Background: Pregnant women's exposure to secondhand smoking (SHS) is associated with detrimental effects on the pregnancy outcomes. Objectives: The objective of the study was to compare the effectiveness of face-to-face counseling, based on health belief model (HBM), combined with a written educational pamphlet, and health education using written pamphlet only, in improving pregnant women's perception, behavior to avoid SHS and change in exposure to SHS. Methods: A randomized controlled trial was conducted in 2016. The intervention group received face-to-face health counseling on SHS, while the control group received only written educational pamphlets. Outcomes were the change in the perception of mother on the four constructs of the HBM and the change in mothers' behavior of avoidance of SHS exposure. Results: A total of 100 women were recruited for the study, of whom 93 (47 intervention and 46 control) women completed the study. All women identified their spouse as a source of SHS exposure. Following the intervention, the intervention group had significantly higher scores in the perception of susceptibility (21 ± 4 vs. 16 ± 7, P < 0.01) and severity (15 ± 3 vs. 12 ± 4, P < 0.01) and reduced perception scores of barriers to avoid SHS exposure (11 ± 4 vs. 9 ± 5, P = 0.03), compared to the control group. However, there was an insignificant change in the exposure to SHS after the intervention in both the groups; where 25 (53.2%) women in the intervention group and 31 (67.4%) in the control group (P = 0.16), continued to being exposed to SHS. Conclusion: Counselling of pregnant women, based on HBM, has insignificant effect in reducing their exposure to SHS; however it is effective in improving their knowledge and perception about SHS exposure.

Background: The geriatric depression scale – short form (GDS-SF) considered an important preliminary screening tool, requires translation in different regional languages and validation, to become of utmost use in Indian context especially in the field level. Objective: The current study aimed to evaluate the psychometric validity of the GDS-SF translated into Bengali among rural elderly population. Methods: The 15-item GDS-SF translated to Bengali language was administered to 206 Bengali speaking geriatrics selected maintaining predecided inclusion and exclusion criteria from villages under a rural block in West Bengal. Latent trait modelling was used to evaluate the psychometric properties of this translated tool. Differential item functioning (DIF) was assessed to measure invariance. Results: The mean age of the participants was 68.77 years (standard deviation 6.81 years). Majority being female (57.77%), Hindu (87.38%), from a joint family background (90.78%). The highest discrimination was observed with item 8 (coefficient 3.682, P < 0.001) followed by item 14 (coefficient 3.020, P < 0.001). Question 2 had least coefficient for difficulty (−1.344, P = 0.013) while item 15 had highest (0.775, P = 0.001). The questionnaire provided maximum information (discrimination) around mean value of latent trait. The total cutoff score of 5 was related nearly to mean latent trait (−0.111). Items 10 and 13 showed consistent DIF across different demographic groups. Conclusion: Psychometric properties of GDS-SF (Bengali) established overall construct and content validity of the tool in this community-based study. Despite some degree of DIF the tool can be used as a preliminary screening method in rural community.

Background: Successful antiretroviral therapy (ART) mainly depends on sustaining high rates of adherence. In the context of Indonesia, none of the previous studies have looked at determinants of HIV adherence among transgender populations. Objectives: This study aimed to explore factors associated with the adherence to ART among HIV-positive transgender women in Yogyakarta, Indonesia. Methods: Face-to-face in-depth interviews with 29 transgender women, also known as Waria, living with HIV were conducted from December 2017 to February 2018. Participants were recruited using purposive and snowball sampling techniques. Data were analyzed thematically using a qualitative data analysis framework. Results: Factors associated with ART adherence among transgender participants were divided into three major levels as follows: (i) individual factors, (ii) social factors, and (iii) structural factors. Feeling tired and lazy due to work, falling asleep before taking medicine, schedule to take the medicine, healthy physical condition of other HIV-positive friends who did not take antiretrovirals, and the lack of finances to travel to health facilities were the influencers of the participants' ART adherence. Conclusion: These findings indicate the need for the development of HIV/AIDS-related health service supporting system in health-care facilities and the dissemination of knowledge and information of HIV/AIDS and its related service for HIV-positive transgender women and other people living with HIV and general populations in other parts of the country and other similar settings globally.

Background: Although air pollution and weather changes have been identified as putative risk factors that precipitate acute attacks of bronchial asthma, so far there have been no studies that could conclusively establisha clear association. Objectives: This study was carried out to investigate the effect of the concentrations of NO₂, SO₂, and particulate matter on exacerbation of bronchial asthma. Methods: A longitudinal study was conducted during February 2014–January 2015. Sixty-one known cases of asthma were recruited from the outpatient department of a chest hospital. Data regarding weather parameter (temperature, rainfall, and relative humidity) and environmental pollution (SO₂and NO₂) and respirable suspended particulate matter were procured from the Indian Meteorological Department and Delhi Pollution Control Committee, respectively. Association was examined using the generalized estimation equation (GEE). Results: Separate models were developed for weather parameter and pollution parameters. This study could not find a significant association between any of the weather parameters and occurrence of asthmatic attacks. In the GEE model, where average values of SO₂, NO₂, and PM were used, the PM was found to be significantly associated with asthmatic attacks. Conclusion: PM was found to increase the risk of exacerbation of asthma three folds.

Background: Improving overall coverage of maternal and child health (MCH) services is essentially required if India in general and Jammu and Kashmir state in particular have to attain the Sustainable Development Goals by the year 2030. Thus, the disparities in coverage of MCH services need to be assessed and addressed. Objectives: The objective of this study was to examine the variation in coverage rates for a key set of interventions in MCH services and to assess the relationship between coverage gap and socioeconomic development across the districts of Jammu and Kashmir. Methods: Data from the National Family Health Survey-4 (NFHS-4), 2015–2016, Census of India 2011, and Digest of Statistics Jammu and Kashmir were used to construct two composite indexes of coverage gap and socioeconomic development at district level. Cronbach's alpha was used to assess the internal consistency of indicators used in the two indexes. Results: The overall coverage gap in the state was 28.17%, and the size of coverage gap was largest for family planning interventions (55.8%), followed by treatment of sick children (26.95%) and maternal and newborn care (18.75%), and was smallest for immunization (10.5%). There is a moderate negative correlation between coverage gap and socioeconomic development (r = −0.63, P = 0.01). Conclusion: Coverage of MCH services and socioeconomic development has a significant disparity in the districts of Jammu and Kashmir. Resource-rich and more urbanized districts are much ahead of the poor and less urbanized districts in terms of the usage of MCH services.

Background: Low bone mineral density (BMD) is implicated in the pathogenesis of osteoporosis and osteopenia, and primarily manifest as fragile bones. This is a rapidly emerging global health problem with increasing prevalence in India. Objectives: The objective of this was to assess the status of bone health and find its determinants among women aged 40 years and above in a rural population of West Bengal. Methods: A community-based cross-sectional study was conducted from May 2017 to April 2018 among 260 women aged 40 years and above residing in the selected villages of Singur through multistage random sampling. Each respondent was interviewed using a structured schedule. Serum Vitamin D and calcium levels were investigated. BMD was assessed through calcaneal quantitative ultrasound. Osteoporosis was diagnosed among those with T-score ≤−2.5, while those with 25(OH) Vitamin D <30 ng/ml were classified to have Vitamin D insufficiency (VDI). Individuals with BMD T-score <−1 were considered to have low BMD. Inferential statistics were employed to find the associates of poor bone health. Results: Out of 260 participants, 34 (13.1%) were screened positive for osteoporosis and 77.7% had low BMD. Approximately 75% had VDI. On multivariable analysis, VDI (adjusted odds ratio [95% confidence interval] = 4.13 [2.12, 8.37]) was a significant predictor of low BMD after adjustment for poor education, decreasing diet score, menopause, presence of comorbidity, underweight, and overweight explaining 43.6% of the variance. Conclusion: Serum Vitamin D levels are implicated to play a crucial role in bone metabolism; however, its effect on the body in accordance with other important hormones should be explored.

Background: Despite the recognized benefits of physical activity (PA), the extent of its recognition and applications as a medical disability (MD) prevention program by practitioners working in Ethiopian health-care settings is unknown. Objective: The objective of the study was to explore health-care professionals' knowledge base and characteristics on the utilization of the frequency, intensity, time (duration), and type principle (FITT) of PA as an MD prevention program in the Ethiopian public health-care system.Methods: A mixed-method research design was used with data collected from 13 public referral hospitals in Ethiopia. In Phase I, quantitative data were collected from 312 health professionals (99 physicians and 213 nurses) using a survey. In Phase II, qualitative data were collected by interviewing health officers (n = 13 physician–hospital managers) and conducting one focus group discussion (n = 6 national health bureau officers). Results: A quarter (28%) of practitioners working in referral hospitals are using PA as an MD prevention program. Higher specialization (adjusted odds ratio [AOR] = 20.203, P < 0.001), many service years (AOR = 0.041, P = 0.014), young age (AOR = 19.871, P < 0.001), and being male (AOR = 0.269, P < 0.001) were associated with using PA as a MDs prevention program. Conclusion: Applying the FITT principle of PA for the prevention of MD among practitioners was very poor. Training of health-care professionals to use PA as a program for MDs prevention is required at the undergraduate level as well as specialized courses on qualification.

Background: With universal access to antiretroviral treatment (ART), the management of people living with human immunodeficiency virus (PLHIV) encompasses holistic, comprehensive care. Despite being a vital goal of care, quality of life (QOL) assessment of PLHIV in India is neglected. Objectives: This study assessed the QOL and its determinants among PLHIV accessing services through ART centers. Methods: The cross-sectional study was conducted from November 2015 to February 2017 among 109 PLHIV attending an ART center in New Delhi. Sociodemographic and clinical profile characteristics were ascertained. QoL was evaluated using the medical outcomes study HIV health survey questionnaire; physical health summary (PHS), and mental health summary (MHS) scores were calculated. Depression was evaluated with the becks depression inventory and social support using the multidimensional scale of perceived social support. Chi-square test, Student's t-test, and analysis of variance were used as test of significance. Results: The overall QOL was: PHS-48.04 ± 8.27 and MHS 42.43 ± 8.79. PHS scores were significantly higher among PLHIV with older age (P = 0.04), higher formal education (P = 0.022), early HIV disease (P = 0.006), higher CD4 counts (current, peak and nadir: P =0.024, 0.008, and ≤0.001, respectively), receiving ART (P = 0.05), with better social support (P = 0.012) and without depression (P ≤ 0.001). Similarly, MHS scores were better in PLHIV with greater formal education (P = 0.009), early HIV disease (P = 0.046), without depression (P ≤ 0.001). Conclusion: Depression and social support mechanisms emerged as two key determinants of QOL. Older age, higher education, less advanced disease, and ART were predictive of better QOL.

Background: Studies have shown parental religious involvement was associated with better health behaviors of their children. However, the relationship between parental religiosity and child dietary behaviors remains unclear. Objectives: This study aimed to examine the relationship between parental religious involvement and the dietary behaviors of school-aged children in mainland, China. Methods: Participants were selected from a northwest province of China using a multi-stage sampling process from July 2017 to October 2017. The frequency of parental religious activities and the importance of religion in life, along with the dietary behaviors of children, were collected using a questionnaire. Dietary pattern analysis coupled with multivariable linear regression was employed to test the association between parental religious involvement and children's dietary behavior. Results: The regression model indicated no significant relationship between parental religious behaviors and children's dietary behaviors in the overall sample. However, the frequency of mother's religious attendance was inversely related to children's consumption of vegetables (β = −0.40, P < 0.05) in the Hui subsample (vs. Han) when stratifying analyses by ethnicity. Conclusion: These findings suggest among those of Hui ethnicity, parental religious involvement may impact children's dietary behavior in a way that may affect their future health habits.

Background: Nutrition epidemiology initially focused on few nutrients thought to be responsible for noncommunicable diseases (NCDs). The database of Indian Nutrition Survey is based majorly on calorie intake. Objective: The objective was to compare the change in the average calorie intake from 1990 to 2012 with the emerging epidemic of diabetes and hypertension (HTN) in India since 1990. Methods: A comprehensive search was made in National Library of Medicine's PubMed database and Google Scholar from March to August 2018, on the above-mentioned subjects. Reports of national surveys (National Sample Survey Office and National Nutrition Monitoring Bureau) were included for average calorie intake among different states from year 1990 onward. Region-wise search depicted by national nutrition surveys resulted in 277 and 587 abstracts on the prevalence of HTN and diabetes mellitus, respectively. There were 51 full-text articles and abstracts on the prevalence of HTN and diabetes from the above regions. Results: The average calorie intake per capita per day in the four zones of country in rural areas decreased from 1990 to 2012. An increasing trend in the prevalence of diabetes from rural areas was observed from 1994 to 2012. The per capita average calorie intake per day in urban areas from 1999 through 2011 in all zones except the eastern part of country was on rise. There was no consistent trend in the prevalence of HTN in any of the zones. Conclusion: It is not just an increase in calories, but a trade-off between the demand for calories and the demand for healthy lifestyles determines the prevalence of NCDs.

Background: Postpartum anemia is associated with postpartum anxiety, depression, poor cognitive interaction, and delayed infant development. Oral iron is the currently recommended therapy but is associated with gastrointestinal complaints and poor compliance. Parenteral iron dextran may cause serious side effects, whereas iron sucrose requires repeated visits. Intravenous ferric carboxymaltose (FCM) is given as an infusion in a single setting, which is logistically convenient both to patients and health system. It can be particularly beneficial for postpartum women who are usually discharged from health facility 48 h after delivery. Objectives: The objectives of this study were to estimate the change in mean hemoglobin (Hb) level 6 weeks after administration of intravenous FCM and to document any adverse events following administration among postpartum women. Methods: A prospective, interventional follow-up study was conducted from August to December 2018. One hundred eligible postpartum women with Hb level of 5–9.9 g/dl were administered a calculated dose of intravenous FCM based on Ganzoni's formula with Hb target of 12 g/dl. Hb and serum ferritin were measured at baseline and at 6 weeks after FCM infusion and compared for mean increase. Results: There was a significant increase in Hb and serum ferritin levels after administration of FCM. The mean (95% confidence interval) increase in the Hb and serum ferritin after 6 weeks was 4.2 (3.9–4.5) g/dl and 137.3 (113.6–161.0) ng/ml, respectively. No major adverse events were reported. Conclusion: Administration of FCM was safe and effective in the treatment of moderate-to-severe anemia among postpartum women.

Background: In India, the measles-rubella (MR) vaccination campaign was conducted with the purpose of vaccinating all children of 9 months–15 years of age with a single dose of MR vaccine. However, it encountered various challenges which may hamper with the coverage. Objectives: This study was conducted to evaluate the recently conducted MR campaign in Manipur pertaining to its coverage and factors for not vaccinating. Methods: The cross-sectional study was conducted in Imphal East district of Manipur during May and June 2018 among 1551 children from two communities. The study tool was adapted from the rapid convenience monitoring tool of the WHO. Descriptive statistics were generated, and multivariable logistic regression analysis was performed with vaccination status as dependent with selected independent variables. Results: Among the study children, 38% were in the age group of 5–10 years, males constituting 51.3%. Only two-third (68.8%) of the children had received the MR vaccine, coverage among Muslim children was 40.4% only, and 6.5% of the respondents reported some forms of adverse events following immunization. Children from the Meitei community were (odds ratio: 14.35, 95% confidence interval: 10.22–20.16) significantly more likely to receive the MR vaccination as compared to children belonging to the Muslim community (P = 0.001). Conclusion: Vaccination coverage of only 68.8% highlighted the need for increased sensitization and involvement of local and religious leaders in generating necessary awareness for improved coverage of the campaign.

Background: Unplanned pregnancies are a major public health concern. In India, 33% of an estimated 48.1 million pregnancies end in induced abortions. Emergency contraceptive pills (ECPs) can prevent pregnancy after sexual intercourse, have been part of India's family planning program since 2002–2003 and are available as over-the-counter drugs. While there are concerns about the overuse of ECPs, the pattern of use of ECPs in India is unknown. Objectives: The objective is to determine the proportion of women who have ever used ECPs and repeatedly used ECPs and also to assess the reasons for use and nonuse of EC pills along with factors associated with the use. Methods: A systematic review of ECP use in India was conducted by electronically searching three databases-PubMed, Popline, and Google Scholar. All studies were published between 2001 and 2017, and the electronic search was last conducted in July 2018. The proportion of use was calculated using meta-analysis, and the other factors were assessed by narratively synthesizing the findings. Thirty-three articles met the inclusion criteria. Results: The pooled proportion of women who ever used ECPs was 6% (95% confidence interval, 0.03–0.10). The proportion of repeat use ranged from 12% to 69%. Five studies reported reasons for not using ECPs, and the most common reasons were religious/cultural beliefs followed by fear of side effects and inadequate knowledge. Studies to understand sociodemographic and other factors affecting the use of ECPs in India are lacking. There are significant concerns about the quality of the studies. The definition of repeat use of ECPs is inconsistent across papers. Furthermore, judgmental attitudes of health-care providers were apparent in some papers. Conclusion: The review highlights important research and program gaps.

Background: Alcohol increases risk of cancer of oral cavity and pharynx, esophagus, colorectal, liver, larynx, and female breast. Objectives: The objective of this study was to determine the relationship of alcohol and cancer in India by meta-analysis. Methods: Systematic Medline searches were performed to identify all the published literature associating alcohol and cancer in India. Initially, we retrieved 1509 studies, but after applying inclusion and exclusion criteria, only 29 studies were found eligible for our meta-analysis. Results: Our meta-analysis shows that alcohol consumption increases the risk of cancer with the odds ratio (OR) of 2.32 (95% confidence interval [CI]: 1.50–3.47) in case–control studies and relative risk of 1.52 (95% CI: 0.97–2.51) in cohort studies. It also shows that risk of oral cavity cancer increases by two times (OR: 1.92, 95% CI: 1.54–3.96) in the population consuming alcohol. Publication analysis showed that studies included in the meta-analysis had wide variation, suggesting good representation all over the country. Conclusion: The result from our meta-analysis supports our hypothesis that alcohol consumption increases the risk of cancer, implying immediate cessation of the habit for cancer risk reduction.

Background: Built environment characteristics in the neighborhood are of utmost priority for a healthy lifestyle in the fast-urbanizing countries. These characteristics are closely linked to the disease burden and challenges in low- and middle-income countries (LMICs), which have been unexplored using open-source data. The present technology offers online resources and open source software that enable researchers to explore built environment characteristics with health and allied phenomena. Objectives: This article intends to delineate methods to capture available and accessible objective built environment variables for a state in India and determine their distribution across the state. Methods: Built environment variables such as population density and residential density were collated from the Census of India. Safety from crime and traffic were captured as crime rates and pedestrian accident rates, respectively, acquired from State Crime Records Bureau. Greenness, built-up density, and land slope were gathered from open-source satellite imagery repository. Road intersection density was derived from OpenStreetMap. Processing and analysis differed for each dataset depending on its source and nature. Results: Each variable showed a distinct pattern across the state. Population and residential density were found to be closely related to each other across both districts and subdistricts. They were both positively related to crime rates, pedestrian accident rates, built-up density, and intersection density, whereas negatively related to land slope and greenness across the subdistricts. Conclusion: Delineating the distribution of built environment variables using available and open-source data in resource-poor settings is a first in public health research among LMICs. Cost-effectiveness and reproducible nature of open-source solutions could equip researchers in resource-poor settings to identify built environment characteristics and patterns across regions.

A daily surveillance for disease detection and response at the Simhastha Kumbh Mela, in Ujjain, Madhya Pradesh, April–May 2016, was established. Existing weekly reporting of the Integrated Disease Surveillance Programme (IDSP) was modified to report 17 diseases or events from 22 public hospitals and three private hospitals in Ujjain. Water samples were also tested for fecal contamination in areas reporting diarrhea. We identified 56,600 ill persons (92% from government hospitals and 8% from private hospitals): 33% had fever, 28% acute respiratory infection, and 26% acute diarrheal diseases. There were 15 deaths (12 injury and 3 drowning). We detected two diarrhea outbreaks (Mahakaal Zone with 9 cases and Dutta Akhara Zone with 42 cases). Among 26 water samples, eight showed fecal contamination. This was a large implementation of daily disease surveillance in a religious mass gathering in India by IDSP. We recommended laboratory confirmation for diseases and similar daily surveillance in future mass gatherings in India.

As part of the MD/MS thesis, a postgraduate resident plans, conducts, analyses, and reports a research study under the guidance of the faculty members of the department. At the end of this process, the resident is expected to know the principles of conducting scientific research. Such an integral component of the resident's training program bears close examination. The thesis does help a resident plan a research study, collect and analyze data, and compile the results. However, lack of dedicated time for thesis-work (especially in patient-care disciplines), the absence of intermediate timelines, and variation in the research ability and interest of faculty guides limit its usefulness. Addressing these issues, ensuring availability and the optimal use of resources, as well as regular monitoring and evaluation at the departmental level, shall go a long way in meeting the goals of a thesis.

The phenomenon of son preference in India and the declining number of girls due to such a mindset has been an area of concern. While the Preconception and Prenatal Diagnostic Techniques Act and the Beti Bachao and Beti Padhao scheme have been the mainstay of the government's initiative to counter this reproductive injustice, recognizing son preference and crime against women as public health concern opens up a new vista to counter this injustice. This study has identified that the public health system needs to engage with the following aspects to counter the problem: counseling services to women and men around fertility choices; access/availability to contraceptive choices; engaging men and boys in developing a response against violence; gender-sensitive training and capacity building; access to sexual and reproductive rights awareness amongst girls, women, boys, and men; and health insurance for senior citizens.