Rural Indian Population Research Articles

Evaluating the role of serum cystatin C as a circulating biomarker of diabetic retinopathy from a rural Indian population

Abstract PURPOSE: This study aimed to evaluate serum cystatin C as a potential biomarker for diabetic retinopathy (DR) in a rural Indian population, addressing the urgent need for effective screening tools amidst rising diabetes prevalence. MATERIALS AND METHODS: A cross-sectional study recruited 112 patients with diabetes mellitus from Sambalpur, Odisha, India, categorized into groups with and without DR. Serum cystatin C levels were measured alongside clinical and demographic parameters, using established diagnostic methods. RESULTS: Patients with DR exhibited significantly higher serum cystatin C levels compared to those without DR (mean: 0.99 ± 0.50 mg/L vs. 0.80 ± 0.36 mg/L, P = 0.027). Adjusted analysis showed a notable association between higher cystatin C tertiles and DR (adjusted odd’s ratio: 7.65, 95% confidence interval: 1.49–39.08, P = 0.01), highlighting its potential as an independent predictor. CONCLUSION: Elevated serum cystatin C levels were strongly associated with the presence of DR, suggesting its utility as a biomarker for early identification and risk stratification in diabetic patients. Integration of cystatin C measurement into routine clinical practice may enhance DR screening and management strategies, offering potential benefits in reducing vision loss and improving patient outcomes. This study underscores the need for further longitudinal research to validate these findings and elucidate the temporal relationship between cystatin C levels and DR progression.

Investigating patient revisit intention in community health centres: a mediational study

Purpose Community health centres (CHCs) play a vital role in healthcare service delivery in rural India and act as a crucial link between the primary and tertiary healthcare systems. The rural population in the union territory of Jammu and Kashmir primarily depends on CHCs for healthcare services due to the scarcity of private healthcare infrastructure and the lack of access to tertiary hospitals. The purpose of this study is to analyse the impact of management capability, staff competence, waiting time and patient satisfaction on revisit intention among patients visiting CHCs for care needs. It further examines the mediational role of patient satisfaction between antecedents of patient satisfaction and revisit intention. Design/methodology/approach A survey by questionnaire was used to collect data from 318 inpatients and outpatients visiting CHCs. Partial least square-structural equation modelling was performed with the help of SmartPLS 3 software to evaluate the causal relationships between variables. Findings The findings of the study ascertain that staff competence and waiting time are strong predictors of patient satisfaction while management capability was reported as an insignificant factor. Patient satisfaction significantly affects revisit intention and successfully mediates the impact of management capability, staff competence and waiting time on revisit intention. Originality/value CHCs play a significant role in bridging the gap between primary healthcare and tertiary healthcare and in delivering healthcare services to the vast rural population in India. This study necessitates the active participation of management to ensure the smooth functioning of CHCs. There is a need to provide adequate staff and necessary infrastructural facilities to reduce the treatment waiting time.

Mental health services in rural India: a big challenge still to be met

There has been a decline in the rural population of India from nearly 82% to about 65% over the past six decades. The National Mental Health Survey of India (2015–2016) reported a lower prevalence of mental disorders in rural areas compared with urban ones. Mental health services in the country are skewed towards the urban areas, and more families are pushed below the poverty line while getting treatment for a member with mental illness. India has expanded its District Mental Health Programme over the past two decades, and it now covers nearly all the districts in the country. Despite that, significant numbers of people with mental disorders, ranging from 70–90%, do not receive adequate treatment. This paper discusses the rural–urban divide in the mental health services, examining the problem and need, and the initiatives taken by the government of India in this direction.

Biological monitoring of exposure to benzene in water pipe smokers of rural Western Uttar Pradesh (India)

Aim: Present study was performed to investigate the possible human exposure to benzene through water pipe smoking, if any, in the selected rural population of Western Uttar Pradesh. Methodology: Urine samples from water pipe smokers of both the sexes were collected and analyzed for urinary concentration of phenol, creatinine and malondialdehyde employing standard methods. Results: The results showed that tobacco used by selected rural population contained traces of benzene in the range of 2.75 to 9.682µl ml-1. Analysis of urine samples for phenol, a major metabolite of benzene, showed its increased concentrations in water pipe smokers than non smokers. Further, the effects of age and gender differences on the excretion of phenol were also recorded. Female water pipe smokers were found to be more vulnerable to benzene exposure than male smokers. Intriguingly, alcoholic water pipe smokers were less vulnerable than the non-alcoholic smokers. Interpretation: It is concluded that respiratory, cardiac and haematological disorders caused by water pipe smoking might be attributed to long term benzene exposure amongst water pipe smokers. Large scale epidemiological studies are warranted in Indian rural population considering WHO (Framework Convention on Tobacco Control) regulations of water pipe smoking and tobacco products. Key words: Biological monitoring, Benzene, Oxidative stress, Phenol, Tobacco, Waterpipe smoking

Role of FIRE-MADE FI for diagnosing frailty in central rural India and its comparison with LASA FI.

An aging population ultimately has deprived physiological stores making them vulnerable for development of a syndrome called frailty, which presents with a cumulative decrease in tolerance, immunity, vision, balance, organ functions, health, and independent living. All these result in rising prevalence of frailty and its components, along with burden of disease, dependence, and health care cost. Thus, early estimation and assessment and interventions to correct it mark the mile stone in geriatric medicine. The present study was conducted with an aim to compare and correlate FIRE-MADE (Frailty Index in Rural Elderly - Mental status, Activities of daily living, Depression, and Events) FI (frailty index) with LASA (Longitudinal Aging Study Amsterdam) FI in central rural India's geriatric population. A cross-sectional study for assessment of frailty in the geriatric population of central rural India, reporting to the medicine department of a tertiary hospital, situated at Wardha district, by using FIRE-MADE and LASA FI was undertaken. Their scores were compared. The efficiency of FIRE-MADE FI in comparison with LASA FI was calculated. A frailty threshold of ≥ 0.25 is considered for diagnosing frailty. Standard descriptive and inferential statistics were used to evaluate all parametric and non-parametric data. Out of 250 geriatric people, 224 (89.6%) were frail according to LASA FI and 204 (81.6%) were frail according to FIRE-MADE FI. As compared to LASA FI, FIRE-MADE FI was 91.07% sensitive and 73.08% specific, with a positive predictive value of 96.68% and a diagnostic accuracy of 89.20%. The Indian rural population of central India has high prevalence of frailty. FIRE-MADE FI can be used as a potential, effective, and validated tool for early diagnosing and management of frailty. Among the parameters of FIRE-MADE FI, IHD was the most important contributing factor for development of frailty, followed by cognitive impairment, polypharmacy, and remaining factors mentioned in FIRE-MADE FI.

Quality of Life and Motor Function in Children with Spina Bifida and Hydrocephalus: Impact on Family Functioning in Indian Rural Population

Background & Purpose: Spina Bifida means “open spine”, and refers to a common congenital birth defects involving a failure of the neural tube to close or to remain closed during early embryogenesis. A significant complication for infants born with myelomeningocele is the onset of hydrocephalus. In rural Indian populations, where socioeconomic constraints and healthcare accessibility are significant challenges, the correlation between motor function and QoL becomes a critical area of investigation. Thus, the purpose of this study is to explore quality of life and motor function in children with spina bifida and hydrocephalus… its impact on family functioning in Indian rural population. Methodology : 20 Subjects with spina bifida and hydrocephalus, age 6 –10 years, both male and female with mean age of 47.30 months were assessed for their demographic profile according to selection criteria. They were assessed for quality of Life by using PedsQL Infant scoring Scale, Family functioning by using PEDSQLFIS, Motor function by using Gross Motor Function Measure (GMFM), socioeconomic status using Modified Kuppuswamy Socioeconomic Scale. The data was collected and computed in a systematic way and then analysed by using SPSS 20. Results : Correlational analysis was done. Statistically significant correlation was found in duration of operation and GMFM, PedsQL Infant scoring Scale and GMFM. Conclusion : This study shows that children with spina bifida and hydrocephalus in rural India benefit from better quality of life when they have improved motor skills. However, the impact of family dynamics, socioeconomic status, and the length of surgery on their quality of life was less clear. Overall, while good motor function is strongly linked to a better quality of life, other factors also play a role.

Optimizing Nutrient Management for Pearl Millet: Insights from a Long-term Field Experiment

The study investigates the impact of integrated nutrient management strategies on the yield and nutrient uptake of pearl millet (Pennisetum glaucum), a vital crop in arid and semi-arid regions. Pearl millet is a significant source of dietary energy and essential nutrients for rural populations in India. However, its productivity remains low compared to other millet-producing countries. This research aims to enhance pearl millet yield through a combination of organic manures, biofertilizers, and chemical fertilizers, addressing the need for sustainable agricultural practices. The experiment was conducted at the Research Farm of Rajmata Vijayaraje Scindia Krishi Vishwavidyalaya during the kharif seasons of 2022 and 2023. Twelve treatment combinations were tested, including 100% NPK along with farmyard manure (FYM) and seed treatments with biofertilizers. Results indicated that the treatment combining 100% NPK with FYM at 10 t/ha/year and biofertilizers significantly improved biological yield, nutrient uptake, and soil organic carbon content. Specifically, the highest biological yield recorded was 8026 kg/ha, with notable increases in total nitrogen, phosphorus, and potassium uptake. This study underscores the importance of integrated nutrient management in enhancing pearl millet productivity while maintaining soil health. By adopting these practices, farmers can improve crop yields and contribute to food security in regions reliant on pearl millet. The findings provide a framework for future research and practical applications in sustainable agriculture, emphasizing the need for balanced nutrient supply systems to optimize crop performance and soil fertility.

The Selection of Biogas Plants in the Indian Context Based on Performability—An Analytic Hierarchy Process and Weighted Aggregated Sum Product Assessment Approach

The purpose of this research paper is to present a framework for selecting a biogas plant for the Indian rural community, considering performability factors such as reliability, quality, maintainability, safety, and sustainability. This will ensure that the plant operates reliably, efficiently, and safely over its entire life cycle and can play a significant role as a decision-support tool for decision-makers (e.g., managers, engineers, stakeholders). The proposed framework integrates the Analytic Hierarchy Process (AHP), and the Weighted Aggregated Sum Product Assessment (WASPAS) to optimally evaluate and prioritize the best alternative based on performability factors. The findings show that the suitable biogas plant in the context of the Indian rural population is a fixed-dome-type plant. The decision-making process in selecting the best biogas plant can be effectively aided by using this suggested tool. Currently, there are no proper tools or methods for selecting biogas plants for rural areas due to a lack of data or relevant literature on operational issues. The proposed method uses performability factors for the selection, which has not been researched so far. Moreover, the AHP–WASPAS approach offers a robust method for selecting biogas plants, ensuring efficient and sustainable energy production. The proposed method will help policymakers and stakeholders to choose the best biogas plant in the context of Indian rural application.

The digital revolution in India: bridging the gap in rural technology adoption

This study investigates the factors that influence the adoption of digital technology in rural areas of India, with a focus on the Digital India Program (DIP). By analyzing the age distribution, education levels, technology adoption rates, and utilization patterns among rural populations, this research provides insights into the effectiveness of the DIP in targeting specific demographics and promoting digital inclusion. Quantitative data were collected from 400 respondents in Kalahandi District in the Odisha state of India. The data collected were analyzed using SPSS. The findings reveal a predominantly young population in rural India, indicating a workforce with significant economic potential and a higher likelihood of embracing digital technologies. Moreover, the study highlights the high levels of education among respondents, indicating a population well-equipped to understand and benefit from digital initiatives. Unexpectedly, the research shows a higher rate of digital technology adoption among female respondents, challenging the perception of gender disparities in technology access. This finding suggests that the DIP has played a vital role in bridging the gender gap and empowering women in rural areas. Additionally, the study uncovers a trend towards mobile-based services over computer-based services, signaling a shift in technology utilization patterns. This emphasizes the need to prioritize mobile technology and improve connectivity in rural areas to ensure wider access to digital platforms.

Exploring community perceptions on underreporting of suicide in Indian rural settings from psychosocial and cultural perspective

BackgroundThe Indian rural population is recognised as one of the vulnerable segments of the society in terms of reporting suicide. Inconsistencies in the reporting of suicide impede the real suicide case, that in turn hinders efforts to prevent suicide. There are differences in suicide motives in rural areas due to the clear cultural and social borders, that could affect reporting. Very few studies have examined these psychological and sociocultural variables in rural context. Thus, the main goal of the current investigation is to comprehend these aspects and recommend strategies accordingly. MethodThe present study employed in-depth interviewing using focus group discussions on a sample of 93 participants. Through purposive sampling 12 areas were shortlisted from four districts from Bihar State, India. Only those areas were selected, where suicide had occurred in the last one year. All the twelve discussions were finally transcribed and using the thematic analysis approach qualitative data were analysed. ResultsThree themes appeared followed by their subthemes. First theme was apprehensions and fears and the subtheme emerged were society's reaction towards suicide and legal procedure. Second theme was religious belief related to suicide and the subthemes were, soul wandering, unfulfilled desire of the soul, and life after death. Third theme was females were more underreported and subtheme emerged i.e., protecting the honor of the family, and laws related to women social issues. ConclusionFindings of this study suggest that psychosocial and cultural factors serve as barrier in reporting and hinders suicide prevention process. This finding indicates that formulating multisectoral approach in reducing community attitude and stigma of rural population towards suicide.

Ocular trauma study in rural indian population – clinical features and visual outcomes based on ocular trauma score

Aim: The study was aimed to assess the clinical features of ocular trauma and to classify and compare mechanical ocular injuries. Materials and Methods: This retrospective study was done on 299 patients with ocular injuries from January 2018 to May 2019. We reviewed case record forms for visual acuity (VA) and anterior segment findings. Fundus findings and intraocular pressure values were also noted. When indicated, radiological examinations such as computed tomography, magnetic resonance imaging, B-scan, and X-ray orbit were performed. The SPSS 11.0 package was used for data analysis. Results: Of the 299 instances in this study, 104 (34.78%) were in the 30–45 age group. The impact on males was 4.8 times greater than that on females. The most frequent cause among the 102 participants (34.11%) was industrial work. Out of 216 cases of closed-globe injuries, more than half, i.e., 113 cases (52.31%), were in zone I. Conclusion: Ocular trauma is more common among young males, with industrial work being the most common cause. A unilateral, closed-globe injury was more common compared to bilateral and open injuries. In open-globe injuries, zone II was more commonly affected, while in closed injuries, zone I was more common. Visual impairment was more severe in open-globe injuries. With regard to the prediction of final VA, our results were comparable to the ocular trauma score study, thus affirming its utility.

Risk Factors of Impediment of the Early Childhood Development in Rural Bengal

Abstract Background: Early childhood development (ECD) is the foundation of future life starting from conception and depends on biological and environmental factors. Seventy-four percent of these children reside in villages; many are underserved and marginalized. Enabling young children to achieve their full developmental potential is a requisite for sustainable development, but globally, 43% of children are still at risk to do so. The problem of ECD is grave for underprivileged rural population in India. Objectives: The objective of the present study was to identify the key risk factors that are prevalent in a marginalized rural community in West Bengal and to observe the impact of these impeding factors on ECD, thereby helping in priority setting in service delivery to optimize ECD promotion. Methods: In this community-based cross-sectional observational study, a random sample survey of 609 households with children 0–6 years was conducted in Purulia district, West Bengal, India, using a Multiple Indicator Cluster Survey III-based questionnaire followed by data analysis. Results: Lack of stimulatory home environment, poor learning opportunities, and inadequate responsive parental care were major hindrances. The cumulative effect of multiple other health and hygiene factors was also hindering ECD. Most factors were strongly influenced by poor maternal education. Conclusion: Education of caregivers, especially parents by dedicated health workers on early learning opportunities, showed the path of applied sciences in pediatric clinical practice. To modulate socioeconomic adversities with responsive parental care, ECD can be fostered.

Combustion of Biomass Fuel and Chronic Obstructive Pulmonary Disease in Rural Population of India

Combustion of Biomass Fuel and Chronic Obstructive Pulmonary Disease in Rural Population of India

IJCM_146A: Development and validation of an infographic educational tool for self-management of hypertension.

Background: Hypertension is a serious condition affecting 33 % of urban & 25 % of rural Indian population. It can be controlled by the antihypertensive medications, but self-management approaches also play a very important role in lowering blood pressure. Infographics are one such material which uses visuals to educate the audience. This study assesses the understandability and actionability of the newly developed infographic aimed at self-blood pressure monitoring, medication adherence and lifestyle modifications with dietary approaches and exercise. Objectives: The objectives of the study were to develop an infographic tool for educating the patients with hypertension and to validate the infographic tool using PEMAT A/V. Methodology: “The study was divided into two phases. First phase was to develop an infographic tool. An infographic was designed using Canva and Procreate. In the second phase, the infographic was validated using the Patient Education Material Assessment Tool - Audio visual (PEMAT-A/V) by 10 participants. PEMAT is a systematic method to evaluate and compare patient education materials. Result: Using Canva, the infographic tool was developed, and then PEMAT-A/V was used to validate it. In terms of understandability and actionability, the mean score was 87.8% and 89.2%. The standard deviations for understandability and actionability were 0.12 and 0.14, respectively. Conclusion: The infographic developed in the study scored a mean percentage of more than 70 in both understandability and actionability and hence, it was concluded that it can be easily understandable by the patients.

Awareness and Perception of Sepsis Among the Urban and Rural Population in India

Traditionally, immunity has been defined as a defence against, or as a resistance to, contagious and infectious diseases. However, in modern understanding, it has become apparent that the immune system's mechanisms that protect against disease can also react against harmless substances. In some instances of severe infection, it's important to be aware that the immune response generated may have unintended adverse consequences. These conditions are associated with sepsis and may even turn out to be life-threatening in certain cases. Sepsis is a whole spectrum of diseases with a systemic and dysregulated host response to an infection. Therefore, it is of utmost importance to investigate and understand the level of awareness among the general public regarding this condition. This study aimed to understand the level of awareness about sepsis among the general population and to compare the perspectives of urban and rural populations. This study revealed that the awareness among both populations is low. Efforts should be made to increase awareness in India.

Association between ApoE ε4 genotype and attentional function in non-demented, middle-aged, and older adults from rural India.

Several genetic factors have been associated with cognitive decline in aging. Apolipoprotein E (ApoE) ε4 has been widely studied in the risk for pathological cognitive decline, including dementia. However, the association between ApoE ε4 and cognitive functioning in the healthy aging Indian population has been understudied, and the results are ambiguous. This study aims to examine the role of the ApoE genotype with attentional function in aging adults (≥45 years) in a rural Indian population. Cross-sectional (baseline) data (n = 2100) was utilized from an ongoing longitudinal cohort study on aging (Srinivaspura Aging, Neurosenescence, and Cognition study). Participants hailed from villages of Srinivaspura in Karnataka, southern India. Participants were categorized based on ApoE-ε4 status into three categories: No ε4, heterozygous ε4, and homozygous ε4. Attentional function was assessed using the auditory and visual attention subtests from a computerized neurocognitive test battery. Linear regression was performed adjusting for age, gender, and education. In model 1 (unadjusted), we did not find an association between ApoE and attention function. In the partially adjusted model 2 (adjusting for age), ApoE ε4 with age was significantly associated with the attention function. Further, with increasing age, there was a decline in attention among homozygous ε4 individuals. Model 3 (model 2 + gender) found that ApoE ε4, age, and gender explained a significant variance in attention function. In addition, with increasing age, males had poor attention in the homozygous as compared to heterozygous group. Model 4 (model 3+ education) explained a significant variance in attention and also revealed that with increasing age, attention declined in the illiterate and low literacy groups in both homozygous and heterozygous groups among both genders. Although ApoE ε4 alone was not associated, it interacted with age, gender, and education to affect attention function in this rural Indian population. Longitudinal cognitive monitoring will yield insights into understanding whether the ApoE ε4 genotype influences the rate of cognitive decline in this rural, aging population.

Profile of poisoning cases in a tertiary care centre in rural South India

BACKGROUND: Poisoning is the fourth most common cause of mortality in rural India. The commonest agents in India appear to be pesticides, sedatives, chemicals, alcohol, animal plant toxins and household toxins. Our hospital receives an average of 20 to 25 poisoning cases every month.
 AIMS: To profile all cases of poisoning those are reported to casualty department at Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER); to study the types and frequency of poisoning cases admitted to the centre; to study the socio demographic associations of the poisoning cases.
 MATERIALS AND METHODS: Present study is a hospital record-based retrospective observational study of acute poisoning cases registered in the medicolegal register in the casualty of CDSIMER, which is a tertiary care centre situated in rural area near Harohalli, Ramanagara District, India.
 RESULTS: Males constituted 58% of the cases and 33.52% of the cases were in the age group of 21–30 years. 81.4% of the cases were able to reach hospital between 1 to 8 hours. 56% of the cases recovered and were discharged within 3 days. In 22 cases the duration of admission was more than 2 weeks as they went into complications. Organo phosphorus group of insecticide was the most common type of poison consumed constituting to 40.8% of the cases followed by Snake bite. Attempt to suicide (60.35%) was more common than accidental poisoning.
 CONCLUSION: Insecticides mainly Organophosphorus compound are the most common group of poisons which causes morbidity and mortality in rural Indian population especially in young adults between 21 to 40 years. Owing to the presence of forests in the region, Snake bite becomes the second largest type of poisoning. Suicide frequently prevails in the rural areas; financial problem is the leading cause for farmers to commit suicide.

Modeling the Predictors of M-Payments Adoption for Indian Rural Transformation

Aim/Purpose: The last decade has witnessed a tremendous progression in mobile penetration across the world and, most importantly, in developing countries like India. This research aims to investigate and analyze the factors influencing the adoption of mobile payments (M-payments) in the Indian rural population. This, in turn, would bring about positive changes in the lives of people in these countries. Background: A conceptual framework was worked upon using UTAUT as a foundation, which included constructs, namely, facilitating conditions, social influences, performance expectancy, and effort expectancy. The model was further extended by incorporating the awareness construct of m-payments to make it more comprehensive and to understand behavioral intentions and usage behavior for m-payments in rural India. Methodology: A questionnaire-based study was conducted to collect primary data from 410 respondents residing in rural areas in the state of Punjab. Convenience sampling was conducted to collect the data. Structural equation modeling was used to conduct statistical analysis, including exploratory and confirmatory factor analyses. Contribution: A new conceptual model for M-payments adoption in rural India was developed based on the study’s findings. Using the findings of the study, marketers, policymakers, and academicians can gain insight into the factors that motivate the rural population to use M-payments. Findings: The study has found that M-payment Awareness (AW) is the strongest factor within the proposed model for deeper diffusion of M-payments in rural areas in the state of Punjab. Performance expectancy (PE), effort expectancy (EE), social influences (SI), and facilitating conditions (FC) are also positively and significantly related to behavioral intentions for using M-payments among the Indian rural population in the state of Punjab. Recommendations for Practitioners: M-payments are emerging as a new mode of transactions among the Indian masses. The government needs to play a pivotal role in advocating the benefits linked with the usage of M-payments by planning financial literacy and awareness campaigns, promoting transparency and accountability of the intermediaries, and reducing transaction costs of using M-payments. Mobile manufacturing companies should come up with devices that are easy to use and incorporate multilanguage mobile applications, especially for rural areas, as India is a multi-lingual country. A robust regulatory framework will not only shape consumer trust but also prevent privacy breaches. Recommendation for Researchers: It is recommended that a comparative study among different M-payment platforms be conducted by exploring constructs such as usefulness and ease of use. However, the vulnerability of data leakage may result in insecurity and skepticism about its adoption. Impact on Society: India’s rural areas have immense potential for adoption of M-payments. Appropriate policies, awareness drives, and necessary infrastructure will boost faster and smoother adoption of M-payments in rural India to thrive in the digital economy. Future Research: The adapted model can be further tested with moderating factors like age, gender, occupation, and education to understand better the complexities of M-payments, especially in rural areas of India. Additionally, cross-sectional studies could be conducted to evaluate the behavioral intentions of different sections of society.

Adverse Drug Reactions in the Bipolar Disorder Patients Treated With Mood Stabilizers

Abstract Background: Bipolar disorder is a chronic illness requiring long-term use of mood stabilizers such as lithium and sodium valproate. The adverse drug reactions (ADRs) of these medicines can severely affect the quality of life of the patients. A comparative study of ADR profile of lithium and valproate in terms of prevalence, severity, and causality has not been done in the rural population of India. Methodology: A cross-sectional, observational study was done in the psychiatry outpatient department of a tertiary health care center. The bipolar disorder patients on lithium carbonate or divalproate monotherapy were chosen for documentation of ADRs after informed consent. The Naranjo causality algorithm and Modified Hartwig and Siegel scale for severity assessment were applied to all participants. The data obtained were statistically analyzed using Epi Info open-source software. Results: The study participants having mean age of 33.83 ± 12.02 years comprised nearly equal number of males and females. Tremors (19.4%), polyuria (11.5%), and polydipsia (11.2%) were the most common ADRs due to lithium, whereas nausea (12.6%), anorexia (10.6%), and sedation (9.1%) were more commonly seen in patients on valproate. Most of the ADRs had a mild severity and were categorized as possible in the Naranjo causality algorithm. Conclusion: Although ADRs are common in bipolar disorder patients treated with lithium or valproate, they are often mild and well tolerated by the patients.

High ambient air pollution erodes the benefits of using clean cooking fuel in preventing low birth weight in India

A large fraction of the population in rural India continues to use biomass fuel for cooking and heating. In-utero exposure to the resulting household air pollution (HAP), is known to increase the risk of low birth weight (LBW). Mitigating HAP, by shifting to clean cooking fuel (CCF), is expected to minimize the risk associated with LBW. However, India also has high levels of ambient air pollution (AAP). Whether exposure to AAP modifies the effect of reducing HAP by switching to CCF on LBW is not known. The present study addressed this knowledge gap by analyzing the National Family Health Survey (2019–21) data of the most recent full-term, singleton, live births from rural households born after 2017 (n = 56 000). In-utero exposure to AAP was calculated from satellite-derived ambient fine particulate matter (PM2.5) concentration at the level of the primary sampling unit for the pregnancy duration of the mothers. The moderation by ambient PM2.5 level on the odds of LBW among CCF users was examined by logistic regression analysis with interaction. The adjusted odds ratio (aOR) of LBW was 7% lower among users of CCF. At the lowest Decile (20–37 μg m−3) of ambient PM2.5 exposure, the aOR of LBW among CCF users was 0.83 (95% CI:0.81–0.85). At every 10th percentile increase in ambient PM2.5 exposure (in the range 21–144 μg m−3), aOR increased gradually, reaching the value of 1 at PM2.5 level of 93 μg m−3. Our results, therefore, suggest that the benefit of using CCF during pregnancy may be downgraded by moderate to high ambient PM2.5 exposure.