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Background & objectives: Globally, mental disorders are rising with increasing urbanization. India has the world's second-largest tribal population and it is critical to appreciate the mental health problems in this population. However, the extent of mental health issues among tribal populations is unknown. Against this background, we systematically reviewed community-based studies on mental health issues among tribal populations in India. Methods: Online databases PubMed, Embase, ProQuest databases and Google Scholar were searched and articles published between January 1990 and May 2021 including primary community-based quantitative observational studies focused exclusively on tribal population were retrieved. PRISMA guidelines were followed and this review was registered on PROSPERO (CRD42020178099). Results: A total of 935 articles were identified, of which 63 were selected for full-text review, and finally, 11 studies were included. Seven studies examined alcohol use disorder with a pooled prevalence of 40 per cent. Two studies reported on suicidal attempts. A few studies mentioned anxiety, depression and other mental health conditions. Interpretation & conclusions: This systematic review established that a few community-based primary studies were conducted on mental health issues among tribal populations over the last three decades. Among these, fewer studies focused exclusively on tribal communities. The studies differed in their study design and the tools used. The findings of these investigations highlighted a limited range of mental health issues, primarily alcoholism, anxiety, depression and suicide.

ObjectivesAntimicrobial resistance is a growing global public health threat driven by interactions between human, animal and environmental factors. Rural settings in low- and middle-income countries may face increased risk due to unregulated antibiotic use, close human–animal interactions, and environmental contamination. This study explored community-level knowledge, attitudes and practices related to antibiotic use and resistance among caregivers of children in rural South India using a One Health perspective.DesignQualitative study using focus group discussions and thematic analysis.SettingFour rural villages in Tirunelveli district, Tamil Nadu, India.ParticipantsSeventy-seven primary caregivers of children aged 2–12 years from households with backyard animals, purposively selected from a rural cohort study.ResultsThree themes emerged. First, human health practices included reliance on home remedies, reuse of prescriptions, self-medication and incomplete antibiotic courses alongside misconceptions about antibiotics. Second, environmental factors such as untreated water consumption, open defecation, poor drainage and improper waste disposal were perceived to increase infection risks. Third, animal-related pathways included close child–animal contact, antibiotic use in livestock and unsafe disposal of animal waste. Limited healthcare access and transport costs influenced treatment-seeking behaviour.ConclusionsInterconnected caregiver practices, environmental conditions and animal husbandry behaviours create multiple pathways for antimicrobial resistance transmission. Integrated, community-based interventions addressing behaviour change, healthcare access and environmental management are essential to support antibiotic stewardship within a One Health framework.

Background & objectives: The National Prevalence Survey of India (2019-2021) estimated 31 per cent tuberculosis infection (TBI) burden among individuals above 15 years of age. However, so far little is known about the TBI burden among the different risk groups in India. Thus, this systematic review and meta-analysis, aimed to estimate the prevalence of TBI in India based on geographies, sociodemographic profile, and risk groups. Methods: To identify the prevalence of TBI in India, data sources such as MEDLINE, EMBASE, CINAHL, and Scopus were searched for articles reporting data between 2013-2022, irrespective of the language and study setting. TBI data were extracted from 77 publications and pooled prevalence was estimated from the 15 community-based cohort studies. Articles were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and were sourced using a predefined search strategy from different databases. Results: Out of 10,521 records, 77 studies (46 cross-sectional and 31 cohort studies) were included. The pooled TBI prevalence for India based on the community-based cohort studies was estimated as 41 per cent [95% confidence interval (CI) 29.5-52.6%] irrespective of the risk of acquiring it, while the estimation was 36 per cent (95% CI 28-45%) prevalence observed among the general population excluding high-risk groups. Regions with high active TB burden were found to have a high TBI prevalence such as Delhi and Tamil Nadu. An increasing trend of TBI was observed with increasing age in India. Interpretation & conclusions: This review demonstrated a high prevalence of TBI in India. The burden of TBI was commensurate with active TB prevalence suggesting possible conversion of TBI to active TB. A high burden was recorded among people residing in the northern and southern regions of the country. Such local epidemiologic variation need to be considered to reprioritize and implement-tailored strategies for managing TBI in India.

While many studies have documented adverse impact of multiple chronic conditions or multimorbidity on COVID-19 outcomes in patients, there is scarcity of report on how physicians managed these patients. We investigated the experiences and challenges of clinicians in managing patients with multimorbidity throughout the COVID-19 pandemic in Odisha state, India. To understand the factors influencing illness management and the adaptive responses of physicians alongside the evolving pandemic, we followed a longitudinal qualitative study design. Twenty-three physicians comprising general practitioners, specialists, and intensivists, were telephonically interviewed in-depth. Saldana’s longitudinal qualitative data analysis method was employed for data analysis. COVID-19 pandemic initially diverted the attention of health systems, resulting in reduced care. With time, the physicians overcame fear, anxiety, and feelings of vulnerability to COVID-19 and started prioritising patients with multimorbidity for treatment and vaccination. All physicians recommended teleconsultation and digital health records to benefit chronic illness care during future public health crises. The findings underscore the transformative potential of physician resilience and adaptation during the COVID-19 pandemic, emphasizing the importance of prioritizing patients with multimorbidity, incorporating teleconsultation, and implementing digital health records in healthcare systems to enhance chronic illness care and preparedness for future public health crises.

Emerging evidence demonstrates how inadequate access to water and sanitation is linked to psychosocial stress, especially among women, forcing them to navigate social and physical barriers during their daily sanitation routines. We examine sanitation-related psychosocial stress (SRPS) across women's reproductive lives in three distinct geographic sites (urban slums, rural villages, and rural tribal villages) in Odisha, India. We explored daily sanitation practices of adolescent, newly married, pregnant, and established adult women (n = 60) and identified stressors encountered during sanitation. Responding to structured data collection methods, women ranked seven sanitation activities (defecation, urination, menstruation, bathing, post-defecation cleaning, carrying water, and changing clothes) based on stress (high to low) and level of freedom (associated with greatest freedom to having the most restrictions). Women then identified common stressors they encountered when practicing sanitation and sorted stressors in constrained piles based on frequency and severity of each issue. The constellation of factors influencing SRPS varies by life stage and location. Overall, sanitation behaviors that were most restricted (i.e., menstruation) were the most stressful. Women in different sites encountered different stressors, and the level of perceived severity varied based on site and life stage. Understanding the influence of place and life stage on SRPS provides a nuanced understanding of sanitation, and may help identify areas for intervention.

Background Health Technology Assessment in India (HTAIn) carries evidence-based decision making in improving health care. This study was done to assess cost-effectiveness of the laparoscopic IPOM technique compared to open VHR from health system perspective of India. Methods A Meta-analysis of outcomes of both procedures was carried out whereas cost estimates were obtained from national health system costing database. Results A meta-analysis of Randomized Control Trials (RCTs) showed similar risk in hernia recurrence rates between laparoscopic IPOM and open technique (RR: 1.28 95% C.I: 0.81, 2.04) but with significantly less risk for wound infections (RR: 0.31 95% C.I: 0.18, 0.54). Estimated cost from National Health System Costing Database (NHSCD) per VHR was high for laparoscopic IPOM (INR 58,872) compared to open hernioplasty (INR 36,166) with estimated Incremental Cost-Effective Ratio of INR 5,023 per wound infection averted. Conclusions Laparoscopic IPOM was not clinically effective in hernia recurrence and less likely to be cost-effective Key points • Laparoscopic IPOM as compared to open surgery for ventral hernia significantly reduces risk for wound infection but not hernia recurrence. • Simulated analysis suggested that laparoscopic IPOM is less likely to be cost-effective as compared to open surgery for ventral hernia.

Women face greater challenges than men in accessing water, sanitation, and hygiene (WASH) resources to address their daily needs, and may respond to these challenges by adopting unsafe practices that increase the risk of reproductive tract infections (RTIs). WASH practices may change as women transition through socially-defined life stage experiences, like marriage and pregnancy. Thus, the relationship between WASH practices and RTIs might vary across female reproductive life stages. This cross-sectional study assessed the relationship between WASH exposures and self-reported RTI symptoms in 3,952 girls and women from two rural districts in India, and tested whether social exposures represented by reproductive life stage was an effect modifier of associations. In fully adjusted models, RTI symptoms were less common in women using a latrine without water for defecation versus open defecation (Odds Ratio (OR) = 0.69; Confidence Interval (CI) = 0.48, 0.98) and those walking shorter distances to a bathing location (OR = 0.79, CI = 0.63, 0.99), but there was no association between using a latrine with a water source and RTIs versus open defecation (OR = 1.09; CI = 0.69, 1.72). Unexpectedly, RTI symptoms were more common for women bathing daily with soap (OR = 6.55, CI = 3.60, 11.94) and for women washing their hands after defecation with soap (OR = 10.27; CI = 5.53, 19.08) or ash/soil/mud (OR = 6.02; CI = 3.07, 11.77) versus water only or no hand washing. WASH practices of girls and women varied across reproductive life stages, but the associations between WASH practices and RTI symptoms were not moderated by or confounded by life stage status. This study provides new evidence that WASH access and practices are associated with self-reported reproductive tract infection symptoms in rural Indian girls and women from different reproductive life stages. However, the counterintuitive directions of effect for soap use highlights that causality and mechanisms of effect cannot be inferred from this study design. Future research is needed to understand whether improvements in water and sanitation access could improve the practice of safe hygiene behaviors and reduce the global burden of RTIs in women.

Oral cancer is a widespread global health problem characterised by high mortality rates, wherein early detection is critical for better survival outcomes and quality of life. While visual examination is the primary method for detecting oral cancer, it may not be practical in remote areas. AI algorithms have shown some promise in detecting cancer from medical images, but their effectiveness in oral cancer detection remains Naïve. This systematic review aims to provide an extensive assessment of the existing evidence about the diagnostic accuracy of AI-driven approaches for detecting oral potentially malignant disorders (OPMDs) and oral cancer using medical diagnostic imaging. Adhering to PRISMA guidelines, the review scrutinised literature from PubMed, Scopus, and IEEE databases, with a specific focus on evaluating the performance of AI architectures across diverse imaging modalities for the detection of these conditions. The performance of AI models, measured by sensitivity and specificity, was assessed using a hierarchical summary receiver operating characteristic (SROC) curve, with heterogeneity quantified through I statistic. To account for inter-study variability, a random effects model was utilized. We screened 296 articles, included 55 studies for qualitative synthesis, and selected 18 studies for meta-analysis. Studies evaluating the diagnostic efficacy of AI-based methods reveal a high sensitivity of 0.87 and specificity of 0.81. The diagnostic odds ratio (DOR) of 131.63 indicates a high likelihood of accurate diagnosis of oral cancer and OPMDs. The SROC curve (AUC) of 0.9758 indicates the exceptional diagnostic performance of such models. The research showed that deep learning (DL) architectures, especially CNNs (convolutional neural networks), were the best at finding OPMDs and oral cancer. Histopathological images exhibited the greatest sensitivity and specificity in these detections. These findings suggest that AI algorithms have the potential to function as reliable tools for the early diagnosis of OPMDs and oral cancer, offering significant advantages, particularly in resource-constrained settings. https://www.crd.york.ac.uk/, PROSPERO (CRD42023476706).

Background Reliable electricity is essential for healthcare delivery, yet underserved facilities in Low- and Middle-income countries (LMICs) often face energy deficits and frequent power outages. The rural Primary Health Centers (PHCs) serve as the first point of care for the underserved population in India. These facilities often struggle to deliver effective health services due to unreliable energy supply. The present study explored the multi-stakeholder’s perspectives on the impact of solar electrification of PHCs on improved health outcomes, effective service delivery and resilient healthcare infrastructure in Rural Karnataka, India. Methods We conducted a qualitative phenomenological study across five districts of North Karnataka, India. A total of 29 in-depth interviews were conducted among various stakeholders including frontline healthcare providers such as medical officers, nurses, technicians, Accredited Social Health Activist (ASHA), and other support staff, along with local communities. Interviews were recorded, transcribed, translated into English and thematically analyzed, adhering to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines in reporting the present study. Results Two main themes emerged: (1) Energy reliability and critical care management with positive impacts on maternal and child health outcomes and service resilience during pandemic and disasters; and (2) Operational efficiency and cost savings including reliable vaccine storage, reduced electricity bills and improved data management systems through solarization of PHCs. Conclusion The perspective highlighted notable changes with the pre and post solarization of PHCs, strengthening the quality, reliability and resilience. It enabled safer deliveries, continuous vaccine cold chain management and improved emergency responses. Scaling the solar powered health infrastructure offers a sustainable pathway to advance universal health coverage and resilience in underserved regions.

Introduction Neglected tropical diseases (NTDs), such as lymphatic filariasis, mimic other chronic conditions and share common risk behaviors with parallel health system issues that require unique interventions. Multiple long-term conditions (MLTCs or multimorbidity), defined as two or more chronic conditions has become increasingly common in low- and middle-income countries (LMICs) such as India. However, data on the prevalence of the interface between NTDs and other chronic conditions are lacking. We estimated the prevalence and correlates of MLTC, assessed the commonly occurring patterns, and investigated the association between self-rated health (SRH) and the number of chronic conditions among patients with lymphatic filariasis. Methods A cross-sectional study was conducted in Odisha, India, using a prevalidated MLTC assessment tool. We employed systematic random sampling to recruit 584 participants aged ≥ 18 years having lymphatic filariasis. MLTC was defined as the coexistence of one or more chronic conditions along with lymphatic filariasis. A multivariable logistic regression model was used to identify the correlates presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). A hierarchical cluster analysis was conducted to identify the major clusters of chronic conditions. An ordinal regression model was used to assess the association between SRH and the number of chronic conditions. Results The overall prevalence of MLTC was 68.8% (95% CI: 64.9–72.6), while the mean number of chronic conditions was 2 ± 2.3. The chance of having MLTCs was greater among males [AOR: 3.9 (95% CI: 2.1–7.3)] than females. Participants with education at the primary and secondary school levels had greater odds of having MLTC [AOR: 2.2 (95% CI: 1.3–3.7)] and [AOR: 2.3 (95% CI: 1.3–3.8)], respectively. The commonly observed triad was lymphatic filariasis with arthritis and peptic ulcer disease (1.5%), while the most common tetrad was lymphatic filariasis, hypertension, diabetes and peptic ulcer disease (0.7%). There was a per unit decrease in SRH with each additional chronic condition. Conclusion We observed a high prevalence of MLTC among people with lymphatic filariasis. The findings of this study will not only be useful for both resource and planning in India but also in similar LMICs with a high burden of lymphatic filariasis.