Enhancing Medication Adherence through Improved Patient-provider Communication: The 6A's of Intervention

Public-health facilities in the developing world often experience a high patient burden, low doctor-patient ratio, drug stock-outs and the lack of avenues for adequate patient-provider communication. We identified strategies for enhancing medication adherence for chronic disorders in Indian health settings that rely on improving patient-provider communication through a review of the literature. These include (A)sk the patient on adherence status, (A)ssess accurately medication adherence, provide (A)ssistance with regimen and enlisting support from all available resources especially family support, (A)nticipating and precluding interruption in adherence, (A)ssurance against harm due to drug sideeffects and finally (A)void blaming the patient for non-adherence.

The knowledge and attitudes towards domestic violence among pregnant women in Delhi, India: a facility-based study

Background: Domestic violence during pregnancy endangers the health of the mother and her child. Aim and Objective: To ascertain the knowledge and attitudes towards domestic violence among pregnant women in India and to find out their sociodemographic predictors. Settings and design: This cross-sectional analysis of baseline data from a prospective study was conducted at the antenatal care (ANC) clinic of a major tertiary care government hospital in New Delhi from 2015-2018. Methods and material: The data were collected through face-to-face interviews with 1500 pregnant women up to 20 weeks of gestation. A p-value < 0.05 was considered statistically significant. Results: The mean (SD) age of the participants was 24.6 (3.6) years. All the participants were married. A total of 1169 (77.9%) participants were aware of domestic violence. The participant comprehension of the types of domestic violence was highest for physical (89.9%), emotional (68.4%), economical (21.5%), and sexual (17.4%) violence. On adjusted analysis, education ?10 years and higher SES were associated with a comprehensive awareness of domestic violence. Conclusions: The awareness of domestic violence, especially beyond physical violence, is low among pregnant women in India.

Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021.

METHODS

We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age-sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework.

FINDINGS

In 2021, diarrhoeal diseases caused an estimated 1·17 million (95% uncertainty interval 0·793-1·62) deaths globally, representing a 60·3% (50·6-69·0) decrease since 1990 (2·93 million [2·31-3·73] deaths). The most pronounced decline was in children younger than 5 years, with a 79·2% (72·4-84·6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147-221) in 1990 to 51·4 million (39·9-65·9) in 2021. In 2021, an estimated 59·0 million (47·2-73·2) DALYs were attributable to diarrhoeal diseases globally, with 30·9 million (23·1-42·0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1-5 months and 2-4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59·0 million (47·2-73·2) to 4·99 million (1·99-10·0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15·2% (11·4-20·1), followed by norovirus at 10·6% (2·3-17·0) and Cryptosporidium spp at 10·2% (7·03-14·3). In children younger than 5 years, the fatal PAF of rotavirus was 35·2% (28·7-43·0), followed by Shigella spp at 24·0% (15·2-37·9) and adenovirus at 23·8% (14·8-36·3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenicEscherichia coli, and enterotoxigenic E coli producing heat-stable toxin.

INTERPRETATION

The substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial.

FUNDING

Bill & Melinda Gates Foundation.

Text messaging improves diabetes-related knowledge of patients in India: A quasi-experimental study

BACKGROUND

. Diabetes-related health education promotes patient efficacy for diabetes self-management. However, sub-optimal knowledge of diabetes in people with diabetes is recognized as a challenge in overcrowded public health facilities in India. We aimed to determine the effect of health education through mobile phone text messages (short messaging service [SMS]) on diabetes-related knowledge of patients with diabetes.

METHODS

. From February 2016 to February 2017, we recruited adult patients with diabetes for this quasi-experimental study done in the outpatient setting of a major tertiary care government hospital in Delhi, India. Participants in the intervention group received a text message on diabetes self-care practices every alternate day for 90 days. We evaluated the patients' knowledge of diabetes using the Spoken Knowledge in Low Literacy in Diabetes (SKILL-D) questionnaire and a self-designed diabetes knowledge questionnaire.

RESULTS

. We enrolled 190 men and 160 women, of whom 52 (13.7%) were lost to follow-up. At baseline, mean diabetes knowledge scores were higher in the intervention group compared to the control group. After the intervention period of 3 months, the diabetes knowledge scores for SKILL-D and the patient diabetes knowledge questionnaire showed a statistically significant increase in the intervention group (mean difference 0.7 and 0.5, respectively; p<0.001, but there was no increase in the control group).

CONCLUSION

. The use of mobile phone technology for diabetes-related health education through mobile text-message (SMS) technology is an effective method for health promotion.

Patterns and Predictors of Abortion Care-Seeking Practices in India: Evidence From a Nationally Representative Cross-Sectional Survey (2019-2021)

Background India continues to have unsafe abortions despite progressive legislation since the past five decades facilitating ease of access to abortion services. This study describes abortion care-seeking patterns (social/therapeutic/humanitarian/sex-selective/safe/unsafe), preferences (public/private/at home), and their determinants among Indian women. Methods Data were taken from the Indian National Family and Health Survey (NFHS-5) (2019-2021) including women aged 15-49 years, who had terminated their last pregnancy by induced abortion within five years prior to the survey (N = 5,856). A bivariate analysis, followed by a multinomial logistic regression model, was performed to assess the predictors affecting the choice of healthcare facility type for an abortion. Predictors of unsafe and self-managed abortions were examined using binary logistic regression. Results About 665,671 women in the reproductive age group responded to the survey, of which 3.42% (n=22,767) reported their most recent pregnancy within the last five years terminated in either a miscarriage, stillbirth or abortion, of which 5,856 (25.72%) underwent an induced abortion. Women undergoing surgical abortion were more likely to avail of either a public (adjusted relative risk ratio (aRRR)=38.06 (23.62, 61.35)) or a private facility (aRRR=44.53 (28.11,70.53)) compared to at-home abortions. Women reporting a social and humanitarian reason for abortion were less likely to undergo an abortion at a public (aRRR=0.25 (0.17,0.35)) or private facility (aRRR=0.32 (0.23,0.44)) than at home. Furthermore, a total of 147 (2.43%) abortions were classified as unsafe. Women reporting sex-selective reasons for abortion were observed to have a higher likelihood of engaging in an unsafe abortion (adjusted odds ratio (aOR)= 1.61 (0.70, 3.70)) compared to those citing a therapeutic reason. Conclusions Self-managed abortions at home were more prevalent in women of lower socioeconomic status, adolescent girls, and those reporting sex-selective reasons for abortion. Furthermore, the reproductive-health program in India should enhance capacity-building initiatives for primary-care healthcare providers, including doctors, nurses, and pharmacists, to effectively prescribe and supervise abortion through medication methods.

Sleep problems and their predictors in community-dwelling older adults with diabetes in India: Evidence from the Longitudinal Ageing Study in India

OBJECTIVES

To ascertain the prevalence and predictors of sleep disorders and poor sleep quality among older adults with Diabetes (DM) in India, and to assess the relationship between sleep quality and DM.

METHODS

Data was utilized from the nationally representative Longitudinal Ageing Study in India (Wave-1, 2017-18), with a total sample of 66606 older adults (≥45 years) selected for the study. Sleep problems and sleep quality score were assessed using an adaptation based on the Jenkins Sleep Scale. Multivariate linear and logistic regressions were conducted to determine the effect of sociodemographic and clinical factors on sleep quality. Mediation analysis (Karlson-Holm-Breen) was done to assess the direct and indirect effects of independent variables on the sleep quality scores. Further, Propensity score matching (PSM) was done to assess the impact of diabetes on sleep problems.

RESULTS

The prevalence of DM was 12.34% (n = 8564, 95% CI: 11.54, 13.20) among whom 24.38% (95% CI: 21.38, 27.65) reported sleep problems. On adjusted analysis, sleep problems were significantly associated with increasing education, higher wealth quintile, lack of physical activity, and multimorbidity. Mediation analysis showed adherence to anti-diabetes medication improved sleep quality (aB = -0.28 (95% CI: -0.54, -0.02)), while comorbidities worsened sleep quality (aB = 0.79 (95% CI: 0.67, 0.92)). Analysis from PSM indicated that DM was associated with a 6.2% higher chance of sleep problems.

CONCLUSIONS

Poor sleep quality is present in nearly one in four individuals diagnosed with DM in India and linked with certain adverse social determinants. Focused interventions to improve assessment and treatment of sleep problems in resource-limited primary care settings require prioritization.

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

METHODS

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

FINDINGS

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

INTERPRETATION

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

FUNDING

Bill & Melinda Gates Foundation.

Menstrual hygiene management and its determinants among adolescent girls in low-income urban areas of Delhi, India: a community-based study

OBJECTIVES

Menstrual hygiene management (MHM) in developing countries is linked to human rights, social justice, and the education and empowerment of young girls. The objective of this study was to assess menstrual hygiene practices and their determinants among adolescent girls, including school dropouts, and the effects of pad distribution programs in urban resettlement areas of Delhi, India.

METHODS

A cross-sectional study was conducted from March 2019 to February 2020 in urban resettlement colonies and 2 villages of Delhi among 1,130 adolescent girls aged 10 to 19 years, who were interviewed face to face.

RESULTS

In total, 954 participants (84.4%) used only disposable sanitary pads, 150 (13.3%) used both sanitary pads and cloths, and 26 (2.3%) used only cloths (n=1,130). Most school-going girls utilized the scheme for pad distribution, but only two-thirds of the girls who were out of school utilized the scheme. In the adjusted analysis, girls with lower educational status, those who had dropped out of school, and those from the Muslim religious community were more likely to use cloths for MHM.

CONCLUSION

More than 4 out of 5 adolescent girls in Delhi in low-income neighborhoods preferred sanitary pads for MHM. The government free pad scheme reached near-universal utilization among school-going girls (97%), but the subsidized pad scheme for girls who did not attend school was insufficiently utilized (75%).

Calorie- and Protein-Deficient Diets Despite Adequate Dietary Diversity among Pregnant Women in a Low-Income Urban Area in Delhi, India

We interviewed 221 antenatal women in the second or third trimester of pregnancy attending a primary care antenatal clinic at a low-income area in Delhi, India, during 2019-20. The Minimum Dietary Diversity-Women (MDD-W) score for 10 food groups was calculated using the open recall method during a 24-h recall period. The median MDD-W score was 6 (IQR 4-7). Low dietary diversity (MDD-W <5) was observed in 65 (29.4%) participants. Low SES and higher age (≥25 years) were statistically significant predictors of lower dietary diversity, but it was unrelated to parity. Furthermore, protein deficit was observed in 185 (83.7%) and calorie deficit in 210 (95%) participants.

Risk assessment of diabetes using the Indian Diabetes Risk Score among older adults: Secondary analysis from the Longitudinal Ageing Study in India

BACKGROUND

The Indian Diabetes Risk Score (IDRS) is a simple tool to assess the probability of an individual having type 2 diabetes (T2DM) but its applicability in community-dwelling older adults is lacking. This study aimed to estimate the risk of T2DM and its determinants among older adults without prior diabetes (DM) using the IDRS, while also assessing its sensitivity and specificity in individuals with a history of diabetes.

METHODS

We analyzed cross-sectional data from the Longitudinal Ageing Study in India (LASI) wave-1 (2017-18). IDRS was calculated amongst individuals aged ≥45 years considering waist circumference, physical activity, age and family history of DM. Risk was categorized as high (≥60), moderate (30-50), and low (<30).

RESULTS

Among 64541 individuals, 7.27 % (95 % CI: 6.78, 7.80) were at low risk, 61.80 % (95 % CI: 60.99, 62.61) at moderate risk, and 30.93 % (95 % CI: 30.19, 31.67) at high risk for T2DM. Adjusted analysis showed higher risk of T2DM among men, widowed/divorced, urban residents, minority religions, overweight, obese, and individuals with hypertension. ROC curve yielded an AUC of 0.67 (95 % CI: 0.66, 0.67, P < 0.001). The IDRS cutoff ≥50 had 73.69 % sensitivity and 51.40 % specificity for T2DM detection.

CONCLUSION

More than 9 in 10 older adults in India without history of DM have high-moderate risk of T2DM when assessed with the IDRS risk-prediction tool. However, the low specificity and moderate sensitivity of IDRS in existing DM cases constraints its practical utility as a decision tool for screening.

Sarcopenic Obesity Burden, Determinants, and Association With Risk of Frailty, Falls, and Functional Impairment in Older Adults With Diabetes: A Propensity Score Matching Analysis

BACKGROUND

Sarcopenic obesity (SO) is a medical and functional state characterized by the coexistence of excessive adipose tissue and sarcopenia inside an individual. Recent epidemiological studies suggest a rising prevalence of SO in patients with diabetes mellitus (DM) probably due to the conducive environment resulting from adipose tissue dysfunction and muscle wasting accelerated by insulin resistance, chronic inflammation, and altered protein metabolism. Individuals with SO may have higher risk of experiencing falls, frailty, and disabilities due to compromised musculoskeletal integrity, gait abnormalities, and reduced functional capacity. The primary study objective was to determine the prevalence and predictors of SO among older adults with a history of DM. The secondary objective was to assess the association of falls, frailty, and functional disability with SO in patients with DM.

METHODOLOGY

This cross-sectional study analyzed data from the nationally representative Longitudinal Aging Study in India (LASI) Wave 1, focusing on individuals aged 60 and above, with an emphasis on diabetes. SO was assessed using the Asian Working Group for Sarcopenia criteria. Propensity score matching (PSM), logistic regression, and mediation analysis were used to explore relationships between diabetes, SO, and health outcomes (falls, frailty, and disabilities).

RESULTS

Among 31,902 participants aged 60 and above, 14.26% had diabetes, and 17.67% of those with diabetes exhibited SO. Female gender (aOR = 2.63) and urban residence (aOR = 1.40) were significantly associated with higher odds of SO in individuals with diabetes. PSM analysis revealed a 9.0% higher likelihood of SO in older adults with DM than those without DM. SO was further linked to increased risk of falls, frailty, and various levels of activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities, with significant mediation effects ranging from 3.67% to 45.81%.

CONCLUSIONS

Diabetes substantially increases the risk of SO and associated functional disability with the risk of falls in older adults. Standard diabetes care should integrate health promotion especially nutrition to mitigate the risk of SO-linked functional disability and falls.

COVID-19 Vaccine Acceptance and Its Determinants in the General Population of Delhi, India: A State Level Cross-Sectional Survey

OBJECTIVE

To ascertain the COVID-19 vaccination acceptance and the factors contributing to vaccine hesitancy and vaccine confidence in the adult population, and the intention for vaccination of their children.

METHODS

This cross-sectional analysis reports the ancillary results of a population-based SARS-CoV-2 serosurvey conducted in Delhi, India, from September 24 to October 14, 2021. Data were collected from 20312 adult participants through a multistage sampling method from all the 274 wards in the 11 districts of the national capital territory region.

RESULTS

 We enrolled 12093 (59.3%) females and 8219 (40.5%) male participants with mean (SD) age of 40.3 (14.6) years. The vaccine acceptance rate in the participants was 67.7% (95% CI 67.1, 68.4), with 6031 (43.8%) having received one dose and 7727 (56.2%) having received two vaccine doses. On adjusted analysis, lack of vaccine acceptance was independently associated with female gender aOR 1.15 (95% CI 1.1, 1.23), younger age-group (18-49 years) aOR 1.85 (95% CI 1.71, 2.0), low educational status aOR 1.88 (95% CI 1.77, 2.0), in those with no history of COVID-19 aOR 1.81 (95% CI 1.69, 1.95), non-healthcare workers aOR 2.1 (95% CI 1.7, 2.53), and in the absence of hypertension comorbidity aOR 1.22 (1.1, 1.38). Lack of awareness of COVID-19 vaccines, including doubts on vaccine efficacy and long-term safety, were primary drivers of vaccine hesitancy in the unvaccinated subgroup. Only 35.6% participants reported a positive intention to vaccinate their children.

CONCLUSIONS

One in three adults lacked vaccine acceptance. High prevalence of delay in second dose vaccination was also observed.

Metabolic syndrome burden, determinants and treatment status in an urban slum resettlement colony in Delhi, India

BACKGROUND

Metabolic syndrome (MetS) in low-resource settings contributes to accentuated risk of cardiovascular disease, including stroke. The study objective was to estimate the prevalence, determinants and treatment status of MetS in an urban slum resettlement population in Delhi, India.

METHODS

This study was conducted from February to May 2023. Multiphase sampling was conducted with 1910 individuals screened for abdominal obesity (AO), with 996 detected as having AO, of which, 400 were selected by simple random sampling and further evaluated for triglycerides (TGs), high-density lipoprotein (HDL) and fasting glucose levels.

RESULTS

Among the 400 participants detected as having AO, 211 had evidence of MetS (52.75% [95% confidence interval 47.83 to 57.62]). The most prevalent combination of MetS clustering was for all five components (AO, diabetes mellitus [DM], hypertension [HTN], low HDL and high TGs; 14.69%), followed by AO, DM and HTN (12.32%). On adjusted analysis, the odds of having MetS was found to be independently associated with increasing age (≥40 y) but not sex.

CONCLUSIONS

A high burden of MetS and suboptimal treatment status is prevalent in urban slum populations. Screening of individuals with AO, especially in those >40 y of age, can be an effective programmatic strategy for early diagnosis and management of MetS and its underlying components.

How do physicians and nurses assess and support patient medication adherence? An examination of a rural secondary care hospital in Delhi, India

Introduction:

Suboptimal medication adherence contributes enormously to patient mortality, morbidity, and related health-care costs. Health-care providers (HCPs) have a pivotal role in supporting medication adherence in their patients through appropriate health communication. We assessed the perspectives and practices of medical doctors and nurses toward the assessment and support for patient medication adherence in Indian health settings.

Materials and Methods:

We conducted a cross-sectional study at a secondary-care hospital in Delhi. Data were collected from medical doctors, interns, and nursing staff using a self-administered questionnaire on the following domains: Medication Adherence, frequency, methods and tools of assessment, high-risk patient identification and interventions applied to promote adherence.

Results:

We recruited a total of 117 HCPs. The common modes of assessment of medication adherence used by the HCPs included a general question (78.6%), observing missed appointments (43.6%), and querying for forgetfulness (29.9%). However, none of the HCPs were aware of validated questionnaire (scales) for the assessment of medication adherence. Drug-related adverse effects as a cause of nonadherence were evaluated by 38.3% HCPs only.

Conclusions:

The development of simple and validated methods for assessing medication adherence applicable in resource-constrained settings along with the curricular training of HCPs on patient adherence and related know-how needs urgent prioritization.

The following core competencies are addressed in this article:

Practice-based learning and improvement, Systems-based practice, and Interpersonal and communication skills.

Text messaging improves diabetes-related knowledge of patients in India: A quasi-experimental study

BACKGROUND

. Diabetes-related health education promotes patient efficacy for diabetes self-management. However, sub-optimal knowledge of diabetes in people with diabetes is recognized as a challenge in overcrowded public health facilities in India. We aimed to determine the effect of health education through mobile phone text messages (short messaging service [SMS]) on diabetes-related knowledge of patients with diabetes.

METHODS

. From February 2016 to February 2017, we recruited adult patients with diabetes for this quasi-experimental study done in the outpatient setting of a major tertiary care government hospital in Delhi, India. Participants in the intervention group received a text message on diabetes self-care practices every alternate day for 90 days. We evaluated the patients' knowledge of diabetes using the Spoken Knowledge in Low Literacy in Diabetes (SKILL-D) questionnaire and a self-designed diabetes knowledge questionnaire.

RESULTS

. We enrolled 190 men and 160 women, of whom 52 (13.7%) were lost to follow-up. At baseline, mean diabetes knowledge scores were higher in the intervention group compared to the control group. After the intervention period of 3 months, the diabetes knowledge scores for SKILL-D and the patient diabetes knowledge questionnaire showed a statistically significant increase in the intervention group (mean difference 0.7 and 0.5, respectively; p<0.001, but there was no increase in the control group).

CONCLUSION

. The use of mobile phone technology for diabetes-related health education through mobile text-message (SMS) technology is an effective method for health promotion.

Prevalence of obesity, determinants, and its association with hyperglycaemia among community dwelling older adolescents in India

BACKGROUND

Globally, obesity and diabetes mellitus (DM) are emergent public health concerns in the adolescent population. India, home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization, with accompanying unhealthy nutritional transition, and sedentary lifestyle.

AIM

To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents (15-19 years) in India.

METHODS

This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India (2019-2021). The survey employed stratified two-stage sampling, with systematic random sampling in rural and urban areas. Statistical analysis included descriptive statistics, bivariate, and multivariable logistic regression, employing generalized linear models.

RESULTS

The weighted prevalence of DM was 1.09% including 0.77% [95% confidence interval (CI): 0.72-0.83] previously diagnosed and 0.32% (95%CI: 0.29-0.35) newly diagnosed cases detected on survey screening. On adjusted analysis, increasing age, higher education levels, higher wealth index, and overweight/obesity were the factors significantly associated with presence of DM. Only 61% of the adolescents with previously diagnosed DM were on anti-diabetes treatment. The weighted prevalence of overweight/obesity among older adolescents was 6.9% with significantly higher odds in the male sex, having higher educational levels, urban residence, and those with a higher wealth index.

CONCLUSION

Nearly one in hundred older adolescents in India have diabetes, with one in three undiagnosed. Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.

The effectiveness of facility-based management of children with Severe acute malnutrition and their determinants in Jharkhand, India: A retrospective study

BACKGROUND

Children with Severe acute malnutrition (SAM) experience a high risk of disease and developmental delays contributing to large scale morbidity and mortality particularly in the developing world with existing progress inadequate to attain the Sustainable Development Goal for improved nutrition, and the cessation of all forms of undernourishment by 2030.The study objective was to assess the functioning and effectiveness of facility-based management of children with SAM in terms of their recovery (anthropometric indicators), adherence to discharge, and follow-up guidelines.

METHODS

This secondary data analysis obtained data from the physical patient registers of two malnutrition treatment centres (MTCs) located in the Jamtara district of Jharkhand. Information of 245 children admitted to these MTCs from April 2019-April 2020 was obtained consecutively including anthropometric outcome (weight, length, and Mean Upper Arm Circumference) measurements during the period of their admission. The primary outcome was the proportion of children who attained the recommended discharge criterion of greater than 15% weight gain at the time of discharge.

RESULTS

The mean (SD) age of the children with SAM was 1.52 (0.73) years including 55.1% females and 44.9% males. There were 38% of children had a MUAC below 11.5 cm, and 62% had a Z score for weight for height below -3SD. The mean (SD) length of admission stay at the MTCs was 17.16 (5.76) days. A statistically significant improvement in the mean weight and MUAC at discharge was found although the effect size was small (0.98 kg). Only 105 (44.3%) (n=237) children with SAM achieved recovery as per the discharge criterion requirement of ≥15% weight gain since the time of admission. The mean (SD) duration of stay of the children who recovered was 20.43 (5.64) days, being significantly higher compared to the children who failed to recover as per the weight guidelines 14.59 (4.4) days (p < 0.001).

CONCLUSION

MTCs were effective in the management of children with SAM although the recovery rate through weight gain criterion was poor due to premature discharge and lack of follow-up suggestive of a high-burden of adverse social determinants and inadequate health system sensitization and preparedness.

Oral self-care practices and treatment seeking behavior in patients with diabetes at a tertiary care government hospital in Delhi, India

BACKGROUND AND AIMS

to determine the oral health practices in patients with DM and to identify their perspectives on treatment-seeking for oral health.

METHODS

We conducted a cross-sectional study in the diabetes clinic of a government hospital in Delhi, India. Data was collected through face-face interviews with the patients.

RESULTS

We enrolled a total of 339 participants having a mean (SD) age of 46.1 (5.4) years. An optimal glycemic control was present in 109 (32.2%) participants. Self-reported poor or very poor condition of teeth and gums was reported by 161 (47.5%) and 69 (20.35%) participants, respectively. The awareness that DM worsens oral health was correctly reported by 15.2% participants. The prevalence of twice-daily brushing was 18.6%, and 15.6% participants underwent a dental examination in the previous 12 months.

CONCLUSION

There exists a high prevalence of poor oral care despite unsatisfactory oral health status among patients with DM in India.

SUMMARY

We recruited 339 patients with DM in Delhi, India. Twice-daily brushing was practiced by 18.6% participants. Self-reported poor or very poor condition of teeth and gums was reported by 47.5% and 20.3% participants, respectively. Patients avoided dental visits when asymptomatic, if not referred and due to fatalistic health beliefs.