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Non-Communicable Diseases (NCDs) are now a leading cause of mortality and morbidity globally, and mental illness is a significant part of it. In India, the treatment gap for common mental disorders is over 80%. In order to bridge this gap, mental health treatment models recommend task-shifting to non-specialists and integration of mental health care into general healthcare services. Other NCDs are being managed effectively by non-specialist healthcare workers (HCWs) at primary care, and mental illness and substance misuse are highly comorbid with other NCDs; hence, integrating mental health care within the NCD services and care framework seems logically feasible and effective. However, country-specific characteristics pose a significant challenge to the implementation of integrated care for mental disorders and NCDs. The primary objective of this study includes the development and implementation of a service delivery model that would result in at least 70% coverage of screening, linkage to care, and management of common mental disorders and substance use disorders (MSUD) among persons seeking care for NCDs at public health facilities. Secondary objectives include assessment of the feasibility of adoption of the implementation model by the health care system and to evaluate the cost of the mental health service strengthening intervention package from the health system’s and the patient’s perspectives. It will be a multi-site implementation research study, employing a mixed-methods quasi-experimental, within-site, three-phase, single-arm, interrupted time series design. The implementation model comprises screening, treatment, and linkage of mental health services integrated into NCD care in at least three blocks in each of the seven selected districts of the seven selected states of India, which are geographically far apart. The expected outcome would be to increase the proportion of patients screened and managed for MSUDs among persons seeking care for NCDs at the public health facilities. The results of this implementation research will provide a roadmap for scaling up of integrated MSUDs services within general healthcare.

Background Meghalaya, one of eight states in the northeastern region of India, has been reported to carry a high malaria burden. However, malaria surveillance, epidemiology, and vector studies are sparse, and no reviews combining these topics with malaria prevention and control strategies have been published in recent years. Furthermore, no analysis of surveillance data has been published documenting the changes in epidemiology following the first distribution of long-lasting insecticidal nets (LLINs) statewide in 2016. Methods A hybrid approach was used to describe the status of malaria in Meghalaya. First, a literature search was performed using the terms ‘malaria’ and ‘Meghalaya’. Second, data were obtained from the Meghalaya State Malaria Control Programme for 2006–2017 for analysis of trends. Data from 3 years 2015–2017 were analysed further by district and year to assess changes in malaria incidence and distribution following the introduction of LLINs. Results/conclusions Like malaria in mainland India, malaria in Meghalaya is complex, with both Plasmodium falciparum and Plasmodium vivax parasites in circulation, multiple Anopheles vector species, and reports of both unusual and severe malaria syndromes across all age groups. Integrated statewide malaria epidemiology, vector, and prevention and control data for Meghalaya are not readily available, and published studies are largely focused on a single topic or a single district or region of the state. Although malaria prevention and control approaches are available, (e.g. spraying, LLINs, personal repellents), their use and effectiveness is also not well characterized in the literature. Analysis of state malaria control programme data indicates that case incidence and related fatalities in Meghalaya have declined over the last decade. This could be attributed to changes in treatment guidelines and/or statewide distribution of effective prevention methods such as LLINs. Since the distribution of more than 900,000 LLINs in 2016, the malaria caseload has declined significantly in most Meghalaya districts, excluding the remote and geographically isolated South Garo Hills. Additionally, the proportion of adult malaria cases (15+ years of age versus children 0–14 years) in most districts was significantly greater following LLIN distribution, which likely reflects common lifestyle practices in these areas (e.g. adults working during night hours; small children in the households receiving priority for bed net protection). While reduction in malaria case incidence and related deaths is clear, the changes in malaria transmission and clinical manifestation have not been characterized. Routine epidemiology and vector surveillance combined with real-time data reporting are essential for the continued reduction and eventual elimination of malaria in Meghalaya.

Socio-ecological determinants of high myopia incidence among school students largely remain unexplored, especially in developing countries. A cross-sectional study was conducted in rural schools in North India to assess the relationship between these determinants and myopia among adolescent students. A public health nurse used a pre-tested questionnaire (demographics, family ocular status, and screen time) and Snellen's chart for testing visual acuity, and referred suspected cases for cycloplegic refraction assessment. Among the total of 955 students, the median (range) age was 14 (13-15) years. The prevalence of myopia was 5.03% (95% confidence interval [CI]: 4.99-5.07). Myopia was found to be associated with computer usage at school (P = 0.058), malnutrition (P = 0.001), and familial myopia (P = 0.079) in the bivariate analysis. Significant predictors of myopia in the regression model were females (odd ratio [OR]: 6.29; 95% CI: 2.69-14.72), higher maternal age (OR: 1.09; 95% CI: 1-1.17), and reading distance <20 cm (OR: 1.98; 95% CI: 1.01-3.87).

A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures. Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster) were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a) experienced illness in the past 30 days, (b) had illness lasting longer than 30 days, (c) were hospitalized in the past 365 days, or (d) had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles. The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2). Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was 16.6% less for acute care, 15% less for hospitalization and 50% less for childbirth than in the private healthcare facilities. Out-of-pocket expenditure was mostly on medicines followed by diagnostic and laboratory tests. Among households experiencing hospitalization, 56.5% had incurred catastrophic expenditures, which was significantly higher in the poorest compared to richest household expenditure quartile (p <0.002). Expenditure on healthcare remains high in Punjab state of India. Efforts to increase utilization of the public sector could decrease out-of-pocket healthcare expenditure.

The coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to the healthcare systems worldwide. This uncharted territory has changed the practices in modern healthcare delivery; this is particularly true in the case of minimally invasive surgery (MIS) where various changes are being adopted. This survey was conducted to determine the impact of the pandemic and the changes being adopted in the field of MIS, from a resource-limited developing country, India. The survey was carried out from 27 July to 22 August 2020, amongst MIS surgeons in India using an online questionnaire generated on Google Forms. The survey was completed by 251 MIS surgeons nationwide. There was a proportional reduction of overall elective surgeries and MIS. Approximately 30% of the surgeons continued to use MIS, as during the pre-pandemic era. Pre-operative tests for COVID-19 (96.1%) and personal protective equipment (PPE, 66%-86%), including respirators (95.2%), are used uniformly across the nation. Almost half (43.1%) of the MIS surgeons are using ≥6 recommended intraoperative modifications in MIS to mitigate the COVID-19 transmission. MIS surgeons in India have adapted within a short time to the challenge of the pandemic by embracing pre-operative testing, PPE and new techniques/technologies to continue patient care. Innovations and low-cost indigenous customisations are the need of the hour for a developing country like India. Further studies are required to establish the true risk of viral transmission involved in MIS and the efficacies of the techniques/devices to reduce the spread of the virus.

BACKGROUND: Global burden of disease (GBD) provides the estimates of mortality and morbidity, while case fatality rate (CFR) helps in understanding the severity of the disease. People infected with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) with underlying medical conditions have shown higher levels of unfavorable outcomes including mortality. We assessed the association of SARS-CoV-2 CFR with disability-adjusted life years (DALY) of various comorbidities in the low-middle income countries (LMIC) and high-income countries (HIC) to study the relationship of coronavirus disease-19 (COVID-19) mortality with GBDs and to understand the linkage between COVID-19 mortality and comorbidities. MATERIALS AND METHODS: This was an ecological study with secondary data analysis comparing the DALY of various morbidities from GBD with CFR of COVID-19. Gross domestic product was the basis of stratifying 177 countries into low-middle income (LMIC) and high-income groups (HIC). The mortality was analyzed using Pearson correlation and linear regression. RESULTS: The median global CFR of SARS-CoV-2 was 2.15. The median CFR among LMIC (n = 60) and HIC (n = 117) was 2.01 (0.00-28.20) and 2.29 (0.00-17.26), respectively. The regression analysis found that, in both LMIC and HIC, maternal disorders were associated with higher SARS-CoV-2 CFR, while tuberculosis, mental health disorders, and were associated with lower CFR. Further, in LMIC, musculoskeletal disorders and nutritional deficiencies were associated with higher CFR, while respiratory disorders were associated with lower CFR. CONCLUSIONS: SARS-CoV-2 infection appears to be a systemic disease. Individuals with comorbidities, such as maternal disorders, neurological diseases, musculoskeletal disorders, and nutritional deficiencies, have poorer outcomes with COVID-19, leading to higher mortality.

Police personnel have been key frontline workers throughout the coronavirus disease 2019 (COVID-19) pandemic. This study was conducted to assess the correlates and outcomes of critically ill police personnel. This retrospective observational study analyzed key parameters of hospitalized police personnel who were critically ill with COVID-19 in Andhra Pradesh, India, between June and October 2020. Survival was analyzed for correlation with body mass index, ABO/Rh blood group, co-morbidities, treatment (oxygen therapy, prone positioning, mechanical ventilation, remdesivir, Ivermectin, oral and nasal topical povidone-iodine). We also performed Cox proportional hazard analysis with relevant function plots. The majority of the 266 patients were male (n = 259; 97.4%) and obese (75.2%). The overall mortality of patients was 38% (n = 101). COVID-19 mortality increased significantly with age (p = 0.019) and BMI (p = 0.030) in the bivariate analysis. There was no significant difference between blood group (p = 0.297), co-morbidity (p = 0.582) and COVID-19 outcome. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the risk factors for COVID-19 mortality were males (HR 4.89, 95% CI: 1.020-23.430) and ventilator therapy (HR 7.5, 95% CI: 4.527-12.296). The protective factors were symptom onset to reverse transcription polymerase chain reaction (RT-PCR) report interval (HR 0.36, 95% CI: 0.158-0.814), prone positioning (HR 0.43, 95% CI: 0.197-0.915), and use of povidone iodine (HR 0.43; 95% CI: 0.273-0.692). COVID-19 mortality among critically ill hospitalized police personnel was reduced by time to diagnostic test result, prone positioning, and povidone-iodine use and increased with male gender and mechanical ventilation.

Background: With coronavirus disease (COVID)-19 pandemic, society is gripped with uncertainty and fear, inclining them toward Yoga to prevent mental health issues. Google Trends (GT) depicts the public interest of the community which may vary due to evolving policy dynamics of the COVID-19 pandemic. Aim: The aim was to study global public interest in Yoga for mental health during the COVID-19 pandemic. Material and Methods: Global time trends were obtained for Yoga, Anxiety, and Depression from November 1, 2019 to May 31, 2020 using GT. The time series analysis was done in three different time periods - pre-COVID-19 phase, transition period, and COVID-19 pandemic phase. Cross-correlation, Spearman rho, Friedman ANOVA test, and forecasting were used for analysis. Results: GT found a global change in the search queries for Yoga, anxiety, and depression during the three time periods. High burden COVID-19 countries - Italy, Spain, Russia, and Brazil had an increasing search trend for Yoga. During the COVID-19 phase, there was a significant positive correlation between the search trends of Yoga with depression (r = 0.232; P < 0.05) and anxiety (r = 0.351; P < 0.05), but higher anxiety and depression searches lead to lower Yoga searches at lag +6. Forecast projected a continuous increase in Yoga searches and anxiety queries. Conclusion: Google Trends captured a significant rise in interest of Yoga among the global community but diminished with time. Hence, the need for interventions to promote Yoga to be part of routine life and for making sure that people adhere to the Yoga practices on a continuous basis.