Background: A novel subjective Motivational Value toward Child Gender (MVCG) tool was developed using the theoretical construct of 10 motivational domains described by Shalom H Schwartz. Objective: The study aimed to summarize the pattern of correlations of (MVCG) in women of reproductive age in Himachal Pradesh, India. Methods: A cross-sectional study was conducted from October 2018 to November 2019 among a sample of 355 women. Required data were collected through an interviewer-administered questionnaire. Maximum likelihood exploratory factor analysis (EFA) with oblique rotation was done with Bartlett's test sphericity and Kaiser-Meyer-Olkin test. Results: A total of 28 (53.8%) questions loaded on eight factors explaining maximum variance (68.7%). Reliability analysis of these questions, with high loadings on extracted factors, of the questionnaire, observed with poor Cronbach's alpha of 0.61 and intraclass cluster coefficient (ICC) 0.49. However, selected domains such as tradition, power, achievement, self-direction, and benevolence were observed with a good Cronbach's alpha and ICC. Conclusion: MCVG is novel tool in its kind with well scalable properties in measuring subjective motivational values towards child gender. After EFA, total questions across 10 domains reduced from 52 to 28, across 8 domains, loaded on 8 factors with good reliability and agreement.

Background: Smoking is a significant risk factor for morbidity and mortality. Health education by health promotion is such a gauge to control tobacco epidemic at both national and multinational levels. Objectives: The objectives of the study were to systematically review the literature to identify models for health behavior change and evaluate evidence for their effectiveness in smoking cessation. Methods: A systematic review of the literature identified four peer-reviewed studies describing two smoking cessation behavioral interventional models (transtheoretical model [TTM] and health belief model [HBM]) between 2008 and 2018. Electronic databases MEDLINE (PubMed) and Google Scholar and Trip database were carried out. There were two randomized controlled trials and two nonrandomized controlled interventional studies. There was a high degree of homogeneity of design, definition of smoking and smoking abstinence, and implementation, followed by comparison of studies. All included studies have evaluated outcome by stage of changes (component of TTM model) and therefore show the reduction of smoking rate. All studies did not have blinding of study participants, leading to a higher risk of bias in the outcome. Results: There was a statistically significant difference between TTM-based interventional group and control group in smoking cessation rate. While comparing HBM- and TTM-based behavioral counseling, there was no statistically significant difference in smoking cessation rate. Conclusion: Both HBM- and TTM-based trainings were found to have positive effects on both smoking cessation and progression between the stages.

Background: Accreditation has become a benchmark for health-care organizations that require huge investment and effort. The impact of accreditation in health-care delivery needs to be assessed. Objectives: The study aimed to assess the impact of accreditation on the quality of public healthcare delivery in primary and secondary healthcare settings in Kerala. Methods: This cross-sectional study was conducted from July 2017 to July 2018 among 621 in-patients in medical wards at accredited (312) and nonaccredited (309) primary (community health center) and secondary (general, women and children, and taluk level hospitals) public health-care facilities. Ten constructs such as physical facility, admission services, patient centeredness, accessibility of medical care, financial matters, professionalism, staff services, medical quality, diagnostic services, and patient satisfaction were used in the study. Nonaccredited and accredited hospitals were compared using Median and Kruskal–Wallis test using SPSS version 22, with a set significance level of P ≤0 .05. Results: The median score of constructs of accredited primary health-care facilities in the Structure, Process, and Outcome domains are higher than the nonaccredited hospitals. There are significant differences between the scores of these three domains in accredited and nonaccredited primary health-care institutions but absent in secondary care institutions. Conclusion: If accreditation has to bring the embedded quality, structural, and procedural aspects of health-care facilities must be improved. Structural upgradation of a health-care facility alone cannot guarantee patient satisfaction. Accreditation process must be perceived as a tool for holistic and continuous transformation of a health-care facility overarching infrastructural and interpersonal domains.

Background: Insufficient physical activity (PA) has a negative effect on mental health. Many countries try to promote PA. The Korea National Health and Nutrition Examination Survey (KNHANES) aims to promote PA and the importance of the recognition of subjective health and body image and mental health. Objectives: The study aimed to analyze the relationship among body factors, PA, and mental health of Korean adults using the seventh KNHANES (2018) survey. Methods: KNHANES is a cross-sectional survey and investigates every 3 years. Data contain 4416 households (19–65-year-old) responses, and it was weighted average or sample fraction by reflecting the sampling and response rate of population ratio. International PA Questionnaire, metabolic equivalents tasks, Health Enhancing PA, Patient Health Questionnaire-9, Body factors, subjective health recognition, and subjective body image recognition were analyzed by t-test, ANOVA, Chi-square test, and Pearson's r. Results: Correlation among PA and mental health, PA of females was correlated with stress. The PA of males was highly related to the overall mental health. In the differences by gender and PA, females enjoying exercise have a tendency of less body mass index (BMI) and more satisfied with subjective body image. Males showed no difference in BMI but on body factors; males with vigorous activity were higher on height and weight than males with walking activity. Mental health with PA, females with walking activity showed higher depression than females with moderate activity. Likewise, males with walking activity exhibited higher depression than males with moderate and vigorous activity. Females and males showed their PA affects perceived stress. Conclusion: These results suggest promoting PA may lead to enhance mental health.

Background: Health-care service delivery is one of the components of six building blocks of World Health Organization Health System Framework. In order to monitor the progress of health-care service delivery, it is necessary to monitor its dimensions. Objective: The current study aimed to assess the health-care service delivery at the lowest health-care delivery post in Haryana. Methods: In this cross-sectional observational study conducted in 17 randomly selected subcenters of Block Shahzadpur, Haryana, from July 2019 to March 2020, an Evaluation Framework was developed to monitor health-care service delivery through its three parameters, namely, service delivery, service provision, and facility assessment. The pretested, semi-structured tools were designed on Epi collect online (version 5) application using the available validated tools. Results: The mean service delivery score for antenatal care assessment, postnatal care assessment, and immunization is 74.9 (78.9%), 24.7 (98.6%), and 40.2 (87.3%), respectively, with an overall score of 139.8 (84.2%). The mean service provision score as assessed by patients and their caregivers through exit interview on five elements was 97%. The mean total score for facility assessment parameter was 81.7 (86.9%). The overall health service delivery score calculated by adding scores of all three parameters was 318.4 (maximum attainable score = 360, 88.4%). Conclusion: A good correlation was observed between individual parameters with total score, indicating higher performance of health-care delivery system. The future studies should focus on understanding the gaps at grassroot level and lay down the dashboard indicators for objectively evaluating health-care delivery system.

Background: Village Health and Nutrition Day (VHND) is a community participation program focusing on pregnant women, lactating mothers, children (0–5 years), and adolescent girls. Objectives: To assess the status of VHND functioning in the rural areas, and to determine the facilitators and barriers of health care service utilization among the beneficiaries. Also, to explore the challenges faced by the front-line workers while conducting the program. Methods: A cross-sectional descriptive study with a mixed-methods approach was conducted among the beneficiaries and the service providers in twelve selected VHND sessions from March to July 2019 in Singur, Hooghly district, West Bengal. Both quantitative and qualitative methods of research were applied to assess the status of the functioning of 12 VHNDs. Results: Among the beneficiaries who attended the sessions; 28.57% were pregnant women, 16.53% were lactating mothers and 17.44% were under-five children. Nonavailability of line-list of adolescent girls and nonavailability of Vitamin A in oil were major observations. Barriers leading to poor service utilization among beneficiaries were the long-distance of the VHND session site, lack of counseling on proper lifestyle practices, poor and inadequate infrastructure. House visits by the Accredited Social Health Activists regarding the information on VHND sessions found to be an important facilitating factor for beneficiaries. Major challenges identified among the healthcare workers were lack of logistics supply, inadequate workforce, and improper the maintenance of the VHND session site. Conclusion: Proper resource mobilization, maintenance and cleanliness of the session sites, appropriate and wholesome counseling can vastly improve the quality of VHND with the concurrent improvement of maternal and child health.

Background: Transformation of Primary Health Centers to Family Health Centers (FHC) in Kerala is a new movement. It is important to study the perspectives of stakeholders about it so that strengthening of the facilitators and tackling the barriers can be done. Objectives: The objectives of this study were to understand the perspectives of patients and health-care workers on the facilitators and barriers of service utilization in a FHC in Central Kerala. Methods: Descriptive qualitative study was done for a period of 3 months at FHC, Mundur, Thrissur district, Kerala. In-depth interview of medical officer, health supervisor, and accountant was conducted. Two focus group discussions at the FHC among Accredited Social Healthcare Activists (ASHAs) and patients and one among community members were done. The Attride-Stirling's thematic network analysis framework was followed for data analysis. The findings are reported in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. Results: The facilitators identified for service utilization are good behavior of staff, evening outpatient department and special clinics, improved infrastructure and clean premise, trust in ASHA workers, subsidized laboratory service, local self-government involvement, funds, and rewards. The barriers of service utilization are staff shortage and workload, lack of awareness among general population about some services, and shortage of medicines. Conclusion: The concept of FHC is agreeable to both the health-care workers and the community. The barriers can be tackled at this stage, and there is a scope to improve health-care quality if this model is introduced across the country.

Background: Men who have sex with men (MSM) are at high risk of acquiring sexually transmitted illnesses. The gross stigmatization of homosexuality and discrimination has always affected their health-seeking behavior. Objectives: The study aimed to assess the magnitude of sexual health problems, factors associated, and their health-seeking behavior. Methods: Descriptive cross-sectional study was conducted in Agra city, Uttar Pradesh during December 2017 and November 2019 among a sample of 52 MSM. The Snowball technique of sampling was used to recruit the eligible subjects. Data were collected by interview and analyzed using MS excel. Results: Overall prevalence of any sexual health problem in past 1 year was 71.2%. Anal/perianal problems (26.9%) and genital/oral vesicles (26.9%) were the most commonly encountered illnesses MSM who had all their sexual encounters with men (completely homosexual), those MSM who used to play both insertive and receptive roles, had 5 or more sexual partners, used condom irregularly had significantly higher chances of having sexual health problems. Most (70.3%) MSM sought treatment for their sexual health problem from an Allopathic doctor; 29.4% took treatment from a government health facility. The majority (94.1%) of them were reportedly satisfied with the health care facility. Most (79.4%) respondents preferred not to disclose their sexual behavior during interaction with their sexual health care provider. Conclusion: High prevalence of sexual health problems was found among MSM who engage in high-risk sexual behavior. MSM requires access to STIs screening. Behavior change communication is needed to improve their health-seeking behavior.

Background: Appropriate infant and young child feeding (IYCF) practices in the early years of life will ensure optimal growth and development of the child. However, many children are not fed in the recommended way. Objectives: To assess the risk of malnutrition as a result of various feeding practice patterns among the children with the application of the decision tree algorithm. Methods: It was a community-based cross-sectional study conducted in the urban slums of Berhampur Municipal Corporation in Ganjam District, Odisha, India, from January to December 2019. Among a sample of 360 children of 6–23 months, nutritional status and feeding practices were determined. Data were analyzed using R version 3.6.1 developed by R Foundation for Statistical Computing, Vienna, Austria. The effect of IYCF practices on nutritional status was explained with the decision tree method with the use of a Chi-squared automatic interaction detection algorithm. Results: The prevalence of children with early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum meal frequency (MMF), and minimum dietary diversity (MDD) was 62.2%, 59.7%, 41.9%, and 19.4%, respectively. The prevalence of wasting, stunting, and underweight among the participants was 36.4%, 31.1%, and 35.3%, respectively. The significant factors which classified and predicted wasting were EBF, EIBF, and MDD, for stunting factors were EBF, MMF, and MDD and for underweight, significant factors were EBF, EIBF, and MDD. Conclusion: With the decision tree approach, the probability of malnutrition in relation to various feeding practices patterns can be easily explained to the mothers and health workers as compared to interpreting odds ratio and strict adherence to IYCF guidelines can also be ensured.

Background: There are rich state-based epidemiological evidences on dementia in India, which shows that neurodegenerative disorders are one of the major public health problems. However, inconsistencies and variability have been observed among the findings of most of the reported studies. Objectives: This meta-analysis was conducted to estimate the overall prevalence of dementia in India. Methods: Databases of several web sources, namely EBSCOhost, PubMed, PsycINFO, and Google Scholar were explored for searching the studies that had previously observed the prevalence of dementia in India. Retrieved articles were systematically selected using specific inclusion and exclusion criteria. The quality of the included studies was assessed through guidelines of strengthening the reporting of observational studies in epidemiology, and the risk of bias was assessed using the guidelines of Quality in Prognosis Studies. Meta-analysis was computed using R software (3.5.3) with “metaphor” package. Results: The present meta-analysis included 20 epidemiological studies consisting of 86,312 persons, out of which a total number of 1193 persons reported to have dementia across several states of India. The results of the meta-analysis indicated the number of elderly that suffer from dementia amounts to 20 per 1000 population (95% confidence interval: 0.02–0.03). The prevalence was higher in older age groups (75 years and above) as compared to those below 75 years of age. However, the prevalence rates were similar for males and females and rural and urban population. Conclusion: Dementia is a common neuropsychiatric condition in the Indian elderly population. Further, evidence-based national survey is needed to estimate the exact prevalence of the disease in the country.

Background: Contraceptive behavior and unmet need for family planning, particularly among the tribal women of reproductive age in India, still remains a public health concern. This needs to be explored in different geographical regions. Objectives: This study aimed to ascertain the contraceptive behavior of tribal married women of 15–49 years and to assess the unmet need for family planning and its determinants. Methods: A descriptive, cross-sectional study was conducted during May 2019 to April 2020 in Barabani Block of Paschim Bardhaman District, West Bengal. A calculated sample of 530 study participants was selected from the study area by the simple random sampling. Required data on contraceptive behavior characteristics, unmet need, and correlates were collected by interviewing them with a predesigned schedule. Bivariate analysis and multivariable logistic regression were done. Data were analyzed using the SPSS software v. 20. Results: All study participants were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate; 51.7% had early marriage, and 52.4% had adolescent pregnancy. Only 41.1% women were found currently using any contraceptives, another 14.5% ever used and 44.4% never used any methods. Apprehension of side effects and spouse disapproval were reported as two common reasons for never using contraceptives. The age of the women appeared as a significant predictor of current contraceptive use. Overall, unmet need for family planning was 19.4% and age of the women, socioeconomic status, and type of the family were found as significant predictors. Conclusion: Issues contributing to unsatisfactory contraceptive behavior and high unmet need for family planning need to be addressed appropriately.

Background: Vitamin D deficiency is highly prevalent among the Indian population and it is found to be associated with many diseases among perimenopausal women in various hospital-based studies. Objectives: This study aimed to find out the Vitamin D status among perimenopausal women and to assess the association of selected factors with Vitamin D status among them. Methods: A cross-sectional study was conducted among 184 perimenopausal women in two districts of Kerala from July 2018 to February 2019. The data were collected and blood sample was taken for determining the 25(OH) D levels after obtaining informed written consent. Descriptive and inferential statistics were done using SPSS version 22. Results: Among the 184 women, 2 (1.1%) had sufficient, 18 (9.8%) had insufficient, and 164 (89.1%) had deficient 25(OH) D levels. The mean 25(OH) D levels among the population were 15.01 ± 4.32 ng/ml (95% confidence interval 14.38–15.63), much lower than the required level of 30 ng/ml. Vitamin D level was significantly higher among women who had exposure to sunlight, were on Vitamin D supplementation, and those who had skin diseases. 25(OH) D levels were higher among residents of Ernakulam district, older age group, low socioeconomic status, mixed-diet consumers, those who attained menopause, and those had calcium supplementation. The level was low among those who regularly use sunscreen topical applications and had other comorbidities such as hypothyroidism. However, none of these factors were significantly associated with 25(OH) D levels. Conclusion: The study showed that Vitamin D deficiency is highly prevalent among the study population.

Background: Disclosure of human immunodeficiency virus (HIV) status has potential benefits for both the individual and society. Objectives: This study aimed to determine the disclosure rate and its associated factors in people living with HIV receiving care in Enugu, Nigeria. Methods: A cross-sectional study using mixed methods was carried out in 5 comprehensive treatment facilities in Enugu, Nigeria during March to August 2019. 300 participants for the quantitative aspect were selected using a simple random sampling method and 30 participants for the qualitative aspect were selected purposively. Interviewer administered questionnaire and focus group discussion were applied for data collection. The quantitative data was analyzed using Epi info version 7; Chi-square test and multivariable logistic regression were applied and a level of statistical significance was set at P < 0.05. The qualitative data were analyzed using thematic analysis. Results: Among 300 participants, 241 (80.3%) had voluntarily disclosed their status to someone within their social network. 228 respondents had sexual partners and 122 (52.4%) had disclosed to their sexual partners. Twenty-five (11.0%) disclosed to their partners on the day of diagnosis. Predictors of disclosure were being female, having a formal education and being 35 years or more. Conclusion: This study revealed high voluntary disclosure rate to someone within the social network, but lower and delayed disclosure rate to sexual partners.

Background: Male participation plays an important role in affecting reproductive health outcomes. Communication between a wife and husband regarding reproductive matters is well recognized as a factor influencing good interpersonal relationships. Objectives: The objectives of this study were to assess male participation in reproductive health care of women and spousal communications and also to identify factors associated with interpersonal relationship. Methods: The present descriptive study was conducted among 104 married women aged 18–49 years in a rural community of Haryana during the months of June and July 2019. Study variables included sociodemographic characteristics, reproductive health characteristics, male participation in reproductive health care of women, and interpersonal communication. Results: Male participation was reported by 72 (69.2%) women with an overall involvement of spouses in antenatal care by 71 (68.3%) women. Joint decisions concerning desired number of children, use of contraceptive, and choice of contraceptive use were reported by 47 (45.2%), 48 (46.2%), and 55 (52.9%) women, respectively. Good interpersonal relationship was reported by 80 (76.9%) women and 67 (64.4%) felt their expectations were fulfilled. Male partners played dominant roles in decisions concerning contraceptive use and place of delivery only. Low socioeconomic status came out to be a significant risk factor of not having good interpersonal relationships (P = 0.02). Conclusion: Male participation in reproductive health care of women was reasonably high. Spouses were having good interpersonal relationships meeting expectations of women. Efforts should be made for increasing male involvement and encouraging better interpersonal communications for attaining desired reproductive health outcomes for women.

Background: Under programmatic settings, routine monitoring and evaluation of household consumption of iodized salt are recommended to track the reach of universal salt iodization strategy. The program needs evaluation in different settings and locations. Objective: The objective of this study was to assess urine-based estimation for recent iodine intake among pregnant women living in hilly terrains of two districts of northern state of India. Methods: A community-based cross-sectional observational study was conducted during September– December 2019 among 202 randomly selected pregnant women in two districts of Himachal Pradesh. With a predesigned schedule, data regarding sociodemographic and behavioral factors and salt consumption were collected by interview. Iodine level of salt was assessed by spot iodine testing kit and urinary iodine concentration (UIC) was measured using ammonium persulfate digestion using spectrophotometer. Results: Women had a mean age of about 26 years, and the period of gestation was of mean 163.7 days. The consumption of iodized salt (>15 ppm) at family level was found to be 83.7%, and the median UIC was 169.0 μg/L. Among assessed, 26.7% had an acceptable level of UIC, whereas 41.1% and 32.2% of women had less (<150 μg/L) and excessive (>250 μg/L) level of UIC, respectively. Conclusion: Recent iodine intake among pregnant women was observed to be adequate, but efforts are to be done to assess the reasons for less and excessive UIC among women.

The patterns of concordant and discordant comorbidities of hypertension and their association with hypertension control were ascertained in this cross-sectional study. A total of 402 adults with hypertension were identified from the baseline survey of a randomized controlled trial for hypertension control among school teachers in Kerala. Chronic conditions were captured and categorized into concordant and discordant comorbidities. Nearly 57% of teachers with hypertension reported multimorbidity. Concordant morbidity was reported by 44% and discordant by 21% of participants. The odds of hypertension control was higher among those who reported at least one discordant morbidity (odds ratio [OR]: 2.76, 95% confidence interval [CI]:1.69–4.49) and those who reported at least one concordant morbidity (OR: 2.08, CI: 1.37–3.16), compared to their counterparts. Hypertension control was higher for those who reported any comorbidity (OR: 2.37, CI: 1.51–3.71) compared to those who did not report any. Well-designed large-scale mixed methods studies are required to thoroughly explore multimorbidity and its relationship with hypertension control in India.

Fish processing employees are exposed to various occupational risk factors that result in musculoskeletal pain (MSP). The objective of the study was to determine the characteristics of MSP among them and its association with the nature of the job and work condition. A cross-sectional study was conducted among 364 employees of five fish processing factories using standard questionnaires. Descriptive analysis and Chi-square test were performed using SPSS software version 15.0. The prevalence of MSP was 77.7% affecting more of the upper extremities (43.8%). Mild and moderate types of pain were more (37.6%) that resulted due to repeated work (30.2%) and work method (35.4%) that include extreme temperature and work posture. The mean numeric pain severity score was 3.02 ± 2.14. Global self-rated health was reported as predominantly good (57.7%). To conclude, the study revealed a higher prevalence of MSP and its various characteristics in detail which help in designing intervention programs.

There is a paucity of antihypertensive drug adherence studies among stroke patients in West Bengal. With an aim to identify antihypertensive drug adherence and its determinants, this descriptive cross-sectional study was conducted for 2 months among a calculated sample of 133 study participants using predesigned and pretested schedule, the metric “Proportion of days covered (PDC),” and the Morisky, Green, and Levine (MGL) Scale. Data were compiled and analyzed using SPSS software (version 20.0). Adherence rates were 31.6% and 44.4% based on the MGL scale and PDC method, respectively. Higher adherence was significantly associated with increased age (P = 0.006), higher literacy (P = 0.013), increased interval between diagnosis of hypertension and present symptom (P = 0.001), a greater gap between antihypertensive treatment initiation and present symptom (P = 0.003), receiving advice on regular drug intake (P = 0.000), and registered medical practitioner prescribing the medication (P = 0.007).

Road crash fatalities form leading cause of deaths in India. Streamlining road crash data systems are essential for building robust prevention strategies. This study explores epidemiological profile of fatal road crashes in a south Indian urban setting. Between April and June 2019, secondary data on fatal road crashes in Puducherry district for 3-year period (2016, 2017, and 2018) were accessed from traffic police records and analyzed. Raw data accessed in descriptive format was converted to analyzable objective format by self-developed data extraction template. 154 fatal crashes happened in Puducherry during this period. Most victims were males (85.7%), in productive age group (41.5%), with higher rates in monsoon and winter seasons (35.1% each), during evening-to-night hours (41.6%), and during weekends (42%). Most offenders (91.2%) were men, elder than victims, with heavy motor vehicles (91.2%) being the culprit vehicle. Rash driving led to most deaths (53.2%).

Rumors have significantly affected immunization campaigns in the past. The ongoing COVID-19 vaccination program in India needs to frame public communication messages both to promote vaccine demand and update as well as counter COVID-related rumors. COVID-related rumors have had wide-ranging effects in the country, from stigmatization of health workers to a crash of prices in the poultry sector. Appropriate communication strategies are critical for tracking, negotiating, and shaping perceptions around the vaccines and the program. Issues that will shape perceptions around the vaccines include product development, prioritization strategies, program rollout activities, and adverse effects following immunization and adverse effects of special interest.

India's journey in the digital health arena and its contribution to the landmark resolution on digital health by the World Health Organization has been recognized globally. India has demonstrated its commitment to leverage digital health as a health system strengthening intervention, as outlined in the National Digital Health Blueprint based on which, the National Digital Health Mission (NDHM) is currently being piloted by the National health authority. Further, the Sandbox environment of NDHM is actively encouraging all the ecosystem partners to familiarize with the evolving national digital health infrastructure. The strategy to enhance the India's progress in implementation and scale-up of digital health interventions are drawing attention to workforce capacity building, harnessing health data to facilitate research and development, evidence-informed development of policies, sustaining efficiency and quality of system through appropriate monitoring, and periodic evaluation informed by frameworks specific to digital health or those adapted to evaluate health informatics applications.