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Item Access to Healthcare Among Tribal Population in India: A Cross‐Sectional Household Survey(2025) Parikipandla, SrideviThis study addresses significant healthcare access challenges faced by India's 104 million‐strong tribal population, who are among the most disadvantaged and typically live in hilly rural and remote areas with poor health infrastructure and resources. The study aims to examine healthcare access patterns in six tribal areas, focussing on primary health centres (PHCs), to develop a strategy that improves healthcare service accessibility, quality, and utilization for tribal communities. Data were collected from 9837 participants from 24 PHC areas across six states. Most respondents (78.8%; CI: 77.98–79.61) reported monthly visits of government health workers to their habitations, indicating regular healthcare access. Two‐thirds confirmed house visits in the last 3 months, primarily receiving immunisation services. A significant portion (57.38%; CI: 56.39–58.36) received health ed ucation, and a majority (64.29%; CI: 63.33–65.24) were satisfied with the services. About 77% depend on PHC and its healthcare staff, though state‐wise variations exist. Common reasons for not using these services included distance (17.45%; CI: 16.71 18.22) and lack of trust (4.57%; CI: 4.17–5.01). Most respondents were examined by a doctor (60.32%; CI: 59.35–61.29) and received diagnostic tests (27.50%; CI: 26.62–28.39). Walking (21.88%; CI: 21.6–22.71) and auto‐rickshaw/cab (20.23%; CI: 19.44 21.04) were the most common travel modes, with a mean travel time of 34 min. The data highlights the tribal population's preferences and experiences with primary healthcare services. Understanding these patterns can guide the design imple mentation research to further improve accessibility and utilisation of primary healthcare services among these vulnerable populations.Item Strengthening Health System and Community Mobilization for Sickle Cell Disease Screening and Management among Tribal Populations in India: An Interventional Study(2023) Parikipandla, SrideviSickle cell disease (SCD) affects 5% of the global population, with over 300,000 infants born yearly. In India, 73% of those with the sickle hemoglobin gene belong to indigenous tribes in remote regions lacking proper healthcare. Despite the prevalence of SCD, India lacked state-led public health programs until recently, leaving a gap in screening and comprehensive care. Hence, the Indian Council of Medical Research conducted implementation research to address this gap. This paper discusses the development and impact of the program, including screening and treatment coverage for SCD in tribal areas. With a quasi-experimental design, this study was conducted in six tribal-dominated districts in three phases – formative, intervention, and evaluation. The intervention included advocacy, partnership building, building the health system’s capacity and community mobilization, and enabling the health systems to screen and manage SCD patients. The capacity building included improving healthcare workers’ skills through training and infrastructure development of primary healthcare (PHC) facilities. The impact of the intervention is visible in terms of people’s participation (54%, 76% and 93% of the participants participated in some intervention activities, underwent symptomatic screening and demanded the continuity of the program, respectively), and improvement in SCD-related knowledge of the community and health workers (with more than 50% of net change in many of the knowledge-related outcomes). By developing screening and treatment models, this intervention model demonstrated the feasibility of SCD care at the PHC level in remote rural areas. This accessible approach allows the tribal population in India to routinely seek SCD care at their local PHCs, offering great convenience. Nevertheless, additional research employing rigorous methodology is required to fine-tune the model. National SCD program may adopt this model, specifically for community-level screening and management of SCD in remote and rural areas.Item Primary healthcare utilization patterns among sickle cell disease patients in tribal India: A multi-centric study(2025) Parikipandla, SrideviAbstract: Background: Prevention and management of chronic diseases have been integrated into the primary healthcare system in recent years. However, due to the social, cultural and geographical barriers, patients of one of such chronic illnesses, viz., sickle cell disease (SCD) have poor utilization and access to healthcare services. Hence, this study explored the utilization of outpatient services by SCD patients and associated factors in five SCD-endemic tribal districts of India. Methods: This cross-sectional quantitative study was conducted on 263 SCD patients or their caregivers and 263 corresponding controls recruited from 5 SCD endemic districts. Data on utilizing outpatient services and health system-related characteristics were collected using a pretested questionnaire. Multiple logistic regression was conducted to explore the association between utilization of outpatient services and independent variables. Results: About 80% of the patients reported the public healthcare system as a regular source of healthcare. 86% of the patients and 65% of the controls or their families visited primary health centres (PHCs) in the past year. More than two-thirds of the patients (67.7%) and more than half of the controls (50.6%) didn’t face any problems accessing PHC services. Patients with 6–10 years of schooling (adjusted odds ratio (AOR) = 0.45), annual family income of USD 480 to USD 720 (AOR = 0.41) and more than USD 720 (AOR = 0.35), > 15 kilometres of distance to PHCs (AOR = 0.32) are less likely to visit PHCs. Conclusion: The primary healthcare system was a regular source of medical care for the majority of the population, and utilization of outpatient services at PHCs was high in our study. Hence, this study emphasizes strengthening screening and management of SCD right from the primary healthcare level so that the healthcare needs of SCD patients can be met for the continuum of care.Item Sickle cell disease in Indian tribal population: Findings of a multi-centre Indian SCD registry(2024) Parikipandla, SrideviBackground: Sickle cell disease (SCD) registries provide crucial real-world data on demographics, epidemiology, healthcare, patient outcomes, and treatment efficacy. This paper presents findings from the Indian SCD Registry (ISCDR) on clinical manifestations, crisis episodes, disease management, and healthcare utilization in patients with SCD from 12 primary health centres (PHCs) in six tribal districts of India. Methods: The ISCDR was introduced along with a three-tier screening process. Its Android-based application incorporates two electronic case report forms for patient data collection over one year. This paper presents a year's data from the ISCDR's 324 patients with SCD. Results: Patients with SCD, aged one to 65 years, exhibited varied clinical manifestations. Most patients (85.2 %) were unaware of their SCD status before enrolling in ISCDR. Moderate to severe anaemia was prevalent (66.05 % and 30.56 %, respectively). Pain was a common complaint (80.86 %; CI: 76.17-85.00), while symptoms of stroke included sudden severe headaches (34.57 %; CI: 29.40-40.02). Common splenic sequestration symptoms included stomach pain (42.90 %; CI: 37.44-48.49) and abdominal tenderness (13.27 %; CI: 9.77-17.46), as a sign. Healthcare utilization was high, with 96.30 % receiving treatment and 83.64 % consuming hydroxyurea. Hospitalization occurred for 38.27 % (CI: 32.95-43.81), and 12.04 % (CI: 8.70-16.09) had blood transfusion during last year. Conclusions: ISCDR serves as a dynamic digital database on SCD epidemiology, clinical aspects, treatment and healthcare utilization. Notably, many patients lacked prior awareness of their SCD status, underscoring the need for improved awareness and care management. Integrating the registry into the national programme can streamline treatment implementation, prioritize management approaches, and optimize individual benefits.Item Knowledge, Attitude and Practices towards Cervical Cancer and its Screening Among Women from Tribal Population of Anuppur District(2025) Parikipandla, SrideviCervical cancer poses a significant public health challenge, especially among tribal women who face barriers in accessing healthcare. This study aimed to evaluate the knowledge, attitudes, and practices of tribal women regarding cervical cancer and HPV screening in Anuppur, a rural district in Madhya Pradesh, India. Conducted between December 2020 and December 2022, the cross-sectional study included one tribal block (Pushprajgarh) and one urban block (Jaithari). The study involved females aged 10-59 years from randomly selected households, excluding those with a history of cancer and those not consenting. Healthcare professionals from local health centres were also included, except those on leave. The sample size was 384, determined using a 95% confidence interval and a 5% margin of error. Data were collected through a structured questionnaire covering sociodemographic characteristics, knowledge, attitudes, and practices related to cervical cancer screening. Knowledge was assessed with questions about risk factors, symptoms, and preventive measures, while attitudes were measured using a 7-point Likert scale. Practice-related questions focused on experiences with Pap smear testing. The study revealed a significant lack of awareness among tribal women about cervical cancer and its link to HPV infection. Many participants had limited understanding of the risk factors, symptoms, and preventive measures, leading to negative attitudes towards screening. Barriers such as financial constraints, cultural beliefs, and limited healthcare access further hindered screening practices. As a result, many women had never undergone cervical cancer screening. These findings highlight the urgent need for targeted interventions and educational programs to improve awareness and promote positive attitudes towards cervical cancer screening among tribal women. Emphasizing the importance of regular screening and addressing misconceptions can help bridge the knowledge gap and enhance preventive measures.Item COVID-19 vaccine acceptance and hesitancy in Indian context: a systematic review and meta analysis(2024) Parikipandla, SrideviVaccination against COVID-19 is vital for achieving herd immunity, and the Government of India has adopted several strategies to achieve coverage. Vaccine hesitancy was identified as a potential obstacle in combating COVID-19. This study aimed to review the COVID-19 vaccine acceptance and hesitancy, and factors associated with vaccine hesitancy based on studies conducted in Indian populations. The data sources (PubMed, Scopus, and Google Scholar) were searched by following PRISMA guidelines, and the search was done in September 2022. We performed a meta-analysis through a random effect model to estimate pooled hesitancy rate with 95% confidence intervals (CI). A total of 3,339 records were searched, of which 46 studies were found to be eligible for inclusion in the review. The included studies covered 65,551 respondents, 55% were female. Studies reported COVID-19 vaccine acceptance rate of 65.7% in January-February 2021, which increased to 92.8% in May-August 2021. Likewise, the rate of vaccine hesitancy in December 2020 was 37%, dropping to 12.1% through November 2021. The estimated pooled COVID-19 vaccine hesitancy was 31% [95% CI: 27% - 36%, I2 = 99.3%]. Most studies highlighted that fear of the vaccine's side effects, efficacy, and safety were major barriers to vaccine acceptance. However, as the review indicates, it is important to consider and address all factors contributing to vaccine hesitancy.Item Cross-Cultural Adaptation, Reliability and Validity of MOS Short Form Health Survey (SF-36) in Sickle Cell Disease Patients in India(2025) Parikipandla, SrideviPurpose Patient-reported outcomes are critical for chronic illnesses like sickle cell disease (SCD), as its clinical manifestation is symptom-based and subjective. In order to conduct this assessment, valid and reliable self-reported tools are required. There is a lack of evidence for the reliability and validity assessment of even generic quality of life tools such as SF-36 in SCD patients. Hence, this study was conducted to address this knowledge gap. Methods This study utilised cross-sectional data from 125 SCD patients selected for a multi-centric study conducted across five SCD-endemic districts. Cross-cultural adaptation and translation of the tool were done in the local languages of these districts. Statistical analyses for floor and ceiling effects, item-internal consistency, interscale correlations and internal consistency were performed. Results Role Limitations due to Physical Problems and Social Functioning are the most affected and least affected areas of SCD patients’ lives, respectively. Item internal consistency was established for all subscales except General Mental Health, which recorded the highest distribution of responses. For subscale Vitality, Energy and Fatigue, only Cronbach’s α coefficient value (0.69) was marginally less than the cutoff. Conclusion Item level and scale level findings found SF-36 to be a reliable and valid tool to use in SCD patients in India. Further research with an adequate sample size is recommended to report conclusive evidence for other local languages.Item Stigma of sickle cell disease among Indian tribal population: A multi-centric qualitative study(2023) Parikipandla, SrideviBackground: Sickle Cell Disease (SCD) is the most prevalent hemoglobinopathy, impacting around 5% of the global population. The Indian tribal population, which has been a key focus of the Indian SCD program, can experience health-related stigma due to the multidimensional impact of the disease. This preliminary qualitative inquiry delves into the lived experiences of individuals and synthesizes domains to identify the sources of stigma. Methodology: The study's framework for developing the stigma tool was rooted in Bronfenbrenner's Ecology of Human Development. The study was implemented in five tribal-dominated districts of India and involved in-depth interviews with sickle cell disease (SCD) patients and their caregivers to explore their stigmatizing experiences. Results: The analysis revealed four overarching themes and several subthemes explaining the type of stigma, its source, and factors contributing to stigmatization. First, the study focused on elements associated with perceived stigma, such as disclosure, self-isolation/refusal to participate, and self-judgment. The second theme pertained to the internalization of stigma. The third theme addressed experienced stigma concerning the disease's impact on day-to-day events, and the fourth theme explored the support system patients needed. The framework highlighted the varying degrees of stigmatizing components within different aspects of patients' ecology. Conclusion: Our study highlights the importance of addressing stigma at various levels. Policies, programs, and healthcare interventions must target stigma across these levels. Culturally adaptive tools for identifying stigma, implementing appropriate interventions, and improving healthcare participation are essential for enhancing the quality of life and reducing the disease burden.Item Advances in nano silver-based biomaterials and their biomedical applications(2024) Birudu Ravi BabuSilver nanoparticles are among the most widely researched and used for nanotechnology-derived structures due to their extraordinary inherent optical properties, chemical stability, catalytic activity, and high conductivity. These idiosyncratic properties can be attributed to their unique physico-chemical characteristics, such as ultrafine sizes, high surface area, diverse shapes, and strong localized surface plasmon resonance. These distinctive features can be tailored using various physical, chemical, and biological synthesis methods. Various physical techniques are viable for producing silver nanoparticles on a large scale, but they suffer from drawbacks such as high-power consumption, expensive set-up, and limited control over nanoparticle size distribution. Chemical methods provide benefits like high yield, consistent shape and size distribution, and cost efficiency, but the residual toxicity of the chemicals involved hinders their biological applications. Biological synthesis approaches effectively overcome the limitations of both physical and chemical methods by eliminating the need for hazardous chemicals, requiring less energy, enabling diverse nanoparticle morphologies, and offering eco-friendliness and exceptional biocompatibility. The novel and promising properties of nanosilver-based biomaterials have been demonstrated to be suitable for a wide range of pharmacological and therapeutic biomedical applications. Their extensive application in wound healing, dentistry, cardiovascular disease treatment, nerve tissue engineering, cancer treatment, and biosensing can be attributed to their inherent antimicrobial and antibiofilm activity, antithrombotic properties, potential for nerve regeneration, photothermal conversion efficiency and sensitivity, respectively. This review discusses the different methods employed for synthesising silver nanoparticles and focuses on using nanosilverbased biomaterials for various biomedical applications.Item Indian Council of Medical Research (ICMR)-Sickle cell disease (SCD) Stigma Scale for India (ISSSI): development and psychometrics(2025) Parikipandla, SrideviBackground Sickle Cell Disease (SCD) places a significant psychological and social burden on patients and their caregivers, often leading to stigma that further diminishes their quality of life. Despite the huge burden of SCD and associated stigma in India, not much research has been done, and no stigma measurement tool is available. Hence, the Indian Council of Medical Research (ICMR) has undertaken a multi-centric study to develop the ICMR-SCD Stigma Scale for India (ISSSI). Methods A systematic approach was employed, beginning with item generation, content validity assessment, pretesting and psychometric validation. This process included exploratory factor analysis demonstrating strong factor loadings. Subsequently, confirmatory factor analysis was conducted to assess model fit, leading to refined scales of 16 items for patients and 17 items for caregivers. Findings This study explicitly developed and validated the ISSSI for Indian SCD patients (ISSSI-Pt) and their caregivers (ISSSI-Cg). The finalized scales capture multidimensional aspects of stigma, including familial and reproductive, social disclosure, illness burden, interpersonal, and healthcare interaction challenges. The findings underscore the scales’ psychometric robustness and utility in clinical and research settings. Interpretation The methodological rigour employed in the scale development makes it a robust tool for understanding SCD-related stigma among Indian SCD patients and their caregivers in clinical and research contexts. The development of the ISSSI represents a significant advancement in understanding and addressing the multifaceted stigma associated with SCD in India. Future studies should apply these scales across diverse cultural and linguistic contexts to enhance their generalizability and impact. Funding Indian Council of Medical Research (Grant Number: NTF/SCD-Stigma/2022/SBHSR).