Parimala Mohanty

Background: Dog-mediated rabies disproportionately affects marginalised and socioeconomically disadvantaged communities. Tea estate (TE) communities in India exemplify one such vulnerable population. Despite their vulnerability, limited research has explored rabies epidemiology within TE settings. This retrospective study uses secondary data to evaluate the incidence of dog bite and their determinants amongst the TE communities in the Udalguri district of Assam state of India. Methods: Secondary data from 17 to 29 months (January 2022 to May 2024) were retrieved from the hospitals and dispensaries of 11 TE of Udalguri district, Assam. The collected information included dog-bite victims’ demographics and adherence to post-exposure prophylaxis (PEP). Data were analysed using R software, employing descriptive statistics, chi-square tests, odds ratios and mixed-effect logistic regression. Administrative approval was obtained prior to data collection. Results: A cumulative annual incidence of 11.8 bites per 1,000 individuals was recorded across 11 TE in Udalguri. Children aged ≤15 years accounted for 35% of cases, and dependents were the most affected occupational group (32%). Most exposures involved dogs (66%), and 76% of incidents were bites. Less than half (43%) of victims completed the full PEP regimen of five doses, although 71% received at least three doses. Chi-square analysis indicated that males and children aged ≤ 15 years were more likely to be bitten by dogs compared to other animals than females and the older residents. Children aged ≤ 15 years and non-workers had higher odds of receiving any PEP, while females and children aged ≤ 15 years are more likely to receive at least three doses. In multivariable analysis, females were less likely than males to be bitten by dogs compared to other animals (aOR = 0.4, 95% CI: 0.3–0.7), older individuals had higher odds of completing PEP (aOR = 1.8, 95% CI: 1.2–2.8), and children (≤15 years) were more likely to receive at least three doses of PEP (aOR = 1.9, 95% CI: 1.1–3.3). Temporal analysis showed no clear seasonal pattern, although spikes were observed during winter and monsoon months. Conclusion: This retrospective study contributes to build the foundation for community-based approach to control dog-mediated rabies in TE by highlighting key epidemiological patterns, demographic vulnerabilities and limitations of the existing intervention implementation delivery among TE communities. We recommend further in-depth investigations to inform the context specific interventions designed to address the unique vulnerabilities, thereby reducing the risk of rabies specifically in tea -estate populations.

Background: It is documented that married women do not utilize contraceptive methods, because of the fear of adverse effects, no or seldom sexual interaction; perception that they should not use contraception during breastfeeding, postpartum amenorrhea, or dissatisfaction with a specific method of contraception. The current study aimed to examine the socio-economic inequalities associated with the non-use of modern contraceptive methods among young (15-24 years) and non-young (25-49 years) married women and the contributing factors in those inequalities. Methods: The present study utilized the cross-sectional data from the fourth round of the National Family Health Survey (NFHS-4) with a sample of 499,627 women who were currently married. The modern methods of family planning include sterilization, injectables, intrauterine devices (IUDs/PPIUDs), contraceptive pills, implants, the standard days method, condoms, diaphragm, foam/jelly, the lactational amenorrhea method, and emergency contraception. Multivariable logistic regression analysis was used to estimate the odds of non-use of modern contraceptive methods according to different age groups after controlling for various confounding factors. Additionally, concentration curve and Wagstaff decomposition method were used in the study. Results: The prevalence of non-use of modern contraceptive use was higher among women from young category (79.0%) than non-young category (45.8%). The difference in prevalence was significant (33.2%; p < 0.001). Women from non-young age group had 39% significantly lower odds of non-use of modern contraceptive use than women from young age group (15–24 years) [AOR: 0.23; CI: 0.23, 0.23]. The value of concentration quintile was -0.022 for young and -0.058 for non-young age groups which also confirms that the non-use of modern contraceptives was more concentrated among women from poor socio-economic group and the inequality is higher among non-young women compared to young women. About 87.8 and 55.5% of the socio-economic inequality was explained by wealth quintile for modern contraceptive use in young and non-young women. A higher percent contribution of educational status (56.8%) in socio-economic inequality in non-use of modern contraceptive use was observed in non-young women compared to only -6.4% in young women. Further, the exposure to mass media was a major contributor to socio-economic inequality in young (35.8%) and non-young (43.2%) women. Conclusion: Adverse socioeconomic and cultural factors like low levels of education, no exposure to mass media, lack of or limited knowledge about family planning, poor household wealth status, religion, and ethnicity remain impediments to the use of modern contraceptives. Thus, the current findings provide evidence to promote and enhance the use of modern contraceptives by reducing socioeconomic inequality.

Background: Monkeypox is a global public health concern, given the recent outbreaks in non-endemic countries where little scientific evidence exists on the disease. Specifically, there is a lack of data on asymptomatic monkeypox virus infection. This study aims to evaluate the overall prevalence of asymptomatic monkeypox virus infection. Methods: In this systematic review and meta-analysis, we performed an extensive literature search in PubMed, Scopus, Web of Science, ProQuest, EMBASE, EBSCOHost, Cochrane, and preprint servers (medRxiv, arXiv, bioRxiv, BioRN, ChiRxiv, ChiRN, and SSRN) and assessed all published articles till September 2022. Primary studies reporting monkeypox infections among asymptomatic participants were included after quality assessment. The characteristics of the study and information on the number of cases and symptomatic status were extracted from the included studies. The heterogeneity between studies was assessed using the I² statistic. Publication bias was analyzed using funnel plots and Egger regression tests. The primary outcome was the pooled prevalence of asymptomatic infections within the examined population. Results: A total of 16 studies were included for qualitative synthesis, while five studies, including 645 individuals, were included for quantitative synthesis. There was substantial heterogeneity between studies (I² = 94.86%; p < 0.01), with a pooled percentage of asymptomatic infections in the studied population of 10.2% (95%CI, 2.5–17.9%). Conclusion: This meta-analysis suggests that many people infected with the monkeypox virus are asymptomatic and difficult to detect. Therefore, prompt detection of these cases of monkeypox virus and appropriate subsequent management is of utmost importance to global public health.

Understanding socioeconomic inequalities in non-communicable disease prevalence and preventive care usage can help design effective action plans for health equality programs among India’s aging population. Hypertension (HTN) and diabetes mellitus (DM) are frequently used as model non-communicable diseases for research and policy purposes as these two are the most prevalent NCDs in India and are the leading causes of mortality. For this investigation, data on 31,464 older persons (aged 60 years and above) who took part in the Longitudinal Ageing Survey of India (LASI: 2017–2018) were analyzed. The concentration index was used to assess socioeconomic inequality whereas relative inequalities indices were used to compare HTN, DM, and preventive care usage between the different groups of individuals based on socioeconomic status. The study reveals that wealthy older adults in India had a higher frequency of HTN and DM than the poor elderly. Significant differences in the usage of preventive care, such as blood pressure/blood glucose monitoring, were found among people with HTN or DM. Furthermore, economic position, education, type of work, and residential status were identified as important factors for monitoring inequalities in access to preventive care for HTN and DM. Disparities in non-communicable diseases can be both a cause and an effect of inequality across social strata in India.

Background: Prevalence of hypertension increases with age, but there is a general perception in India that women are less affected at every stage of life, although empiric evidence hardly exists regarding gender difference in hypertension in Indians of different ages. Therefore, we aimed to examine the gender difference in hypertension among Indians across various age-groups; and the contribution of variation in body mass index (BMI) to this difference. Methods: Data were analysed after combining National Family Health Survey 4 (n = 294,584 aged 35–49 years) and Study of Ageing and Health wave 2 (n = 7118 aged 50 + years) datasets (NFHS-SAGE). Longitudinal Ageing Study of India (LASI) dataset (n = 65,900 aged > 45years) was analysed to replicate the results. Hypertension was defined if systolic and diastolic blood pressure was > 89 and/or > 139 respectively and/or if there was a history of anti-hypertensive medication. Descriptive summaries were tabulated and plotted to examine the gender difference in hypertension in various age-groups (35–39,40–44, 45–49, 50–54, 55–59, 60–64, 65–69, ≥ 70). Odds Ratios (ORs) from logistic regression models estimated the age gradient of hypertension and their male-female difference, adjusted for Body Mass Index (BMI). Results: Males had a higher prevalence of hypertension up to 50 years; after that, females had higher rates. The estimates of age gradient, expressed as ORs, were 1.02 (1.02, 1.02) in males versus 1.05(1.05, 1.06) in females (p < 0.001) in NFHS-SAGE and 1.01(1.01, 1.02) in males versus 1.04(1.03, 1.04)in females (p < 0.001) in LASI;these differences marginally changed after adjustment with BMI. Conclusion: This is perhaps the first study to comprehensively demonstrate that cardio-metabolic risk in Indian females surpasses males after 50 years of age, “busting the myth” that Indian females are always at much lower risk than males; and this evidence should inform the Indian healthcare system to prioritise older women for screening and treatment of hypertension.

Sarcopenia refers to common age-related changes characterised by loss of muscle mass, strength, and physical performance that results in physical disability, poorer health status, and higher mortality in older adults. Diet quality is indicated as a potentially modifiable risk factor for sarcopenia. However, the association between diet quality and sarcopenia in developing economies appears to be conflicting. Hence, we conducted a systematic review of the literature from developing economies examining the relationship between diet quality and at least one of the three components of sarcopenia, including muscle mass, muscle strength, and physical performance, and the overall risk of sarcopenia. No restrictions on age and study design were employed. We identified 15 studies that met review inclusion criteria. There was heterogeneity among the studies in the diet quality metric used and sarcopenia-related outcomes evaluated. Longitudinal evidence and studies relating diet quality to a holistic definition of sarcopenia were lacking. Although limited and predominantly cross-sectional, the evidence consistently showed that diet quality defined by diversity and nutrient adequacy was positively associated with sarcopenia components, such as muscle mass, muscle strength, and physical performance.

Introduction: The morbidity and mortality among under-five children are many times higher in slums than more privileged urban neighbourhoods. This could be correlated with the caregivers’ behaviour too. Therefore, we intended to assess the health care seeking behaviour for their children among caregivers of under-five children in urban slums of Bhubaneswar city. Methods: It was a cross-sectional study conducted during Jan 2019 to April 2019 in Bhubaneswar, India. Data regarding health care seeking behaviour of 530 caregivers of under-five (U5) children residing in urban slums of Bhubaneswar, whose children suffered from any illness in last one month, were collected. Results: The most common childhood illnesses for which healthcare were sought were diarrhoeal diseases (30.4%) followed by respiratory infections (29.1%). A concept analysis of the predisposing factors was built up as “socio cultural context”, “economic context”, “education context”, and “individual preference” to know the health care seeking pattern. The health care seeking behaviour among the caregivers of under-five children was significantly associated with sex of child, size of the household, social group of caregiver, mother with mass media knowledge, age, education and occupation of mother, mother having BPL card, if suffering from chronic disease, decision making person for seeking health care, time lapse in approaching the health care facility and income loss due to U5 children illnesses. Conclusions: The challenge is to know about signs and symptoms of ill-health and to recognise when to seek health care services. Measures can be taken to promote awareness for seeking timely appropriate care. There is a need to develop locally adapted behaviour change communication interventions for childhood Illnesses.