Background: In India, health expenditure accounts for <5% of the Gross domestic product and the level of out-of-pocket (OOP) spending is 69.5% of total health expenditures. OOP expenditure (OOPE) has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. Objectives: The study aimed to estimate the OOPE on health and catastrophic health expenditure (CHE) and their sociodemographic determinants in a rural area of Purba Barddhaman. Methods: A community-based cross-sectional study was conducted between July 2018 and February 2019 in Bhatar Block of Purba Bardhaman district, West Bengal. Required sample of 235 households, selected randomly were primary study units. One respondent from each household was interviewed with a predesigned, pretested schedule for sociodemographic and health-care expenditure-related variables. Mann–Whitney U test/Kruskal Wallis H test and multivariable logistic regression was applied. Results: The median OOP health expenditure was Rs. 3870 (inter quartile range: 2156–4952). Of 235 families, 38 (16.2%) had CHE over a period of 1 year. The significant correlates for CHE were type of village according to the presence of public health-care facility (adjusted odds ratio [AOR] = 4.748; 95% confidence interval [CI]: 1.886–11.956), presence of health insurance (AOR = 11.124; 95% CI: 3.690–33.535) and gender of the head of the family (AOR = 18.176; 95% CI: 3.353–98.534). Concentration curve suggested a higher concentration of CHE among poor households. Conclusion: CHE is substantially high in the area. The efforts are required to make the services available as close to the households as possible and to increase awareness about health facilities.

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Background: Diarrhea is the most common illness in children under 5 years of age, accounting for a financial burden for families in developing countries. Objective: The aim of this study is to determine the out-of-pocket health expenditure for the management of diarrhoeal illness among the under-five children in in-patient and out-patient cases. Methods: A cross-sectional study was conducted during January-April 2018 among 60 under-five children with diarrheal illness reporting to pediatric outpatient department (OPD) and 60 under-five children admitted to pediatric ward of a tertiary care teaching hospital. For determining the out-of-pocket health expenditure, both direct and indirect costs for the management of diarrheal illness were estimated both for out-patient and in-patient cases. The cost of the treatment has been presented as the cost of prehospital visits, during a hospital visit and posthospital visit. Results: Overall, median out-of-pocket health expenditure for the management of diarrheal illness for out-patient and in-patient cases were Rs. 1186 (interquartile range [IQR]: Rs. 510) and Rs. 6385 (IQR: Rs. 5889), respectively. The median direct expenditure for OPD cases was Rs. 778.50 (IQR: Rs. 263) and indirect expenditure for OPD cases were Rs. 407.50 (IQR: Rs. 336) The median direct and indirect expenditure for inpatient cases were Rs. 3823 (IQR: Rs. 1942) and Rs. 2237 (IQR: Rs. 4256) respectively. Only 13% of in-patient cases had some kind of medical insurance. Conclusion: A considerable economic burden is faced by the families for treating diarrhea in under-five children. Improved access to safe drinking water and sanitation, promotion of hand hygiene, exclusive breastfeeding, rotavirus vaccination, and use of oral rehydration therapy will reduce hospitalization and out-of-pocket expenditure. The study findings recommend for appropriate policy for provision of financial protection while seeking health care services.

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Background: Improving quality of health services and providing safe care require well-trained and skilled workforce. The inclusion of components of patient safety in graduate training curricula, followed by adherence to curricula in teaching programs, can improve the quality of health-care services. Objectives: To review the existing training curricula for five subgroups of health workforce (Allopathic doctors, nurses, laboratory technicians, pharmacists, and nurse midwives) and to document the components and identified variables of patient safety covered. Methods: A mixed-methods study was conducted during July 2017–March 2018. Data were collected through desk review, field visits, in-depth interviews, self-administered questionnaires, and focused group discussions (FGDs). A total of 24 variables were identified by the experts to review the training curricula. Results: Seven states, 28 institutes, and 42 health-care facilities were visited. A total of 516 staff from different health cadres participated in the study through 54 interviews, 156 self-administered questionnaires, and 24 FGDs. Of 24 patient safety variables considered, 16 were covered in the medical and nursing, 9 in laboratory technician and pharmacist, and 5 in midwives' curricula. The teaching material on the patient safety, for most categories of staff, was not available in consolidated form, and there was no standardization. Conclusion: There is a need for the development of comprehensive training material cum operational modules on patient safety, suitably adopted as per the learning needs of different subgroups of health staff. The need for strengthening patient safety has been further underscored as the health workforce is fighting the coronavirus disease 19 (COVID-19) pandemic. The initiatives on patient safety will contribute to improved overall quality of health services, which in turn would advance universal health coverage.

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Background: Mass gatherings (MGs) have made many problems for the health system and potentially threaten the health of those participated in these gatherings. MGs account for a range of public health risks including communicable diseases, waterborne diseases, water treatment, and outbreaks. Objectives: The present study aimed to identify public health risks threatening the health of people participating in MGs in Iran. Methods: A qualitative study was designed using a conventional qualitative content analysis approach. Participants were selected using a purposive sampling method among the managers and staff who have experiences in the field of health in MGs in Iran. Subjects were interviewed through individual in-depth interviews after obtaining informed consent. Semi-structured interviews were used to collect the data from December 2018 to February 2019. To analyze the data, the content of recorded interviews was written verbatim. Preliminary data were repeatedly and simultaneously retrieved to give a general understanding of them. Results: The main theme emerged from data analysis on 16 interviews was related to public health risks involving the following categories: food hygiene deficiencies, communicable diseases risks, defects in health supervision, and the risk of environmental contamination. Conclusion: It is of paramount importance to identify the risks threatening the health of people participating in MGs. In the present study, the main public health risks were detected.

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Background: Light pollution is inappropriate or excessive use of artificial light. Nighttime sky radiance is an effective measure to study its effects on individual sleep quality. Objectives: The study is aimed to measure the effect of light pollution on the sleep quality and compare among people residing in selected rural and urban areas of West Bengal, India. Methods: A comparative cross-sectional study was conducted during September–October 2018 in 10 villages of Barasat II block and 10 wards of Kolkata Municipal Corporation. Two hundred and sixty-three participants from urban and 249 participants from rural areas were selected through multi-stage sampling. Data regarding sleep quality and other selected factors were geotagged along with the radiance data. Multi-level linear regression models were built. Results: The mean age of the participants from rural and urban areas were respectively 37.65 (±10.77) years and 38.10 (±11.02) years. Gender-wise the participants were distributed almost evenly in urban and rural areas. Among the urban and rural population, the observed mean global Pittsburgh Sleep Quality Index scores were 12.63 (±3.04) and 9.23 (±2.27), respectively. Poorer sleep quality was observed to be statistically significant with increasing level of exposure. Multi-level models show that, at an exposure of >40.0 nW/cm²/sr the adjusted coefficient was 11.52 (95% confidence interval [CI]: 9.65, 13.40) in the overall model and 12.84 (95% CI: 12.31, 13.37) for urban participants. Conclusion: The disturbance in sleep is associated with higher levels of night-time radiance of the sky strongly observed among the urban population.

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Background: Nutritional anemia due to iron deficiency is the most common cause of anemia in India. The average diet in India is low in iron and mostly of vegetable origin. This can be improved by increasing awareness of foodstuffs that are rich in iron and ensuring their availability. Objective: The objective of the study was to assess the quality of information available on iron-rich foods and to assess their production and consumption in India. Methods: This was a review of common textbooks for medical, nursing, and home science students; related policy and program documents; and government publications on production and consumption of various foodstuffs in India. Results: Details of specific foods that are rich in iron have not been provided. Instead, food groups such as pulses, cereals, nuts, and green leafy vegetables (GLVs) have been mentioned that are good sources of non-heme iron. This is in spite of the fact that all the foodstuffs in these groups are not uniformly iron rich. Among cereals and pulses, rice and red gram dal (arhar) are the most commonly produced and consumed, though they have the lowest iron content. Spinach and mustard leaves believed to be iron rich and commonly consumed are among those GLVs having lowest iron content. Conclusion: Details of 5–10 foodstuffs which have the highest iron content within each food group should be available in relevant books and documents meant for education, production, and consumption data.

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Leadership skills in a public health professional (PHP) are more important today in view of rapidly changing disease pattern, higher priority to universal health coverage, health in all policies, health being demanded as a human right, and emergence of pandemics from zoonotic diseases. Most of us become accidental leaders as we never receive training in leadership skills. This not only undermines the effectiveness of PHP but also undermines the credibility of public health as a specialty. Jim Collin's five levels of leadership are useful to understand the various levels of leadership for a PHP. Technical excellence which denotes first level of leadership is necessary but not sufficient to become a leader. One needs team work, emotional competencies, prioritization ( first things first), listening skills, advocacy, negotiation, networking skills, along with conviction, commitment, and courage to do what one thinks is right. Leadership is a life-long journey, not a destination. Being engaged in leadership for more than a decade, I developed a three domain leadership capacity development model very useful in designing and conducting leadership development trainings to develop leadership skills among PHPs, academicians, and health researchers.

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Background: Tribal children in India bear a higher burden of undernutrition when compared to other communities. However, inequality within tribal communities is under-researched. Objectives: To examine the factors associated with inequality in undernutrition between Paniya and Kurichiya tribal communities in Wayanad district of Kerala. Methods: A cross-sectional analytical study was conducted during August to October 2018 among 314 children aged 2–5 years belonging to Paniya (151) and Kurichiya (163) communities. Participants were selected using multistage cluster sampling. Data were collected using structured interview schedule based on household food insecurity access scale; relevant individual, parental, and household factors were ascertained; child nutritional status was assessed based on anthropometric measurements. The composite index of anthropometric failure (CIAF) was used as an aggregate indicator of undernutrition. Statistical analysis was done using Chi-square test and univariate and multivariable logistic regression. Results: There were significant differences in the prevalence of stunting, underweight, and wasting between Paniya (52.3%, 58.9%, and 25.2%, respectively) and Kurichiya (28.2%, 31.1%, and 12.3%, respectively) tribal children. Based on the CIAF, 66.9% and 41.1% of Paniya and Kurichiya children, respectively, were undernourished. Intratribal difference was observed to exist in all three forms of anthropometric failures simultaneously. Significant factors associated with CIAF were community identity, household food insecurity, and maternal early marriage. Significant factor associated with all three forms of undernutrition was maternal experience of domestic violence. Conclusion: This study demonstrates the child nutritional inequality within the tribal communities and indicates the need for more focused policies and programs among vulnerable tribal groups to ensure food security and empowerment of women.

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Background: Malnutrition in the elderly is a significant public health problem and has serious implications on the overall health of the elderly. There are very few community-based studies on malnutrition among the elderly, especially in India. Objectives: The objective was to find out the prevalence of malnutrition and its associated risk factors among the elderly in urbanized villages of Delhi. Methods: A cross-sectional study was conducted during November 2015 to April 2017 in two urbanized villages of East Delhi among 353 elderly (>60 years) individuals. A semi-structured interview schedule was used to record the sociodemographic and relevant personal details of the elderly. To determine the prevalence of malnutrition, Mini Nutritional Assessment scale was used. Statistical analysis included simple descriptive analysis and tests of significance such as Chi-square test. Multivariable logistic regression was used to identify the predictors of malnutrition. Results: The prevalence of possible malnutrition was found to be 49.3%. On bivariate analysis, age, gender, education status, marital and residential status, per capita income, financial dependency, and family size were found to be associated with malnutrition (P < 0.05). Age >70 years, being tenant, and financial dependency were observed to be significant predictors of possible malnutrition in multiple logistic regression. Conclusion: Malnutrition needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging. Social and economic parameters are linked with the occurrence of malnutrition among the elderly and must be considered in the development of preventive strategies.

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Erythema multiforme (EM) is an immunomediated mucocutaneous disorder of usually unknown etiology which has been known to occur following an infection like herpes virus or exposure to drugs. It primarily affects adolescents, young adults, but can occur at any age. Vaccines are also documented as precipitating factors for EM. In the year 2017, the case of a 25-year-old male patient with lesions of EM which appeared after 30 min of administration of tetanus toxoid vaccine is reported here.

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India is the second-largest consumer of tobacco in the world, second only to China. The World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) is an evidence-based treaty which consists of demand reduction and supply reduction measures. Article 6 of the WHO FCTC requires the Parties to implement tax policies and where appropriate, price policies, on tobacco products so as to contribute to the health objectives aimed at reducing tobacco consumption. The article aimed to analyze the association between taxation structures of smokeless tobacco (SLT) and the prevalence of SLT use at the country level. The article concluded that just as cigarettes, SLT taxes, and prices are also key factors in controlling the demand for SLT products. It calls for uniform taxation across all types of tobacco products for effective and sustained impact and also to prevent product substitution.

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Background: Infant and child feeding practices are a prevalent challenge in Haryana. Objectives: The present study aimed to determine factors associated with non-initiation of breastfeeding within 1 h of birth, no exclusive breastfeeding (EBF) and no continued breastfeeding in Haryana. Methods: National Family Health Survey-4 data for the state of Haryana was used for analysis. The outcomes were non-initiation of breastfeeding within 1 h of birth, no EBF, and no continued breastfeeding. Independent variables were categorized as sociodemographic, maternal, and child level factors. Each category of factors was added step-by-step to the logistic regression model for multivariable analysis. Results: Delayed initiation of breastfeeding was higher among poorer wealth quintiles. Home deliveries (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI]-1.27–2.84), cesarean section (AOR = 2.22, 95% CI-1.46–3.40), body mass index (BMI) >25 kg/m² (AOR = 1.62, 95% CI-1.13–2.33), and not receiving postnatal check-up (AOR 1.36, 95% CI-1.40–1.78) increases likelihood of delayed initiation of breastfeeding beyond 1 h of birth. Increased risk of non-EBF was associated with no postnatal check-ups and BMI >25 kg/m2. Risk of discontinuation of breastfeeding was significantly high with birth interval of <2 years (AOR = 1.52, 95% CI-1.08–2.14) and if babies did not receive postnatal check-up (AOR = 1.54, 95% CI-1.04–2.27). Conclusion: The study highlighted need for focused approach to counsel overweight/obese mothers, cesarean section, and home delivered mothers. Community awareness, adequate birth spacing, and postnatal visits are vital for improving exclusive and continued breastfeeding practices. Communities and health-care providers should provide adequate support to mothers for breastfeeding during the antenatal and postnatal periods.

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Background: The so-called protected tribal population are also facing burden of noncommunicable diseases. The high altitude tribes are thought to be genetically and environmentally protected from hypertension (HTN) like diseases. Objective: The objective is to estimate the prevalence of HTN among tribes residing at high altitudes (>6000 feet above sea level) of India. Methods: The meta-analysis was undertaken during March to August 2018. National Library of Medicine's PubMed database, and Google scholar were comprehensively searched including search terms such as “blood pressure, hypertension and prevalence” combined with “tribal, tribes, high altitude, India.” Articles on the prevalence of HTN were searched first and then were segregated on the basis of high altitude (>6000 ft). Results: Initially, 69 references and a total of 16 abstracts were screened. After applying the inclusion and exclusion criteria on 16, eight studies were included. Meta-analysis of the prevalence of selected studies resulted in a pooled estimate mean prevalence of HTN among tribal population to be 11.43% (95% confidence interval: 6.72%–17.21%). Conclusion: The role of epidemiological transition needs to be read in the context of social anthropology to identify factors preventing HTN among high altitude tribes.

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Hypothyroidism is a disease assuming increasing relevance. The causative role of acidic nature of drinking water has not yet been investigated in Kerala. We attempted to determine the spatial association between the occurrence of self-reported hypothyroidism and pH of ground water using the geographic information system. The cross-sectional study was conducted among 1649 individuals residing in the subcenter area in urban Trivandrum. Self-reported hypothyroidism was obtained by the interview. Differential Global Positioning System was used to record the location of each house and its drinking water source. PH of 50 open-well water samples was estimated. The prevalence of self-reported hypothyroidism was 4.24%. Maps depicting pH distribution and occurrence of hypothyroidism were prepared. Most of the areas had acidic ground water. Geo-statistical analysis revealed the occurrence of statistically significant clustering of hypothyroid individuals in areas having acidic ground water. The study brings out possible linkage between hypothyroidism and acidic water intake necessitating detailed epidemiological investigations for drawing more robust associations.

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Nutrition continues to be a major challenge in India. Children, Adolescents, Pregnant and Lactating women have various nutrition related public health issues which needs accelerated efforts. Department of Community Medicine & Family Medicine, AIIMS, Bhubaneswar undertook various community-based nutrition interventions and initiatives in Odisha and documented the good practices and results. This article captures multiple nutritional programmes implemented in Odisha with support of Government and other organizations.

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Background: During HIV sentinel surveillance (HSS) 2017 round, the sampling strategy to recruit female sex workers (FSWs) was changed from consecutive to random sampling. This may affect the participation and HIV positivity rates among FSWs. Objective: The objective of this study is to estimate the nonparticipation rates among FSWs and its effect on the observed HIV prevalence rate during HSS-2017. Methods: The data were collected from FSW sentinel sites located in the states of Delhi, Jharkhand, Uttar Pradesh, and Uttarakhand (Central Zone). The HIV positivity rate among FSWs who participated in HSS-2017 was compared with the HIV positivity rate of those who did not participate. HIV status of the participants was obtained from HSS-2017 data. The master list of participating targeted intervention sites was accessed to obtain the last known HIV status of the eligible nonparticipants. Results: Nonparticipation rate of FSWs from the central zone during HSS2017 was 10.8%. The HIV positivity rate among nonparticipant FSW was four times and six times higher in Delhi and UP, respectively. Conclusion: Selective nonparticipation of eligible FSWs might have led to the underestimation of the HIV positivity rate in the central zone during the HSS-2017 round.

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Background: Aging population and life expectancy are increasing globally, to cope with this trend, successful aging (SA) attracted the attention of gerontology research to determine its prevalence, risk factors, and its correlates. However, the published research about SA and older adult's health are sparse in Palestine. Objectives: This study aimed to determine the prevalence and correlates of SA, normal aging, and mild cognitive impairment (MCI) among Palestinian older adults in Hebron governorates. Methods: A cross-sectional study was conducted during March 2018–May 2018 among a total of 185 participants selected by stratified random sampling from five different areas in Hebron governance. SA was defined based on the multidimentional model; absence of chronic diseases, normal functional status with complete independency, maintains normal cognitive and psychological function and social engagement. Sociodemographic data, nutrition, and health status were also collected and analyzed. Results: The prevalence of SA among older Palestinians (22.2%), usual aging (58.9%), and the MCI (18.9%), with no significant difference in the prevalence between men and women P <0.05. The most prevalent subdomain is independent living skill (77.8%) and the lowest is the absence of chronic diseases (30.8%). SA was associated with younger older age (60–70 years), still working, and well-nourished participants. Conclusion: The results of this study revealed, successful aging is associated with younger age, still working and good nutritional status. Further research with appropriate methodology different parts of Palestine is required.

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