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Item Contextual Risk Factors of Stunting and Severe Stunting among Indonesian Children Under 2 Years: Based on Cross-sectional Data from Basic Health Research(Wolters Kluwer – Medknow, 2025-03) Djaiman, SP; Rizkianti, A; Rachmalina, R; Achjar, KA; Lestari, AS; Ruspawan, IMBackground: Stunting is the most common form of chronic malnutrition in children that continues to be a public health concern in Indonesia. Local capacity at district, subdistrict, and village levels is still insufficient and remains a major constraint that needs to be addressed. Objectives: This study aimed to assess factors related to stunting and severe stunting among children aged under 2 years at the individual, household, and district levels. Materials and Methods: The integrated 2018 Indonesian Basic Health Research and National Socioeconomic Survey were analyzed utilizing multilevel multinomial logistic regression analysis to examine the role of the individual, household, and district levels with stunting and severe stunting among children aged under 2 years. The magnitude of the role of the individual/household level and district level in the prevalence of stunting and severe stunting can be seen from the Interclass Correlation Coefficient (ICC) value. Results: At the district level, food insecurity status is the main predictor of increased odds of severe stunting. ICC individuals and households for stunting 83. 6% severe stunting 25.4%, ICC at the district stunting 16.4%, and severe stunting 74.7%. This indicates that the district level has a greater contribution to the prevalence of severe stunting and the individual/household level contributes more to the prevalence of stunting. Conclusions: This study’s findings have resulted in the influence of district contextual factors on severe stunting and an effect of the individual household factors on stunting indicating that multilevel interventions are the key to preventing and reducing stunting and severe stunting.Item A Correlational Study between Chest Computed Tomography Severity Score and Laboratory Biomarker among COVID-19 Patient Admitted to a Tertiary Care Institute in a Tribal Belt of Central India(Wolters Kluwer – Medknow, 2025-03) Alam, MN; Khatoon, S; Verma, A; Thakur, H; Manwani, VKBackground: COVID?19 an emerging viral disease is a new challenge before the world. While having limited resources, early identification and deciding the need for hospitalization is important in management. Objectives: Can Chest high-resolution computed tomography (HRCT) score be used as a prognostic factor and along biomarkers as a composite indicator to determine outcomes in COVID?19 pneumonia? Materials and Methods: A cross-sectional record-based study was conducted at a Tertiary Care Institute in Central India on 400 reverse transcription polymerase chain reaction confirmed COVID?19 patients during March 1st, 2021–May 31st, 2021. Results: The mean age was 42.82 years with male predominance (67%). Comorbidity was positively associated with computed tomography severity score (CT?SS) (P = 0.0). Most common comorbidities were hypertension (26%), diabetes (21%), chronic obstructive pulmonary disease (17%), and chronic kidney disease (17%). There was a statistically significant positive association between oxygen requirement (P = 0.002) and biomarkers including D-dimmer, serum ferritin, and C-reactive protein with HRCT severity score (HRCT-SS). Cycle threshold value had varying relation to the CT-SS. Conclusion: HRCT?SS can be used as a predictor for COVID?19 pneumonia severity and mortality outcome.Item Lagged Effects of Rainfall on Malaria: A Case Study of Meghalaya(Wolters Kluwer – Medknow, 2025-03) Chungkham, HS; Marbaniang, SP; Gogoi, HBackground: In the relationship between malaria and meteorological factors, existing studies mainly focus on the interaction between different climatic factors, while interaction within one specific climatic predictor at different lag times has been largely neglected. Objectives: This paper aims to explore the interaction of lagged rainfalls and their impact on malaria incidence. Materials and Methods: Monthly malaria cases and three climatic variables of 4 districts in Meghalaya from 2005 to 2017 were analyzed with the varying coefficient?distributed lag nonlinear model. The correlation patterns of the 2nd-, 3rd-, and 4th?month lags would vary over different rainfall levels at the 1st-month lag. During the period 2005–2017, a total of 309,133 malaria cases were reported in all the districts under study. Results: The monthly average rainfall ranges from a minimum of 181.79 mm in South Garo to a maximum of 367.87 in Jaintia. Furthermore, South Garo and East Khasi are the hottest and the coolest places under study with 26.96°C and 16.86°C, respectively. Rainfall levels in the 1st?month lag affect the nonlinear patterns between the incidence of malaria and rainfall at each lag time. The low rainfall level at the 1st-month lag may promote malaria incidence as rainfall increases. However, for the high rainfall level at the 1st-month lag, malaria incidence decreases as rainfall increases. Conclusion: The interaction effect between lagged rainfalls on malaria incidence was observed in this study, and highlights its importance for future studies to better understand and predict malaria transmission.Item Comparing ChAdOx1 nCoV-19 Coronavirus Vaccine (Recombinant) (Covishield) and BBV152; Bharat Biotech COVID-19 Vaccine (Covaxin) for COVID-19: Reports of Adverse Events Following Vaccination among the Indian Population(Wolters Kluwer – Medknow, 2025-03) Kaur, S; Rohilla, L; Kayina, CA; Kaur, J; Kaur, G; Walia, A; Kumar, P; Singh, A; Saini, S; Soni, SL; Malhotra, PBackground: COVID?19 is declared a global pandemic by the WHO; vaccines were the need of the hour to reduce mortality and return to some form of normal life. The Indian government provides two vaccines as per the program; ChAdOx1 nCoV?19 and BBV152; Bharat Biotech COVID?19 vaccine. However, vaccine hesitancy is a major public health concern. Objective: To evaluate the adverse events following immunization (AEFIs) after COVID?19 vaccination. The safety profile of ChAdOx1 nCoV?19 and BBV152 vaccine was also studied. Materials and Methods: This was a large?scale, cross?sectional survey. Beneficiaries who had their vaccination in the past 2 weeks were sent an online survey performa regarding AEFIs after COVID?19 vaccine. Results: Out of 2311 participants, 58% received ChAdOx1?nCoV?19 and 42% received BBV152 COVID?19 vaccine, with the mean ± standard deviation age (years) of 36.3 ± 14.5 and 16.9 ± 4.07, respectively. The previous history of COVID?19 infection was reported in 7% of the participants. In the ChAdOx1?nCoV?19 group, 85.3% participants reported at least one adverse reaction, with pain at site being the most common, followed by fever, fatigue, and feeling of unwellness. In the BBV152 group, 17% reported adverse reaction, with pain site being the most common, followed by tenderness, fatigue, and feeling of unwellness. In the BBV152 group, a significant positive association was observed between AEFIs and age. In the ChAdOx1?nCoV?19 group, age was marginally associated with AEFIs. AEFIs were more after first dose (121 vs. 43, P < 0.001, adjusted odds ratio (OR) =3.39 [95% confidence interval [CI]: 2.24–5.11], P < 0.001) among elderly (adjusted OR = 0.60, 95% CI: 0.36–0.99, P = 0.047) and women (721 vs. 423, P = 0.001, adjusted OR = 1.68 [95% CI: 1.24–2.29], P = 0.001). Conclusion: Our study observed that both ChAdOx1 nCoV?19 and BBV152 have a favorable safety profile without serious AEFIs in any of the beneficiaries.Item Needlestick and Sharp Injuries among Health Care Workers in a Tertiary Care Hospital in Manipur, India: A Cross-sectional Study(Wolters Kluwer – Medknow, 2025-03) Umar, AY; Devi, HS; Laikhuram, PBackground: Needlestick and sharp injuries (NSSIs) are the single greatest occupational hazard among health-care workers (HCWs) worldwide. Data related to such injuries are scarce in India. This study encompassed multiple categories of HCWs to compare the prevalence and associated factors of NSSI between them. Objective: To determine the prevalence of NSSI and identify the associated risk factors among HCWs of a tertiary care hospital in Manipur. Materials and Methods: A cross-sectional study was conducted with a sample size of 383. Stratified sampling by probability proportionate to size was done. A self?administered questionnaire was used. Data were analyzed using the chi-square test and logistic regression. Results: A total of 357 HCWs participated in the study. The prevalence of NSSI in the preceding 1 year was 23.8%. A needle on a disposable syringe was the most common device that caused the injury (71.8%). Recapping of needles was the most common procedure that led to the injury (28.2%). More than half (61.2%) of the participants did not report the injury to the concerned authorities. Participants who were fully vaccinated against hepatitis B were less likely to have had an injury in the past 1 year. Participants were more likely to report the injuries to the concerned authorities if the sharp item was contaminated. Conclusion: One in every four participants had sustained at least one episode of NSSI in the preceding year. More than half of the injuries were not reported. It is imperative to conduct training sessions regarding NSSIs in the hospital at regular basis.Item Family Adoption Program in MBBS Curriculum: A Qualitative Study to Assess the Implementation Challenges and Possible Solutions in the Existing System(Wolters Kluwer – Medknow, 2025-03) Aikat, A; Chakraborty, A; Paul, KK; Sarkar, AP; Basu, R; Basu, M; Mitra, K; Bandyopadhyay, SBackground: The family adoption program has been inculcated in the undergraduate medical curriculum vide the March 2022 directives to ensure community-based hands-on experience from the beginning and increase the availability and accessibility of doctors or medical professionals in the rural areas and is currently in a nascent phase of implementation across the various medical colleges in India. Objectives: To assess the challenges faced while implementing the new initiative of family adoption over three and a half years and possible solutions offered by the faculties of Community Medicine of various colleges of West Bengal based on their hands-on experience. Materials and Methods: A crosssectional qualitative study was carried out among the Community Medicine faculty representatives from 24 medical colleges in West Bengal. After due informed consent, they were interviewed by a panel of senior faculty members based on a semi-structured questionnaire. A qualitative thematic content analysis was carried out to identify the major themes involved. Result: The four themes emerging were sustainability of adopted families, human resources and other Logistics issues, logbook proto-type, and building on previous successful implementation of family visits. Various modifications were mentioned by different respondents. Discussion and Conclusion: Despite the different deterring issues noted, solutions by the implementers themselves that can have far-reaching implications were identified. A successful implementation of FAP can make a difference in public health, and develop Indian Medical Graduates competent to serve the community at their best.Item “Want a Job with a Safer Future” Findings from an Exploratory Qualitative Inquiry with Community Health Officers Using Time–Motion Study(Wolters Kluwer – Medknow, 2025-03) Wanjari, D; Giri, M; Raut, AV; Dighikar, M; Paradkar, RJ; Gupta, SSBackground: Community Health Officer (CHO) is a newer cadre of health-care providers introduced under the Ayushman Bharat Program to enhance the functioning of Health and Wellness Centres by taking health-care services closer to the community. Objectives: The objectives of this study were to assess the work pattern and workload of CHOs and understand the barriers and challenges faced by them during delivery for improving their efficiency. Materials and Methods: An exploratory qualitative inquiry was done with six purposively chosen CHOs from all the primary health centres of a rural community development block in Central India using time–motion study as a tool. Each CHO’s work pattern, workload was studied for 1 week using 24-h recall method. Validation of the information provided by CHOs was done by asking them to submit activity photographs. Semi-structured interviews were conducted with CHOs and analyzed using thematic analysis to understand their perspectives, barriers, and challenges. Results: They were found to spend roughly 64.2% of their time on curative work, 21.3% on managerial work, and around 14.5% on promotive, preventive work. On data triangulation, a knowledge-application gap was observed. The major barriers and challenges found were focus on clinical care, lack of microplanning, insufficient resources, and no job security. Conclusion: The work distribution of the CHOs is focused more on curative and managerial aspects with minimal focus on promotive, preventive aspects. To foster “Wellness” of the community through a holistic approach as envisaged under the Ayushman Bharat Program, strategies need to be devised with greater emphasis on health promotion, addressing the challenges raised by this new cadre.Item Determination of Human Papillomavirus Serotypes in Endocervical Samples from Patients with Normal Cytology from a Mexican Population by Polymerase Chain Reaction-restriction Fragment Length Polymorphism(Wolters Kluwer – Medknow, 2025-03) Díaz-Vallejo, JJ; Lagunes-Bae, E; Córdoba-Colorado, D; Pérez-Vásquez, MO; Pascual-Mathey, LI.Human papillomavirus (HPV) is associated with cervical cancer (CC). Genotypes 16 and 18 are high?risk (HR) factors for CC. The Papanicolaou (Pap) identifies the morphological changes for CC. However, HPV is presented in normal Pap smears. This study aimed to estimate the prevalence of HPV in patients with normal cytology and a cross-sectional study was conducted among 141 women with normal cytology. DNA was extracted from a cervical swab. The viral genome was screened by polymerase chain reaction-restriction fragment length polymorphism, using MY09/11 and L1C1/L1C2 oligonucleotides. Abivariate analysis of the main risk factors was performed. Odds ratios(ORs) and 95% confidence intervals (CIs) were obtained from multiple logistic regression models. HPV prevalence increased to 16.3% (95% CI) when L1C1/L1C2 were used. Genotypes 11, 13, 33, and 59 were detected; 33 and 59 are HR factors for CC. The number of sexual partners is associated with HPV, OR 5.2 (P < 0.05). The regional HR variations should be considered in CC prevention.Item Mumps in Patients with Acute Encephalitis Syndrome in Assam, India during January 2018 to July 2021(Wolters Kluwer – Medknow, 2025-03) Sarmah, K; Sarma, K; Borah, PK; Sharma, A; Mahanta, J; Borkakoty, BAcute encephalitis syndrome (AES), a major public health problem, has been reported worldwide. The potential etiology of AES varies from viruses, bacteria, fungi, and parasites with viruses being most prevalent. The virus-mediated AES in Assam is not well characterized. Most viruses causing AES lack specific treatment, but encephalitis caused by mumps virus(MuV) can be effectively treated. Therefore, the present study was undertaken to identify MuV positivity in AES cases during January 2018–July 2021. Using enzyme immunoassay MuV immunoglobulin M antibodies were tested in 317 samples (cerebrospinal fluid and serum) of which positivity was found in 22.0% (70/317), with higher prevalence in males and bulk of cases occurring in July. Quantitative reverse transcription-polymerase chain reaction positive MuV cases were genotyped targeting small hydrophobic gene which revealed the circulation of genotypes C and G during the studied period. Despite Japanese encephalitis(JE) being considered the major viral etiology for AES, the present study highlights the emergence of MuV over JE with time.Item Impact of the Updated World Health Organization Guideline on Hemoglobin Cutoffs on National Anemia Prevalence Estimates in 6–59-month-old Indian Children(Wolters Kluwer – Medknow, 2025-03) Thomas, T; Kurpad, AV; Ghosh, S; Sachdev, HS.The World Health Organization has recently lowered the hemoglobin (Hb) diagnostic cutoff for anemia in 6–23?month?old children by 0.5 g/dL and specifies the use of venous blood. The national prevalence of anemia defined from venous blood in children 6–23 months reduced by ~10% points when using the new Hb cutofItem Influence of Social Circumstances and Health-care Support on Intention-to-quit Tobacco among Population Aged 15–49 Years in India: An Analysis of National Family Health Survey-5 Data(Wolters Kluwer – Medknow, 2025-03) Dutta, S; Mishra, A; Shukla, V; Singh, A; Basu, M; Goel, SBackground: Several national programs targeting a reduction in tobacco use are operational in India, but still the burden is huge. Understanding the influence of social factors and the health?care system on the intention?to?quit(ITQ) tobacco is of immense importance for efforts toward tobacco control and cessation in India. Objectives: To estimate the proportion of the adult population with ITQ tobacco; and to find out if the social circumstances of the study population and the availability of health care support has an influence on their ITQ tobacco. Materials and Methods: Data from India’s National Family and Health Survey (NFHS?5) (2019?2021) were used. The primary outcome was ITQ tobacco among male and female population aged 15–49 years and the explanatory variables were background characteristics, health?care support, and social circumstances. The Statistical Package for the Social Sciences was used for data analysis. Weighted proportion of tobacco users and ITQ tobacco was calculated. Multivariable binary logistic regression was employed to check the association between background characteristics and ITQ tobacco. Results: Overall, 39.6% of the male and 4.1% female participants were tobacco consumers. ITQ was present in 30.1% of male and 31.8% of female tobacco users. Females with high women empowerment were major tobacco users (7.5%). Most participants (40%) who had visited private health facilities had an ITQ. Ahigher proportion of tobacco use was seen with the presence of another smoker at home. Conclusion: Females had a higher ITQ tobacco compared to males. Visit to a private health facility and the presence of another smoker at home influenced the ITQ.Item Risk Factors of Retinopathy of Prematurity: A Prospective Study(Wolters Kluwer – Medknow, 2025-03) Sankar, BK; Amin, H; Pappa, P; Riaz, KMA prospective observational study was conducted to find out the risk factors of retinopathy of prematurity (ROP). A total of 311 preterm infants with gestational age ?34 weeks and birth weight ?2000 g admitted to neonatal intensive care unit (NICU) were screened by Indirect ophthalmoscopy. Both univariate (Chi-square test) and multivariate regression analysis were used for analyzing risk factors. Any stage of ROP was seen in 58 (18.64%) infants, Plus disease in 13 eyes of 7 infants, and aggressive posterior retinopathy of prematurity in 1 infant. In univariate analysis, gestational diabetes, type of delivery, gestational age, birth weight, hemoglobin at birth, Apgar at 1 and 5 min, duration of oxygen administration, ventilator support, continuous positive airway pressure, hood, nasal prongs, hyaline membrane disease, surfactant, PDA, sepsis, and weight on postnatal day 15 showed statistically significant association with ROP. Gestational diabetes (P = 0.029), duration of oxygen administration (P = 0.003), and gestational age (P = 0.012) were statistically significant in multivariate analysis.Item Dietary Factors that Influence Iron Deficiency Anemia in India(Wolters Kluwer – Medknow, 2025-03) Peter, M; Amrit; Roshin, JE; Varghese, J; Venkatesan, PIron deficiency anemia is a major public health concern in India and is widespread in different regions of this country. Nutritional iron deficiency, in particular, lack of sufficient consumption of heme iron and other dietary factors, are considered to play a role in the high prevalence of anemia in India. In this regard, we constructed a database of nutritional iron consumption by its source and dietary factors that affect iron consumption (Vitamin C, phytates, calcium, and polyphenols) at the district level using the food consumption database extracted from the national household consumption survey. In both rural and urban regions, the consumption of iron from animal sources was only a minor fraction of the total iron consumption. Total and plant sources of iron consumption were comparatively higher in North-Western and Central regions and lower in Eastern regions. Phytates are consumed in higher amounts in many regions of IndiaItem Antihypertensive Medication Adherence and Related Factors among Elderly Hypertensive Patients in China: A Meta-analysis(Wolters Kluwer – Medknow, 2025-03) Liu, H; Zuo, X; Zhou, Z; Ma, Y; Wang, B; Shi, X.Background: Hypertension is one of the most common chronic diseases among elderly people, while medication adherence is associated with a decreased risk of complications in elderly hypertensive patients. Objectives: The purpose of this meta-analysis was to estimate the adherence to antihypertensive medication and related factors in elderly hypertensive patients in China. Materials and Methods: The databases served to retrieve the relevant literature before May 31, 2023. A systematic review (PROSPERO-CRD 42021278970) was conducted in accordance with PRISMA (Preferred Reporting Item for Systematic Reviews and Meta Analyses). Subgroup analysis, I2 statistics, publication bias, and quality assessment were conducted. Results: The prevalence of medication adherence among old hypertensive patients in China was 43% (95% confidence interval [CI]: 37%–49%). Medication adherence was related to education level (odds ratio [OR] = 2.12, 95% CI: 1.46-3.08), marriage (OR = 1.37,95% CI: 1.09–1.72) and the nonpresence of comorbidities (OR = 1.55, 95% CI: 1.11-2.16), but not related to the course of the disease ?5 years (OR = 0.91,95% CI: 0.67-1.24). Adherence to antihypertensive medication among the old hypertensive population in China was moderate. Conclusion: Healthcare professionals should attach importance to older hypertension patients with low level of education and no spouse.Item A Study to Evaluate the Impact of M-teaching on Knowledge, Attitude, and Practice about Digital Health Utilization in Tuberculosis Prevention and Control among Active Tuberculosis Cases and Their Close Contacts in Faridabad, Haryana(Wolters Kluwer – Medknow, 2025-03) Rani, B; Gauba, A; Jaglan, V; Mattoo, SK.Background: The wise use and deployment of digital health (e/m-health) technologies with conventional approaches(in-person directly observed therapy) can play an essential role in improving access to information and providing people-centered tuberculosis (TB) care and support, preventing and controlling TB more effectively globally (by 2030) and in India (by 2025). Objectives: The objectives of this study were to assess the knowledge, attitude, and practice (KAP) level and to evaluate the impact of “mobile-based teaching session” (time taken: 10–12 min) on that KAP level toward digital health technology utilization for TB prevention and control. Materials and Methods: A preexperimental (single group) pre- and posttest design was employed with cluster simple random sampling among 51 active TB cases and their close contacts (age group: 12–78 years) in Faridabad, Haryana, from July to October 2022. Data were collected through telephonic interviews (total time taken: 5–6 min) using a structured questionnaire. The Wilcoxon signed?rank test was computed to compare pre? and posttest rank scores using the SPSS (29.0.0.0) version at the P < 0.05 (two?tailed) significance level. Results: Despite having a positive attitude, the majority showed a lower knowledge and practice level preintervention, whereas after the intervention, their KAP level improved statistically significantly. Conclusions: The study results provide a significant preliminary base for decision?makers and health?care providers to plan and impart digital literacy for TB prevention and control more effectivelyItem Increase in Scabies Cases and Permethrin Nonresponse in Türkiye(Wolters Kluwer – Medknow, 2025-03) Aydemir, S; Kul, Z; Barlik, F; Saygin, M; Ekici, A; Yilmaz, HBackground: There has been an increase in scabies cases in Türkiye, and is considered to be an epidemic. Objective: The aim of this study was to assess scabies cases and the current status of scabies treatment by comparing patients who received scabies diagnosis and treatment before the COVID?19 pandemic, during the pandemic, and the normalization process. Materials and Methods: In this study, data of patients who applied to Van ?pekyolu 1st Family Health Center and received a scabies diagnosis were evaluated retrospectively. Demographic data such as age, sex, application dates, and treatment methods were received from the electronic registration database of Van ?pekyolu 1st Family Health Center. Categorical variables were presented as numbers (n) and percentages (%). The “two proportions Z-test and Fisher’s exact” test of the ratios were used for categorical variables. Results: Before the pandemic, among 4009 patients with dermatology complaints, 56 (1.4%) received a scabies diagnosis. An increase in scabies cases has been observed since 2018, and the annual case count has further increased during the pandemic. Before the pandemic, 10 (17.9%) out of 56 patients diagnosed with scabies and 70 (31.1%) out of 225 patients diagnosed with scabies during and after the pandemic experienced recurrence after permethrin treatment. Patients who did not respond to permethrin treatment were successfully treated with ivermectin. Conclusions: An increase in scabies cases has been identified in conjunction with the COVID?19 pandemic and the recurrence of scabies in patients treated with permethrin after the pandemic has raised concerns about the potential development of resistance to permethrin.Item Barriers and Facilitators of Health Care Workers’ Compliance with Infection Prevention and Control Practices in Health-care Facilities: A Systematic Literature Review(Wolters Kluwer – Medknow, 2025-03) Abalkhail, A; Elbehiry, A.Background: Health?care?associated infections (HAIs) are prevalent in health?care facilities, with 7%–10% of patients in developed countries acquiring one. In low? and middle?income countries, the incidence is higher. Reducing HAIs is a global priority, requiring effective infection prevention and control (IPC) measures. Objectives: This systematic review analyzes barriers and enablers in compliance with IPC procedures in hospitals. Materials and Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Literature was obtained from the databases such as MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science, and other sources of gray literature. Government and health-care body websites were also searched for relevant references. The search used Boolean operators to combine keywords and text words in MeSH, title, abstract, and full text. Results: Several factors can act as barriers or facilitators to health-care workers’ compliance with IPC practices. Key barriers include lack of knowledge and training, time constraints, workload, inadequate resources, and cultural and behavioral factors. Key facilitators include leadership and management support, education and training, adequate resources, and monitoring and feedback. Conclusion: This review aimed to identify factors causing noncompliance with infection control procedures and identify research gaps. Addressing both barriers and facilitators is crucial in promoting a safer health-care environment and reducing the incidence of HAIs.Item Trends in Noncommunicable Diseases among Brazil, Russian Federation, India, China, and South African Countries (2000–2016): An Investigation of Fruits and Vegetables Intake and Health-care Financing on Noncommunicable Diseases Mortality Rate(Wolters Kluwer – Medknow, 2025-03) Manchala, S; Chinta, KB.Globally, 41 million people die annually from noncommunicable diseases(NCDs). The trends in deaths attributed to NCDs increased by 13.58, 154, 108, and 5.12 thousand per annum each in Brazil, China, India, and South Africa, respectively, while declined (16.14 thousand per annum) in Russia during the period 2000 and 2016. Regression estimates reveal that for every 1 US$ increase in current health expenditure per capita, NCD mortality rate declined by 0.32, 0.27, 1.68, 0.49, and 0.12 per 100,000 population in Brazil, China, India, Russia, and South Africa, respectively. Further, vegetables intake per capita is found to be highly negatively correlated with NCD mortality rate with statistical significance (P < 0.05) for China, underscoring the importance of vegetables in reducing risk factors for NCDs. This study underscores the need for further research and better implementation of policies, for reducing NCDs and catastrophic loss to the population and economies.Item Socioeconomic Factors Influencing Treatment and Outcomes in Acute Myeloid Leukemia(Wolters Kluwer – Medknow, 2025-03) Nethala, P; Chitrapur, RG; Franklyn, NN; Hanmantgad, S.Evaluation and reduction of socioeconomic inequalities in cancer survival are a public health priority worldwide. In developing countries such as India, the high-economic burden of acute myeloid leukemia (AML) remains understudied despite its severe impact on outcomes. This study investigated the impact of socioeconomic factors on mortality and survival in AML. Conducted from January 2019 to February 2022 at a tertiary care center in India, it included 41 newly diagnosed AML patients. Socioeconomic determinants such as education, insurance status, social support, and socioeconomic status (SES) (using the Modified Kuppuswamy Scale, 2021) were assessed. Using adjusted multivariable Cox proportional hazards ratio (HR), the study found that lower SES was associated with an increased mortality risk compared to the upper socioeconomic class(lower?middle class HR = 19.9 [P = 0.027], upper-lower class HR = 400 [P = 0.004], and lower class HR = 1221 [P = 0.002]). The overall survival difference between SES classes was not statistically significant. This evidence emphasizes the need for equitable access to AML treatment in developing countries.Item A Study to Understand the Reasons for Early Treatment Discontinuation among People Living with Hepatitis C in Punjab, India(Wolters Kluwer – Medknow, 2025-03) Mutreja, K; Boeke, CE; Tandon, R; Witschi, M; Sindhwani, S; Chawla, UBackground: Punjab, India’s public sector hepatitis C virus (HCV) program has initiated >60,000 patients on free?of?cost treatment. However, >10% of patients initiated but did not complete treatment. Objective: To assess reasons for early HCV treatment discontinuation in Punjab, India. Materials and Methods: Telephonic interviews were conducted among 475 people living with HCV who discontinued HCV treatment (2018–2019) to identify primary self?reported reasons for treatment discontinuation. Results: Eighty-nine percent of respondents were male; 59% were aged 18–35 years. The leading reasons for treatment discontinuation were feeling better/well(24%), relocation (20%), and lack of time to visit the facility due to work or personal obligations (15%). Limited awareness about HCV and poor counseling emerged as prominent root causes for many of the reasons cited. Seventy-eight percent of the respondents were not counseled on the importance of treatment completion, and 63% were not aware that HCV treatment discontinuation can have health consequences. Conclusion: This study has revealed that there is a strong need to improve counseling for HCV in Punjab, given that many participants did not understand the importance of completing HCV treatment despite the resolution of symptoms and feeling well. Interventions such as refresher trainings and enhanced counseling materials, better support of patient transfers across facilities, and multimonth dispensations may help to improve retention in care.