Southern Indian State Research Articles

Compliance to Tobacco Advertising and Promotion Ban in Four Regions of a Southern Indian State – A Descriptive Cross-Sectional Study

Abstract Tobacco advertising and promotion influences youth smoking initiation and regular use. India’s Cigarettes and Other Tobacco Products Act, 2003, bans tobacco advertising and promotion but allows Point of Sale (PoS) advertisements under specific conditions. This study aimed to assess compliance with the ban on tobacco advertising at the PoS in the Karnataka state of Southern India. A cross-sectional observational survey was conducted in 529 PoS across Karnataka’s four administrative regions between January to March 2020 using a checklist. The research assistants visited shops selling tobacco products, observed each store during business hours for 10 minutes, and completed the checklist. Proportions and percentages were calculated for each domain of the checklist. The study showed that 127 (24%) shops out of 529 had direct PoS advertisements. Among the total violations, product showcases (94.5%), Stickers (76%), and Posters (75.6%) were prominently used for the promotion of tobacco products. Advertisements were seen more commonly in petty shops (92%) and urban areas (59.8%). Product displays, stickers, and posters were used most often to violate advertising laws. Compliance should be improved in urban and petty shops, to decrease tobacco product exposure and accessibility.

A Cross-sectional Study of the Length of Stay of Persons with Mental Illnesses and Revenue to a Government Tertiary Neuropsychiatric Hospital Under Ayushman Bharat.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a health insurance scheme launched by the Government of India (GOI) in 2018 to cover the in-patient (IP) treatment expenditures, including mental illness treatment expenditures, for 500 million Indians. AB-PMJAY pays 100% of treatment expenditures for persons below the poverty line (BPL) and 30% for people above the poverty line (APL). Ayushman Bharat Arogya Karnataka (ABAK) trust implements this scheme in Karnataka, a southern Indian state. Data of persons with mental illness (PMI) admitted under AB-PMJAY at a tertiary care neuropsychiatric hospital between 2018 and 2021 was analyzed to understand the socio-demographic and clinical variables, the average length of stay (LOS), and the amount claimed by the hospital. Median LOS for PMI with any clinical diagnoses was 18 days (range 2-145),14 for those with substance use or mood disorders, and 24 days for those with schizophrenia and other psychotic disorders. The hospital claimed an amount of Indian Rupees (INR) 15,291,349 for treating 868 PMI under AB-PMJAY. The minimum and maximum LOS varied 70-fold, and there was a significant difference between different PMIs based on their clinical diagnosis. ABAK paid ₹3,488-12,750 per PMI for their treatment. Further research is needed to determine the variables influencing the LOS and the cost to the implementing agency.

Genotypic and phenotypic diversity of Mycobacterium tuberculosis strains from eastern India.

Whole genome sequencing has been used to investigate the genomic diversity of M. tuberculosis in the northern and southern states of India, but information about the eastern part of the country is still limited. Through a sequencing-based strategy, this study seeks to comprehend the diversity and drug resistance pattern in the eastern region. A total of 102 M. tuberculosis isolates from North East (n = 54), and Odisha (n = 48) were sequenced along with 7 follow up isolates from Sikkim. The pre-XDR and XDR isolates diagnosed as per the NTEP diagnostic algorithm were subjected for phenotypic second-line liquid culture drug susceptibility testing in MGIT-960 system. After filtering out low quality isolates based on taxonomic classification and depth of coverage, variant calling was performed. We observed a high prevalence of multi-drug resistant TB (MDR-TB) lineage 2 (52/54) isolates in northeast whereas there was a mixed representation of lineage 1 (30/48) & lineage 3 (11/48) in Odisha. The MDR-TB isolates from Sikkim posed a high rate (51/53) of fluoroquinolone resistance and pairwise SNV distances (≤10) indicating possible local transmission events in the region. We observed occurrence of genetic variations in genes associated with bedaquiline and delamanid resistance. Our findings show the diversity of M. tuberculosis vary across the eastern regions, in north eastern states lineage 2 has a dominant presence while lineage 1 and 3 has mixed representation in Odisha. The high prevalence of fluoroquinolone resistance in north eastern region associated with variations in gyrA gene and may have been caused by local transmission events based on genomic similarities.

An Exploratory Study on Crime against Scheduled Tribes in Southern States of India

The paper discussed status of crime against Scheduled Tribes in Southern States of India. It has found that number of crimes registered in Telangana is comparatively higher than the other states of the region. Rate of total crime against STs is highest in Kerala followed by Telangana, and Andhra Pradesh. Incidences of attempt to commit murder is highest in Karnataka followed by Andhra Pradesh and Telangana. Incidences of simple hurt, grievous hurt, assault on women with intent to outrage her modesty, sexual harassment, and assault or use of criminal force on women with intent to disrobe are also higher in Karnataka. There are incidences of voyeurism in Andhra Pradesh and Telangana. The incidences and victims of kidnapping and abduction against scheduled tribes are higher in Andhra Pradesh and Telangana. There are no incidence of kidnapping and abduction of women to compel her for marriage in southern states except Andhra Pradesh. There are no incidences of procuration of minor girls against scheduled tribes in any state of the region. Incidences and victims of rape against scheduled tribes is highest in Telangana followed by Karnataka and Kerala. Karnataka is the only state have the incidences and victims of Robbery. Therefore, government of the concern states should implement policies for reducing crimes against scheduled tribes.

Assessment of Vaccination Impact in PPR-Control Program Implemented in Southern States of India: A System Dynamics Model Approach.

Mass vaccination against peste des petits ruminants (PPR) in two southern states of India, namely Andhra Pradesh and Karnataka, has reduced disease outbreaks significantly. The sporadic outbreaks reported now can be attributed in part to the recurring movement of sheep and goats between these contiguous states. This study assessed the present level of economic burden and impact of vaccination on the local system (one state), considering the exposure from the external system (neighboring state) using a system dynamic (SD) model. The SD model relies on interdependence, interaction, information feedback, and circular causality and captures potential feedback between disease control interventions and their impact on various epidemiological and economic outcomes. The data for parameterization of the model were collected through surveys, expert elicitation, and literature review. The sporadic outbreaks reported in recent years (<10 outbreaks/year during 2022) were due to continuous "mass vaccination" for more than a decade. During 2021-2022, the PPR incidence was less in both the states, with an estimated loss of USD 26.30 and USD 22.86 million in Andhra Pradesh and Karnataka, respectively. The SD model results showed a systemic increase in flock size and offtakes and a decline in the number of infected and death cases under high vaccination coverage (75% and 100% coverage) compared to the low-coverage scenario. Hence, the coordinated inter-state vaccination efforts offer better prospects, as efforts in one state have positive externalities in terms of fewer outbreaks in a neighboring state.

Posterior Positivity Distribution Analysis of Subclinical Bluetongue in the Eastern and North-Eastern States of India: A Wakeup Call for Outbreak Preparedness.

Bluetongue (BT) is considered endemic in the southern states of India, with sporadic incidences reported from the northern, western and central parts of India. However, the eastern and north-eastern states of India have not experienced active disease so far. In the recent past, an extensive sero-epidemiological investigation was carried out in the eastern and north-eastern Indian states. With the aim of getting updated and refined estimates of positivity rates, the sero-surveillance data were analyzed using the Markov chain Monte Carlo (MCMC) method to calculate the positivity rates of various species across different states and agro-climatic zones. The posterior positivity distribution helped in accurately estimating the seroprevalence of bluetongue virus (BTV) among different species and regions. The MCMC method was applied for the first time in a BTV seroprevalence analysis that enhanced our understanding of infection dynamics, guided targeted interventions and supported better decision-making in bluetongue disease control, prevention and disease preparedness. This exercise is quite pertinent in the context of the recent upsurge of newer BTV strains, e.g., BTV-3 and BTV-8, in the western world. In short, as a powerful computational tool, MCMC could be used for accurate seroprevalence estimation, species-specific insights, regional analysis, enhanced decision-making and epidemiological insights for bluetongue.

Exploring the dynamics of dragon fruit production and its constraints in southern states of India

Dragon fruit, or pitaya, has become famous owing to its unique look, health advantages, and resilience to diverse climates, rendering it especially appropriate for Southern India. This study investigates the economic feasibility and production challenges of dragon fruit farming in Andhra Pradesh, Karnataka, and Tamil Nadu in 2024. Financial assessments using Net Present Value (NPV), Benefit-Cost Ratio (BCR), and Internal Rate of Return (IRR) indicate that dragon fruit farming is profitable in these states, with Andhra Pradesh and Karnataka showing better financial outcomes compared to Tamil Nadu. Garrett's Ranking Technique was employed to identify and rank the production and marketing constraints. Key production challenges in Tamil Nadu and Andhra Pradesh include the high cost of installation materials and insufficient technical support, while Karnataka primarily faces a shortage of skilled labor. On the marketing front, the absence of adequate cold storage facilities and high transportation costs pose significant hurdles across all states. The findings highlight the need for targeted solutions, such as improving access to affordable installation materials, upgrading cold-storage infrastructure, and implementing training programs for farmers. Addressing these challenges can enhance the profitability and sustainability of the dragon fruit industry in Southern India.

Tele-counseling services for COVID-19 patients: Experiences from a state mental health institute in South India.

The COVID-19 pandemic has had profound implications for individuals' physical and mental health (MH), as well as well-being of populations worldwide. Several underlying issues which have a significant impact on MH, such as stress, worry, frustration, and uncertainty, were widespread during the COVID-19 pandemic. One of the common measures resorted to was to provide MH services to the population using information technology. This study shares the experience of tele-counseling services for patients with COVID-19 living in the hospital and in-home isolation during the pandemic phase of COVID-19 in the Dharwad district of Karnataka, a southern state in India. A mixed approach was used, which included 300 participants affected by COVID-19 and 3 case studies. The information was collected using a structured interviewer-administered questionnaire and case study methods. The mean age of the COVID patients was 40.72 ± 14.61 years. More than half of the COVID patients (51%) received treatment at hospital. Seventy-nine percent of callers received only single counseling session. The main tele-counseling services provided included supportive counseling (44%), sleep hygienic techniques (9%), general information on COVID (15%), problem-solving techniques (1.3%), relaxation techniques (5.7%), mindful mediation (2%), grief counseling (3.3%), family counseling (1.7%), and stress management (2.7%). Tele-counseling services during an emergency like the COVID-19 pandemic can help in promoting MH and well-being of people affected by the pandemic. It is possible to provide such psychological first aid using information technology.

Beyond the business case: Impacts and resilience post-adoption of decentralized renewable energy for rural livelihoods

Productive uses of energy – tied to the usage of energy for economically productive appliances – to catalyze improvements in livelihoods, healthcare, and education have gained increased attention recently from governments and donor organizations. Through an intensive qualitative field-study of 64 rural entrepreneurs in southern Indian state of Karnataka who adopted different types of Decentralized Renewable Energy Assisted Machines (DREAMs) to start or improve existing rural enterprises such as roti-making, blacksmithing, tailoring, and food-processing, we contribute toward understanding when, how, and for whom do such productive uses make a positive impact. Going beyond the analysis of financial returns, we present an integrated impact-resilience framework to analyze the non-financial and broader socio-economic impacts of improved electricity access for rural enterprises. We show that DREAMs activate a cascade of interlocking set of impacts and livelihood resilience measures. While there is a general appreciation that DREAMs may contribute to making the adopting households more resilient, we trace the pathways through which such resilience building might occur. The reorganizational effects of DREAMs on the economic and social fabric of rural life appear to be quite large and potent. Our observation of multi-faceted positive spillovers resulting from the adoption and use of DREAMs lends support for policy interventions to develop and support the local and regional ecosystems that undergird deployment of DREAMs in rural areas.

Local Library Authorities in South Indian Public Libraries Acts: A Case Study

Abstract Legislation pertaining to public libraries is a helpful instrument for attaining state-mandated library services, financial support, resource and network sharing among libraries, and administrative effectiveness. In order to better understand the history of Public Libraries Acts in the Southern Indian states, this paper looks at a number of public library development aspects. Another focal point of the study is a comparative analysis of the provision of involvement of Local Library Authorities as well as their role and governance model in the Southern Indian states of India. The current work is based on data gathered from primary and secondary sources. To study the Public Libraries Acts of the southern states of India, the respective state government’s gazetteer notification and website of RRRLF were used as sources for data collection. The study has extensively analyzed the Local Library Authorities of Public Libraries Acts of South Indian States and made a comparative study among the different elements of the Local Library Authorities of the Public Libraries Acts. The study finds out that Kerala state has taken several distinctive steps in the development of its Local Library Authorities, including the establishment of block-level libraries. The study reveals that the local community and the Local Library Authorities have a tight relationship and are mutually fulfilling their objectives. Despite having sufficient provision for engagement of Local Library Authorities in the Public Libraries Act of the southern states, there is still debate about the proper implementation of the Acts.

Clinical Profile and Outcomes of Pediatric Snakebite Envenomation: A Three-Year Retrospective Study From a Rural Tertiary Care Center in South India.

Background Snakebite envenomation remains a significant public health challenge in tropical countries, particularly affecting the pediatric population. Children are especially vulnerable because of their smaller body mass, outdoor activities, and delayed presentation to healthcare facilities. This study aimed to analyze the clinical profile, demographic patterns, and envenomation characteristics of snakebites in children aged 1-16 years presenting to a tertiary care center. Additionally, the study sought to evaluate the spectrum of complications and clinical outcomes in pediatric snakebite cases while assessing the mortality rate and associated risk factors in pediatric snakebite envenomation. Methodology A retrospective medical record review was conducted analyzing all snakebite cases in children aged below 16 years admitted to the Department of Pediatrics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu (southern state in India), between January 2021 and December 2023. Data extracted included demographics, bite characteristics, clinical manifestations, time to healthcare presentation, and treatment details. Management protocols followed World Health Organization (WHO) guidelines for snakebite envenomation, including the administration of polyvalent anti-snake venom (ASV) when indicated. Results Among 202 pediatric snakebite cases, children aged 9-12 years constituted the majority (n = 110, 54.5%), with significant male predominance (n = 148, 73.3%). Unidentified snakes were responsible for the highest proportion of bites (n = 72, 35.6%), followed by vipers (n = 65, 32.2%) and cobras (n = 53, 26.2%). Lower limb bites were most frequent (n = 108, 53.5%), and seasonal analysis revealed peak incidence during January-April (n = 106, 52.5%). Common clinical manifestations included hematuria (n = 112, 55.4%), oliguria (n = 102, 50.5%), and renal failure (n = 80, 39.6%). Most patients (n = 120, 59.4%) received antivenom within six hours, with 46.6% (n = 94) requiring 5-10 vials. The overall mortality rate was 9.9% (n = 20). Statistical analysis revealed significant associations between mortality and snake species identification (p = 0.0014), with the highest mortality in unidentified snakebites (n = 15, 20.8%). Anatomical bite site (p = 0.042), renal failure (p = 0.001), respiratory paralysis (p = 0.001), and ptosis (p = 0.001) were also significantly associated with mortality. Time to antivenom administration significantly impacted survival (p = 0.001), with mortality rates of 0.8% (n = 1) for treatment within six hours, increasing to 38.5% (n = 10) for delays beyond 12 hours. Demographics and local manifestations showed no significant correlation with mortality. Conclusion Our study reveals distinct patterns in pediatric snakebites, predominantly affecting male children in pre-adolescent age. The high proportion of unidentified snakes remains challenging. With renal and hematological manifestations being frequent, mortality is significantly influenced by delayed treatment, respiratory paralysis, and renal failure. Early antivenom administration, proper snake identification, and prompt medical intervention remain crucial factors in improving outcomes and reducing mortality.

Factors Associated with Acute Respiratory Infection among Children Under 5 Years in India: Results from 2019 to 2021 National Family Health Survey

Abstract Introduction: Acute respiratory infections (ARIs) remain the leading global cause of death in children under-five. Targeted initiatives are needed to address healthcare inequities and reduce under-five mortality, particularly in disproportionately impacted low- and middle- income countries. To inform initiatives and identify high-risk groups, this study explored regional risk factors for ARIs among Indian children. Material and Methods: Our retrospective, observational study utilized India’s National Family Health Survey (NFHS-5). Bivariate and multivariable models were employed to investigate associations between respiratory infections and explanatory variables, including environmental factors, child characteristics, maternal characteristics, enabling factors, and household characteristics. Results: Of the 201,133 children under-five included in our sample, 2.85% [2.78-2.92%] experienced a recent respiratory infection. In multivariate analysis, children from northern and central regions had the highest odds of infection, while those from the southern region had the lowest. Healthcare accessibility, maternal smoking, caste, age (child), and birthweight were among additional variables associated with infections. Our study revealed significant regional differences in prevalence of acute respiratory infection symptoms. Notably, inability to access healthcare increased a child’s risk of infection. Several states in southern India, which typically had lower ARI symptom rates, have adopted initiatives to strengthen public health infrastructure, including the WHO’s Integrated Management of Neonatal and Childhood Illnesses program. Such initiatives could serve as models for broader health improvement efforts across regions. Furthermore, observed variability in disease burden suggests that with detailed and deliberate implementation of programs, advancements in under-five mortality due to ARI can be achieved.

A Brief Review of the Microweiseinae (Coleoptera: Coccinellidae) of the Indian Region, Including Description of a New Species.

Indian species of Microweiseinae are reviewed, comprising eight species (five species of Serangium Blackburn, one species of Microserangium Miyatake, and two species of Scymnomorphus Weise, including one new species from the southern Indian state of Kerala, Scymnomorphus ochraceus sp. n.). Illustrated diagnostic accounts are given for all species with details of distribution, biology, and host insects, wherever they are known. Immature stages are illustrated for Serangium parcesetosum Sicard and Serangium chapini (Kapur). An updated checklist of the Microweiseinae of India is given. The need for focused collections and systematic studies to unearth the hidden diversity of Indian Microweiseinae is discussed, and comments on their poor utilization in applied biological control in India are made.

Genetic Evaluation of Monthly Test-Day Milk Yields of Jersey Crossbred Cattle Under Farmers' Production System in Tamil Nadu, India.

Tamil Nadu, a state in southern India, is bereft of any native dairy or dual-purpose cattle breeds, and the state depends chiefly on crossbred cattle for milk production. Jersey crossbred cattle account for 90% of the state's milk production. This genetic evaluation study aimed to assess milk production traits, including test-day milk yields (TDMYs), total lactation milk yield (TMY), and 305-day milk yield (305MY), in these cattle reared under farmers' conditions. Data on monthly TDMYs (TDMY1 to TDMY10) of Jersey crossbred cows (n = 75,627) reared by the farmers over 11 years (2012-2022) were collected for evaluation. The influence of non-genetic factors viz., location (agroclimatic zones), period and season of calving, and parity on TDMYs, TMY and 305MY were assessed, and the variance and covariance components for genetic parameters (heritability and genetic correlation) of the traits were estimated by the method of restricted maximum likelihood (REML) under a multivariate animal model and by a random regression model (RRM). The overall means of various TDMYs ranged from 4.98 (TDMY10) to 9.95 kg (TDMY2), and for TMY and 305MY, the means were 2480.33 and 2393.71 kg, respectively. The heritabilities estimated by the multivariate animal model for TDMYs were moderate and ranged from 0.26 ± 0.02 to 0.37 ± 0.02 and the estimates were less variable throughout lactation, while the estimates obtained by RRM were medium to high and ranged between 0.29 ± 0.01 and 0.67 ± 0.02 for milk yield on day 5 to 305 (DIM 5-DIM 305). The heritabilities estimated for TMY and 305MY were 0.43 ± 0.02 and 0.43 ± 0.02, respectively. The estimates of heritability for mid-lactation yields were comparatively less than those at the beginning and the end of lactation. The moderate to high estimates of heritabilities for TDMYs, TMY, and 305MY obtained in the present study offer ample scope for improving milk production through selective breeding. Genetic correlations between TDMYs estimated by the multivariate animal model were positive and high, with a range between 0.75 ± 0.03 and 0.99 ± 0.00. Considerably higher estimates (0.98-0.99) were observed between adjacent TDMYs showing strong genetic associations. By RRM, genetic correlations estimated between DIMs were positive (except for DIM 5 with DIM 125 to DIM 185 and DIM 125 with DIM 305), and the magnitude of genetic correlation decreased with an increase in the interval between the DIMs. The high genetic correlation observed between the TDMYs (in the early stage of lactation) and total lactation milk yield suggested that these test-day yields could be used favorably for the early selection of cows for milk production, which facilitates reduction in the generation interval and consequently increases the annual genetic gain for the milk production traits.

Exploring emotional ties: Insights into intrinsic motivations and casual gaming intentions

This research explores the relationship between casual gamers' intrinsic motives and gameplay intentions. Drawing upon the attachment theory, this study investigates the interaction effect of attachment between intrinsic gaming motives and intentions. The study adopted a cross-sectional survey design through an online survey. A total of 390 students from a university located in the southern state of India participated in the survey. The proposed model was examined using Confirmatory Factor Analysis (CFA) and the study's hypotheses were tested using partial least square-structural equation modeling (PLS-SEM). The study contributes with its three important findings: First, gamers' hedonic motives, flow experience, and attachment to esports had a significant direct and positive association with gameplay intentions. Second, attachment to esports partially mediates the hedonic motive-gameplay intention and flow-gameplay intentions relationship, while fully mediating the relationship between fantasy and gameplay intentions. Third, escape had neither a direct nor an indirect impact on gameplay intentions. This study builds on the esports literature from casual gamers' psychology perspective. Furthermore, the findings may help game designers and marketers to develop more effective strategies to engage their target audience. Sports and leisure research has highlighted players' gaming motives and intentions often focusing on technology acceptance. Nevertheless, the affective element that motivates players to participate in casual gaming remains largely untapped. This study explores the role of casual players' attachment to esports and its influence on their intrinsic motives and gaming intentions.

Exploring the attitudes and beliefs of women regarding the implementation of midwife-led care in India: A mixed methods study

ProblemDespite the recent introduction of midwifery services in India to improve maternal and newborn healthcare, there is limited research on women’s perspectives on midwife-led care. BackgroundThe Government of India initiated midwifery services guidelines in 2018 to improve the quality of care for pregnant women and newborns across the country. It is important to develop evidence-based strategies which can optimise the implementation of these new midwifery services. AimThis study explored women’s attitudes and beliefs towards the implementation of midwife-led care in two southern states of India. MethodsA convergent mixed methods design was employed using an online questionnaire and semi-structured online interviews. Quantitative data was analysed using descriptive statistics and qualitative analysis used a framework approach. Data from both sources were then integrated through merging techniques. FindingsA total of 307 women completed the online survey, and 23 participated in in-depth interviews. The study highlighted inadequate knowledge of midwife-led care among women. Despite this, 60 % expressed optimism about its benefits. Key factors to women’s acceptance included better understanding outcomes, having trust in midwives, receiving respectful care, and having autonomy in decision-making. They also required midwife-led birthing units would be clean, accessible, and well resourced. DiscussionMost participants perceived midwife-led care as beneficial, valuing its skilled, responsive and compassionate services. ConclusionInsights from this study have implications for the implementation of midwife-led care which should consider the informational needs, safety standards and cultural contexts of women and their families living in both urban and rural areas of India.

Lifestyle Factors in Diabetes Management: Insights from the Kerala Paradox for the Indian Diaspora

With an estimated 101 million people living with diabetes, India ranks second in the world for the highest number of cases. In particular, Kerala, a state in southern India, faces what is known as the "Kerala Paradox", where strong socio-economic indicators fail to translate into lower levels of lifestyle-related diseases. As a result, Kerala has one of the highest diabetes prevalence rates in the country, ranking among the top three. This research paper aims to thoroughly analyse the Kerala Paradox and explore the factors contributing to it. It then extends the analysis through primary data to assess whether these lifestyle factors also influence the prevalence of diabetes in the Delhi NCR region. The latter half of the paper builds on findings from the literature review and primary research to evaluate the implications for diabetes management across the Indian diaspora. Keywords: India, Kerala paradox, Diabetes, Lifestyle factors, Physical activity, Dietary habits, Diabetes Management

Incidence of Non-Communicable Diseases and Out-of-Pocket Expenditure among Senior Elderly of five Districts in Kerala

Background: The nation's healthcare system, which is already struggling with constraints, faces a significant challenge from India's growing elderly population. As the prevalence of non-communicable diseases (NCDs) rises among this demographic, concerns mount over the strain on healthcare services. Objective: the study's primary aim was to evaluate the incidence of NCDs and the financial burden of out-of-pocket expenses associated with hospital stays for the middle-aged and older segments of the population. Methods: The referenced study, employing a systematic random sampling method, sought to gather pertinent data within Kerala—a state in southern India. Conducted across five specific districts. Results: The findings from a sample of 500 individuals revealed that 45% were afflicted with NCDs. Notably, a significant majority of these patients, irrespective of their economic status, opted for private healthcare providers, accounting for 60.5% of the respondents. This preference underscores the perceived or actual disparities in the quality of care between private and public healthcare institutions. Conclusions: The study's insights are crucial in understanding the healthcare dynamics at play and could serve as a catalyst for policy reform, aiming to enhance the accessibility and affordability of healthcare for India's aging population. It also highlights the urgent need for a robust healthcare system that can accommodate the complex needs of the elderly, particularly in managing chronic conditions that require long-term care and substantial financial resources. Way ahead: Utilising frontline staff (ANMs and ASHAs) can assist in putting NCD interventions into practice at the community level.

Prevalence and Risk Factors of Endometriosis Among Infertile Women in a Tertiary Care Center in South India.

Background Endometriosis is a gynecological conundrum because of its challenging diagnosis and treatment. It seems to affect every aspect of a woman's reproductive system, rendering her incapable of conceiving or achieving a successful pregnancy outcome independently. This study sought to determine the prevalence of endometriosis and clinical attributes of infertile women undergoing diagnostic laparoscopy. Methodology The current research is an analytical cross-sectional study that was carried out from April 2017 to December 2018. We included 103 women diagnosed with infertility and who underwent laparoscopy in the fertility center at GovernmentMedical College Thiruvananthapuram, Kerala, a southern state of India. A semistructured questionnaire was used to collect information on the sociodemographic, menstrual, and reproductive characteristics. Family history and associated symptoms of endometriosis were elicited. Patients were put into four stages by the revised American Fertility Society (rAFS) grading, which was used for the laparoscopic staging. Results Among the 103 cases who underwent laparoscopy, 23 patients (22.3%) were diagnosed with endometriosis. Of the 23 cases of endometriosis, one (4.3%) had minimal endometriosis, two (8.7%) had mild endometriosis, and 10 (43.5%) each had moderate and severe endometriosis. Dysmenorrhea was significantly more prevalent among cases (87%, 20 participants) compared to controls (48.8%, 39 participants) (p = 0.001). Approximately 56.5% (13 participants) of cases had dyspareunia, compared to only 31.3% (25 participants) of controls, and this difference was statistically significant (p = 0.027). About 52.2% of the cases (12 participants) experienced premenstrual spotting, while none of the controls did. The p-value of 0.001 shows a statistically significant difference. Out of the total cases examined, 56.5% (13 participants) reached menarche at or before 12 years, whereas 43.5% (10 participants) attained it after reaching the age of 12. Among the control group, 31.2% (25 participants) of individuals had menarche at or before the age of 12, while 68.8% (55 participants) experienced it later. The difference that was observed had a statistically significant result (p = 0.027). The majority of cases (about 65.2%) experienced cycles lasting less than 21 days, with 30.4% having cycles within the normal range, and 4.3% experiencing cycles longer than 35 days. The significant difference in proportion is evident with a p-value of 0.015. Out of the cases, around 34.8% (eight participants) had a history of pelvic surgery. Compared to the control group, nearly 30.4% of the cases (seven participants) had a positive family history of endometriosis. There were no additional risk factors associated with the development of endometriosis. Conclusion The prevalence of endometriosis among infertile women undergoing diagnostic laparoscopy was more than one-fifth of the study patients. The common complaints were dysmenorrhea, followed by dyspareunia and premenstrual spotting. Risk factors associated with endometriosis were early menarche, frequent cycles, and positive family history.

A Rank-Based Quotient Analysis of Constraints Faced by PM-KISAN Beneficiaries across Southern States of India: Key Issues and Policy Implications

The Pradhan Mantri Kisan Samman Nidhi (PM-KISAN) scheme, launched in 2018, aims to provide crucial financial support to farmers in India. This study analyses the constraints experienced by PM-KISAN recipients across five southern Indian states: Tamil Nadu, Andhra Pradesh, Telangana, Karnataka and Kerala. Data was gathered from 1,900 farmers through open-ended surveys, and the constraints were ranked using the Rank Based Quotient (RBQ) method. The top constraint, cited by 98.2% of farmers, was the inadequacy of the Rs. 6,000 annual payments, which was considered insufficient for meaningful agricultural investment. Other key issues included exclusion due to outdated land records (88.8%), ineligibility of tenant farmers (85.5%), irregular fund disbursement (75.4%), and a lack of awareness about the scheme's guidelines (70.5%). These findings indicate the need for policy reforms, including increasing the grant amount, revising eligibility criteria, and improving awareness and transparency in fund distribution. Addressing these issues could significantly improve the impact of the PM KISAN scheme, particularly for small and marginal farmers.