Publications by authors named "Sitanshu Sekhar Kar"

108 Publications

Evaluation of the International Society on Thrombosis & Haemostasis scoring system & its modifications in diagnosis of disseminated intravascular coagulation: A pilot study from southern India.

Indian J Med Res 2022 Feb;155(2):306-310

Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.

Background & Objectives: Diagnosis of disseminated intravascular coagulation (DIC) rests primarily on the clinical profile along with supportive laboratory tests. The International Society on Thrombosis and Haemostasis (ISTH) had proposed a scoring system for the diagnosis of overt DIC. However, fibrinogen values which are supposed to be low are often found to be elevated due to the associated inflammation seen in some cases. Moreover, peripheral smear is known to show schistocytes, which is also not included in the score. This study was done to evaluate ISTH scoring system and its modifications in suspected DIC.

Methods: Fifty-six patients were enrolled for the present study of whom; in four, fibrinogen assay could not be done. Modifications in the ISTH scoring with the exclusion of fibrinogen, i.e. modified ISTH (MI) score and subsequent inclusion of schistocytes, i.e. modified ISTH with schistocytes (MIS) score, were used. The modified scores were analyzed for diagnostic accuracy parameters and agreement with ISTH score.

Results: Amongst 56 cases, 9/52 (17.3%), 22 (39.3%) and 17 (30.4%) were diagnosed as positive for overt DIC by ISTH, MI and MIS scores and mortality was 33, 22.7 and 17.6 per cent, respectively. The sensitivity, specificity, positive and negative predictive values for the MI score were 100, 74.4, 45 and 100 per cent and for MIS score were 100, 86, 60 and 100 per cent, respectively. The agreement between MI score and MIS score with ISTH score was moderate [κ=0.502, 95% confidence interval (CI): 0.272-0.732, P<0.001] and substantial (κ=0.681, 95% CI: 0.45-0.91, P<0.001).

Interpretation & Conclusions: In the present study, the calculated mortality was highest by ISTH score. Best agreement was between MIS score and ISTH score. In a resource-constrained setup where fibrinogen assay and therefore ISTH score is difficult, it is suggested that MIS score can be considered.
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http://dx.doi.org/10.4103/ijmr.IJMR_1236_19DOI Listing
February 2022

Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

PLoS One 2022 8;17(8):e0272042. Epub 2022 Aug 8.

All India Institute of Medical Sciences, Nagpur, India.

Background: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India.

Methods: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model.

Results: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM.

Conclusions: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272042PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9359565PMC
August 2022

Community health workers willingness to participate in COVID-19 vaccine trials and intention to vaccinate: A cross-sectional survey in India.

Clin Epidemiol Glob Health 2022 Sep-Oct;17:101113. Epub 2022 Jul 30.

Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Background: Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers' willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India.

Methods: A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine.

Results: Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18-7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51-8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24-4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17-4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12-0.88), p = 0.027].

Conclusions: Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.
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http://dx.doi.org/10.1016/j.cegh.2022.101113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9338829PMC
July 2022

High prevalence of abdominal obesities and metabolically unhealthy individuals in a highly urbanized district of India: findings of a cross-sectional survey in Puducherry.

Fam Pract 2022 Aug 1. Epub 2022 Aug 1.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Background: Abdominal obesities are better markers for predicting cardiovascular abnormalities than risk stratification based only on body mass index (BMI). We aimed to estimate the prevalence of abdominal adiposities using predictive equations for Asian Indian adults and to determine the prevalence of metabolically healthy subjects among those overweight/obese and with normal BMI.

Methods: A community-based survey was conducted among those aged 18-69 years in the district of Puducherry between February 2019 and February 2020. We surveyed 2,560 individuals selected through multi-stage cluster random sampling from urban and rural areas (50 wards and 50 villages, respectively) of the district. Anthropometric measurements, such as height, weight, waist circumference, and blood pressure were recorded from each participant. Fasting blood sample was collected from each alternate participant to estimate metabolic risk factors.

Results: Over four-fifths (85.6%; 95% CI: 84.2-86.9) and two-thirds (69.7%; 95% CI: 67.9-71.6) of the population in the district had high levels of intra-abdominal adipose tissue (IAAT) and total abdominal fat (TAF), respectively. Both the risk factors were significantly higher among women and urban population. About 43% (95% CI: 41-44.9) of the population had high abdominal subcutaneous adipose tissue (SCAT) with a significantly higher prevalence among the urban population. Among those overweight/obese (n = 773), almost all 99.4% (95% CI: 98.7-99.9) were metabolically unhealthy. Among subjects with normal BMI (n = 314), only about 2.9% (95% CI: 1.3-4.8) were metabolically healthy.

Conclusion: We highlight the substantially high prevalence of IAAT, TAF, and SCAT in the district of Puducherry. Almost all the study population was metabolically unhealthy irrespective of their BMI levels.
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http://dx.doi.org/10.1093/fampra/cmac082DOI Listing
August 2022

What is the Out-of-Pocket Expenditure on Medicines in India? An Empirical Assessment using a Novel Methodology.

Health Policy Plan 2022 Jul 21. Epub 2022 Jul 21.

Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India.

The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicines expenditure using a novel methodology. OOP expenditure data were collected through exit-interviews with 5252 out-patient department (OPD) patients in three states of India. Follow-up interviews were conducted after day 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from National Sample Survey (NSS) 75th round for the corresponding states and districts, which is based on household survey methodology. The share of medicines in OOP expenditure did not change significantly for organized private hospitals using patient-reported versus imputation-based method (30.74% to 29.61%). Large reductions were observed for single-doctor clinics, especially in case of Ayurvedic (64.51% to 36.51%) and Homeopathic (57.53% to 42.74%) practitioners. After adjustment for socio-demographic factors and types of ailments, we found that household data collection as per NSS methodology leads to an increase of 25% and 26% in reported share of medicines for public and private sector out-patient consultations respectively, as compared to facility based exit interviews with imputation of expenditure for medicines as per actual quantity and price data. The nature of health care transactions at single-doctor clinics in rural India leads to an over-reporting of expenditure on medicines by patients. While household surveys are valid to provide total expenditure, these are less likely to correctly estimate the share of medicines expenditure.
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http://dx.doi.org/10.1093/heapol/czac057DOI Listing
July 2022

Effectiveness of BBV152/Covaxin and AZD1222/Covishield vaccines against severe COVID-19 and B.1.617.2/Delta variant in India, 2021: A multi-centric hospital-based case-control study.

Int J Infect Dis 2022 Jul 14. Epub 2022 Jul 14.

All India Institute of Medical Sciences, Jodhpur, India.

Background: India introduced BBV152/Covaxin and AZD1222/Covishield vaccines from January 2021. We estimated effectiveness of these vaccines against severe Coronavirus disease 2019 (COVID-19) among individuals aged ≥45 years.

Methods: We did a multi-centric, hospital-based, case-control study between May and July 2021. Cases were severe COVID-19 patients and controls were COVID-19 negative individuals from 11 hospitals. Vaccine effectiveness (VE) was estimated for full (2 doses ≥14days) and partial (1 dose ≥21 days) vaccination; duration between two vaccine doses and against the Delta variant. We used a random effects logistic regression model to calculate adjusted odds ratios (aOR) with 95% CI after adjusting for relevant known confounders.

Results: We enrolled 1,143 cases and 2,541 controls. The VE of full vaccination was 85% (95% CI: 79%-89%) with AZD1222/Covishield and 71% (95% CI: 57%-81%) with BBV152/Covaxin. The VE was highest for an interval of 6-8 weeks between two doses of AZD1222/Covishield (94%, 95% CI: 86%-97%) and BBV152/Covaxin (93%, 95% CI: 34%-99%). The VE estimates were similar against the Delta strain and sub-lineages.

Conclusion: BBV152/Covaxin and AZD1222/Covishield were effective against severe COVID-19 among the Indian population during the period of dominance of highly transmissible Delta variant in second wave of pandemic. An escalation of two-dose coverage with COVID-19 vaccines is critical to reduce severe COVID-19 and further mitigate the pandemic in the country.
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http://dx.doi.org/10.1016/j.ijid.2022.07.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288262PMC
July 2022

Indicators for maternal near miss: an observational study, India.

Bull World Health Organ 2022 Jul 2;100(7):436-446. Epub 2022 Jun 2.

Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Puducherry, 605006, India.

Objective: To compare the incidence of maternal near miss using the World Health Organization (WHO) near-miss tool and six other criteria sets, including criteria designed for low-resource settings or specifically for India.

Methods: In a cohort study we used WHO severity indicators to identify women with potentially life-threatening conditions during pregnancy or childbirth admitted to a referral hospital in Puducherry, India, from May 2018 to April 2021. We analysed sociodemographic, clinical and laboratory data for each woman and calculated the incidence of maternal near miss and other process indicators for each set of criteria.

Findings: We analysed data on 37 590 live births; 1833 (4.9%) women were identified with potentially life-threatening conditions, 380 women had severe maternal outcomes and 57 died. Applying the different sets of criteria to the same data, we found the incidence of maternal near miss ranged from 7.6 to 15.6 per 1000 live births. Only the Global Network criteria (which exclude laboratory data that may not be available in low-resource settings) and the WHO criteria could identify all women who died. Applying the criterion of any number of units of blood transfusion increased the overall number of women identified with near miss.

Conclusion: The WHO and Global Network criteria may be used to detect maternal near miss in low-resource settings. Future studies could assess the usefulness of blood transfusion as an indicator for maternal near miss, especially in low- to middle-income countries where the indicator may not reflect severe maternal morbidity if the number of units received is not specified.
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http://dx.doi.org/10.2471/BLT.21.287737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9243687PMC
July 2022

Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set.

Value Health 2022 Jul 5;25(7):1218-1226. Epub 2022 Jan 5.

Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Objectives: This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare.

Methods: A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set.

Results: A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension.

Conclusions: This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare.
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http://dx.doi.org/10.1016/j.jval.2021.11.1370DOI Listing
July 2022

Performance of WHO updated cardiovascular disease risk prediction charts in a low-resource setting - Findings from a community-based survey in Puducherry, India.

Nutr Metab Cardiovasc Dis 2022 Jun 4. Epub 2022 Jun 4.

Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention (NVI), World Health Organization, Geneva, Switzerland.

Background And Aim: The World Health Organization has revised the cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. These charts (non-lab and lab versions) estimate the total CVD risk in an individual, of which the non-lab is for low-resource settings. We aimed to estimate the burden of ten-year risk of fatal or non-fatal CVD event in the district of Puducherry in India using 'non-lab' and 'lab' versions of WHO CVD risk prediction charts, and to evaluate the agreement between them.

Methods And Results: We included 710 individuals aged 40-69 years who participated in a district wide non-communicable diseases survey conducted in Puducherry, India, during 2019-20. Both charts use information on age, gender, systolic blood pressure and smoking status. Additionally, lab-chart requires individual's status on diabetes mellitus and total cholesterol while non-lab requires body mass index. Population in different CVD risk levels was presented using proportions (95% confidence intervals). Agreement between lab and non-lab charts was evaluated using Cohen's Kappa (k). The lab and non-lab charts estimated 3% (95% CI: 1.7-4.2) and none of the population respectively, to have high risk (≥20%) for fatal or non-fatal CVD event over the next ten years. Both the charts showed 89.4% (95% CI:87.2%-91.7%) concordance in CVD risk prediction indicating a good level of agreement (k = 0.653).

Conclusion: WHO updated CVD risk prediction charts are feasible to apply when data is available and there is good agreement between non-lab and lab based charts.
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http://dx.doi.org/10.1016/j.numecd.2022.05.024DOI Listing
June 2022

Sociodemographic Determinants of Willingness and Extent to Pay for COVID-19 Vaccine in India.

Front Public Health 2022 6;10:870880. Epub 2022 Jun 6.

Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: Responding to the fast transmission rates and increasing fatality rates, countries across the world expedited the development and deployment of the vaccine for coronavirus disease 2019 (COVID-19). Evaluation of individuals' willingness to pay (WTP) would provide pertinent information regarding future demand and financing preferences, which shall help to devise the effective payment strategy for COVID-19 vaccination.

Methods: A nationwide, cross-sectional, and self-administered online survey using a structured questionnaire was conducted to identify the sociodemographic determinants of willingness and extent to pay for COVID-19 vaccine in India. A non-probability convenience sampling followed by snowball sampling was employed to recruit participants ( = 3,341). The likelihood of sociodemographic determinants to predict willingness and extent to pay was modeled using the multivariate binary logistic regression analysis.

Results: Out of 3,371 participants, 68% ( = 2,271) were willingness to pay for COVID-19 vaccine. Results showed significantly higher odds for willingness to pay among participants who were single [adjusted odds ratio (aOR) = 1.394, < 0.01] and having a family size of 4 members (aOR = 1.346, < 0.01). The adjusted odds ratio sizably increased from 1.396 for participants whose monthly income was between INR 10,000 and 20,000/month to 2.240 for participants whose monthly income was above INR 50,000/month. Further, out of 2,271 of those participants who were willingness to pay for COVID-19 vaccine, majority ( = 1,246, 54.9%) of participants were willingness to pay below 50% of COVID-19 vaccine cost. This study found that those who are single (aOR = 0.688, < 0.01), having an income between INR 20,000 and 50,000/month (aOR = 0.686, < 0.05), and those who belonged to socially disadvantaged category (aOR = 0.450, < 0.01) were estimated to have significantly lower odds of willingness to pay more than 50% of COVID-19 vaccine cost.

Conclusion: This study observed that majority of those participants who willingness to pay for COVID-19 vaccine were willingness to pay only up to 50% of COVID-19 vaccine and income was observed as a precursor predictor of the willingness and extent to pay for COVID-19 vaccine. The understanding on the willingness and extent to pay for COVID-19 vaccine and its sociodemographic determinants will be helpful for making the strategic decisions related to the financing of COVID vaccine in India.
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http://dx.doi.org/10.3389/fpubh.2022.870880DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9207713PMC
June 2022

Cost-Utility Analysis of Dabigatran and Warfarin for Stroke Prevention Among Patients With Nonvalvular Atrial Fibrillation in India.

Value Health Reg Issues 2022 Jun 3;31:119-126. Epub 2022 Jun 3.

Director, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

Objectives: Dabigatran has a better safety profile and requires less monitoring, but is costlier than warfarin. This study evaluated the cost-utility of dabigatran relative to warfarin for preventing stroke in nonvalvular atrial fibrillation (NVAF) in India.

Methods: A Markov decision analysis model was developed to compare dabigatran (110 or 150 mg twice a day) to warfarin titrated to target prothrombin time in patients with NVAF at high risk of stroke. Model utilities and transition probabilities were based on literature and costs on market prices. Data on out-of-pocket expenses and income lost were taken from a nationally representative survey. We adopted a societal perspective and discounted both costs and outcomes at 3%. Ischemic stroke, intracranial bleed, other major bleeds, and death were outcomes of NVAF. The model projected the costs, life-years, and quality-adjusted life-years (QALYs) for each intervention over a lifetime. We used gross domestic product per capita of India (US dollars [US$]1889) as the cost-effectiveness threshold. Sensitivity analyses were conducted.

Results: Treatment with either dose of dabigatran was associated with gain in life-years and QALYs compared with warfarin. The discounted incremental cost-effectiveness ratios/QALYs for both doses of dabigatran (110 mg US$7519; 150 mg US$6634) were above the cost-effectiveness threshold, and the probability of being cost-effective at this threshold was low. Cost of dabigatran was an important factor in determining incremental cost-effectiveness ratio. Price reduction of 150 mg dose by 49% will make it cost-effective.

Conclusions: Dabigatran is not cost-effective in the Indian societal context. Reducing the price of dabigatran 150 mg by half will make it cost-effective.
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http://dx.doi.org/10.1016/j.vhri.2022.04.007DOI Listing
June 2022

Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India.

Front Med (Lausanne) 2022 18;9:806702. Epub 2022 May 18.

Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Background: Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India.

Methods: A cross-sectional web-based study was designed, parents or caregivers ( = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents.

Results: Seven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects.

Conclusion: Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.
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http://dx.doi.org/10.3389/fmed.2022.806702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159272PMC
May 2022

Hyperbaric oxygen therapy as an adjunct to the standard wound care for the treatment of diabetic foot ulcers in Indian patients: a cost utility analysis.

Expert Rev Pharmacoecon Outcomes Res 2022 Jun 10:1-8. Epub 2022 Jun 10.

Health Technology Assessment Resource Centre, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Background: Diabetic foot ulcer (DFU) is a common complication of diabetes. Hyperbaric oxygen therapy (HBOT) is an adjunct treatment that expedites the healing of DFU.

Aim: To evaluate the cost-utility of using standard wound care (SWC) plus HBOT as compared to SWC alone for the treatment of DFU from a societal perspective in the Indian context.

Method: A Markov decision analysis model comparing SWC with and without HBOT was developed. Data for the model were derived from relevant literature and secondary data from India. The main outcome measures were minor and major lower extremity amputations (LEA) averted, incremental quality-adjusted-life-years (QALY) gained, incremental costs, incremental cost-effectiveness ratio (ICER) per amputation averted and ICER per QALY gained. Sensitivity and threshold analyses were also done.

Result: HBOT, when added to SWC, lowered the proportion of minor LEA and major LEA among patients with DFU by 6.1% and 4.2%, respectively. The discounted ICER was INR 193,939 [95% CI: 186,745-203,753] or US$ 2,621 [95% CI: 2,524-2,753] per QALY gained.

Conclusion: SWC plus HBOT is not cost-effective in India. Additional information is required on patient experiences with adjunctive HBOT, if it were to be adopted as the standard of care in India.
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http://dx.doi.org/10.1080/14737167.2022.2085562DOI Listing
June 2022

Association Between Anthropometric Risk Factors and Metabolic Syndrome Among Adults in India: A Systematic Review and Meta-Analysis of Observational Studies.

Prev Chronic Dis 2022 05 5;19:E24. Epub 2022 May 5.

Senior Resident, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Introduction: Several studies have explored the effect of anthropometric risk factors on metabolic syndrome. However, no systematic effort has explored the effect of overweight and obesity on the prevalence of metabolic syndrome in India. Thus, we undertook a meta-analysis to estimate the effect of anthropometric risk factors on the prevalence of metabolic syndrome.

Methods: We searched databases PubMed Central, EMBASE, MEDLINE, and Cochrane library and search engines ScienceDirect and Google Scholar, from January 1964 through March 2021. We used the Newcastle-Ottawa scale to assess the quality of published studies, conducted a meta-analysis with a random-effects model, and reported pooled odds ratios (OR) with 95% CIs.

Results: We analyzed 26 studies with a total of 37,965 participants. Most studies had good to satisfactory quality on the Newcastle-Ottawa scale. Participants who were overweight (pooled OR, 5.47; 95% CI, 3.70-8.09) or obese (pooled OR, 5.00; 95% CI, 3.61-6.93) had higher odds of having metabolic syndrome than those of normal or low body weight. Sensitivity analysis showed no significant variation in the magnitude or direction of outcome, indicating the lack of influence of a single study on the overall pooled estimate.

Conclusion: Overweight and obesity are significantly associated with metabolic syndrome. On the basis of evidence, clinicians and policy makers should implement weight reduction strategies among patients and the general population.
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http://dx.doi.org/10.5888/pcd19.210231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9109643PMC
May 2022

Metabolic Syndrome and Its Associated Factors Among Faculty Members in a Tertiary Care Teaching Hospital, Puducherry: A Cross-Sectional Analytical Study.

Metab Syndr Relat Disord 2022 Aug 14;20(6):336-343. Epub 2022 Apr 14.

Department of Endocrinology, JIPMER, Puducherry, India.

Settings-based approach has received lot of attention under WHO renewed strategy of health promotion. It advocates regular screening/health check-ups of employees to maintain a healthy workplace. This study aimed to assess prevalence of metabolic syndrome (MetS) among faculty members and its association with selected sociodemographic, behavioral and biochemical parameters, and to determine the 10-year fatal or nonfatal cardiovascular risk using WHO-ISH risk chart. A cross-sectional study was conducted among 252 teaching faculty members using standardized international protocols to measure behavioral risk factors (smoking, alcohol consumption, diet pattern, physical activity, sleep, and stress), physical characteristics (weight, height, waist and hip circumferences, and blood pressure), and biochemical parameters (fasting glucose and lipid profile). Risk factor profiling was done using WHO/ISH risk prediction chart. Among 252 participants (males: 172 and females: 80), 58 (24.1%) were with MetS. Prevalence was higher in males (24.6%) than females (22.6%). The younger doctors (≤40 years) had lesser prevalence of MetS compared with the elderly (>40 years) doctors (20.3% vs. 26%). Age and diet pattern were found to be independently associated with MetS. The risk of having a cardiovascular event in 10 years was <5% (low risk) for 87.5% of study participants. Although we included doctors who are probably the most health-conscious population, we have found that one in four have a chance of having MetS. There is a need for periodic screening program and lifestyle modification strategies to control the burden of MetS among doctors.
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http://dx.doi.org/10.1089/met.2021.0152DOI Listing
August 2022

Quality of life in lower limb amputees: a cross-sectional study from a tertiary care center of South India.

Prosthet Orthot Int 2022 Jun 22;46(3):246-251. Epub 2022 Mar 22.

Department of Preventive and Social Medicine (PSM), JIPMER, Puducherry, India.

Background: Various literature have dealt with the physical aspect of amputation and the functional outcome after amputation. There are a few studies that give focused attention to the quality of life (QOL) of amputees. These studies are mostly from the developed countries. This study analyzed amputation as a whole and how it affects an individual physically, psychologically, emotionally, and socially, which would enable the health care providers to help the amputees to attain a better QOL.

Study Design: Cross-sectional study.

Materials And Methods: This cross-sectional study was conducted on lower limb amputees. Data were collected using a proforma for demographic details and two pretested questionnaires-the World Health Organization QOL-Bref and prostheses-specific Trinity Amputation and Prosthesis Experience Scales-Revised questionnaires. The data were analyzed using SPSS software, version 20.

Results: Amputation significantly affects all domains of the QOL. Age was a significant determinant of QOL of amputees, and it was found that the QOL decreased with an increase in age. 48.1% of the amputees were using a prosthetic device, and they were found to have a significantly better QOL. The prevalence of residual limb pain and phantom limb pain was 52.9% and 37%, respectively.

Conclusion: Nearly half of the population perceived that their QOL was neither poor nor good. The QOL of the physical domain was better than the other domains. The most important factors that were found to be associated with QOL of amputees were age, duration since amputation, and use of prosthesis.
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http://dx.doi.org/10.1097/PXR.0000000000000108DOI Listing
June 2022

Current fertility desire and its associated factors among currently married eligible couples in urban and rural area of Puducherry, south India.

Afr Health Sci 2021 Sep;21(3):1385-1395

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

Background: There are paucity of studies on current fertility desire at community level.

Objective: To assess current fertility desire and its associated factors among eligible couples of reproductive age group in Puducherry, India.

Methods: A community-based cross-sectional study from 2016 to 2017 among 2228 currently married eligible couples assessed socio-demographic and fertility-related factors associated with fertility desire. Data were collected based on the National Family Health Survey questionnaire. Association of fertility desire was assessed by univariate and generalised linear regression analysis.

Results: Out of 1979 respondents, current fertility desire within two years was 13.7% (95% CI, 12.3%-15.3%). Mean number of children (SD) currently living and preferred was 1.77(0.851) and 2.11 (0.528) respectively. After adjusting for confounders, the significant factors positively associated with fertility desire include woman's age of 18-24 (APR = 2.91), 25-29 years (APR=2.48), 30-34 (APR=2.47), 35-39(APR=2.06), high socioeconomic status (APR=2.02), those without child (APR=52.35) and those with one child (APR=35.60).

Conclusion: The fertility desire is comparatively lesser than other areas. Those without or with a single child and high socioeconomic status group had comparatively more fertility desire.
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http://dx.doi.org/10.4314/ahs.v21i3.50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843305PMC
September 2021

Comparison of COVID-19 Infection in Children During the First and Second Wave.

Indian J Pediatr 2022 Feb 19. Epub 2022 Feb 19.

Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.

Concerns have been raised in the media that 'the third wave' will severely affect children. Here, an experience of SARS-CoV-2 infection in children is reported. Of the 8,626 SARS-CoV-2 RT-PCR tests performed in children (0-17 y) from March 2020 to July 2021 at the authors' institute, 1470 (17%) were positive, [711/4821 (14.7%) during the first wave (July 2020 to January 2021), and 759/3583 (21.2%) during the second wave (February 2021 to July 2021)]. The children in both waves were similar in presentation (74.1% mildly symptomatic versus 80.2% mildly symptomatic; rest asymptomatic). None of them had COVID pneumonia. Five children died (0.3%), all of a serious primary non-COVID disease. Seventy-three cases of MIS-C during August 2020 to July 2021, with low mortality (2.7%) were also identified. The similarity in COVID-19 infection in children between the first and the second waves seems to suggest that the likelihood of the 'third wave' hitting children hard is low.
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http://dx.doi.org/10.1007/s12098-022-04127-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8857888PMC
February 2022

Effectiveness of Covishield vaccine in preventing Covid-19 - A test-negative case-control study.

Vaccine 2022 05 9;40(24):3294-3297. Epub 2022 Feb 9.

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Introduction: This study aimed at assessing the vaccine effectiveness (VE) of Covishield, which is identical to AstraZeneca vaccine, in preventing laboratory-confirmed Covid-19.

Methods: Using test-negative case-control design, information on vaccination status of cases with Covid-19 among healthcare workers in our institution in Puducherry, India, and an equal number of controls matched for age and date of testing, was obtained. The groups were compared using multivariable conditional logistic regression to calculate odds ratios (OR). VE was calculated as 100*(1-adjusted odds ratio)%.

Results: Using data from 360 case-control pairs, VE of one dose and of two doses, in providing protection against Covid-19 was 49% (95% CI: 17%-68%) and 54% (27%-71%), respectively. Among cases with moderately severe disease that required oxygen therapy, VE following any number of vaccine doses was 95% (44%-100%).

Conclusion: Covishield vaccine protected significantly against Covid-19, with a higher protection rate against severe forms of disease.
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http://dx.doi.org/10.1016/j.vaccine.2022.02.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8825308PMC
May 2022

Serum biomarkers of maternal morbidity and adverse outcome in severe pre-eclampsia.

Eur J Obstet Gynecol Reprod Biol 2022 Mar 22;270:190-194. Epub 2022 Jan 22.

Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry 605006, India.

Objective: To evaluate the association of maternal serum biomarkers of myocardial damage, oxidative stress and angiogenic imbalance with maternal adverse outcomes in women with severe pre-eclampsia.

Methods: This was a prospective cohort study, where maternal serum biomarkers were evaluated in women admitted with severe pre-eclampsia to a tertiary care centre between March 2019 and February 2020. Serum markers included brain naturetic peptide (BNP), cardiac troponin-T (cTnT), cystatin-C (cys-C), soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), Total Anti-Oxidant status (TAO) and malondialdehyde (MAO). Main outcome measures were adverse maternal outcomes defined as eclampsia, pulmonary oedema, acute kidney injury, placental abruption and HELLP syndrome.

Results: Adverse maternal outcomes occurred in 93(37.2%, 95% CI: 31.2%-43.6%) of the 250 women with severe pre-eclampsia included in the study, including 21 with pulmonary oedema, 25 with acute kidney injury and 36 with eclampsia. BNP levels were higher among women who developed pulmonary oedema (55.4 pg/mL vs 42.0 pg/mL, p = 0.008). TAO levels were higher in women who developed eclampsia (4.6 mM, IQR 3.1-5.7, p < 0.001) and acute kidney injury (4.1 mM, IQR 3.2-6.3, p = 0.002) compared to those who did not develop any complications (2.93 mM, IQR 2.3-4.1).

Conclusions: Even though the endothelial dysfunction and oxidative stress biomarkers were associated with development of preeclampsia, it may have limited utility in identifying women who might develop adverse outcomes.
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http://dx.doi.org/10.1016/j.ejogrb.2022.01.017DOI Listing
March 2022

Factors Influencing COVID-19 Vaccination Intentions Among College Students: A Cross-Sectional Study in India.

Front Public Health 2021 15;9:735902. Epub 2021 Dec 15.

Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.

Students act as messengers in delivering effective messages for better uptake of health-promoting behavior. Understanding their knowledge about coronavirus disease 2019 (COVID-19), intentions to use the COVID-19 vaccine, and its associated factors will help develop promising strategies in vaccine promotion concerning the current COVID-19 pandemic. A cross-sectional online survey was carried out among students in the healthcare and non-healthcare sectors to assess their intentions to get vaccinated against the COVID-19. A non-probability snowball sampling technique was used to recruit study participants ( = 655) through social media platforms and emails. Study participants were recruited across the country, including six major geographical regions (Eastern, Western, Northern, Southern, North-east, and Central) in India between November 2020 and January 2021 before the introduction of the COVID-19 vaccine. Descriptive statistics were used to present the sociodemographic, and vaccine-related behaviors of the study participants. Key determinants that likely predict vaccine acceptance among students were modeled using logistic regression analysis. For each analysis, < 0.05 was considered significant. A total of 655 students were recruited, 323 from healthcare and 332 from non-healthcare sectors, to assess their intentions to receive the COVID-19 vaccine. Of the 655 students, 63.8% expressed intentions to receive the COVID-19 vaccine. The acceptance was higher among non-healthcare students (54.07 vs. 45.93%). At the time of the study, 27.8% of the students indicated that they had been exposed to a confirmed COVID-19 patient. A vast majority (93.4%) of the students knew about the COVID-19 virus, and most (89.3%) of them were aware of the development of a COVID-19 vaccine. The history of vaccine hesitancy was found to be low (17.1%). Only one-third (33.4%) of the students showed concern about contracting COVID-19. Trust in the healthcare system [adjusted odds ratio (aOR): 4.13; (95% CI: 2.83-6.04), < 0.00] and trust in domestic vaccines [aOR: 1.46; (95% CI: 1.02-2.08), < 0.05] emerged as the significant predictors of student's intention to get vaccinated. Higher acceptance for vaccine was observed among students in the non-healthcare [aOR: 1.982; 95% CI: 1.334-2.946, < 0.00]. This study shows that the Indian college students had relatively high levels of positive intentions to receive COVID-19 vaccines, although about one-third were not sure or unwilling to receive the vaccine, highlighting possible vaccine hesitancy. Informational campaigns and other strategies to address vaccine hesitancy are needed to promote uptake of COVID-19 vaccines.
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http://dx.doi.org/10.3389/fpubh.2021.735902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714761PMC
January 2022

Organizing the first-ever virtual IPHACON - What did we learn?

Indian J Public Health 2021 Oct-Dec;65(4):329-331

Professor (Senior Scale), Department of Preventive & Social Medicine, JIPMER, Organising Chairperson, IPHACON 2021, Puducherry, India.

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http://dx.doi.org/10.4103/ijph.ijph_2050_21DOI Listing
May 2022

Impact of second wave of COVID-19 pandemic on the hesitancy and refusal of COVID-19 vaccination in Puducherry, India: a longitudinal study.

Hum Vaccin Immunother 2021 12 30;17(12):5024-5029. Epub 2021 Nov 30.

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.

The second wave of COVID-19 pandemic has spread rampantly throughout India between April and May 2021, leading to high mortality rates. Identifying any change in the rate of vaccine hesitancy or refusal due to such mass casualty events will provide further insights on developing appropriate risk communication strategy. Hence, this study was undertaken to identify the vaccine hesitancy and refusal before and during the second wave of COVID-19 pandemic. We conducted a longitudinal study among 900 adults to know about their vaccine hesitancy and refusal pattern before (March 2021 - round-1) and during the second wave of COVID-19 pandemic (May 2021 - round-2). Telephonic interview was conducted using the pre-tested semi-structured questionnaire. There was an increase in the vaccine hesitancy (27.8% in round-1 to 32.7% in round-2) and refusal (25.6% in round-1 to 35.6% in round-2) during the second wave of pandemic in Puducherry. In adjusted analysis, vaccine hesitancy was found to increase by 1.19 times during the round-2 survey compared to round-1 survey (aIRR = 1.19; 95%CI: 1.03-1.37). We also found that the vaccine refusal increased by 1.40 times during the round-2 survey compared to round-1 survey (aIRR = 1.40; 95%CI: 1.22-1.62) after adjusting for age, place of residence, and occupation. We found that the confidence in COVID-19 vaccine efficacy and safety has declined over time leading to increase in the vaccine hesitancy and refusal in our study cohort, with more than one-third refusing to get themselves vaccinated during the second wave of pandemic.
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http://dx.doi.org/10.1080/21645515.2021.2000262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8903963PMC
December 2021

Evidence on article 5.3 of FCTC (tobacco industry interference in tobacco control activities) in India- a qualitative scoping study.

BMC Public Health 2021 10 14;21(1):1855. Epub 2021 Oct 14.

Department of English and Cultural Studies, Panjab University, Chandigarh, India.

Background: The Tobacco Industry (henceforth TI) yearns to portray itself as being "socially responsible" and fights for the decision-making positions; that are it used to deter, delay or dilute tobacco control measures. There is little documented evidence of Tobacco Industry Interference (henceforth TII) from India, the scope of their interference and challenges faced by the experts for effective tobacco control. This research study seeks to cover this significant gap in the literature on the TI of India.

Methods: A cross-sectional qualitative research design, based upon in-depth interviews (N = 26), was used to explore the key stakeholders' opinions regarding TII in India. The interviews used a set of questions to collect information about the participant's roles and responsibilities in tobacco control, the nature of TII faced by the participants, means of influence by TI, barriers and challenges to tobacco control efforts.

Results: Most of the respondents were engaged in tobacco control, training, advocacy and awareness generation activities for 5-10 years or more. The respondents defined the TI and its scope as per their experience with the help of the power ranking methodology. Most of them perceived TI as 'manufacturers' while others consider them as 'advertisers', 'public relation companies', 'wholesalers', 'vendors', and 'Government firms with TI stocks. The research team identified six significant domains: influencing the policy and administrative decisions, Interference in the implementation of tobacco control laws and activities, false propaganda and hiding the truth, manipulating front action groups (FAG), rampant tobacco advertising and promotion activities and others under which TII activities were classified. Most respondents believed that TI players were interfering in the policy decisions, implementing the tobacco control laws and activities and manipulating the FAG. A detailed taxonomic classification of the TII strategies that emerged from our analysis was linked to article 5.3 of FCTC.

Conclusions: The study documented a significant level of TII in different domains, with stakeholders acting at various hierarchical levels. Thus providing insight into the tactics of the TI in order to enable stakeholders to anticipate and pre-empt the kinds of alliances the TI may attempt to build; stimulating academicians and researchers to undertake in-depth analysis into various strategies and therefore underscoring the need to ensuring transparency in official interaction with the TI and its representatives.
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http://dx.doi.org/10.1186/s12889-021-11773-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515702PMC
October 2021

Communicating risk: Status of health warning labels on various tobacco products in Indian market.

Indian J Tuberc 2021 17;68S:S48-S54. Epub 2021 Jul 17.

Department of Preventive and Social Medicine, JIPMER, Puducherry, India. Electronic address:

Background: Owing to the role of tobacco packaging as a strong medium of communication, display of health warnings on tobacco packs effectively impart health risks of tobacco consumption to those currently using or contemplating the use of tobacco.

Methods: This community based cross-sectional analytical study was conducted among 2044 tobacco product packs, each collected from a different PoS, to estimate the non-compliance of section 7, 8 & 9 of COTPA among various tobacco products and its association with the PoS characteristics. Data were collected by observation of PoS by field investigators and then purchase of a unique product from each vendor followed by a brief interview of the tobacco vendor.

Results: The study documented an absence of health warning label on 15.51% [95% CI: 13.99-17.13] of the total 2044 tobacco products collected. The non-compliance to 'quality of health warning picture' was lowest 5.96% [95% CI: 4.91-7.16] among the tobacco products with a health warning label. The multivariate regression model revealed that absence of health warning on tobacco product packs were higher among the PoS in rural area (aPR 1.38; 95% CI: 1.16-1.65; p < 0.001) and among street/mobile vendors (aPR 1.65; 95% CI: 1.22-2.24; p = 0.001). The PoS not displaying tobacco products (aPR 1.36; 95% CI: 1.08-1.72; p = 0.01), selling flavored chewable tobacco (aPR 1.67; 95% CI: 1.24-2.27; p = 0.001), not selling loose cigarettes (aPR 2.93; 95% CI: 1.94-4.43; p < 0.001) and with vendors not enquiring age proof (aPR 10.69; 95% CI: 1.59-72.09; p < 0.001) had higher proportion of tobacco products without health warning labels. A greater proportion of smokeless/local variety tobacco products (aPR 18.06; 95% CI: 12.31-26.51; p < 0.001) had absence of health warning label.

Conclusion: The data provided by us have clear policy implications. We recommend regular enforcement activities to monitor the presence of health warning labels on tobacco product packs along and accurate printing of the same with adherence to the Ministry of Health and Family Welfare templates.
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http://dx.doi.org/10.1016/j.ijtb.2021.07.009DOI Listing
December 2021

Prevalence and factors associated with the sale of loose cigarettes at Point of Sale: A cross-sectional analytical study from four Indian states.

Indian J Tuberc 2021 28;68S:S39-S47. Epub 2021 Aug 28.

Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Background: The Framework Convention on Tobacco Control (FCTC) has established that sale of loose cigarettes increases the affordability and accessibility of tobacco for minors. Acknowledging this threat to public health, the Department of Consumer Affairs, Government of India amended the Legal Metrology Act to prohibit sale of loose cigarettes. Regardless, over 70% of the total cigarette sale in the country is in the form of loose cigarettes majority of which is being sold at unrecognized, unrecorded and unregulated informal sector of economy. However, there is a paucity of studies examining the factors associated with sale of loose cigarettes and further research is warranted in the country to know the dynamics of this issue.

Objective: To determine the prevalence and the factors associated with the sale of loose cigarettes at Point of Sale (PoS) in the selected four Indian states.

Methods: A community based cross-sectional analytical study was conducted among a total of 2044 PoS in the project states of Meghalaya, Odisha, Puducherry and Telangana using purposive sampling technique. The characteristics of tobacco vendors and the status of loose cigarettes sale were collected using a structured and pre-tested checklist. Proportion for prevalence estimate, bivariate and multivariable log binomial regression analysis were done.

Results: The prevalence of loose cigarette sale was 93.05% [95% CI: 91.89-94.1]. Sale of loose cigarette showed a significant association with area (aPR 1.03; 95% CI: 1-1.06; p = 0.025), sale of tobacco products to minors (aPR 1.07; 95% CI: 1.04-1.11; p < 0.001), sale of smoking aids to customers (aPR 1.05; 95% CI: 1.01-1.09; p = 0.02), sale of flavored chewable tobacco (aPR 1.08; 95% CI: 1.03-1.12; p = 0.001) and presence of pack warning (aPR 1.18; 95% CI: 1.11-1.25; p < 0.001).

Conclusion: Our findings infer an open disregard for the laws specific to sale of loose cigarettes at PoS. The factors associated with the sale of loose cigarette needs to be addressed through prompt implementation of the tobacco control laws and suitable policy formulation.
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http://dx.doi.org/10.1016/j.ijtb.2021.08.029DOI Listing
December 2021

Tobacco consumption trends and correlates of successful cessation in Indian females: Findings of Global Adult Tobacco Surveys.

Indian J Tuberc 2021 1;68S:S29-S38. Epub 2021 Sep 1.

Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; Public Health Masters Program, School of Medicine, University of Limerick, Ireland; Faculty of Human and Health Sciences, Swansea University, United Kingdom. Electronic address:

Background: Female gender is being affected disproportionately by tobacco use. The correlates of tobacco use among women are different from men, which has not been studied in India. To develop gender-sensitive interventions and policies in tobacco control, it's essential to ascertain the factors that affect tobacco consumption and successful cessation among Indian women.

Methods: This secondary data analysis was done for females respondents aged >15 years using the data generated from the GATS-1 (2009-2010) and GATS-II (2016-2017). The primary dependent variables included interest in quitting smoking/SLT, attempt to quit smoking/SLT, successful quitting. The independent variables were broadly categorized as a community, household, and individual level. Simple descriptive analysis using % age relative change was used to calculate the change in tobacco consumption between two rounds of GATS, whereas; bivariate and multivariable logistic regression were used to calculate the unadjusted and adjusted odds ratio for cessation related variables (GATS-2).

Results: There was a 29.5% relative reduction in the prevalence of tobacco use in round-2 among females. A maximum reduction in the prevalence was observed in the 15-29 years (-51.3%), those not exposed the media advertisements (-19.9%). While unadjusted OR depicted that unmarried women, young age, asked by health workers about tobacco use, and advice given by them increased the interest in quitting smoking, none of them emerged to be significant on a multivariable logistic regression except the advice given by the health care provider. Successful cessation (>6 months) of SLT products is possible in urban areas, with decreased exposure to media advertisements.

Conclusion: There is an urgent need for gender-sensitive policies in tobacco control and the integration of these policies with relevant national health programs. This shall help to synergize efforts and obtain better outcomes that would support the overarching goal of tobacco-free India.
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http://dx.doi.org/10.1016/j.ijtb.2021.08.037DOI Listing
December 2021

Depiction of tobacco in Indian mass media: A content analysis.

Indian J Tuberc 2021 11;68S:S23-S28. Epub 2021 Aug 11.

Department of Preventive and Social Medicine, JIPMER, Puducherry, India. Electronic address:

Background: Although exposure to tobacco content on mass media is a well-grounded source for early initiation, less is known on how tobacco is portrayed in mass media.

Objectives: To determine the proportion of tobacco appearances and the percentage of pro or anti-tobacco messages in the selected print, electronic and internet based Indian mass media.

Methods: The content analysis was conducted among selected categories of: top two daily newspapers in terms of readership, topmost Television channel in terms of viewership and top five trending videos on YouTube. The tobacco appearances in newspaper, television (five minute interval) and YouTube (one minute interval) were recorded and coded as pro or anti-tobacco messages.

Results: Tobacco appearances were present in 0.3% of 9373 [95% CI: 0.2-0.5] advertisements reviewed in Newspapers; all of which were pro-tobacco messages. Among the total 1512 intervals watched on Television, 18.1% [95% CI: 16.2-20.1] had tobacco appearance. There were a total of 289 tobacco incidents in television of which 92.4% were pro-tobacco messages. Out of the total 900 videos watched on YouTube, 11.44% [95% CI: 9.49-13.65] had tobacco appearance. Among the 206 tobacco incidents present in YouTube, 98.5% were pro-tobacco messages.

Conclusions: The study documented considerable extent of pro-tobacco depictions in Indian mass media.
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http://dx.doi.org/10.1016/j.ijtb.2021.08.002DOI Listing
December 2021

National level E-Resource Centre for Tobacco Control (E-RCTC): One stop solution to information on tobacco control in India.

Indian J Tuberc 2021 2;68S:S115-S123. Epub 2021 Sep 2.

Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

The existing information on tobacco control, though highly valuable, is lying scattered at different sources. Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh in collaboration and technical support of International Union against TB and Lung Diseases (The Union) undertook an initiative to start a national level E-Resource Centre for Tobacco Control (E-RCTC) with an aim to provide relevant information on tobacco control under one roof thereby countering the misleading facts on tobacco control which exist on various web engines. The national level E-Resource Centre for Tobacco Control was developed in three stages. In the span of less than 3 years, the portal is open in public domain with over 2,36,019 visitors from around 80+ countries (as on 23rd July 2020), and growing. The portal showcases an array of valuable and vital information related to tobacco control initiatives under various heads like: Policies and Legislations, Circulars and Orders, National Tobacco Control Programme (NTCP), Publications and IEC Materials. India's first national level Resource Centre for Tobacco Control has proved to be a much-needed step in the country for facilitating speedy implementation of World Health Organization- Framework Convention on Tobacco Control (WHO-FCTC), MPOWER and other tobacco control interventions. Even with its limitations like absence of an interactive mechanism among a few others, the Resource Centre is nothing less than a storehouse of knowledge as it showcases content that are immensely helpful for the tobacco control community. Constant efforts are being made to improve the national level E-Resource Centre for Tobacco Control website and minimize the drawbacks.
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http://dx.doi.org/10.1016/j.ijtb.2021.08.040DOI Listing
December 2021

Pricing of tobacco products: Pre and post GST implementation.

Indian J Tuberc 2021 1;68S:S101-S104. Epub 2021 Sep 1.

Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India; Public Health Masters Program, School of Medicine, University of Limerick, Ireland; Faculty of Human and Health Sciences, Swansea University, United Kingdom. Electronic address:

There is ample evidence stating that any taxation policy that effectively increases the real price of tobacco products reduces its use. In the past, several countries have documented instances; wherein the intended effects of tobacco taxation were undermined by aggressive pricing strategies of the industry. However, there is a dearth of such evidence in Indian context. Hence, the current study was conducted to ascertain the changes in the retail price of locally available tobacco products during pre and post GST period in India. This cross-sectional analytical study was conducted among all available tobacco products in the states of Meghalaya, Odisha, Puducherry and Telangana. The information on maximum retail price (MRP) pre and post GST implementation on tobacco products was gathered from the owners of Point of Sale (PoS), vendors and retailers of various tobacco products. The results showed that of the total 154 brands observed pre and post GST implementation, 33.12% [95%CI 25.75-41.15] did not exhibit any increase in their price. The proportion of tobacco product brands with decrease/no change in price was a higher in Meghalaya (PR = 44; 95%CI: 6.32-306.3), Odisha (PR = 23; 95%CI: 3.25-162.7) and Puducherry (PR = 1.48; 95%CI: 0.1-22.84) as compared to Telangana. As compared to cigarettes, smokeless tobacco (PR = 1.84; 95%CI 1.16-2.89) and bidi (PR = 1.74; 95%CI: 0.78-3.9) had more number of brands with a decrease/no change in price post GST implementation. Moreover, four new brands of smokeless tobacco were introduced into the market following GST implementation. The study clearly suggests a departure from the outcomes envisaged by taxation policy on tobacco products in the country. Given the importance of price as a determinant in tobacco use especially among youth, there is an urgent need for strengthening our tax regime for tobacco products.
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http://dx.doi.org/10.1016/j.ijtb.2021.08.038DOI Listing
December 2021
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