High-level arsenic contamination of drinking water in West Bengal (WB), India is a grave public health concern, with 26 million people remaining affected. Two decades of research has provided detailed information on multiple aspects of exposure assessment and risk characterization. However, policy paralysis due to lack of finances and lack of any administrative coordination between the Central and State Governments has hampered the implementation of long-term solutions. Household- and community-level arsenic removal units have provided some relief to the suffering population. In view of the increased funding through the 12th Five-Year Plan period, it is the responsibility of the authorities to implement piped water supply schemes with single-point treatment facilities as the permanent solution to this three-decade-long crisis. Incorporating research evidence into policy and focusing on behavior change communication would be crucial to that end.

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The prevention, control, and management of sexually transmitted infections/reproductive tract infection (STI/RTI) are well-recognized cost-effective strategies for controlling the spread of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). A cross-sectional descriptive study was done over a period of 1 year to assess the prevalence of STI, knowledge level about STI, and the STI-HIV link among the female sex workers (FSWs) of Lucknow city, Uttar Pradesh, India along with their biosocial characteristics. Most of the FSWs were illiterate, married, Hindus, and belonged to general category. The prevalence rates of STI among street-based and home-based FSWs were 50.6% and 29.8%, respectively. Knowledge about the role of condom in prevention of STI and the STI-HIV link was significantly less among home-based FSWs than those who are street-based. There is a great lack in the awareness among FSWs regarding STI and their prevention. Behavior change communication (BCC) and advocacy strategy were developed, especially for the home-based group, to strengthen their knowledge regarding the STI-HIV link.

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Background: Janani Shishu Suraksha Karyakram (JSSK) was launched in India to ensure cost-free institutional delivery. Objectives: 1) To assess the awareness of recently delivered women regarding JSSK 2) To estimate the cost of institutional delivery and its differentials. Materials and Methods: A community-based, cross-sectional study was conducted in a rural community in Bankura, West Bengal, India in 2013, among 210 women who delivered babies in the last 12 months. Information regarding sociodemographic and health service-related variables as well as item-wise costs incurred for institutional delivery were collected. Costs were expressed in Indian National Rupee (INR). A nonparametric, bivariate analysis was performed to examine the difference in median cost. Results: All components of JSSK were known to 12.9% women; the highest (77.1%) for admission and lowest (29.0%) for blood transfusion. The median (±IQR) costs of delivery in the Block level Primary Health Center (PHC), medical college, and private facilities were INR 205.0 (±825.0), 900.0 (±1013.0), and 6600.0 (±16195.0), respectively. Median cost of normal delivery in a private facility (INR 2750.0) was 3.6 times of that in a government facility (INR 765.0). Median direct cost of caesarian section (CS) in a government facility (INR 1100.0) was nearly one-fifteenth of that in a private facility (INR 16,350.0). Cash incentives under Janani Suraksha Yojana for poor and socially marginalized women could not cover the cost of CS delivery in a government facility. Conclusion: Gaps existed in the awareness of beneficiaries regarding entitlement under JSSK. Drugs and transport were two major causes of out-of-pocket (OOP) expenditure in public health facilities.

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The strategy for prevention and control of sexually transmitted infections (STIs) in India is based on syndromic case management delivered through designated STI/reproductive tract infection (RTI) centers (DSRCs) situated in medical colleges, district hospitals, and STI-clinics of targeted interventions programs. Laboratory tests for enhanced syndromic management are available at some sites. To ensure country-level planning and effective local implementation of STI services, reliable and consistent epidemiologic information is required on the distribution of STI cases, rate and trends of newly acquired infections, and STI prevalence in specific population groups. The present STI management information system is inadequate to meet these requirements because it is based on syndromic data and limited laboratory investigations on STIs reported passively by DSRCs and laboratories. Geographically representative information on the etiology of STI syndromes and antimicrobial susceptibility of STI pathogens although essential for optimizing available treatment options, is deficient. Surveillance must provide high quality information on: (a) prevalence of STIs such as syphilis, trichomoniasis, gonorrhea, and chlamydia among high-risk groups; syphilis in the general population and pregnant antenatal women; (b) demographic characteristics such as age, sex, new/recurrent episode, and type of syndromically diagnosed STI cases; (c) proportion of acute infections such as urethral discharge (UD) in men and nonherpetic genital ulcer disease (GUD) in men and women; (d) etiology of STI syndromes; and (e) gonococcal antimicrobial susceptibility. We describe here a framework for an STI sentinel surveillance system in India, building on the existing STI reporting systems and infrastructure, an overview of the components of the proposed surveillance system, and operational challenges in its implementation.

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Objective: The objective of this study was to translate the Geriatric Oral Health Assessment Index (GOHAI) into the Hindi language and assess its validity and reliability for use among people in India. Materials and Methods: GOHAI was translated into the Hindi language and self-administered to 420 subjects aged 55 years or above. The measures for reliability, and concurrent, convergent, and discriminant validity were assessed. The questionnaire sought information about sociodemographic details, habits related to tobacco, dental visits, tooth brushing, and self-reported perceptions of general and oral health. Results: Cronbach's alpha (0.774) showed high internal consistency and homogeneity between items. Low GOHAI scores were associated with the perceptions of poor oral and general health, low satisfaction with oral health, and a perceived need for dental care. Respondents with high socioeconomic status were likely to have high GOHAI scores. Conclusion: The Hindi version of the GOHAI demonstrated acceptable validity and reliability, and will be an important instrument to measure oral health-related quality of life (OHRQoL) for people in this region.

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Emotional intelligence (EI) is the ability to identify, assess, and control the emotions of oneself, of others, and of groups. Stress resulting from having to meet professional demands is common in the medical student's life. The perceived stress (PS) can be either an input or an outflow of EI or the lack thereof. This study was done to assess EI levels and to find out its association with sociodemographic variables and PS among medical students. Data were collected using a self-administered questionnaire from 198 first-year and 208 second-year medical students. EI scores were found to increase with age (r = 0.169, P = 0.004). PS scores were found to be higher among first-year students (P = 0.05). PS scores were found to decrease with increase in EI scores (r = −0.226, P < 0.001). Hence, if sufficient measures to improve EI are provided in the beginning, it would make students more stress-free during their training years at medical schools.

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Introduction: Guideline development gathered pace in India after the inception of National Rural Health Mission (NRHM) in 2005. However, there is a lack of adequate information about guideline development process, review, and update. This paper reports on the systematic appraisal of Indian guidelines related to maternity management (MM) and family planning (FP) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which was one of the components of a pilot research in 2012-13. Materials and Methods: Forty-four selected guidelines about MM and FP, identified through a consensus building workshop, were independently appraised by two appraisers with AGREE instrument having six different domains. Mean item scores, domain scores, and standardized scores were calculated by averaging the scores across the two appraisers. Results: Most guidelines scored high in scope and purpose and clarity of presentation. However, they had little documentation about the development group member details, incorporation of patient views, evidence search method, method chosen for formulating recommendations, tools for application, potential barriers, cost implications, and information about the funding body. Nonclinical guidelines scored higher than clinical guidelines (P = 0.01) for MM in the domain applicability. Clinical FP guidelines scored higher than nonclinical guidelines in the domain of rigor of development (0.01). Conclusion: Despite being clinically sound, Indian guidelines score poorly due to weak documentation about their development process. It is recommended that the guideline development process be improved with systematic documentation for achieving standardization.

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A large number of Indian couples are exposed to the risk of heterosexual human immunodeficiency virus (HIV) transmission. The present records-based study was undertaken at the voluntary counselling and testing facility of a tertiary care hospital in New Delhi, India to determine HIV prevalence among Indian couples; to assess the magnitude of seroconcordance and discordance among HIV-affected couples; and to compare the concordant and discordant partnerships for sociodemographic determinants and cluster of differentiation 4 (CD4) counts. Of the 1309 couples included in the study, 249 (19%) were HIV-affected, and of them 113 (45.4%) were concordantly and 136 (54.6%) discordantly affected by HIV. Males were the HIV-infected partners in 72% of the serodiscordant partnerships analyzed. Seroconcordance was significantly associated with the occupation status of being a housewife (P = 0.009). The contribution of discordant partnerships to the burden of HIV/acquired immune deficiency syndrome (AIDS) is significant, warranting novel couple-targeted counselling strategies and preventive measures, including safe sexual behavior and possibly preexposure HIV prophylaxis of the uninfected partner.

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Objective: To determine the pattern and reasons for psychoactive substance use by long-distance commercial vehicle drivers in a Nigerian city. Materials and Methods: All licensed long-distance commercial vehicle drivers who travel a distance of at least 500 km from the city metropolis were recruited. Each fourth consecutive driver who was to load his vehicle for the day was interviewed at the 10 long-distance motor parks. They responded to a sociodemographic and semi-structured pro forma requesting the type of drug used and the reason and pattern of use. The data obtained were analyzed by means of descriptive statistics using the statistical package for social sciences (SPSS) version 16. Results: All the respondents were males with a mean age of 43.4 years. There was no statistically significant difference between the mean age of substance users and nonusers (t = 0.491, P = 0.853). The reasons given for drug use were to keep awake while driving, for pleasure, as part of the culture, peer influence, as a substitute for food and for no obvious reason. The pattern of use tended to be related to the reason given for the use. Conclusion: The reason for drug use in long-distance drivers could be used to modify the pattern of use to minimize the risk associated with drugged driving.

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Anthrax is one of the top 10 diseases reported in India and also one of the major causes of death in livestock. This study was conducted to confirm the outbreak of suspected anthrax, determine the transmission mechanism, and implement control measures in Bhatar block of Burdwan district, West Bengal, India. A cross-sectional descriptive study was conducted through house-to-house visits in Oregram and Kathaldanga villages during the period from May 30, 2013 to June 8, 2013. Out of the 93 persons exposed to anthrax, 11 persons had history of slaughtering, while 82 consumed the meat. All of the 7 cases of suspected anthrax were male (mean age 41.14 ± 10.04 years) and involved in slaughtering the animal. Most cases presented with papule and vesicle over the upper extremity and the trunk. One patient among the suspected cases died. The outbreak was labeled as a suspected anthrax outbreak. A health awareness camp was organized to improve awareness of anthrax among villagers.

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Community-based surveys are essential to monitor iodine deficiency disorders (IDD) program at both the state and national levels. There is paucity of information on population iodine nutrition status in Haryana state using standard methods. A cross-sectional study was conducted in villages of Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, Haryana, India. A total of 465 randomly selected individuals were assessed for urinary iodine concentration (UIC) by microplate method and household salt iodine content using iodometric titration. Of the interviewed households, 73% were using adequately iodized salt (≥15 ppm). Iodine nutrition was deficient in 17% respondents (UIC <100 μg/L); 20.2% among males and 13.9% among females. Iodine intake of the study population as measured by UIC was adequate but nearly one-fourth of households in the study population were consuming inadequately iodized salt. The availability and access to adequately iodized salt in the study population should be improved by strengthening regulatory monitoring.

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Drinking unsafe and unhygienic water can cause waterborne diseases such as diarrhea and typhoid. The present study describes the microbial evaluation of bottled water sold in North India. The samples were analyzed for total viable count and coliforms and susceptibility to different antibiotics. Though free of coliforms, the samples had a total viable count ranging from 0.01 × 10 ^[1] cfu/mL to 2.40 × 10 ^[3] cfu/mL and in 17% of the samples, total viable count was much higher than specified by the Bureau of Indian Standards (BIS), Government of India. Among the samples, 6.5% also showed fungal growth. On checking the sensitivity of bacteria isolates to different antibiotics, most of the strains were found to be resistant to a number of antibiotics. It can thus be concluded that the consumption of bottled water with a high viable count and that was bacteria-resistant to different antibiotics may have an effect on the health of the consumers, especially immune-compromised individuals.

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