Prevalence of self-reported reproductive tract infections/sexually transmitted infections symptoms and treatment seeking behavior among the married tribal women in Udaipur, Rajasthan

Background: Indian tribes are culturally distinct communities, with unique traditions and practices. Lack of awareness and “culture of silence” about reproductive health issues among women in rural areas contributes to high burden of reproductive tract infections/sexually tract infections. Rural tribal women also suffer from ignorance, poverty and lack of access to quality health care, which makes them more vulnerable to RTIs/STIs.Methods: It was a community based cross sectional study conducted among 200 tribal women living in rural Udaipur, Rajasthan. The study was conducted from May 2019 to November 2019. A predesigned, pretested and structured questionnaire was used to take the interview of eligible women. Questionnaire included questions about sociodemographic profile, questions to assess the knowledge regarding RTIs and history of occurrence of any RTI symptom in the past six months and; questions to assess the treatment seeking behaviour for RTI symptoms.Results: Most of the participants were 26-35 years old.About 37% gave the history of experiencing RTI symptoms, vaginal discharge being the most common (46%) symptom. Regarding the treatment, most (34%) of the females took treatment from government hospital, followed by 26% of women who bought the medicines direct from pharmacy (over the counter), about 16% consulted a private practitioner. Prevalence was found to be significantly higher in less educated, belonging to lower socioeconomic status and among non-users of contraceptive methods.Conclusions: Health education and active participation of stakeholders in the reproductive health programs is essential to strengthen the ongoing schemes about improving reproductive health of tribal women

A perspective on Master of Public Health (MPH) Graduates in India: Current role and way head

The public health sector of any country deals on the forefront and utilizes the multidisciplinary approach. In India the Masters of Public Health graduates are trained in unstandardized manner and lack a regulatory body. The gap created in serving the unserved can easily be fulfilled by utilization of this workforce in systematic manner, The emerging competition in the field, undervalued sector in terms of monitory benefits, poor demand and limited training institutions for MPH graduates along with the contribution of MPH during COVID 19 pandemic has been emphasized in the article. The perception of those working in the field has been highlighted with the way ahead of MPH program in India

Prevalence and pattern of anemia in the second and third trimester pregnancy in Western Rajasthan

Background: Anemia in pregnancy is related to maternal-fetal morbidity and mortality. In developing countries like India it is important to study prevalence and pattern of anemia in pregnancy especially in the region with higher maternal mortality rate like western Rajasthan. The main objective was to study the prevalence and pattern of anemia in second and third trimester pregnant females in western Rajasthan.Methods: In this cross sectional study females with second and third trimester pregnancy were evaluated for presence of anemia with its morphological type and severity.Results: 17,552 second and third trimester pregnant females were evaluated and prevalence of anemia was found 48.4%. The percentages of mild, moderate and severe anemia were 35.1%, 51.3% and 13.4% respectively. Most common morphological type was microcytic hypochromic anemia (51%) followed by normocytic normochromic anemia (32%), dimorphic anemia (13%) and macrocytic anemia (4%).  Conclusions: There is high prevalence of anemia in pregnant females. This warrants the need of proper prophylaxis and early diagnosis of anemia in pregnancy to minimize the maternal-fetal morbidity and mortality

A study of cytological pattern of cervical papanicolaou smears in western Rajasthan, India

Background: Cervical cancer is one of the most common cancers of Indian females. Western Rajasthan differs a lot from rest of India in respect of geographical conditions, environment, culture, population density etc. and it also has relatively lower literacy rate which is one of the risk factor for many diseases. The objective of this study was to estimate the prevalence of cervical cytological pattern in females of western Rajasthan by using conventional Papanicolaou (Pap) smears for the screening of inflammatory, premalignant and malignant lesions of the cervix.Methods: This cross sectional study was conducted at tertiary care institute of western Rajasthan for 1.5 year duration, on 1768 females who were screened by Pap smear examination. After staining with conventional Papanicolaou technique, all smears were classified as per Bethesda nomenclature.Results: Out of 1768 smears 1039 (58.7%) were abnormal Pap smears, 445 (25.1%) were normal Pap smears while 284 (16.1%) smears had inadequate sample material to be examined. Out of 1039 abnormal smears, 956 (92.01%) smears reported to have inflammatory/reactive changes whereas 26 (2.50%) had atrophic changes in Pap smear and abnormality in epithelial cell was reported in 57(5.49%) smears.Conclusions: Pap smear examination is an effective screening procedure to detect cervical cytological abnormalities. Routine cytological screening by Pap smear should be offered to all women above 19 years or within 3 years of sexual activity. It is recommended to improve the awareness about the disease amongst females and skills of health care personal about proper preparation of Pap smear

Socio-epidemiological study of malnutrition and associated risk factors among under five children in rural Rajasthan

Background: Malnutrition continues to be a major problem in India and is rightfully described as “the silent emergency.” Sociocultural factors and rural urban disparity in health services in our country further impact the health outcomes. The effects of malnutrition are long-term and trap generations in the vicious circle of poverty. Improving nutrition is therefore essential to accelerate economic growth and development of the country.Methods: It was a community-based cross-sectional study conducted among 200 under five children residing in rural Udaipur, Rajasthan. Random sampling technique was used to select the study participants. A structured validated questionnaire was used to collect socio demographic data, birth history, Anganwadi beneficiary status etc. Mid upper arm circumference (MUAC), weight and heights were recorded and classified as underweight, wasted and stunted, using standard World Health Organization (WHO) guidelines.Results: This study revealed that 58% of the study population was stunted, 45% was wasted, 54% was underweight and 5% was overweight of the study population was overweight. Regarding the association of malnutrition parameters with other factors, it was found that malnutrition was high among female children, lower socioeconomic class, children of low educated mothers and children who were not exclusively breast fed.Conclusions: To combat malnutrition in India, there is need of multifaceted approach, taking into account the sociocultural determinants, demographic variables, especially in rural areas. In addition to providing supplementary nutrition, innovations regarding specific interventions targeted towards vulnerable population is necessary

Use of emergency contraceptive pill in India: boon or bane

It has been almost fifteen years since emergency contraceptive pills (ECPs) have been made available over the counter in India. There have been concerns about the overuse/misuse of ECPs and probability to replace regular contraceptive methods. This article presents various facets of the use of emergency contraceptive pills in India and highlights the importance of potential research to prevent its misuse

Knowledge, attitude, and practices in response to COVID-19 pandemic in Indian population

Background: The World Health Organization (WHO) had reported COVID-19 disease as a pandemic in March 2020, following which India witnessed more than 29,451 cases on 29th April. Correct knowledge about the disease, the right attitude, and response to infection control recommendations among people is of utmost importance to limit the contagion.Methods: A Cross-Sectional, web-based online study was conducted for five days. The responses (N= 1231) were collected across social networks using snowball sampling. The survey questionnaire assessed the knowledge, attitude, and practical aspects of participants for COVID-19. Knowledge items assessed the causative agent of COVID-19, it’s clinical symptoms, routes of transmission, preventive measures etc. Positive or negative attitudes towards mask usage and restriction compliance were assessed. Socio-demographic data and scores were de-identified and analyzed using appropriate statistical tests.Results: The mean age of participants (N=1231) was 32.3±13.7 years and 60.9% were males. High knowledge years and 60.9% participants were males. High knowledge accuracy rate of 84.5% and a mean score of 10.19±1.6 out of 12 was observed. Mean attitude and practice scores were 2.33±0.66 (3) and 1.97±0.16 (2) respectively. A significantly higher knowledge status was observed among females, medical workers, students, and homemakers. Similarly, better attitudes were noticed in males, adults (30-60 years), graduates, and those in job/service. As for practices, no such difference was noticed as more than 98% of participants were compliant to lockdown restrictions and practiced proper distancing and personal hygiene measures.Conclusions: Satisfactory awareness and response were observed owing to the public awareness campaign. Knowledge gaps, poor attitudes, and prevailing myths need to be addressed through targeted communication strategy.

Demographic characters and factors favouring emergence of diabetes mellitus type two

Background: Diabetes mellitus (DM) is associated with high morbidity and mortality. It has various complications. Risk factor control is effective way of prevention. Current study was conducted to know demographic profile including risk factors related to diabetes mellitus in patients attending a tertiary health care institute of Rajasthan.Methods: This cross-sectional study was conducted for the duration of six months. In the study 623 diabetes mellitus type 2 patients were included and subjected to evaluation of various demographic parameters and risk factors like age, sex, economic status, area of residence, obesity, hypertension (HTN), lack of exercise, smoking, dyslipidemia and positive family history.Results: Mean age of diabetic population was 62 years. Male-female, urban-rural ratios were nearly 1:1 and 3:2 respectively. Nearly 7 % patients were found to be below poverty line (BPL). On risk factor evaluation of 623 diabetic patients it was found that 598 (96%) patients had lack of exercise, 406 (65.2%) patients had age more than 60 years, 394 (63.2%) patients had dyslipidemia, 210 (33.7%) patients were smoker as per the mentioned criteria, 144 (23.1%) patients were obese, 118 (19%) patients had HTN before emergence of DM and 90 (14.4%) patients had positive family history.Conclusions: High prevalence of risk factors in Indian community is alarming. Health education, promotion of exercise, favourable life style, dietary modification, cessation of smoking, screening programmes for early detection of derange blood pressure, blood sugar, lipid profile can be effective prevention strategies

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions