In 2021, globally, cardiometabolic diseases (CMDs) accounted for 35% of the 1.73 billion disability-adjusted life years (DALYs) attributed to non-communicable diseases. The Healthy Life Trajectories Initiative (HeLTI), a four-country randomised controlled trial based on the developmental origins of health and disease(DOHaD) concept, evaluates whether integrated longitudinal public health interventions started prepregnancy reduce the risk of childhood adiposity and, consequently, the development of CMDs in the offspring. This paper presents the protocol for the economic evaluation of the interventions in the Indian arm of HeLTI. The aim is to facilitate the translation of effective and affordable preventive strategies that mitigate the health, social and economic burden of CMDs. A within-trial economic evaluation will be conducted from provider, health system and societal perspectives. Costs will be identified using the activity-based costing method mapped onto a theory-of-change framework that attributes interventions to health outcomes. Costs will include both direct and indirect costs as well as capital and recurring costs. Cost data will be collected using project accounts, time-use tools, surveys and key informant interviews. The incremental cost-effectiveness ratio (ICER) will be estimated for the fat mass index, a measure of adiposity, the primary health outcome, at the fifth year of offspring. Cost-utility and cost-consequence results will be presented for health-related quality of life (HRQoL) and other secondary health outcomes, respectively, in mothers and offsprings. Sensitivity of the results to assumptions will be analysed and uncertainty intervals will be presented. Equity impact of the outcomes will be assessed using the social determinants of health framework. The study has been approved by the ethics committees of the lead local institutions, CSI Holdsworth Memorial Hospital (Ref CSIHMH/ERU2019/1) and Swami Vivekananda Youth Movement (Ref IRB 004/2020-21). Findings will be disseminated through scholarly articles, policy briefs, opinion pieces, conferences, interactive sessions with stakeholders and the HeLTI website. ISRCTN20161479.
The evidence base for preoperative health-related quality of life (HRQoL) in degenerative lumbar conditions derives predominantly from Western populations. This study characterised HRQoL across four degenerative lumbar conditions in a multi-ethnic Southeast Asian surgical cohort and identified factors associated with physical and mental health at composite and domain levels. Cross-sectional analysis of 1173 preoperative patients from a Singaporean spine surgery registry (2017-2022). SF-36 norm-based T-scores were computed for eight domains and two component summaries. Diagnosis-stratified stepwise multiple regression identified factors associated with the Physical Component Summary (PCS), Mental Component Summary (MCS), and domain scores. LASSO regression served as a sensitivity analysis. Mean PCS was 35.6 (SD 8.9), 1.4 SD below the US normative mean, whereas MCS was 50.3 (SD 9.7), near normative levels. Physical functioning and role-physical were the most impaired domains. Scores differed across the four diagnoses on six of the ten SF-36 outcomes (one-way ANOVA, all p < 0.05; corroborated by Kruskal-Wallis tests), although effect sizes were small (eta-squared ≤ 0.02). Functional disability showed the strongest association with PCS across all four conditions (β range: - 0.32 to - 0.28; adjusted R2 = 0.48-0.52). MCS models explained limited variance (adjusted R2 = 0.09-0.22). At the domain level, physical functioning had the highest adjusted R2 (0.57-0.67), exceeding even PCS. Indian ethnicity was independently associated with lower MCS in two conditions. LASSO sensitivity analyses corroborated the stepwise findings. Functional disability was most strongly associated with physical HRQoL, channelled through physical functioning limitations. Conventional variables explained limited mental HRQoL variance, suggesting unmeasured psychological and cultural factors play a substantial role. While functional disability's primacy was consistent with Western evidence, secondary patterns diverged from Western cohorts. These findings underscore the need to incorporate psychological and culturally adapted measures into preoperative assessment. Most existing evidence on quality of life prior to spine surgery is derived from studies conducted in Western populations. In this study, we examined 1173 patients in Singapore awaiting surgery for four common spinal conditions. Using the SF-36 health questionnaire, we found that patients’ physical health scores were substantially lower than those of the general population, while mental health scores were relatively preserved. Difficulty in performing everyday activities was the factor most strongly associated with poorer physical health, rather than pain severity, body mass index, or comorbidities. In contrast, mental health was more difficult to explain, with commonly measured clinical factors accounting for only a small proportion of the observed variation. We also observed that patients of Indian ethnicity reported lower mental wellbeing compared to those of Chinese ethnicity. These findings suggest that determinants of quality of life may differ between Asian and Western populations and highlight the need to give greater consideration to psychological and cultural factors in the care of patients undergoing spine surgery.
Diabetes has emerged as a major health challenge, evident by the rapid rise of cases. As per the National Family Health Survey-5 (NFHS-5), high blood sugar levels have been reported among 13.5% of Indian women and 15.6% of Indian men. However, nearly half of the population with diabetes is estimated to be undetected, especially adults. Diabetes-related comorbidities can be prevented by detecting the high risk at an early stage through assessment and screening of this large pool of adults. The objective of this study was to assess the risk of type 2 diabetes mellitus (T2DM)among the adult population. A community-based cross-sectional survey was carried out at Jodhpur, Rajasthan, including 271 adults selected using a multistage sampling method. Data were collected through an interview schedule consisting of sociodemographic characteristics and assessment of lifestyle and behavioral, physical, and biochemical parameters. The Indian Diabetes Risk Score (IRDS) was used to assess the risk of diabetes. Data were analyzed with the help of SPSS version 25. The adults' mean age was 40.64 ± 13.21 years, and 26.5% of them mentioned having a family history of T2DM. In this location, most adults have a moderate (40%) to high (31%) risk of developing T2DM. About 25.5% of the adults have other co-morbidities. Age, gender, education, occupation, comorbidity, family history of diabetes, history of tobacco, physical activity, and body mass index were significantly associated with an increased risk for developing diabetes ( P < 0.05). A significant proportion of the adults were found to have a high-to-moderate risk. Poor lifestyle behaviors can further aggravate the situation. This calls for an urgent action plan to promote lifestyle behavior modifications and combat the ever-increasing burden of diabetes among this age group.
The COVID-19 pandemic posed significant mental health challenges to the Healthcare Service Providers (HSPs), causing a tremendous impact on the psychological, economical, and social well-being. This study focuses on evaluating the mental health status of HSPs working in COVID-19 wards of government hospitals in Kolkata. A cross-sectional study was conducted for 2 years (2020-2022) on 590 HSPs of selected government hospitals in Kolkata, selected by two-stage random sampling, to assess the level of mental health status (anxiety, stress, and depression), using an interview schedule, comprising "Generalized Anxiety disorder-7 scale," "Perceived stress scale," and "Patient's Health questionnaire-9." Descriptive and inferential statistics were applied as applicable. Among the participants, 46.8% belonged to the age group of 25-34 years and almost 55% comprised males. About 58.4% of HSPs were doctors, out of which 33% were postgraduate trainees. Almost 58.0% were working in COVID-19 wards of government hospitals were having mild-to-moderate/severe anxiety, 63% of them were having moderate stress, followed by low and high stress. Doctors or nurses by occupation, and maintaining a high socioeconomic status had higher odds of suffering from moderate anxiety. More than half of the HSPs working in COVID-19 wards of government hospitals had mild-to-severe anxiety, whereas housekeeping staff and nursing staffs had high levels of anxiety as compared to doctors.
Maintaining optimal youth nutritional health is an urgent socio-economic imperative that underpins long-term human productivity and rights-based development. However, modern youth cohorts face unique dietary threats caused by the widespread availability of ultra-processed foods, targeted digital marketing, and complex food labeling protocols. Although Artificial Intelligence (AI) presents innovative avenues for personalized dietary profiling, existing systems remain largely technocentric and detached from statutory frameworks or behavioral realities. This study bridges this interdisciplinary divide by evaluating a rights-based, technology-driven framework to improve youth nutritional health. It aims to: (1) empirically evaluate the "Knowledge-Attitude-Practice" (KAP) gap linking statutory consumer rights to real-world eating habits; (2) present the engineering design of a non-commercial Progressive Web Application (PWA) built to translate legal safeguards into daily behavioral changes; and (3) triangulate these findings using data from youth surveys and expert legal and nutritional panels. Using a cross-sectional approach based on non-parametric power constraints, a validated survey instrument was completed by a target sample of Indian youth (n = 354, aged 15-25 years). Concurrently, data matrices were compiled from regional legal experts (n = 12) and public nutrition professionals (n = 12) to cross-verify structural bottlenecks. Group variances, demographic dependencies, and rank associations were analyzed using robust non-parametric tests, including One-Way ANOVA, Kruskal-Wallis (H), Welch's t-test, and Kendall's Tau (τ) correlation coefficients. Inferential analysis revealed unexpected demographic trends: undergraduate status predicted significantly higher FSSAI safety awareness than post-graduate status (p = 0.0037), while subjective health ratings exhibited a non-linear relationship with household income (p = 0.0004), peaking in the lower-middle financial tier. Crucially, rank correlation testing revealed that the relationship between statutory knowledge and actual dietary actions is functionally non-existent (τ = -0.001). This near-zero correlation provides clear empirical proof of a pronounced Knowledge-Action Gap, confirming that passive legal literacy fails to influence food selection in modern environments. By framing automated behavioral interventions within the constitutional protections of Article 21 of the Constitution of India and the Consumer Protection Act, 2019, this study shows how the open-access PWA (nutrition-zb.pages.dev) can bridge this behavioral gap. This shifts the focus of consumer health informatics from basic self-tracking to a rights-based, systemic public health intervention.
Background and objectives Preconception care (PCC) comprises a set of biomedical, behavioural, and social interventions provided before conception to improve maternal and neonatal outcomes. PCC remains a critical missing link in the continuum of reproductive healthcare in India. This study assessed public health-system preparedness and community perception related to PCC service delivery in Maharashtra. Methods A mixed-method, pre-intervention situational analysis was conducted to assess public health-system preparedness and community perceptions regarding PCC service delivery in selected districts of Maharashtra, India. Using stratified purposive sampling, 31 public health facilities were assessed using a facility checklist adapted from World Health Organization (WHO) SARA (Service Availability and Readiness Assessment) domains and mapped to WHO health system building blocks. Additionally, 143 key informant interviews (KIIs) were conducted among healthcare providers, and 20 focus group discussions (FGDs) were conducted with newly married couples and mothers-in-law across rural (tribal and non-tribal) and urban (slum and non-slum) settings. Qualitative findings were thematically analysed using the social ecological model. Both models were triangulated using a COM-B (capacity, opportunity, motivation→ behaviour) framework. Results All assessed facilities had basic infrastructure and manpower; however, PCC services were largely restricted to anaemia prophylaxis and family planning commodities. Major systemic challenges included the absence of PCC-specific guidelines, irregular supply of essential medicines and diagnostics, limited health management and information systems (HMIS) integration, weak policy coordination, inadequate human resources, and referral pathways. From the community perspective, PCC awareness was negligible; misconceptions linked it to infertility care, and family gatekeeping limited women's autonomy. Gender norms and poor male involvement further constrained service uptake. Interpretation and conclusions Although Maharashtra has favourable policy support for PCC through the Mission Vatsalya initiative, significant gaps persist in the health system's readiness and community awareness. Developing PCC-specific operational and technical guidelines, capacity building, provision of information, and education material, PCC indicator integration in HMIS, and demand generation, coupled with male involvement, can optimise PCC uptake and improve PCC service utilisation.
Tuberculosis (TB) is a significant health issue in the world, and lack of health literacy has resulted in delayed care-seeking practices, non-compliance with treatment regimens, and subsequent stigma in communities with the infection. The objective of the study was to determine whether multi-platform digital media campaigns enhance health literacy of the community on TB. The study involved a cluster-randomized controlled trial with sixteen communities in four districts in twelve months with intervention communities (n = 8) having targeted digital media campaigns and control communities (n = 8) having regular health education materials. Digital intervention consisted of orchestrated content dissemination via social media, short video messages, interactive mobile applications, and community WhatsApp groups to contact an approximated number of 47,832 people. Primary endpoint was TB knowledge score; attitudes, stigma perception, and care-seeking intention were prespecified key secondary outcomes. Analyses used mixed-effects models accounting for community-level clustering (ICC assumed 0.05. TB knowledge scores, attitude indices, stigma perceptions and care-seeking intentions were assessed by using validated instruments at pre- and post-intervention using a 2156 population (1084 with intervention and 1072 with control). The outcomes showed that the post-intervention TB knowledge scores were significantly higher in intervention communities (74.8 ± 12.3 vs. 52.4 ± 15.7, p < 0.001), the positive attitude toward the TB patients were also better (68.2% vs. 41.6%, p < 0.001), the scores on stigma perception were lower (2.3 ± 0.9 vs. 4.1 ± 1.2, p < 0.001), and the intentions to seek care were more favorable The metrics of digital content engagement showed that 78.3% of the messages were recalled and 2.4 million videos have been viewed in total. These results indicate that carefully planned digital media campaigns have a great impact on increasing the level of TB health literacy, which is a scalable and cost-effective method of health communication at the community level.
Tuberculosis (TB) remains a critical public health challenge in India, where sustained patient engagement is essential for its effective management. Despite the pivotal role of health literacy, the ability to access, understand, appraise, and apply health-related information in treatment adherence and outcomes, few tools are TB specific, culturally attuned to India, and psychometrically validated. The Health Literacy Instrument for Adults (HELIA), developed in Iran, is a multidimensional, World Health Organization (WHO)-aligned measure with proven reliability and open access, making it an ideal candidate for adaptation. This study aimed to culturally adapt and validate the HELIA for use among adults receiving TB treatment in India (HELIA-TB). An exploratory sequential mixed-methods design was employed for the cultural adaptation and psychometric validation of the HELIA-TB in Junagadh district, Gujarat, India, between March 2024 and March 2025. The qualitative phase included expert review, forward translation, cognitive interviews with adults with TB and  frontline healthcare workers, back translation, and pilot testing, following international cross-cultural validation guidelines. Findings from the qualitative phase directly informed item modification, simplification of terminology, and contextual adaptation of the HELIA-TB prior to quantitative psychometric validation. The finalized instrument was subsequently administered to 393 adults with TB to assess internal consistency, test-retest reliability, content validity, and construct validity. HELIA-TB retained the original five domains, access, reading, understanding, appraisal, decision-making with TB specific modifications. Internal consistency and test-retest reliability were high (α = 0.82-0.89 across domains; 0.86 overall; ICC = 0.88), and so was content validity (S-CVI/Ave = 0.92). Health literacy scores were significantly associated with treatment adherence (Cohen's d = 0.89, p < 0.001) and self-rated health (Cohen's d = 0.76, p < 0.001). No significant differences were observed by TB type or drug resistance status. The adapted HELIA-TB demonstrated satisfactory psychometric properties and may support assessment of health literacy and development of targeted TB care interventions in the Indian context.
This article is a structured narrative review that synthesizes empirical findings and expert consensus and provides policy guidance to outline implementation pathways for integrating Yoga into mainstream healthcare systems, with India as a case example. Yoga is an ancient health practice traditionally used as a holistic approach to health management and wellbeing. However, the acceptance of Yoga as an evidence-based practice in the modern healthcare delivery requires systematic reassessment for its implementation within the healthcare system to make healthcare more affordable, improve prevention, rehabilitation, and resilience thus reduce strain on medical resources. In this review, we have organized the literature review and practical insights around three core themes: stakeholder configurations and governance, economic and quality management, and implementation strategies and evaluation to develop an actionable framework for an optimal care system responsive to patients' needs and adaptable to different community settings. This article has incorporated peer-reviewed studies on the effectiveness of Yoga, its implementation in mainstream healthcare, along with relevant publicly available policy, accreditation, and practice standard sources, to emphasize constructs of implementation science and evidence-based practice. The review identifies a know-do gap between growing evidence for Yoga and its system-level adoption, proposing a staged framework that integrates stakeholder engagement, economic evaluation, quality management, and monitoring to support evidence-based implementation. We propose a comprehensive, context-sensitive model that combines traditional wisdom with contemporary behavioral, clinical, and systems-based approaches. By embedding Yoga within an implementation science framework, we advocate for its role as a mainstream, evidence-informed system. Adoption of Yoga as a therapeutic and preventive modality can be accelerated through standardized protocols, transparent evaluation and regulation, and tripartite governance among state actors, healthcare institutions, and Yoga professionals; however, the feasibility hinges on context-sensitive financial support, stakeholder management, and workforce development.
Tuberculosis is one of the major infectious diseases that result in a significant morbidity and mortality, especially in the resource-limited communities with a lack of health literacy that hinders the early detection and the compliance with the treatment. Health education through technology is an up-and-coming method of bettering community empowerment in the TB control programs. In this paper, the researcher compared the robustness of a holistic technology-based health education framework using interventions of mobile applications, interactive voice response systems, and digital kiosks in communities to empower the communities with TB. The study was a cluster-randomized controlled trial in 24 communities (12 intervention and 12 control) and used on 1847 adults above 12 months. The main outcomes were TB knowledge levels, health-seeking behavior levels, community-engagement levels, and TB case detection rates. Community empowerment was conceptualized as a multidimensional construct encompassing knowledge acquisition, proactive health-seeking behavior, collective engagement, and stigma reduction. Findings showed that communities that were equipped with technology scored higher in terms of TB knowledge (76.8 ± 12.4 vs. 52.3 ± 14.7, p < 0.001) and index of health-seeking behavior (3.82 ± 0.67 vs. 2.41 ± 0.84, p < 0.001) than control communities. The score of community engagement in intervention communities scored 156 percent higher than in controls, which scored 23 percent higher. It is interesting to note that the rate of TB cases detection in the intervention communities was 34.2 percent as opposed to 8.7 percent in the control community (p = 0.002). The platform that had been enabled by the technology proved to be very effective when it came to empowering communities to undertake the TB control process and provided a model that could be expanded to enable the introduction of digital health education into the public health programs aimed at protecting against the spread of infectious diseases in the endemic areas.
Health-related quality of life (HRQoL) data among patients with breast cancer (BC) in Malaysia remain limited. This study aimed to describe HRQoL and identify its key predictors to inform future health policy planning. A cross-sectional survey was conducted between April 2023 and January 2025 among BC outpatients in eight public specialist hospitals in Malaysia. Sociodemographic and clinical data were collected alongside patient-reported outcome measures, including the EuroQol-5 Dimension 5-Level questionnaire (EQ-5D-5L), a preference-based health utility measure, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), a cancer-specific HRQoL questionnaire. Multivariable linear regression models were used to identify independent predictors of HRQoL for each instrument. The mean (standard deviation) EQ-5D-5L health state utility value (HSUV) was 0.853 (0.179), the mean EQ-VAS score was 79.2 (19.1), and the mean (standard deviation) EORTC QLQ-C30 summary score was 83.3 (15.3). The EQ-5D-5L dimensions with the highest prevalence of reported problems were pain/discomfort and anxiety/depression. The EQ-5D-5L HSUV and VAS score demonstrated moderate to strong positive correlations with the EORTC QLQ-C30 summary score (ρ = 0.503 to 0.672, p < 0.001). In multivariable analysis, advanced cancer stage, Chinese ethnicity, and lower education were independently associated with poorer EQ-5D-5L HSUV. EQ-VAS scores were associated with Indian ethnicity and completion of the questionnaire in English. For EORTC QLQ-C30, advanced cancer stages and Chinese ethnicity remained significant predictors. HRQoL among patients with BC in Malaysia was primarily influenced by cancer stage, ethnicity, and education level. Advanced cancer stage was consistently associated with poorer patient-reported outcomes. The complementary use of EQ-5D-5L and EORTC QLQ-C30 provides more comprehensive estimates to inform survivorship care and future economic evaluations.
Background and objectives This study validates the discriminative ability of a community-based assessment checklist (CBAC) compared with other point-of-care tools for community screening to identify individuals at high risk of diabetes and hypertension. The data for this study were collected during 2019-20 in selected areas of Mysuru city, Karnataka. Methods CBAC was administered to residents aged 30 yrs and above, without known cases of diabetes mellitus, hypertension, or cancer. Random capillary blood glucose (RCBG) and blood pressure (BP) were measured for comparison with the CBAC score. Screening performance was assessed using receiver operating characteristics (ROC) analysis and the area under the curve (AUC). Results CBAC was administered to 32,686 people, and 31,594 had complete data for CBAC and RBS, and 32,645 had both CBAC scores and BP values. The analysis showed a poor AUC of 0.62 (95% CI: 0.61-0.63) for identifying individuals at risk of diabetes with RCBG value of ≥140 mg/dL and an AUC of 0.61 (95% CI: 0.60-0.61) for individuals at risk of hypertension with BP values of (systolic ≥140 mmHg OR diastolic ≥90 mmHg). Youden's index indicated that the CBAC cut-off of >4, though optimal for both at-risk of diabetes and hypertension, was poor at 0.17 and 0.15, respectively. Interpretation and conclusions The discriminative ability of CBAC was found to be poor compared with other point-of-care tools. We propose that trained frontline health staff administer RCBG and BP tests alongside the CBAC to enable more efficient public health triaging.
Health system responsiveness (HSR) is a core health system goal yet remains underexamined for older adults with functional limitations and socio-economic vulnerability in India. To present a novel assessment of HSR among older adults aged 60+ with functional limitations and socio-economic vulnerability in India across six domains: prompt attention, dignity, communication, confidentiality, choice of providers, and quality of amenities. We analysed data from the nationally representative Longitudinal Ageing Study in India Wave 1 (2017-2018), including 16,659 older adults for outpatient care and 2,358 for inpatient care. Multivariable linear regressions assessed the association between HSR and functional limitations, multimorbidity, and socio-economic factors. Functional limitations were defined as one or more limitations in Activities of Daily Living and/or Instrumental Activities of Daily Living. Overall HSR score was calculated by summing across domains. Median HSR score was 24 (range 6-30), equivalent to approximately 75 on a 0-100 scale, for outpatient and inpatient care. Older adults with functional limitations experienced poorer responsiveness in outpatient (β = -0.62; 95%CI: -0.84, -0.41) and inpatient care (β = -0.62; 95%CI: -1.14, -0.09). Negative associations were observed in public facilities, while in private facilities this was significant only for outpatient care. Among those with functional limitations, lower castes and lower economic status reported poorer responsiveness. Older adults with functional limitations in India experience poorer HSR, with worse care among lower castes and poorer groups. These findings suggest the presence of ableism within the Indian health system that needs to be systematically identified and tackled to ensure equitable and responsive healthcare. Main findings: Older adults with functional limitations in India experience poorer health system responsiveness in both outpatient and inpatient care, with disparities particularly pronounced in public facilities and further amplified by socio-economic disadvantage.Added knowledge: This study provides one of the first nationally representative assessments across India of health system responsiveness among older adults with functional limitations, highlighting how ageing, functional limitations, and socio-economic vulnerability intersect to shape non-clinical care experiences.Global health impact for policy and action: Strengthening health system responsiveness through policy action and health system reforms to address structural ableism is essential to provide equitable, disability-responsive care for India’s ageing population, especially those with functional limitations and socio-economic disadvantage.
High-risk pregnancies have been found to be associated with various adverse maternal or neonatal outcomes such as having a low-birth-weight (LBW) newborn, stillbirth and pre-term delivery, cesarean section (CS), stillbirths, and infant deaths. To estimate the burden of high-risk pregnancy and its association with pregnancy and birth outcomes. Retrospective cohort study conducted in rural Haryana among pregnant women registered in health management information system from January 2020 to December 2022, i.e., 3 years. The calculated sample size was 6928. There were two groups of pregnant women, one without high-risk factors (nonexposed) and another with high-risk factors during the course of the pregnancy (exposed). They were followed up till termination of pregnancy or childbirth and their outcomes were recorded. We included 6402 participants in the study. The mean (standard deviation) age of the pregnant women was 27.5 years (4.2 years). The prevalence of high-risk pregnancy was 37.0%. History of (H/o) abortion was significantly associated with stillbirth (odds ratio [OR]-3.89, 95% confidence interval [CI]-1.19-12.75). H/o CS was significantly associated with having LBW newborn (OR-1.42, 95% CI-1.08-1.87), preterm delivery (OR-1.78, 95% CI-1.41-2.25), and CS (OR-15.78, 95% CI-12.40-20.09). Twins/multiple gestation was significantly associated with having LBW newborn (OR-5.72, 95% CI-2.36-13.91), preterm birth (OR-6.61, 95% CI-2.68-16.26), and CS (OR-3.56, 95% CI-1.45-8.75). More focused intervention targeting maternal nutrition is needed at all the levels of health care. Uniform criteria for classifying high-risk pregnancies are need of the hour, which can be assisted by this study.
The dual epidemic of HIV/AIDS and extensively drug-resistant tuberculosis (XDR-TB) remains a critical public health challenge in South Asia. HIV/AIDS compromises immune function, heightening susceptibility to opportunistic infections like TB, while XDR-TB, characterized by resistance to isoniazid, rifampicin, fluoroquinolones, and second-line injectables, severely complicates treatment and increases mortality risk. Despite global efforts, such as the WHO's End TB Strategy, progress in South Asia has been uneven, with limited exploration of regional and sex-specific mortality disparities. This study leverages Global Burden of Disease (GBD) 2021 data to analyze temporal trends and regional variations in HIV/AIDS and XDR-TB mortality across South Asia from 1993 to 2021, aiming to guide targeted public health interventions. We performed a retrospective, population-based analysis of HIV/AIDS and XDR-TB mortality trends in five South Asian countries (Nepal, Pakistan, Bhutan, Bangladesh, India) and the region overall, using GBD 2021 data. Annual mortality rates (AMR) per 100,000 population were extracted for both diseases, stratified by sex. Joinpoint regression analysis was utilized to evaluate temporal trends, detecting significant changes in AMR through Annual Percent Change (APC) and Average Annual Percent Change (AAPC), reported with 95 % confidence intervals (CIs) and p-values. From 1993 to 2021, HIV/AIDS and XDR-TB co-infection mortality exhibited significant increases across South Asia, with marked regional and sex-specific variations. Pakistan recorded the highest AAPC for both sexes combined (43.75 %, 95 % CI: 36.91-56.57, p < 0.000001), reflecting a persistent and substantial rise, followed by Bangladesh with an AAPC of 31.43 % (95 % CI: 24.97-40.61, p < 0.000001). Nepal showed an AAPC of 22.52 % (95 % CI: 12.09-35.81, p < 0.000001), while India and Bhutan had comparatively lower AAPCs of 8.06 % (95 % CI: 1.70-16.33, p = 0.0168) and 6.99 % (95 % CI: 3.79-10.50, p < 0.000001), respectively. Regionally, South Asia's AAPC was 7.98 % (95 % CI: 1.91-15.99, p = 0.011). Sex-stratified analyses highlighted disparities, with females in Pakistan exhibiting the highest AAPC (46.00 %, 95 % CI: 38.72-59.59, p < 0.000001), followed by females in Bangladesh (32.77 %, 95 % CI: 26.24-41.93, p < 0.000001). Joinpoint regression for South Asia identified six distinct segments, with an early peak APC of 393.84 % (1993-1995, 95 % CI: 336.40-463.07, p < 0.000001), driven by limited antiretroviral therapy (ART) and diagnostic access, followed by a significant decline from 2008 to 2021 (APC: -5.69 %, 95 % CI: -6.48 to -5.14, p = 0.0016). Country-specific trends revealed steep increases from 1993 to 2005 across all nations, with Nepal, Bangladesh, and India showing significant declines from 2018 to 2021 (e.g., India: APC -6.08 %, p = 0.0012), likely due to improved ART coverage and TB management. Pakistan, however, showed no decline, with a sustained APC of 6.50 % (2013-2021, p < 0.000001). Females in India experienced a sharper decline from 2019 to 2021 (APC: -17.38 %, 95 % CI: -22.64 to -9.38, p < 0.000001) compared to males (APC: -7.15 %, p < 0.000001), suggesting sex-specific treatment access differences. South Asia faced substantial HIV/AIDS and XDR-TB co-infection mortality increases from 1993 to 2005, with recent declines in Nepal, Bangladesh, and India reflecting enhanced treatment access and healthcare improvements. Pakistan's persistent mortality rise underscores ongoing challenges, including drug resistance and limited healthcare infrastructure. Sex-specific disparities emphasize the need for tailored interventions.
Poor counseling by healthcare providers contributes to dissatisfaction and poor treatment adherence among people with tuberculosis (TB). The objective of the study was to assess the effect of counseling training on directly observed treatment, short-course (DOTS) provider performance and patient outcomes in TB care. A community-based intervention study was conducted in two TB units of Jodhpur, with one receiving the World Health Organization (WHO)-based counseling training and the other serving as a control. Knowledge, attitude, and practice (KAP) and counseling skills of healthcare workers, patient satisfaction, and medication adherence were assessed pre- and postintervention. Posttraining, healthcare workers in the intervention unit showed significant improvement in KAP and counseling skills compared to baseline and control units ( P < 0.001). Attitude scores improved marginally. Patient satisfaction and medication adherence showed modest improvement, but the difference-in-difference analysis showed no statistically significant change. WHO module-based training improves DOTS provider counseling, but patient outcomes need broader system and community support.
Multidrug-resistant tuberculosis (MDR-TB) remains a major cause of morbidity and mortality worldwide, with people living with HIV experiencing persistently poor treatment outcomes. Clofazimine and bedaquiline are cornerstone drugs in contemporary all-oral MDR-TB regimens, yet their complex pharmacokinetics and substantial interindividual variability complicate regimen optimisation, particularly in vulnerable populations. Robust plasma-based drug quantification is essential to characterise exposure-response relationships and inform individualised therapy. We developed and validated a rapid, sensitive and specific liquid chromatography-tandem mass spectrometry assay for quantifying these drugs in human plasma. The methods were successfully applied on plasma samples from study participants with MDR-TB with or without HIV coinfection who received clofazimine and bedaquiline as part of MDR-TB therapy assessing the Cmax, Tmax and AUC in both groups. The method addresses key analytical challenges posed by clofazimine's extreme lipophilicity and reliably quantifies concentrations across a broad, clinically relevant range, including potentially toxic exposures. Linearity was obtained between 0.0313 to 4.0 mg/L, and the method met bioanalytical method validation criteria along with interlab comparison with a reference laboratory, all within acceptable limits. We observed significantly lower Cmax concentrations of both drugs among HIV-infected participants compared to HIV-uninfected participants (p = 0.011 for clofazimine and p = 0.02 for bedaquiline), highlighting the need for therapeutic drug monitoring in this vulnerable group. This work provides a robust analytical foundation for pharmacokinetic, therapeutic drug monitoring and exposure-response studies of key MDR-TB drugs and supports efforts to optimise treatment outcomes, especially among people living with HIV.
Asthma education among caregivers is an integral part of asthma management. The study validates the Hindi version of the Newcastle Asthma Knowledge Questionnaire (NAKQ). This was a pilot study conducted among 100 parents of children between 7 and 15 years with bronchial asthma. The original English NAKQ tool was forward and back translated into Hindi. A face-to-face interview was conducted to administer the tool. Exploratory factor analysis (EFA) and confirmatory factor analysis were carried out to understand the factor structure, construct, validity, and reliability of the questionnaire. The Cronbach's alpha value was 0.641. The Hindi NAKQ was factorable as demonstrated by a significant Bartlett's test of sphericity. The EFA revealed a four-factor solution explaining 22.5% of the variance. The construct validity showed that items 4, 7, 14, and 17 had poor correlation (of the total 31 items) with the overall scale score (<0.2), and therefore, the items were deleted. Using the four factors with all 27 items, a statistical model was generated with a good fit, as indicated by a root mean square error of approximation (RMSEA) value of 0.0546, which was close to the acceptable cutoff of 0.06. The Hindi-translated version of NAKQ tool is reliable and valid to be administered among the Indian participants.
Oral cancer is a significant health issue in the country, accounting for one-fourth of all cases worldwide. A shortage of specialized healthcare, limited access to screening tools, and diagnostic facilities are key contributors to delayed diagnosis. Artificial Intelligence can be a promising tool for the early screening of oral cancer. However, its application in India remains underexplored and lacks systematic evaluation. A scoping review was conducted using the Arksey and O'Malley (2005) framework and the approach by Peters et al. (2015). The PRISMA framework was adopted for selecting relevant studies on AI applications for oral cancer screening in India. Studies were systematically searched in PubMed, CINAHL, Scopus, and Google Scholar. Reviewers extracted relevant data and systematically mapped them to identify strengths, weaknesses, opportunities, and threats of AI applications in oral cancer screening within India. Of the 265 identified studies, 33 were selected for final review. Various designs were used, including cross-sectional field evaluations, pilot and prospective studies, scoping and systematic reviews, narrative reviews, and experimental studies. AI methodologies demonstrated high diagnostic accuracy, with strengths in portability, scalability, and affordability in low-resource settings. Weaknesses reported were a lack of standardized data, limited digital literacy, and infrastructural gaps. AI models offer opportunities to enhance screening coverage, integrate multimodal datasets, and support personalized treatment planning. Key threats observed were data variability, lack of regulatory and ethical frameworks, and data privacy concerns. AI offers strengths in improving oral cancer screening in India through early detection and reducing inequities. Despite its promising strengths, AI faces challenges such as scalability, infrastructure gaps, and ethical issues when implemented for oral cancer screening in the Indian context. For the successful integration of AI, technological innovation, robust digital infrastructure, adequate workforce training, and regulatory guidelines are required.
The tuberculosis (TB) score, a composite score based on nine domains of TB care and management, optimally should be more than 80 points. However, in the South Goa district in Goa, India, the TB score has been consistently below this level. Improving the TB score would help improve program implementation. The objective of the study was to identify reasons and solutions for sub-optimal TB score in South Goa. Through a sequential exploratory mixed methods study design, using the quantitative data from the "sub-national certification of progress towards TB free status" exercise conducted in India and qualitative data obtained from the National Tuberculosis Elimination Programme (NTEP) functionaries within the South Goa district, "Achievement Gap" in TB score, reasons and solutions were explored. Qualitative exploration was through key informant interviews and the nominal group technique. Manual coding and descriptive content analysis were done, followed by the development of codes and themes. Weighted ranking of "achievement gap" identified five poorly performing TB domains. Reasons for suboptimal TB score were poor knowledge and awareness about TB and NTEP, Social factors, challenges in NTEP implementation at the level of diagnosis of TB and management of TB and various administrative issues. Solutions identified included training of health staff, awareness campaigns, recruitment of staff to vacant posts, an effective system for monitoring and supervision of NTEP implementation, resolving administrative issues, solving transportation issues and reduction of delays at various levels. Practical, simple local solutions could be generated from within the NTEP which are likely to be acceptable, easily implemented in a time-bound manner.