Background: A child receiving an acceptable diet is expected to reach the optimal anthropometric measures. More than 60% of dietary requirement has to be met through complimentary diet. Objectives: This aimed to estimate the prevalence of dietary diversity and to assess factors associated with it from caregivers' perceptions by quantitative and qualitative participatory techniques. Methods: A mixed-method study comprising community-based cross-sectional quantitative and participatory rural appraisal qualitative components was conducted in 25 villages from the field practice area of medical institute in South India during 2017. Caregivers of eligible children 6–23 months from villages were interviewed regarding various food groups consumed in the last 24 h using a validated checklist. Association of demographic-, child, and mother-related characteristics with inappropriate dietary diversity was identified using multivariate negative log-binomial model. Results: Of the 603 eligible children, 75.1% had inappropriate dietary diversity. Although inappropriate dietary diversity prevailed across all categories, mothers with less than primary education (adjusted prevalence ratio [PR]: 1.26) children <1 year (adjusted PR: 1.29) and not on current breastfeeding (adjusted PR: 1.15) had significantly more inappropriate diversity. Restraining and motivating forces for dietary diversity were initially recorded from free listing and subjected to force-field analysis. Ignorance, lack of literacy, affordability issues, nuclear family pattern, and influence of junk foods are restraining forces. Conclusion: Inappropriate dietary diversity among 6–23 months children in the rural block of Tamil Nadu, South India, is extensive (75%). Current Child development programs should focus to address these issues based on these identified contextual factors.

Background: Cement in one hand is the most used substance for construction all over the world but on the other hand prolonged exposure from cement dust particles along with smoking, long working duration in dusty environments and increasing age impairs pulmonary functions. Objectives: The study aimed to determine the effect of cement dust on the pulmonary functions of cement factory workers. Methods: It was a cross-sectional observational study conducted from October 2019 to February 2020 among 360 workers of cement factories of Chhattisgarh state selected by systematic random sampling who were interviewed. Spirometry was done and their forced vital capacity, forced expiratory volume in one second, Forced expiratory flow, peak expiratory flow rate, and lung age were determined with a flow-sensing spirometer. Data were collected, entered in MS Excel spreadsheet, and analyzed using SPSS software (version 20.0) for Chi-square test, linear regression, and general linear model. Results: One-third of the study subjects had pulmonary dysfunction, out of which 10% and 30% were having severe and moderate dysfunction, respectively. Significant higher Odds for developing impaired pulmonary functions were seen among >40 years of age (adjusted odds ratio [AOR] =1.88 [1.13, 3.12]), more than 10 years of service (AOR = 4.69 [2.32, 9.53]) and smokers (AOR = 4.45 [2.53, 7.83]) Conclusion: Working in dusty environment along with other factors in cement factories significantly decrease lung parameters. Exposure with dust is strong predictor for chronic respiratory symptoms.

Background: In India, there exists public health insurance for government employees and poor people. However, the middle-income households (MIHs) remain neglected. Objectives: The study was conducted to find out the coverage of health insurance and its determinants among MIH. Methods: It was a community-based sequential exploratory mixed methods study. Group interview and key informant interview were conducted among various stakeholders related to insurance coverage. The quantitative survey was done among 400 randomly selected head of households (HoHs) in an urban area of Puducherry. Manual content analysis was done for qualitative data. Generalized linear model with Poisson distribution was used to calculate the adjusted prevalence ratio (aPR) using Stata software. Results: The coverage of health insurance among the MIH was 41% (95% confidence interval [CI]: 36.1–50). The major reasons reported for not having insurance were poor financial status (63.7%) and lack of felt needs (59.4%). The significant determinants for the lack of health insurance among MIH were unskilled occupation (aPR: 1.62, 95% CI: 1.13–2.34) and lower education status (aPR: 1.79, 95% CI: 1.22–2.64) of HoH and less monthly family income (aPR: 2.19, 95% CI: 1.18–4.08). Conclusion: The health insurance coverage of 41% among MIH is better despite the fact that there was no public insurance scheme available for them in Puducherry. The MIH with the identified determinants might be considered in future for including them under publicly sponsored health insurance scheme.

Background: The Universal Health Insurance System (UHIS) has currently entered into service in July 2019 in Port-Said, a small governorate in Egypt, as a pilot to be generalized in 5 phases. Objectives: The study aimed to compare the quality of referral practice under the UHIS and the traditional system (Mansoura). Methods: A comparative cross-sectional study that was conducted in the duration from July 2019 to June 2020, targeted all physicians and nurses working in primary health care (PHC) sites and hospitals within the UHIS (204 doctors, 396 nurses) with an equal number from PHC sites and hospitals in Mansoura (205 doctors and 395 nurses). A predesigned validated self-administered questionnaire was used to collect data. Results: The study included 1200 physicians and nurses. Results showed that receiving referrals without letters and referrals not conforming with the rules were significantly lower in the UHIS (13.4% vs. 50.2%, and 39.5% vs. 60.7%, respectively). Denying a referral was significantly higher in the UHIS (38.8% vs. 21%, P ≤ 0.001). The drawbacks in the referral system were less reported in the UHIS (P ≤ 0.001 for most items). There were no significant differences regarding the presence of rules for referral or attending training courses related to the referral process (P = 0.269, P = 0.188, respectively). Conclusions: The study indicates that considerable improvements in the quality of the referral process were achieved. However, the system needs more efforts related to in-service training of the staff, feedback letter.

Background: Low level laser therapy is a novel noninvasive technology used to stimulate the acupoints recognized for tobacco cessation. Objective: To compare the effect of laser auricular acupuncture, psychological counseling, and combination of laser acupuncture and psychological counseling in reducing nicotine dependence due to smoking. Methods: Smokers (n = 150) fulfilling the eligibility criteria were randomly allocated to three interventional groups. Evaluation of the nicotine dependence and physical effects due to smoking were done using Fagerstrom test and Visual Analog Scale, respectively, at baseline and 1 month postintervention. Person's Chi-square, Kruskal Wallis analysis of variance, and Wilcoxon signed-rank tests were used for the statistical analysis. Statistical significance was set at P ≤ 0.05. Results: There was a statistically significant reduction in nicotine dependence (P = 0.00) and physical effects related to smoking (P < 0.05) in all the interventional groups 1 month postintervention. Reduction in Fagerstrom test scores was significantly higher (P = 0.001) in Group 3 (laser acupuncture with psychological counseling) as compared to other groups. There was significant reduction (P < 0.01) in irritability, tiredness, craving, headaches, and significant increase (P < 0.05) in the unpleasant taste due to smoking and ability to concentrate in laser acupuncture with psychological counseling group as compared to other groups. Conclusion: Auricular laser acupuncture with psychological counseling was effective in reducing nicotine dependence due to smoking.

Background: Substance abuse by female sex workers (FSWs) is particularly prevalent in the Northeastern states in India. It is important to understand how the FSWs actually function in different contexts. Objectives: The study aimed to describe various characteristics of substance abusing FSWs and to explore the changing trends in sex work dynamics in Imphal, Northeast India. Methods: This community-based, mixed-method, cross-sectional study was conducted among FSWs in Imphal from May 2017 to August 2019. 288 FSWs were recruited using respondent-driven sampling method and were interviewed using a semistructured questionnaire after obtaining written informed consent. Focus group discussions and in-depth interviews were conducted with participants and key informants. Results: The mean ± standard deviation age of the respondents was 30.9 ± 6.1 years; 53.8% were Christian. Majority (98.3%) of the respondents reported sex work as their only source of income; drug use (41.3%) and poverty and debt (35%) were main reasons for involvement in sex work. The most common place of solicitation was lodge/hotel (72.9%); condom was not used during the last sexual act by 2.1%; and heroin was frequently used before having sex by 52.1% and 9.3% used mobile phones for soliciting clients. “Pimps helped in getting customers but want to avoid paying half to them.” “It's easy to contact customers on mobile phone. I have 10–12 regular customers contacting through mobile.” Conclusions: Substances abusing FSWs predominantly uses heroin before sexual act and continue to practice unprotected sex. Newer technology like mobile phones was used for soliciting clients.

Background: COVID-19 is a public health concern currently demanding continuous efforts to understand its epidemiology. Pimpri-Chinchwad township with a population of over 25 lakhs is located in Maharashtra, one of the worst affected states in India. After the incidence peaked in the township in mid-September 2020, cases started declining even as lockdown restrictions were eased. Objectives: A seroprevalence study was conducted to understand the transmission dynamics of the pandemic in this region. Methods: We carried out a population-based seroprevalence study for IgG antibodies for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among 5000 residents 12 years and above selected by the cluster random sampling. We selected 50 clusters in slums, 80 clusters in tenements, and 70 clusters from housing societies. The field work for collection of samples was carried out from October 07 to October 17, 2020. We used kit from Abbott (SARS-CoV-2 IgG), which employs chemiluminescent microparticle immunoassay technology. The prevalence of IgG antibodies was expressed as point estimates with 95% confidence intervals (CIs). These were weighted for areas and cluster effect and further adjusted for test performance. Results: The overall seropositivity for IgG was 34.04% (95% CIl 31.3%–36.8%). Slum dwellers had 40.9% positivity rate (95% CI 37.0%–44.7%), those in tenements 41.2% (95% CI 37.7%–44.8%) and people living in housing societies had 29.8% positivity (95% CI 25.8%–33.8%). Conclusion: A considerable proportion of population had encountered the novel coronavirus approaching partial, if not complete, herd immunity, which may partly explain the declining trend in spite of easing of lockdown restrictions.

Background: Female dominion in family planning has underestimated men's participation in female reproductive health. Objective: To assess male's involvement in female reproductive health with regard to safe motherhood and family planning and to explore the factors influencing the participation of males in reproductive and sexual health. Methods: A community-based, mixed-method study was conducted from May 2018 to January 2019 in urban Puducherry. All eligible couples with at least one child were included. Two-stage random sampling with a sample size of 373 was considered. Data were collected separately among spouses using epi-collect 5 and analyzed using the SPSS software version 23. Qualitative data were obtained using free-listing and pile-sorting techniques, analyzed in Anthropac software. Results: 39.9% had planned their pregnancy. Only 33.5% of couples had decided together with the place of delivery. 76.7% of wives wish to involve their husbands in family planning. 88.2% of wives and 89.8% of husbands chose tubectomy as the preferred method of permanent contraception. Both husband and wife were involved in child rearing among 60.3% of participants. The changing dynamics of society, health-care provider initiative, and literacy level favored males' involvement in females' reproductive health. Conclusion: Men were involved in planning the pregnancy, supporting their spouse by accompanying for antenatal checkups, discussing with their partners about the complications faced during pregnancy. Health care facility-related factors and faith were perceived as hindering factors for males' involvement in reproductive health by either gender.

Background: Overweight and obesity during adolescence is an important public health problem. However, little is known about the age-and sex-specific mid-upper arm circumference (MUAC) cut-offs for identifying overweight and obese adolescents. Objectives: The present study was planned to assess diagnostic performance of MUAC in identifying overweight and obese adolescents and estimating age specific MUAC cut-offs, separately for males and females, taking body mass index for age Z-score (BAZ) as the gold standard. Methods: The present study is secondary data analysis using Comprehensive National Nutrition Survey, India, on 31,471 adolescents. The, area under curve receiver operating characteristic curve (AUC), and Youden Index were used to estimate MUAC cut-offs for overweight (BAZ > +1) and obesity (BAZ > +2). Results: The MUAC cut-offs to identify overweight were: For 10–14 years– 22.9/23.4 cm, for 15–19 years – 27.0/25.6 cm for males and females, respectively; and for obesity were: For 10–14 years – 24.5/25.1, for 15–19 years – 28.5/28.0 cm for males and females, respectively. For overweight, among males, the age-specific cut-off ranged between 21.2 cm (10 years) and 29.8 (19 years), and for females ranged between 21.2 cm (10 years) and 26.7 cm (19 years). For obesity, it ranged between 22.4 cm (10 years) and 31.1 cm (18 years) for males, and 23.9 cm (10 years) to 26.9 cm (19 years) for females. For obesity, AUC ranged between 0.81 and 0.92, indicating good to excellent diagnostic accuracy. Conclusion: Age- and sex-specific MUAC cut-offs could be considered as a screening tool for identifying overweight and obese adolescents.

Background: The Government of India introduced a new cadre of Community Health Officers (CHOs) in the primary health-care system through the Ayushman Bharat Health and Wellness Centres (HWCs) program. Objectives: The study aimed to assess the activities performed and time spent by the existing and new primary health-care team members at the HWC level. Methods: A time and motion study was undertaken in four HWCs in Punjab over a period of 3 months, to assess the time spent by auxiliary nurse midwives (ANMs) and CHOs on different services and activities. Data were collected through direct continuous observation of four CHOs and four ANMs during working hours for a period of 6 consecutive days of a week, along with structured time allocation interviews of all participants. Results: The CHOs spent 5.7 (5.6–5.9) hours per day on duty of which 57% was productively involved in service delivery. The average time spent by ANMs was 4.9 (4.5–5.3) hours per day, with nearly 62% productive time. While the CHOs spent nearly 40% of their time on services for non-communicable diseases (NCDs), the ANMs spent 51% of their time on maternal, infant, child, and adolescent health services. Conclusion: The introduction of HWCs and CHOs has nudged the health system toward comprehensive primary health care by placing a renewed emphasis on NCDs. The study provides useful evidence for staff, program implementers, and policymakers, to aid informed decision-making for human resource management.

Background: The high prevalence of diabetes, urinary tract infection (UTI) in persons with diabetes, and antibiotic resistance throughout the world including India is a cause of concern for health-care providers. Objectives: The study aimed to assess the prevalence of uropathogens, their resistance pattern, and associated factors of UTI among adults with diabetes. Methods: A cross-sectional study was conducted during the year 2018–2019 among 504 adult diabetic patients attending a tertiary care hospital of Bhubaneswar, Eastern India. Using recommended culture methods, clean-catch midstream urine samples were examined for the presence of pathogenic bacteria and their antimicrobial susceptibility pattern. Results: The prevalence of UTI was 75.4% and the predominant isolates were Escherichia coli (25.6%), Enterococcus spp. (18.7%), and Klebsiella spp. (8.1%). Most of the bacteria isolates were sensitive to nitrofurantoin (80.8%), gentamicin (76.8%), and amikacin (72.1%) whereas resistant to cefpodoxime (77.6%), cefixime (70.8%), and cefadroxil (65.0%). The overall multidrug resistance (MDR) to two or more antimicrobial agents was observed in 87.4% bacterial isolates. The odds of developing UTIs were significantly higher in females with diabetes (adjusted odds ratio [AOR]: 2.04; 95% confidence interval CI: 1.33–3.13), those with Stage I/II hypertension (AOR: 1.77; 95% CI: 1.04–3.008), and those having glycated hemoglobin level >9% (75 mmol) (AOR: 2.15; 95% CI: 1.13–4.10) compared with their counterparts. Conclusion: The prevalence of UTI and MDR to commonly used antibiotics among diabetic patients is alarming, and thus, isolation of uropathogenic bacteria and antimicrobial susceptibility testing is crucial for the treatment of UTI in persons with diabetes.

India despite progress in tobacco cessation delivery in government sector has lagged in private health sector. Adopting a two-fold approach of intensive intervention-based counseling with (or without) pharmacotherapy; and prescheduled proactive follow-ups over the subsequent year, this study reports 337 tobacco patients, each followed for a period of 1 year. It observed a quit rate (QR) of 40.9% for total abstinence at 1 year but with a drop of 15.9% when patients were followed up, up to 6 months (49.6%) versus 6–12 months (34.7%). The pharmacotherapy did not benefit to whom it was prescribed (196 [58.2%] patients; QR: 34.7%) versus the rest to who it was either not prescribed or was declined (141 [41.8%] patients; QR 49.6%). Countrywide tobacco cessation clinics (TCCs) may be established in private sector hospitals, and the component of quitline methodology of making proactive calls may be integrated to improve QR in India.

The new competency-based undergraduate medical curriculum advocates early clinical exposure in medical training for adequate orientation to societal and patient needs. The present study aimed to explore the experiences of medical students about community-based training in rural hospitals during the first phase of clinical exposure. An exploratory qualitative study was conducted among 75 Bachelor of Medicine and Bachelor of Surgery students who underwent the training program as part of their undergraduate medical training using “most significant change” technique. The responses collected were analyzed using the inductive approach of thematic analysis. Majority of the participants opined that the program not only has enabled them to better understand their academic learning but also has provided a social learning experience. The student feedback throws light on the potential of such community-based learning programs to inspire the students to become a more humane version of themselves. This study observed that the remote hospital-based training has positively influenced the students.

Postmenopausal women are routinely prescribed calcium and Vitamin-D supplements in view of their increased risk of osteoporosis and fractures. A community-based interventional study was undertaken to determine the effect of Vitamin-D supplementation on self-perceived health-related quality of life in 290 postmenopausal women over 6 months in 2015. Vitamin D (60,000 IU) was supplemented for 8 weeks. The CDC-Health-Related Quality-of-Life Questionnaire -14 was administered to the subjects at baseline and post intervention. The pre and postintervention responses were compared using Chi-square test and paired t-test as appropriate. There was a significant improvement in their overall general health status. Mean systolic blood pressure (BP) was reduced by 3.0% (P = 0.0705) and the mean diastolic BP by 3.2% (P = 0.0419). Post supplementation, high serum Vitamin-D levels was observed in 6.5% of the 92 subjects tested. Prescribing Vitamin D to postmenopausal women without checking the serum levels prior to supplementation may occasionally lead to toxicity.

Appropriate and timely care during pregnancy and delivery can improve maternal health. The present study aimed at determining factors associated with late antenatal care (ANC) initiation among pregnant women attending a comprehensive health clinic in Kandahar Province of Afghanistan. Of the 420 pregnant women, 281 (66.9%) presented late (>12 weeks) for their first ANC visit. The multivariable analysis showed that women with lack of knowledge on when to start ANC (adjusted odds ratio [AOR] =4.82; 95% confidence interval [CI]: 2.63–8.84), not planned last pregnancy (AOR = 3.07; 95% CI: 1.72–5.5), and no ANC visit in the past (AOR = 17.56; 95% CI: 5.89–52.3) were significantly associated with late ANC initiation. Cox and Snell R² was 0.2 and Nagelkerke R² was 0.4. This study has found high rates of late ANC initiation among pregnant women in the study area. The factors associated with late ANC initiation should be addressed to contribute to the reduction of late ANC initiation, and this in turn can improve maternal and fetal health.

Citarum River in West Java, Indonesia, is the most polluted river in the world which pollutes the ocean. This is caused by lack of community empowerment for domestic waste prevention and management. This study aimed to identify factors influencing community empowerment for domestic waste prevention and management, as well as the intervention for improvement. A scoping review was conducted using databases such as Google Scholar, EBSCOhost, and PubMed with keywords such as community empowerment, domestic waste management, waste prevention, and healthy living, published from 2009 to 2019. Initially, a total of 57,339 articles were retrieved, and with inclusion and exclusion criteria, eight articles were included for this review. Based on the results, three influencing factors were found at the individual, community, and government level. Regarding the intervention, promoting people and participatory engagement were the most effective ways to empower people in promoting healthy and clean behavior. Further research is needed to improve community empowerment for waste management among people living in the river basin to reduce pollution from domestic waste.

The COVID-19 pandemic has spread globally with 190.8 million infected cases and 4.1 million deaths as of July 18, 2021. In absence of any definite antiviral agent availability and therapeutic armamentarium, vaccines are considered critical. While 20 vaccines are in use, about 295 vaccines are underdevelopment globally using eleven technological platforms. While the vaccines have >80% efficacy, the ultracold (−70°C and −20°C) storage and logistics requirements for some raise concerns for implementation, especially in developing countries. The Ebola vaccination in African countries, which required an ultracold chain provided lessons for these COVID-19 vaccines. The existing vaccine cold chain system suffers from temperature excursions at cold chain stores and during transportations in different countries suggests careful assessment and addressing the gaps for effective vaccine introduction. Appropriate attention for cold chain storage, logistics (especially the last mile), and vaccine management and upgradation is needed to achieve optimal vaccine effectiveness for curtailing the pandemic.

Cholera is a diarrheal disease causing major health issue in developing countries where it is endemic and causes outbreaks. India ranks first with an estimated 675,188 number of cases and 20,256 number of deaths annually with one-third of its population at risk. The two broad approaches for cholera control are improving sanitation and vaccination. Now both live and killed oral vaccines are available. Live vaccines are advantageous in respect of intestinal colonization and rapid immune response and also lead to in vivo exposure of bacterial products leading to good immunological response against wild Vibrio cholerae infection. The three major delivery strategies which can be considered for the implementation of oral cholera vaccine are preemptive vaccination, reactive vaccinations, and National Immunization Program. We propose the use of cholera live oral vaccines for achieving control of this disease by repeated vaccination of the susceptible population in a series of pulses to control it from the entire population.

This COVID-19 pandemic has posed difficulty in verbal communication among health-care workers with usage of respirators and personal protective equipments. We propose a four tick technique for the nonverbal closed loop communication in health-care settings with limited resources such as low and middle-income countries. It is simple, easy to learn, train, effective, ensuring patient safety and can be extended to nonhealth-care settings and in electronic form.

The management of drug-resistant (DR) tuberculosis (TB) remains a challenge particularly in remote rural areas of the country. Although the treatment with wholly oral drug regimens, including bedaquiline (BDQ) and delamanid, is rolled out under the National TB Elimination Program, little is known about its coverage and the effectiveness in hard-to-reach tribal areas. The present report describes the early identification and successful management, through team effort, of a case of extensively DR TB belonging to the Saharia tribe – a Particularly Vulnerable Tribal Groups (PVTGs) of Madhya Pradesh, which has a very high prevalence of TB. The BDQ-containing regimen was well tolerated and found effective with minimal side effects and contributed to the reduced time to culture conversion and radiological improvements. The concerted efforts and strategies need to be adopted for effective implementation of Programmatic management of DR TB (PMDT) guidelines in remote tribal areas of the country.

There were many challenges faced by both health-care workers and the common population during the COVID-19 pandemic. One such case was witnessed where a migrant worker abandoned his child in a tertiary care hospital, while he was undergoing treatment for acute liver disease and was reported COVID-19 positive. The child was treated for COVID-19 in the dedicated isolation facility of the hospital as per the guidelines. Later, when the child was declared COVID-19 negative and was ready to discharge, treating doctors found it difficult to hand over the child. The timely intervention and extraordinary efforts by the department of hospital administration and child welfare committee reunited the child with his family.