Search

Objectives: Diabetes is a significant public health concern in India, with Kerala being labeled as the diabetes capital of the country. The study aims to evaluate the prevalence, treatment, and management of diabetes to examine the unmet need for care to propose cost-effective strategies. Design: A cross-sectional study was conducted on a geographically defined cohort population in Ernakulam. Sample: This paper presents diabetes data of adults ≥30 years enrolled from the community cohort. The interviews were conducted with 997 participants at their residence. Measurement: Random blood glucose was assessed for each participant using a finger prick test. Results: The overall prevalence of diabetes was 30.1%, of which 4.1% of participants had undiagnosed diabetes. Among those with diabetes, 86.3% were aware of their diagnosis; among those aware, 86.5% were on treatment. Among those on treatment for diabetes, 54% achieved controlled blood sugar. Conclusion: The challenge in diabetes management is controlling the blood glucose levels of people who adhere to treatment. Younger employed females from lower-income quartiles have the highest risk. The study also raises questions about quality and strategies for medication compliance. The findings inspire future research on care needs, policies, and program responses to reduce the diabetes disease burden. [ABSTRACT FROM AUTHOR]

Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examined multifactorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India. Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, consumption of iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation. During pregnancy, women consumed 28 IFA and 8 calcium tablets, 18% consumed diverse diet, and 17% were weighed ≥3 times. Nutrition knowledge was associated with consumption of diverse diet (odds ratio [OR] = 2.2 times), IFA (2.3 times), calcium (11.7 times), and weight monitoring (1.3 times). Beliefs and self‐efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better nutrition practices. Under optimal program implementation, we estimate that 51% of women would have adequate diet diversity, an average consumption of 98 IFA, and 106 calcium tablets, and women would be weighed 4.9 times during pregnancy. Strengthening existing program operations and increasing demand for services has the potential to result in large improvements in maternal nutrition practices from current baseline levels but may not be sufficient to meet World Health Organization‐recommended levels without creating an enabling environment including improvements in education and income levels to support behaviour change. [ABSTRACT FROM AUTHOR]

Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 μg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors. Key messages: The Comprehensive National Nutrition Survey (CNNS) 2016–2018 is the only nationally representative survey to measure haemoglobin, haemoglobinopathies, biomarkers of micronutrient deficiencies, diet and social factors in Indian adolescents aged 10–19 years.Using CNNS data, we found that 28.5% of adolescents (girls: 39.6%, boys: 17.6%) were anaemic, with variation by region or state.Our prevalence estimates translate to 72 million adolescents being anaemic, with Uttar Pradesh having twice as many anaemic adolescents as any other state.Iron deficiency, haemoglobinopathies, vitamin A deficiency and zinc deficiency were associated with an increased risk of anaemia; these associations may vary subnationally. [ABSTRACT FROM AUTHOR]

Maternal iodine (I) status is critical in embryonic and foetal development. We examined the effect of preconception iodine supplementation on maternal iodine status and on birth outcomes. Non‐pregnant women in Guatemala, India and Pakistan (n ~ 100 per arm per site) were randomized ≥ 3 months prior to conception to one of three intervention arms: a multimicronutrient‐fortified lipid‐based nutrient supplement containing 250‐μg I per day started immediately after randomization (Arm 1), the same supplement started at ~12 weeks gestation (Arm 2) and no intervention supplement (Arm 3). Urinary I (μg/L) to creatinine (mg/dl) ratios (I/Cr) were determined at 12 weeks for Arm 1 versus Arm 2 (before supplement started) and 34 weeks for all arms. Generalized linear models were used to assess the relationship of I/Cr with arm and with newborn anthropometry. At 12 weeks gestation, adjusted mean I/Cr (μg/g) for all sites combined was significantly higher for Arm 1 versus Arm 2: (203 [95% CI: 189, 217] vs. 163 [95% CI: 152, 175], p < 0.0001). Overall adjusted prevalence of I/Cr < 150 μg/g was also lower in Arm 1 versus Arm 2: 32% (95% CI: 26%, 38%) versus 43% (95% CI: 37%, 49%) (p = 0.0052). At 34 weeks, adjusted mean I/Cr for Arm 1 (235, 95% CI: 220, 252) and Arm 2 (254, 95% CI: 238, 272) did not differ significantly but were significantly higher than Arm 3 (200, 95% CI: 184, 218) (p < 0.0001). Nominally significant positive associations were observed between I/Cr at 12 weeks and birth length and head circumference z‐scores (p = 0.028 and p = 0.005, respectively). These findings support the importance of first trimester iodine status and suggest need for preconception supplementation beyond salt iodization alone. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the quality of care in known diabetes patients of Delhi. Methods: A cross‐sectional survey was conducted using a two‐stage cluster design. In all, 30 of 150 wards were chosen in Stage 1 (using a random computer‐generated seed value and then selecting wards at a predefined sampling interval; Probability Proportionate to Size—Systematic) and one colony from each ward was selected randomly in Stage 2. The selected areas were surveyed house‐to‐house in one‐of‐four random directions to recruit a minimum of 25 subjects (known diabetes ≥1 year; 35–65 years of age) per area. Data were collected by interview, blood sampling and from medical records by specifically trained research staff. Results: A total of 843 subjects (of 1315 eligible) were enrolled from 11,490 houses. For the intermediate outcome measures, an estimated 33.5% (95% CI 27.3–40.2) had an HbA1c value >10%, 67.2% (95% CI 62.8–71.4) had an LDL cholesterol level >100 mg/dl and 57.3% (95% CI 50.4–63.9) had BP levels >140/90 mmHg. For the processes of care in the last 1 year, 25.6% (95% CI 19.7–32.6) of the patients had an HbA1c (A1c) estimation and 2.4% (95% CI 1.1–4.9) had a dilated eye examination and 4.1% (95% CI 2.6–6.2) had foot examination. Diabetes self‐management education was provided to only 11.3% (95% CI 8.6–14.7) while nutrition counselling was provided to 56.0% (95% CI 51.7–60.2). Conclusions: The glycaemic control, lipid control and BP management of known diabetes patients in Delhi are unacceptably poor and a wide gap exists between practice recommendations and delivery of diabetes care in Delhi. [ABSTRACT FROM AUTHOR]

Evidence on strategies to improve infant and young child feeding in India, a country that carries the world's largest burden of undernutrition, is limited. In the context of a programme evaluation in two districts in Uttar Pradesh, we sought to understand the multiple influences on breastfeeding practices and to model potential programme influence on improving breastfeeding. A cross‐sectional survey was conducted among 1,838 recently delivered women, 1,194 husbands, and 1,353 mothers/mothers‐in‐law. We used bivariate and multivariable logistic regression models to examine the association between key determinants (maternal, household, community, and health services) and breastfeeding outcomes [early initiation of breastfeeding (EIBF)], prelacteal feed, and exclusive breastfeeding (EBF). We used population attributable risk analysis to estimate potential improvement in breastfeeding practices. Breastfeeding practices were suboptimal: EIBF (26.3%), EBF (54%), and prelacteal feeding (33%). EIBF was positively associated with maternal knowledge, counselling during pregnancy/delivery, and vaginal delivery at a health facility. Prelacteal feeds were less likely to be given when mothers had higher knowledge, beliefs and self‐efficacy, delivered at health facility, and mothers/mothers‐in‐law had attended school. EBF was positively associated with maternal knowledge, beliefs and self‐efficacy, parity, and socio‐economic status. High maternal stress and domestic violence contributed to lower EBF. Under optimal programme implementation, we estimate EIBF can be improved by 25%, prelacteal feeding can be reduced by 25%, and EBF can be increased by 23%. A multifactorial approach, including maternal‐, health service‐, family‐, and community‐level interventions has the potential to lead to significant improvements in breastfeeding practices in Uttar Pradesh. [ABSTRACT FROM AUTHOR]

Aim: This study examined the determinants of attitudes and beliefs about human papillomavirus (HPV) infection, cervical cancer and HPV vaccine among parents of adolescent girls in Mysore, India. Methods: A random sample of 800 parents who had at least one adolescent‐aged daughter attending school were recruited for a survey. Results: Most parents (n = 778; 97.3%) completed the survey. Compared to Hindus, Muslims were more likely to perceive that their daughters are susceptible to HPV infection (adjusted odds ratio [aOR]: 4.94; 95% confidence interval [CI]: 2.87, 8.49) or cervical cancer (aOR: 2.73; 95% CI: 1.55, 4.80). However, the likelihood of perceiving that daughters are susceptible to HPV infection (aOR: 0.94; 95% CI: 0.90, 0.98) or cervical cancer (aOR: 0.95; 95% CI: 0.92, 0.99) decreased with an increase in the age of the parents. Perceived severity of HPV infection (aOR: 0.36; 95% CI: 0.14, 0.97) and cervical cancer (aOR: 0.33; 95% CI: 0.15, 0.74) was lower among Muslims than Hindus. Muslims had lower odds of believing that HPV vaccine is safe (aOR: 0.47; 95% CI: 0.25, 0.89) or could protect against cervical cancer (aOR: 0.27; 95% CI: 0.16, 0.48), but were more likely to feel that HPV vaccination may cause girls to become more sexually active (aOR: 1.92; 95% CI: 1.09, 3.39). The odds of believing that HPV vaccine is effective increased with an increase in the age of the parents (aOR: 1.03; 95% CI: 1.003, 1.06). Conclusion: Among Indian parents, age and religion of parents are associated with parental attitudes and beliefs about the threat of HPV and cervical cancer as well as the risks and benefits of HPV vaccine. [ABSTRACT FROM AUTHOR]

Abstract: A community‐based cross‐sectional study was carried out with 603 children ages 5 and under and 500 of their mothers from 510 households to examine the prevalence of undernutrition and chronic diseases among the Khasis of North‐East India. Anthropometric measurements including Mid‐Upper Arm Circumference, height, and weight were taken. Dry blood spots to estimate haemoglobin and vitamin A were collected from children and women separately by finger prick. Mothers provided data about household socio‐demographic particulars and infant and young child feeding practices. The prevalence in children of underweight was 31%, stunting was 57%, and wasting was 10%. Undernutrition was higher among boys as compared to girls. Nutrient intakes were below recommended levels. The prevalence of anaemia among children ages 1 to 5 years old was 68%, and vitamin A deficiency was 59%, and they were 83% and 48%, respectively, among women. Hypertension was observed in 15% of women, whereas diabetes was less than 1%. Only about 20% of households were food secure, and this was associated with parental literacy, per capita income, and family size. Undernutrition was unacceptably high among the Khasis despite rich food biodiversity. Proper implementation of nutritional intervention programs such as Integrated Child Development Services, Mid Day Meal, and the Public Distribution System will improve the nutrient intake and nutritional status of the population. Additionally, preservation of forest lands and products paired with judicious use of the rich food biodiversity available will promote dietary diversity and ultimately better nutrition and health. [ABSTRACT FROM AUTHOR]

Adoption disclosure is an important indicator of the healthy development and psychological well-being of adopted children. However, findings from studies conducted among Asian domestic adoptive parents have highlighted some concerns. Using Kirk's theoretical proposition, a study was conducted among 86 Indian domestic adoptive parents to determine the societal and familial factors related to adoption disclosure. The results showed that while many of the parents had talked openly about their adoption to their immediate families (95.3%) and others of their social network (88.4%), they were hesitant in telling the child. Only 12.8% of the Indian parents had told their child about adoption, and 31.4% were planning to tell. The results of the logistic regression analysis revealed that children who were above 6 months at adoption were more likely to have had disclosures from their parents about their adoption. Further, adoptive parents who had told or were planning to tell their child about adoption perceived less about the loss of the biological parenthood and were more likely to perceive the beneficial effects of adoption disclosure to the child. These findings have implications for the provision of appropriate strategies, resources and support to adoptive families seeking to deal with adoption disclosure. [ABSTRACT FROM AUTHOR]

Objective The objective of this study is to evaluate the impact of support group intervention on family system strengths of rural caregivers of stroke patients. Design True experimental pretest and post-test design was adopted for the study. Setting The study was conducted in Kattankulathur Block, a rural area in Kancheepuram district, India. Participants Two hundred forty caregivers of stroke patients were selected by simple random sampling technique. Intervention Enrolment in self-help groups and attending meetings were used as the interventional strategy for the purpose of this study. Main outcome measure The main outcome of the study was to evaluate the impact of support group intervention on family system strengths of rural caregivers of stroke patients. Results Following intervention, the mean score and the standard deviation of the experimental group increased to 44.73 and 5.83, respectively, the control group mean score remained at 22.08 and the standard deviation was 3.07 at t = 37.58. P value was 0.001, which is statistically significant at the confidence interval of 39.45%. Conclusion It was found that there was a significant and positive increase in the family system strengths of caregivers who participated in the self-help group meetings, thereby suggesting that support group intervention programs are an effective nursing strategy that can be employed for improving the overall well-being of the caregivers of stroke patients. [ABSTRACT FROM AUTHOR]

Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster-randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home-visits would increase children's dietary intake, growth and development compared with home-visit-complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother-infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi-weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12-month intervention to the CFG and RCF&PG significantly ( P < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0-0.4] in the CFG (but not RCF&PG) and increased ( P < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8-5.3) in the RCF&PG (but not CFG) compared with CG. Community-based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food-secure rural Indian families. [ABSTRACT FROM AUTHOR]

Inadequate dietary intake is a critical underlying determinant of child undernutrition. This study examined the association between anthropometric‐based and food‐based nutritional failure among children in India. We used the 2015–2016 National Nutrition Monitoring Bureau data where anthropometric outcomes and food intake were both measured for each child. We followed the World Health Organization child growth reference standards to define anthropometric failures (i.e., height‐for‐age z score < −2 SD for stunting, weight‐for‐age z score < −2 SD for underweight, and weight‐for‐height z score < −2 SD for wasting), and the Indian Council of Medical Research recommended dietary allowance (RDA) to define adequacy in intake of calorie, protein, and fat. We used descriptive and regression‐based assessments to test the association between the two indicators of nutritional failure and also computed the area under the receiver operating characteristic curve (AUC). The prevalence of stunting, underweight, and wasting was 28.6%, 24.3%, and 12.8%, respectively, whereas 78.2%, 27.4%, and 50.8% of the children had below RDA norms consumption of calorie, protein, and fat, respectively. We found weak‐to‐null correlation between anthropometric failures and food failures (Pearson correlation ranging from −0.013 to 0.147) and poor discriminatory accuracy (AUC < 0.62), suggesting that in the Indian context, anthropometric failures are not directly associated with food intake. This finding highlights the need for improving adequate intake of macronutrients and draws attention toward adopting a multifactorial approach to improve child nutrition in India. Poor food intake itself merits exclusive policy focus as it is an important nutrition and health concern. [ABSTRACT FROM AUTHOR]