A cluster randomized, controlled trial of breast and cervix cancer screening in Mumbai, India: methodology and interim results after three rounds of screening

Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries. In May 1998, supported by a grant from the NCI (US), the Tata Memorial Hospital, Mumbai, India, started a cluster-randomized, controlled, screening-trial for cervix and breast cancer using trained primary health workers to provide health-education, visual-inspection of cervix (with 4% acetic acid-VIA) and clinical breast examination (CBE) in the screening arm, and only health education in the control arm. Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers. The methodology and interim results after three rounds of screening are presented here. Good randomization was achieved between the screening (n = 75360) and control arms (n = 76178). In the screening arm we see: High screening participation rates; Low attrition; Good compliance to diagnostic confirmation; Significant downstaging; Excellent treatment completion rate; Improving case fatality ratios. The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion, language, age, education, occupation, income and health-seeking behavior for gynecological and breast-related complaints. During the same period, in the control arm we see excellent participation rate for health education; Low attrition and a good number of symptomatic referrals for both cervix and breast

IJCM_364A: A Cross Sectional Study on Sickle Cell Disease awareness among adolescents in a tribal district of Maharashtra, India

Background: Sickle Cell Disease (SCD) poses a substantial health concern in India, especially among tribal populations. The Ministry of Health and Family Welfare’s Tribal Health Expert Committee has identified SCD as one of the top 10 challenges in tribal health. This study aims to assess the knowledge gap about SCD among school-going adolescents in a tribal district of Maharashtra. Objective: 1. To assess awareness of sickle cell anaemia among adolescents aged 12-18 years in a tribal district of Maharashtra 2. To provide recommendations based on study findings. Methodology: A cross-sectional study was conducted in a tribal district of Maharashtra, involving 394 school-going adolescents. Participant’s knowledge of sickle cell anaemia was assessed through face-to-face interview after obtaining necessary permissions from concerned authorities and assent from the participants. Data collection included information on general awareness, understanding of disease transmission, familiarity with sickle cell crisis, and preventive measures, with strict maintenance of data confidentiality. Results: Out of the 394 participants surveyed, 212 (53.8%) were females, and 182 (46.2%) were males. Only 19 students (5%) demonstrated awareness of SCD, with 16 (7.5%) females and 3 (1.6%) males out of the total. Surprisingly, none (0%) had knowledge of its transmission or had undergone screening for SCD. Within the aware subset, only 3 (15%) recognized Sickle Cell Crises, and a lone respondent (5%) was aware of its preventive measures. Conclusion: The study highlights a notable lack of sickle cell disease awareness among school-going adolescents in Maharashtra’s tribal district, posing a potential public health challenge. Urgent, tailored interventions are essential to sensitize the future generation, aligning with SDG 3, which aims for improved health and well -being through enhanced understanding and awareness

Establishing a model workplace tobacco cessation program in India

Background: Tobacco use is highly prevalent and culturally accepted in rural Maharashtra, India. Aims: To study the knowledge, attitude, and practices (KAP) regarding tobacco consumption, identify reasons for initiation and continuation of tobacco use, identify prevalence of tobacco consumption and its relation with different precancerous lesions, provide professional help for quitting tobacco, and develop local manpower for tobacco cessation activities. Settings, Design, Methods and Material: The present study was conducted for one year in a chemical industrial unit in Ratnagiri district. All employees (104) were interviewed and screened for oral neoplasia. Their socio-demographic features, habits, awareness levels etc. were recorded. Active intervention in the form of awareness lectures, focus group discussions, one-to-one counseling and, if needed, pharmacotherapy was offered to the tobacco users. Results: All employees actively participated in the program. Overall, 48.08% of the employees were found to use tobacco, among which the smokeless forms were predominant. Peer pressure and pleasure were the main reasons for initiation of tobacco consumption, and the belief that, though injurious, it would not harm them, avoiding physical discomfort on quitting and relieving stress were important factors for continuation of the habit. Employees had poor knowledge regarding the ill-effects of tobacco. 40% of tobacco users had oral precancerous lesions, which were predominant in employees consuming smokeless forms of tobacco. Conclusions: Identifying reasons for initiation and continuation of tobacco consumption along with baseline assessment of knowledge, attitudes, and practices regarding tobacco use, are important in formulating strategies for a comprehensive workplace tobacco cessation program

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020