This article offers a cross-sectional exploration of the COVID-19 containment strategy in Kerala and highlights its initial effectiveness in the Kasaragod district, the first to record a second stage transmission in the state with a cluster of cases from 23 March 2020 onwards. Despite its underwhelming healthcare infrastructure, Kasaragod district managed to contain the transmission and record a 100 per cent recovery rate, indicating a promising model of infection control. However, the district subsequently succumbed to community-level transmission when another wave of positive cases of COVID-19 was detected among repatriated overseas citizens on 7 May 2020. The article explores the confluence of elements that allowed the initial successful recovery from a second stage transmission and then examines the factors that later led to community-level transmission. Given the close connections of Kerala to other parts of the world through migration, the article illustrates how precariously the local is now part of the global.

The caste system and resulting social exclusion are important social determinants of health inequity in India. This article critically analyzes the influence of the caste system on health inequity in India, starting with a historical perspective and moving to the current status. The article argues that the caste system has deprived Dalits and tribal people in India of achieving health equity. The programs to promote health are often disease-specific and not culturally informed, leading to poor attention at the policy level to the intersecting disadvantages that make Dalits and tribal communities vulnerable, resulting in poor health. The authors suggest strengthening and promoting primary care, improving health access for Dalit and tribal populations, and the need for pivotal changes in the medical education system, shifting the emphasis from specialized care to training family physicians to be oriented toward community health needs, keeping health equity in perspective.

Lymphatic filariasis (LF) is a neglected tropical disease affecting communities in tropical and subtropical regions marked by poor socio-economic conditions. Regular hospital-based follow-up and home-based Morbidity Management and Disability Prevention (MMDP) are below par among LF patients due to reasons ranging from travelling costs to stigma. Telehealth interventions are suggested as a promising adjunct tool in such scenarios, integrating medical expertise and accessibility, but rarely used for LF. This article reflects on the insights from an LF clinic on the potential of telehealth interventions in enabling patients to access medical care and improving their home-based MMDP. Despite challenges like poor digital literacy and access to technology, the telehealth service facilitated remote consultations and dissemination of educational materials, allowing clinicians to monitor patient conditions and provide necessary medical guidance. The approach has shown substantial potential in improving lymphedema care, particularly in resource-limited settings, by offering a feasible solution to the barriers faced by traditional healthcare delivery. The pilot program underscores the importance of continued research and adaptation to optimize telehealth interventions for chronic disease management, ensuring comprehensive and accessible care for underserved populations.

Morbidity Management and Disability Prevention (MMDP) remain an under-addressed component of lymphatic filariasis elimination. Despite the simplicity of the hygiene-based regimen, adherence to these practices remains low due to multiple barriers, exacerbating chronic suffering. As the primary role remains vested in the patients, this study explores their perspectives and barriers to home-based care to inform strategies to improve outcomes. This study employed a mixed-methods approach using an explanatory sequential design. The quantitative phase involved a cross-sectional survey of 321 adult patients from Puducherry and adjacent areas of Tamil Nadu, utilising a validated questionnaire informed by the Self-Management Assessment Scale (SeMaS) framework. The qualitative phase comprised 12 in-depth interviews (IDIs) and four focus group discussions (FGDs), with participants evenly distributed based on gender and health-seeking behaviours, and the data were analyzed using deductive thematic analysis. Only 46.4% of participants regularly practised home-based limb care. Morbidity management scores were significantly higher among patients with an income (p = 0.005) and regular healthcare visits (p < 0.001), and lower among those with grade 4 lymphedema (p < 0.001). Participants under 60 years (p < 0.001), women (p = 0.015), and those with higher grades of lymphedema (p < 0.001) perceived a higher disease burden. Key barriers pertaining to home-based care were identified in social support (84.7%), perceived disease burden (33.0%), and mental health issues (15%). Qualitative findings highlighted the interactions of socioeconomic, structural, and cultural factors, indicating the key role of structural factors alongside individual-level determinants like locus of control, self-efficacy, and emotional well-being. The findings underscore the need for a multifaceted approach that transcends individual-level interventions to include systemic reforms, such as policy integration, capacity building, and community-driven support mechanisms. Addressing the barriers holistically and tailoring the solutions addressing diverse disadvantaged groups can enhance adherence to morbidity management practices.