to be associated with age and educational status. Conclusion: At the community level, uncorrected refractive errors contribute largely to visual impairment in the age group of 15-49 years.

Prevalence and causes of visual impairment amongst older adults in a rural area of North India: a cross-sectional study.

OBJECTIVES: To determine the prevalence, causes and associated factors for visual impairment (VI) in rural population of Jhajjar district, Haryana, north India. METHODS: A community-based, cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 50 years and above were selected using compact segment cluster sampling approach. Presenting visual acuity using LogMAR E chart was measured along with collection of other demographic details as part of the house-to-house survey. Subjective refraction and torch light examination were performed at a clinic site within the village to ascertain VI and its cause. VI was considered when presenting visual acuity was less than 6/18 in the better eye. Common causes of VI viz uncorrected refractive errors, cataract, central corneal opacity and others were noted by optometrists. Descriptive analysis was undertaken. Multivariate logistic regression analysis was performed for determining associated factors with VI. RESULTS: Out of 2025 enumerated adults, 1690 (83.5%) were examined at the household level and 1575 (78%) completed all study procedures. The prevalence of VI was found to be 24.5% (95% CI 21.1 to 26.3) and blindness was 5% (95% CI 3.9 to 6.1). The most common causes of VI were uncorrected refractive errors (50%) and cataract (37%). The VI in study participants was found to be associated with age, gender, marital and educational status. CONCLUSIONS: VI is still a public health problem in rural population of Jhajjar district, Haryana. Provision of spectacles and cataract surgical services are simple interventions to address this issue.

Effect of intravenous iron sucrose on hemoglobin level, when administered in a standard-dose, to anemic pregnant women in rural Northern India.

INTRODUCTION: To combat anemia among pregnant women, in Haryana, Northern India, administration of intravenous iron sucrose (IVIS) was initiated in 2014 as a public-health measure. We assessed the effect of IVIS on hemoglobin (Hb) levels among the pregnant anemic women. METHODS: Pregnant women identified as moderately or severely anemic (Hb <10.0 g/dL) in the second or third trimester during routine antenatal care were prescribed IVIS in a standard-dose of 400 mg given as 100 mg on alternate days. Neither dose calculation, nor allowance for iron-store, was included in this study. We analyzed the data collected between June 2014 and December 2015, at the two primary-health-centers, on Hb level (by HemoCue method) before start of the therapy (baseline), and 4-week or more after the last infusion (endline). RESULTS: A total of 990 women received IVIS. Both baseline and endline Hg-levels were available for 763 (77%), who were included in the analysis. At baseline, the proportion of moderate and severe anemia was 87.94% and 12.06%, respectively. Mean (standard deviation)-Hb increased from 7.85 g/dL (0.80) at baseline, to 9.62 g/dL (1.30) at endline, with a mean increase of 1.76 g/dL (95% confidence interval 1.67, 1.85). The mean increase in Hb-level for pregnant women who had severe and moderate anemia at baseline was 2.54 g/dL and 1.65 g/dL, respectively. Overall, 15.33% of women achieved normal Hb-level by the time of endline measurement. No serious adverse reactions were reported during the observation period. CONCLUSION: Mean increase in Hb-level was 1.76 mg/dL. Severely anemic pregnant women had larger increase in Hb-level when compared with pregnant women with moderate anemia.