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COVID has expedited and expanded the already precarious smart city development in India with the multitude of 'smart' COVID responses-broadly known as CovTech-introduced since the early days of the global pandemic. This paper offers an analysis of the scope and scale of smart responses to COVID in the first 20 cities prioritized for smart city implementation-as part of the Smart Cities Mission in India. The analysis unravels the diversity within the smart COVID response, as 125 COVID applications, 14 COVID-War-Rooms, and numerous examples of smart public place initiatives are discussed. The findings include a typology of COVID applications and shed light on the operations of COVID-War-Rooms throughout the nation. The learnings point toward a mostly top-down approach to smart COVID response. Yet, early evidence indicates the existence of an alternative subaltern smart COVID response to provide bottom-up support to the most vulnerable groups, filling the gaps in the top-down approach. More research is required to thoroughly understand the scope and scale of the subaltern smart response to COVID.

The need for systemic healthcare policies to systematically eliminate NTDs globally and in India has been stressed for more than two decades. Yet, the present policies and the research on them do not meet the need. We present an ontological framework, a research roadmap, and a policy brief to address the gap. The ontology clearly, concisely, and comprehensively represents the combinations of diseases, the objectives regarding the diseases, the entities to address them, the outcomes sought, and the potential policy instruments to invoke. The paper explicates the state of the-policies and state of the research on policies to eliminate NTDs in India. It highlights the significant gaps in the diseases covered, balance in the objectives, comprehensiveness of policies, portfolio of outcomes, and involvement of entities. Last, it presents a set of systemic policies congruent with the ontology to systematically address the gaps. The recommendations are aligned with the present research, policies, practices, and recommendations in India and of the WHO, UN agencies, and other similar bodies. The approach can be generalized to provide roadmaps for other countries facing a similar challenge and for other diseases of similar complexity. The roadmaps, with continuous feedback and learning, can help navigate the challenge efficiently and effectively.

This paper explores the influence of social media in fostering resilience within an urban spatial context, specifically in Bangalore, India, during the COVID-19 lockdown, a period marked by a surge in digital communication due to movement restrictions. To control the rapid spread of the virus, over 1.38 billion people were given stay-at-home orders by the government of India during the onset of the pandemic. The restrictions in movement forced individuals to shift to online modes of connection and communication. As the field of digital epidemiology, that is, the use of digital tools and data to understand and improve health took center stage during the pandemic, the focus shifted towards the social media landscape, which is often associated with its negative aspects, such as misinformation. However, this paper delves into social media's potential to build resilience on a local scale, particularly given its increased usage during the pandemic. Through in-depth online interviews with eight urban residents, we conducted a thematic analysis to understand social media's role during the lockdown. Results indicate that social media facilitated effective information exchange and fostered a sense of community. Furthermore, it engendered an environment conducive to prosocial behavior, a known resilience amplifier. We also highlight the importance of baseline context regarding the users directly engaged in social media data generation with respect to digital epidemiology analytics tools for large-scale social media data and the need for qualitative input feeding into their design. Our study highlights the need for a balanced perspective on social media use in times of crisis, recognizing its potential to boost community resilience in an urban setting, and further enriching digital epidemiology approaches.

The treatment and reuse of wastewater for irrigation can lead to occupational health risks for sewage treatment plant (STP) workers and farmers. Sanitation Safety Planning (SSP) is an approach which can be used to measure and mitigate these risks. This paper explores what impact a novel secondary treatment process, consisting of an integrated permeate channel (IPC) membrane combined with a constructed wetland plus, has on the occupational health risks compared with the existing activated sludge wastewater treatment process and reuse system in Kanpur, Uttar Pradesh. A mixed methodology was used, which included key informant interviews, structured observations, and E. coli analysis. This data was used to undertake semi-quantitative risk assessments following the SSP approach. The novel secondary treatment increased the number of health risks which the STP workers were exposed to, but the severity of the risks was lower. This was due to the differences in treatment processes and infrastructures. The number of health risks for the farmers decreased both in number and severity. For their children, the severity of the health impacts decreased. These changes were due to the increase in the microbiological quality of the irrigation water. This study highlights the potential of using a semi-quantitative risk assessment to assess the occupational health impacts of using novel treatment technologies.

Remote sensing (RS), satellite imaging (SI), and geospatial analysis have established themselves as extremely useful and very diverse domains for research associated with space, spatio-temporal components, and geography. We evaluated in this review the existing evidence on the application of those geospatial techniques, tools, and methods in the coronavirus pandemic. We reviewed and retrieved nine research studies that directly used geospatial techniques, remote sensing, or satellite imaging as part of their research analysis. Articles included studies from Europe, Somalia, the USA, Indonesia, Iran, Ecuador, China, and India. Two papers used only satellite imaging data, three papers used remote sensing, three papers used a combination of both satellite imaging and remote sensing. One paper mentioned the use of spatiotemporal data. Many studies used reports from healthcare facilities and geospatial agencies to collect the type of data. The aim of this review was to show the use of remote sensing, satellite imaging, and geospatial data in defining features and relationships that are related to the spread and mortality rate of COVID-19 around the world. This review should ensure that these innovations and technologies are instantly available to assist decision-making and robust scientific research that will improve the population health diseases outcomes around the globe.

Adolescents and young adult comprise a significant proportion of India's population. Although, this group of the population faces serious challenges to their health and well-being. To promote their health and well-being, Centre of Excellence (CoE) at King George's Medical University, Lucknow, India, serves as an advanced care facility for 10-24-year-old adolescents and young adult women. This paper reports the socio-demographic characteristics of, and health services availed to adolescents and young adults who are visiting the CoE in Lucknow, India. A total of 6038 beneficiaries received clinical services during June 2018-March 2022. Out of total clinical services, 38.37% counselling and 37.53% referral services were utilised. Menstruation (46.29%), sexual and reproductive (28.19%), nutrition (5.91%), and mental health (1.67%) related problems were highly reported. The age of beneficiaries is classified into three categories, i.e., 10-14, 15-19, and 20-24 years. Prevalence of overweight was highest among adolescents aged 20-24 years compared to other age groups. Other than nutrition, late-adolescent girls (15-19) faced more health problems than their counterparts. The percentage of beneficiaries decreased significantly during and post the COVID-19 period (<0.001). Therefore, age-specific programs are currently needed, and interventions need to be designed accordingly.

The year 2022 has served as a recall for the impact that climate change has in the South Asian region, which is one of the most vulnerable regions to climate shock. With a paucity of climate-based and geospatial observational studies in South Asia, this paper (i) links power sectors and carbon dioxide emissions, (ii) maps nitrogen dioxide density across three countries (Pakistan, India, and Bangladesh), (iii) understands electricity generation trends and projects weather changes through 2100. We monitored data monitored between 1995 and 2021. The following databases were used: the International Energy Agency, the World Bank, the UN Food and Agricultural Organization. Raw data was obtained for climate indicators, which were entered into Microsoft Excel. Geospatial trends were generated in the ArcGIS geostatistical tool by adopting the ordinary kriging method to interpolate and create continuous surfaces depicting the concentration of nitrogen dioxide in the three countries. We found increased usage of coal and fossil fuels in three countries (Pakistan, India, and Bangladesh). Both were significant contributors to carbon dioxide emissions. The geographic localities in South Asia were densely clouded with nitrogen dioxide as reported with the tropospheric column mapping. There are expected to be increased days with a heat index >35 °C, and consecutive dry days from 2020 and 2100. We also found increased chances of flooding in certain regions across the three countries. This study monitored climate change indicators and projects between 1995 and 2100. Lastly, we make recommendations to improve the relationship of the environment and living beings.

Context: COVID-19 was declared 'a global pandemic' by the World Health Organization in March 2020. India's lockdown, one of the harshest in the world, came with additional challenges for women. This paper aims to assess the impact of COVID-19 pandemic-related pathways on the first thousand days of life in the Integrated Child Development Scheme and the public distribution ecosystem in India., Data Sources: Using Cochrane guidelines, electronic databases, namely Google Scholar and PubMed-NCBI, were searched for evidence between 1 March 2020 and 1 May 2022. A total of 73 studies were identified in initial search; 20 met the inclusion criteria and, thus, were included in the research analysis. Primary studies were conducted throughout pan-India in rural, urban, and semi-urban areas to study the impact of COVID-19 pandemic-related pathways on the first 1000 days of life. The impact of social security, food insecurity, service delivery, nutrition of pregnant and nursing mothers (P&NMs), and infant and young child feeding (IYCF) varied between geographies and within geographies. Most of the primary studies were conducted at small scale, while only three studies were pan-Indian. The majority of studies were conducted on the mental health of P&NMs and pre-natal and post-natal service delivery disruption. The paucity of the available literature highlights the need to undertake research on the impact of the COVID-19 pandemic-related pathways on 1000 days of life in India and worldwide. The best implementation practices were observed where cross-sectional programs were carried out in relation to health services and social security for P&NMs and children.

The impact of heat stress among the elderly in India-particularly the elderly poor-has received little or no attention. Consequently, their susceptibility to heat-related illnesses is virtually unknown, as are the strategies they use to avoid, or deal with, the heat. This study examined perceptions of comfort, heat-related symptoms, and coping behaviors of 130 elderly residents of Kolkata slums and 180 elderly residents of rural villages south of Kolkata during a 90-day period when the average 24-h heat indexes were between 38.6 °C and 41.8 °C. Elderly participants in this study reported being comfortable under relatively warm conditions-probably explained by acclimatization to the high level of experienced heat stress. The prevalence of most heat-related symptoms was significantly greater among elderly women, who also were more likely to report multiple symptoms and more severe symptoms. Elderly women in the rural villages were exposed to significantly hotter conditions during the day than elderly men, making it likely that gender differences in symptom frequency, number and severity were related to gender differences in heat stress. Elderly men and elderly village residents made use of a greater array of heat-coping behaviors and exhibited fewer heat-related symptoms than elderly women and elderly slum residents. Overall, heat measurements and heat-related symptoms were less likely to be significant predictors of most coping strategies than personal characteristics, building structures and location. This suggests that heat-coping behaviors during hot weather were the result of complex, culturally influenced decisions based on many different considerations besides just heat stress., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

The Himalayan region is a fragile high mountain landscape where the population experiences acute vulnerability within a complex coupled human-natural system due to environmental, social, and economic linkages. The lack of significant regional and spatial knowledge of multi-faceted vulnerabilities hinders any potential recommendations to address these vulnerabilities. We systematically reviewed the literature to recommend mitigation interventions based on the region's socio-economic and ecological vulnerability research to date. We applied the PRISMA (Preferred Reporting of Items for Systematic Review and Meta-Analysis) criteria to search for results from four comprehensive databases. For our assessment, we compiled a final sample ( n = 59) of vulnerability research papers to examine the vulnerability types, spatial variation, assessment methodology, and significant drivers of change. Our study represented all Himalayan countries, namely, India, Nepal, Pakistan, China, and Bhutan. More than half of the vulnerability studies were conducted in the central Himalayan region, a quarter in the western Himalayas, and a few in the eastern Himalayas. Our review revealed that the primary drivers of change were climate change, land use/land cover, and glacial lake formation. The vulnerability assessments in the Himalayan region primarily used social science methods as compared to natural science methods. While the vulnerability studies seldom assessed mitigation interventions, our analysis identified fourteen recommendations. The recommended interventions mainly included policy interventions, livelihood improvement, and adaptation measures. This study emphasized that sustainable development requires cross-sectoral interventions to manage existing resources and mitigate the confronting vulnerabilities of the region.

This paper presents an ontological review of the global research on access to geriatric disability care and a roadmap for future research to address the problem in India. First, the dominant research focus is on resources (human, financial, and spatial) that affect access to disability care; there is little focus on informational and technological resources. Second, functional disabilities are the dominant focus of the research, followed by cognitive, mental, and locomotor disabilities; there is little focus on speech, hearing, and visual disabilities. Third, barriers, inhibitors, and catalysts of physical access are the dominant focus, with relatively less focus on virtual access; there is very little emphasis on the drivers to access. Fourth, the primary, although not dominant, focus is on access for urban and rural populations; there is very little focus on access for underserved and indigenous populations. Future research must address these gaps systematically to improve access. This paper adds: (a) a systemic framework for the study of an important, complex, emerging problem; (b) a systematic review of the global research on the problem; and (c) a research roadmap to address the emerging problem in India.

The world has been facing a pandemic owing to COVID-19. We have also seen the geographic expansion and outbreaks of other emerging infectious diseases (EID) in recent years. This paper investigates the direct and indirect effects of land use land cover change (LULCC) on EID outbreaks in the context of Wayanad District of Kerala, India. Wayanad is in the vulnerable tropical forested region, and it is named as one of the four environmental change hotspots. The focus of this project is mainly three EIDs prevalent in this region: Kyasanur forest disease (KFD), Dengue and Leptospirosis. Our results, based on topographical map, remote sensing and extensive field work, show that the natural forest in Wayanad was replaced with agriculture and forest plantation during 1950-2018. This paper further suggests that encroachment of forest by forest plantation causes the human-animal conflict resulting in the outbreak of KFD cases. Our analysis reveals that a high number of Dengue cases is found in the forested regions of the district and over the adjacent human-made agriculture plantation areas. High and medium number of Leptospirosis cases contain a high portion of land area devoted to paddy cultivation and agricultural plantation. In summary, the results clearly show the linkage between the outbreak of above mentioned EIDs and LULCC in the context of Wayanad district, Kerala. We also discuss in detail the causal pathway involving human-environmental dynamics through which plantation leads to the outbreak of KFD. Replacing forests with plantations poses an alarming threat of disease outbreak in the community.

Machine learning techniques facilitate efficient analysis of complex networks, and can be used to discover communities. This study aimed use such approaches to raise awareness of the COVID-19. In this regard, social network analysis describes the clustering and classification processes for detecting communities. The background of this paper analyzed the geographical distribution of Tambaram, Chennai, and its public health care units. This study assessed the spatial distribution and presence of spatiotemporal clustering of public health care units in different geographical settings over four months in the Tambaram zone. To partition a homophily synthetic network of 100 nodes into clusters, an empirical evaluation of two search strategies was conducted for all IDs centrality of linkage is same. First, we analyzed the spatial information between the nodes for segmenting the sparse graph of the groups. Bipartite The structure of the sociograms 1-50 and 51-100 was taken into account while segmentation and divide them is based on the clustering coefficient values. The result of the cohesive block yielded 5.86 density values for cluster two, which received a percentage of 74.2. This research objective indicates that sub-communities have better access to influence, which might be leveraged to appropriately share information with the public could be used in the sharing of information accurately with the public.

The conventional paper-based system for malaria surveillance is time-consuming, difficult to track and resource-intensive. Few digital platforms are in use but wide-scale deployment and acceptability remain to be seen. To address this issue, we created a malaria surveillance mobile app that offers real-time data to stakeholders and establishes a centralised data repository. The MoSQuIT app was designed to collect data from the field and was integrated with a web-based platform for data integration and analysis. The MoSQuIT app was deployed on mobile phones of accredited social health activists (ASHA) working in international border villages in the northeast (NE) Indian states of Assam, Tripura and Arunachal Pradesh for 20 months in a phased manner. This paper shares the challenges and opportunities associated with the use of MoSQuIT for malaria surveillance. MoSQuIT employs the same data entry formats as the NVBDCP's malaria surveillance programme. Using this app, a total of 8221 fever cases were recorded, which included 1192 (14.5%) cases of P. falciparum malaria, 280 (3.4%) cases of P. vivax malaria and 52 (0.6%) mixed infection cases. Depending on network availability, GPS coordinates of the fever cases were acquired by the app. The present study demonstrated that mobile-phone-based malaria surveillance facilitates the quick transmission of data from the field to decision makers. Geospatial tagging of cases helped with easy visualisation of the case distribution for the identification of malaria-prone areas and potential outbreaks, especially in hilly and remote regions of Northeast India. However, to achieve the full operational potential of the system, operational challenges have to be overcome.

The unprecedented outbreak of the COVID-19 pandemic has forced governments to devise national strategies to curtail its spread. The present study analyzes the national strategies of India and the United States for the COVID-19 vaccine roll out. The paper presents an ontology of COVID-19 vaccine roll out, maps the national strategies, identifies, analyzes the emphases and gaps in them, and proposes corrections to the same. The analysis shows that the national strategies are selective in their focus and siloed in their approach. They must be systematized to address the emerging challenges effectively. Thus, there is need for a systemic understanding and analysis to reinforce the effective pathways to manage vaccine roll out, reposition the ineffective ones, and engineer new ones through feedback and learning.

With the development of trade liberalization, the pollutants emissions embodied in global trade are increasing. The pollution haven hypothesis caused by trade has aroused wide attention. The fragmentation of international production has reshaped trade patterns. The proportion of intermediate product trade in global trade is increasing. However, little has been done to study the pollution haven of different pollutants under different trade patterns. In this paper, major environmental pollutants CO 2 (carbon dioxide), SO 2 (sulfur dioxide), and NO x (nitrogen oxides) are selected as the research objects. This study investigated the global pollution haven phenomenon in 43 countries and 56 major industries from 2000 to 2014. Based on the MRIO model, the trade mode is divided into three specific patterns: final product trade, intermediate product trade in the last stage of production, and the trade related to the global value chain. The results show that trade liberalization could reduce global CO 2 , SO 2 , and NOx emissions, and intermediate product trade has a more significant emission reduction effect than final product trade. Trade's impacts on each country are various, and the main drivers are also different. For example, the European Union avoids becoming a pollution haven mainly through the trade related to the global value chain. The suppressed emissions under this trade pattern are 71.8 Mt CO 2 , 2.2 Mt SO 2 , 2.2 Mt NO x . India avoids most pollutants emissions through intermediate product trade. China has become the most serious pollution haven through final product trade. The trade pattern could increase China 829.4 Mt CO 2 , 4.5 Mt SO 2 , 2.6 Mt NO x emissions in 2014.

Online examinations, commonly referred to as e-exams (electronic examinations), underwent a considerable progression, getting adapted ubiquitously among higher education institutions worldwide. Their preferment was rapid due to the emergence of the COVID-19 pandemic. The process of conducting exams online is being opted as the appropriate way of assessment, ensuring the students' safety and well-being. According to Warts et al., this form of examination has been pretty effective in the past when blended with the conventional assessment. However, at present, implemented as the singular way of assessment, e-exams have shown a more significant promise in being beneficial to the learners. As a matter of fact, a comprehensive analysis on understanding the learners' perception towards the e-exams was not done earlier, particularly in the developing nations. Thus, it was pertinent to examine the pre-requisites of e-exams to promote it as a useful tool for the smooth conduct of exams in the aforesaid nations. Against such a backdrop, this study was conducted during January to March 2021 on 207 students enrolled in four universities, three situated in the National Capital Territory (NCT) of Delhi, India: Delhi University (DU), Jamia Millia Islamia (JMI), and Jawaharlal Nehru University (JNU), and one situated in Saudi Arabia, namely Saudi Electronic University (SEU). A quantitative approach was employed for the study, with the responses recorded via web questionnaires. Confirmatory -factor analysis (CFA) was applied in the study to examine whether the process of conducting online examinations is being chosen as the appropriate form of assessment, ensuring the safety and well-being of students through AMOS (version 24) software. For determining the reliability of the two latent constructs, namely "Perceptions of students towards E-exams (PSE)" and "Pre-requisites of E-exams (POE)," Cronbach's alpha was used through SPSS (version 25) software in the study, and the results reveal that the strong internal consistency exists between all the measured variables. In addition, the mean and standard deviation were used by the researchers to find out the pre-requisites of the online examination system. The participants expressed their insights on the relative benefits of online examination. Their perception was based on pedagogy, validity and reliability, affective factors, practicality, and security. From their insights, it was concluded that online examination is more advantageous than conventional paper-based exams. The outcome also applies to the authenticity of grading and the overall efficiency concerning the time, effort, and expenditure on conducting the examination. Contrarily, the participating students also recognized numerous hurdles in implementing e-exams concerning security, validity, and impartiality. The conclusion further revealed that online examination is especially relevant for formative assessment of learning instead of summative assessment, provided authenticity, security, and flexibility are used as fundamental tenants in the proper implementation of e-exams. The outcome of the present study will facilitate higher education institutions and policymakers in taking the electronic examination system to the next level., Competing Interests: The authors declare no conflicts of interest.

This paper studies the interplay between social distancing and the spread of the COVID-19 disease-a global pandemic that has affected most of the world's population. Our goals are to (1) to observe the correlation between the strictness of social distancing policies and the spread of disease and (2) to determine the optimal adoption level of social distancing policies. The earliest instances of the virus were found in China, and the virus has reached the United States with devastating consequences. Other countries severely affected by the pandemic are Brazil, Russia, the United Kingdom, Spain, India, Italy, and France. Although it is impossible to stop it, it is possible to slow down its spread to reduce its impact on the society and economy. Governments around the world have deployed various policies to reduce the virus spread in response to the pandemic. To assess the effectiveness of these policies, the system's dynamics of the society needs to be analyzed, which is generally not possible with mathematical linear equations or Monte Carlo methods because human society is a complex adaptive system with continuous feedback loops. Because of the challenges with the other methods, we chose agent-based methods to conduct our study. Moreover, recent agent-based modeling studies for the COVID-19 pandemic show significant promise in assisting decision-makers in managing the crisis by applying policies such as social distancing, disease testing, contact tracing, home isolation, emergency hospitalization, and travel prevention to reduce infection rates. Based on modeling studies conducted in Imperial College, increasing levels of interventions could slow the spread of disease and infection. We ran the model with six different percentages of social distancing while keeping the other parameters constant. The results show that social distancing affects the spread of COVID-19 significantly, in turn decreasing the spread of disease and infection rates when implemented at higher levels. We also validated these results by using the behavior space tool with ten experiments with varying social distancing levels. We conclude that applying and increasing social distancing policy levels leads to a significant reduction in infection spread and the number of deaths. Both experiments show that infection rates are reduced drastically when social distancing intervention is implemented between 80% to 100%.

Background and Aim: India has had a wheelchair-delivery system in place for several years but its impact on users is inadequate. Therefore, this research reviews the system to examine how the right to personal mobility can be served better., Method: this paper undertakes a narrative review of the existing government-aided wheelchair provision system from the perspectives of legislation and implementing agencies, both governmental and non-governmental, through document review and key informant interviews., Results: the results indicate that all steps of the government-funded wheelchair provision system are executed by the same system. Manufacture and supply take place nationally, but wheelchair services are largely absent. Moreover, the right to access mobility devices is not upheld for all users., Conclusion: the established government-aided wheelchair provision system is inadequate in terms of coverage, design, production, supply, and wheelchair services. Therefore, there is a need to reconsider the system by increasing its coverage and creating partnerships between the government, non-governmental agencies, and private agencies to improve access.

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0-23 months, 24-59 months, and 0-59 months in South Asia. A weighted sample of 564,518 children aged 0-59 months from the most recent demographic and health surveys (2014-2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0-23 months (25%) as compared to 24-59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0-23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24-59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0-59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

When a disaster occurs during a pandemic, it would be a case of concurrent crises (synonymous to cascading disasters or compounding disasters). The single-hazard approach to disaster response system is not suited for this scenario. As shown from the experiences of the Philippines, India, Japan, and the Republic of Korea, the conventional single-hazard approach needed to integrate new measures, including basic skills training on handling COVID-19 for disaster responders; additional stockpiles of face coverings, disinfectants, tents, and personal protective equipment (PPE); social distancing at evacuation centers; updating of standard operation procedures (SOPs) and guidelines for disaster response to adapt to the concurrent crises situations. Building on the reports presented by the member countries of Asian Disaster Reduction Center (ADRC), this paper highlights three evolving disaster response practices during the COVID-19 pandemic: (i) digitalization of some aspects of disaster response, including early warning, surveillance, and impact assessment; (ii) dispersed evacuation to enforce social distancing, including other measures such as testing, tracing, and isolating infected individuals; (iii) remote psychological first aid to disaster-impacted individuals who are already experiencing anxieties from the pandemic. Indicative outcomes of the evolving response practices are discussed, including whether these could serve as entry points to transition the disaster response system from a single-hazard approach towards a multihazard approach.

Menstrual hygiene management and health is increasingly gaining policy importance in a bid to promote dignity, gender equality and reproductive health. Effective and adequate menstrual hygiene management requires women and girls to have access to their menstrual health materials and products of choice, but also extends into having private, clean and safe spaces for using these materials. The paper provides empirical evidence of the inequality in menstrual hygiene management in Kinshasa (DRC), Ethiopia, Ghana, Kenya, Rajasthan (India), Indonesia, Nigeria and Uganda using concentration indices and decomposition methods. There is consistent evidence of wealth-related inequality in the conditions of menstrual hygiene management spaces as well as access to sanitary pads across all countries. Wealth, education, the rural-urban divide and infrastructural limitations of the household are major contributors to these inequalities. While wealth is identified as one of the key drivers of unequal access to menstrual hygiene management, other socio-economic, environmental and household factors require urgent policy attention. This specifically includes the lack of safe MHM spaces which threaten the health and dignity of women and girls.

In the digital era, technology innovation and adoption trigger economic growth and enhance CO 2 emissions through productivity, which places it in the mainstream policy debate. For BRICS economies, this paper uses the first method proposed in the literature to quantify their information and communication technology (ICT) and innovatively links each country to their information technology adoption rate, as a surrogate indicator for measuring information and communication technology. Environmental Kuznets curve evidence is also examined, using technology innovation, technology adoption, and trade openness as the control variables for sustainable development. The results show that two out of three technology innovation instruments, fixed telephone, and broadband subscriptions increase CO 2 emissions. Simultaneously, mobile cellular subscriptions have a lowering effect on CO 2 emission in BRICS. The technology adoption indicators, high-technology exports, and electric power consumption also cause an upsurge in CO 2 emission. Moreover, trade openness also enriches the level of CO 2 emission in the BRICS regions. There is a need to devise technology innovation and adoption policies to better use technology and to ensure a green environment.

The preferential form of living for the elderly in India is within the extended family. India is undergoing rapid economic development, an increase in mobility, and changes in gender norms due to an increase in women's labour force participation, which places challenges on traditional intergenerational relationships. Ageing and the well-being of the elderly is a rising concern, especially considering that their proportion of the population is expected to grow rapidly in coming decades. There is a lack of universal state provision for the elderly's basic needs, which is especially profound for elderly women, since most do not have an independent income. This leaves the elderly dependent upon the benevolence of their adult children's families or other relatives. This paper explores, with help of narrative analysis and critical contributions from capability theory, elderly women's agency freedoms and how this can be contextualised with their varying capability sets. With help of Spivak's notion of the silent subaltern, the paper anchors elderly women's abilities to voice to their agency freedom. The master narrative of the silent supportive wife and side-lined mother-in-law as well as three counter-narratives explore alternative agencies taken by elderly women.

In India, cardiovascular disease (CVD), with hypertension as its foremost risk factor, has the highest prevalence rate of non-communicable diseases (NCDs) and a rising mortality. Previous research has found a clustering of behavioural and social risks pertaining to NCDs, though the latter are infrequently addressed in public health interventions in India. This paper reaches toward the development of a social intervention to address social determinants of NCD relating to hypertension and diabetes. We used Theory of Change (ToC) as a theoretical approach to programme design. Mixed methods were used, including qualitative interviews with community members ( n = 20), Accredited Social Health Activists ( n = 6) and health professionals ( n = 8), and a stakeholder workshop ( n = 5 participants). The recruitment of participants from one local area in Kerala enabled us to map service provision and gain a holistic understanding of how to utilise the existing workforce to target social risk factors. The findings suggest that social interventions need to focus on ensuring health behaviour information reaches all parts of the community, and that those with more social risk factors are identified and supported to engage with treatment. Further research is required to test the resulting intervention model.

The evolving field of mobile health (mHealth) is revolutionizing collection, management, and quality of clinical data in health systems. Particularly in low- and middle-income countries (LMICs), mHealth approaches for clinical decision support and record-keeping offer numerous potential advantages over paper records and in-person training and supervision. We conducted a content analysis of qualitative in-depth interviews using the Technology Acceptance Model 3 (TAM-3) to explore perspectives of providers and health managers in Madhya Pradesh and Rajasthan, India who were using the ASMAN (Alliance for Saving Mothers and Newborns) platform, a package of mHealth technologies to support management during the peripartum period. Respondents uniformly found ASMAN easy to use and felt it improved quality of care, reduced referral rates, ensured timely referral when needed, and aided reporting requirements. The TAM-3 model captured many determinants of reported respondent use behavior, including shifting workflow and job performance. However, some barriers to ASMAN digital platform use were structural and reported more often in facilities where ASMAN use was less consistent; these affect long-term impact, sustainability, and scalability of ASMAN and similar mHealth interventions. The transitioning of the program to the government, ensuring availability of dedicated funds, human resource support, and training and integration with government health information systems will ensure the sustainability of ASMAN.

There is a shortage of research on the participation of children with intellectual disabilities from middle-income countries. Also, most child assessments measure either the child's or the caregiver's perceptions of participation. Participation, however, is an amalgamation of both perspectives, as caregivers play a significant role in both accessing and facilitating opportunities for children's participation. This paper reports on both perceptions-those of children with intellectual disabilities and those of their caregiver, in India and South Africa. A quantitative group comparison was conducted using the Children's Assessment of Participation and Enjoyment (CAPE) that was translated into Bengali and four South African languages. One hundred child-caregiver dyads from India and 123 pairs from South Africa participated in the study. The results revealed interesting similarities and differences in participation patterns, both between countries and between children and their caregivers. Differences between countries were mostly related to the intensity of participation, with whom, and where participation occurred. Caregiver and child reports differed significantly regarding participation and the enjoyment of activities. This study emphasises the need for consideration of cultural differences when examining participation and suggests that a combined caregiver-and-child-reported approach may provide the broadest perspective on children's participation.

The globally fast-spreading novel coronavirus disease (COVID-19) is now testing the abilities of all countries to manage its widespread implications on public health. To effectively contain its impacts, a nation-wide temporary lockdown was enforced in India. The resultant panic buying and stockpiling incidents together with spread of misinformation created a sense of food insecurity at local level. This paper discusses a specific case of Nagpur from the worst affected Maharashtra state of India, wherein the urban-rural food supply chains were reportedly disrupted. Based on formal interviews with local government officials, a month-long timeline of COVID-19 outbreak in Nagpur was studied along with the consequent government initiatives for maintaining public health and food supply. While the city residents were confined to their homes, this study then assessed their perceived food security at household level, along with their "Immediate Concerns" and "Key Information Sources". Through online surveys at two different time intervals, the concerns of "Food and Grocery" were found to be rising, and "Government Apps and Websites" were identified as the most reliable source of information. Based on the research findings, the authors further suggest specific policy recommendations for addressing the immediate and long-term concerns related to food systems in Nagpur.

Adequate nutritional intake for mothers during pregnancy and for children in the first two years of life is known to be crucial for a child's lifelong physical and neurodevelopment. In this regard, the global nutrition community has focused on strategies for improving nutritional intake during the first 1,000 day period. This is largely justified by the observed steep decline in children's height-for-age z scores from birth to 23 months and presumed growth faltering at later ages as a reflection of earlier deprivation that is accumulated and irreversible. Empirical evidence on the age-stratified burden of child undernutrition is needed to re-evaluate the appropriate age for nutrition interventions to target among children. Using data from two successive rounds of National Family Health Surveys conducted in 2006 and 2016, the objective of this paper was to analyze intertemporal changes in the age-stratified burden of child stunting across socioeconomic groups in India. We found that child stunting in India was significantly concentrated among children entering preschool age (24 or above months). Further, the temporal reduction in stunting was relatively higher among children aged 36-47 months compared to younger groups (below 12 and 12-23 months). Greater socioeconomic inequalities persisted in stunting among children from 24 months or above age-groups, and these inequalities have increased over time. Children of preschool age (24 or above months) from economically vulnerable households experienced larger reductions in the prevalence of stunting between 2006 and 2016, suggesting that policy research and strategies beyond the first 1000 days could be critical for accelerating the pace of improvement of child nutrition in India.

With increasing girl's enrolment in schools, school preparedness to ensure a menstrual friendly environment is crucial. The study aimed to conduct a systematic review regarding the existing evidence on menstrual hygiene management (MHM) across schools in India. It further aimed to highlight the actions that have been taken by the government to improve the MHM situation in India. We conducted the systematic literature search using PubMed, EMBASE, and Web of Science for searching the peer-reviewed articles and Google Scholar for anecdotal reports published from inception until 30 October 2019. Of 1125 publications retrieved through the search, 183 papers were included in this review, using a priori created data-extraction form. Meta-analysis was used to estimate the pooled prevalence (PP) of MHM practices in schools. Less than half of the girls were aware of menstruation before menarche (PP 0.45, 0.39 to 0.51, I 2 = 100.0%, n = 122). Teachers were a less common source of information about menstruation to girls (PP 0.07, 0.05 to 0.08, I 2 = 100.0%, n = 86). Separate toilets for girls were present in around half of the schools (PP 0.56, 0.42 to 0.75, I 2 100.0%, n = 11). MHM in schools should be strengthened with convergence between various departments for explicit implementation of guidelines., Competing Interests: Madhusudan, M.; Chaluvaraj, T.S.; Chaitra, M.M.; Ankitha, S.; Pavithra, M.S.; Mahadeva Urthy, T.S. Menstrual hygiene: knowledge and practice among secondary school girls of Hosakote, rural Bangalore. Int. J. Basic Appl. Med. Sci. 2014, 4, 313–320.

Background: This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets., Methods: Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored., Results: Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come., Conclusions: Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.

Data on the prevalence and causes of hearing loss is lacking from many low and middle-income countries, in part, because all-age population-based surveys of hearing loss can be expensive and time consuming. Restricting samples to older adults would reduce the sample size required, as hearing loss is more prevalent in this group. Population-based surveys of hearing loss require clinicians to be involved in the data collection team and reducing the duration of the survey may help to minimise the impact on service delivery. The objective of this paper was to identify the optimal age-group for conduct of population-based surveys of hearing loss, balancing sample size efficiencies, and expected response rates with ability to make inferences to the all-age population., Methods: Between 2013-2014, two all aged population-based surveys of hearing loss were conducted in one district each of India and Cameroon. Secondary data analysis was conducted to determine the proportion of hearing loss (moderate or greater) in people aged 30+, 40+ and 50+. Poisson regression models were developed to predict the expected prevalence of hearing loss in the whole population, based on the prevalence in people aged 30+, 40+, and 50+, which was compared to the observed prevalence. The distribution of causes in these age groups was also compared to the all-age population. Sample sizes and response rates were estimated to assess which age cut-off is most rapid., Results: Of 160 people in India and 131 in Cameroon with moderate or greater hearing loss, over 70% were older than 50 in both settings. For people aged 30+ (90.6% India; 76.3% Cameroon), 40+ (81% India; 75% Cameroon) and 50+ (73% India; 73% Cameroon) the proportions were higher. Prediction based on Poisson distributed observations the predicted prevalence based on those aged 30+, 40+, and 50+ fell within the confidence intervals of the observed prevalence. The distribution of probable causes of hearing loss in the older age groups was statistically similar to the total population. Sample size calculations and an analysis of response rates suggested that a focus on those aged 50+ would minimise costs the most by reducing the survey duration., Conclusion: Restricting the age group included in surveys of hearing loss, in particular to people aged 50+, would still allow inferences to be made to the total population, and would mean that the required sample size would be smaller, thus reducing the duration of the survey and costs.

Background: Improvements in child health are a key indicator of progress towards the third goal of the United Nations' Sustainable Development Goals. Poor nutritional outcomes of Indian children are occurring in the context of high economic growth rates. The aim of this paper is to conduct a comprehensive analysis of the demographic and socio-economic factors contributing to changes in the nutritional status of children aged 0-5 years in India using data from the 2004-2005 and 2011-2012 Indian Human Development Survey., Methods: To identify how much the different socio-economic conditions of households contribute to the changes observed in stunting, underweight and the Composite Index of Anthropometric Failure (CIAF), we employ both linear and non-linear decompositions, as well as the unconditional quantile technique., Results: We find the incidence of stunting and underweight dropping by 7 and 6 percentage points, respectively. Much of this remarkable improvement is encountered in the Central and Western regions. A household's economic situation, as well as maternal body mass index and education, account for much of the change in child nutrition. The same holds for CIAF in the non-linear decomposition. Although higher maternal autonomy is associated with a decrease in stunting and underweight, the contribution of maternal autonomy to improvements is relatively small., Conclusions: Household wealth consistently makes the largest contribution to improvements in undernutrition. Nevertheless, maternal autonomy and education also play a relatively important role.

We thank the authors for their interest in our paper [...].

Indian cities struggle with some of the highest ambient air pollution levels in the world. While national efforts are building momentum towards concerted action to reduce air pollution, individual cities are taking action on this challenge to protect communities from the many health problems caused by this harmful environmental exposure. In 2017, the city of Ahmedabad launched a regional air pollution monitoring and risk communication project, the Air Information and Response (AIR) Plan. The centerpiece of the plan is an air quality index developed by the Indian Institute of Tropical Meteorology&rsquo;s System for Air Quality and Weather Forecasting and Research program that summarizes information from 10 new continuous air pollution monitoring stations in the region, each reporting data that can help people avoid harmful exposures and inform policy strategies to achieve cleaner air. This paper focuses on the motivation, development, and implementation of Ahmedabad&rsquo;s AIR Plan. The project is discussed in terms of its collaborative roots, public health purpose in addressing the grave threat of air pollution (particularly to vulnerable groups), technical aspects in deploying air monitoring technology, and broader goals for the dissemination of an air quality index linked to specific health messages and suggested actions to reduce harmful exposures. The city of Ahmedabad is among the first cities in India where city leaders, state government, and civil society are proactively working together to address the country&rsquo;s air pollution challenge with a focus on public health. The lessons learned from the development of the AIR Plan serve as a template for other cities aiming to address the heavy burden of air pollution on public health. Effective working relationships are vital since they form the foundation for long-term success and useful knowledge sharing beyond a single city.

School-based nutrition promotion is critical to the development of healthy eating habits in adolescents. Unfortunately, most Indian secondary schools do not support healthy eating among adolescents. Therefore, this study was designed to understand the perspectives of teachers and parents regarding the potential barriers to nutrition promotion in Indian secondary schools. Thirty-two teachers and 280 parents from five private English-speaking secondary schools in Kolkata, India took part in a cross-sectional survey. The paper-based survey instrument included both quantitative and qualitative items which were derived from previously published evidence. Descriptive and chi-square analyses were conducted on the quantitative data. Qualitative data were evaluated by thematic data analysis underpinned by the template analysis technique. Five main barriers to nutrition promotion emerged from the study. These included the perceived strong preference for energy-dense, nutrient-poor foods among students; lack of government canteen guidelines; limited engagement of parents, teachers, and adolescents in canteen operations; the widespread display of eye-catching food advertisements; and poor knowledge among canteen personnel with regards to healthy food preparation. These findings about the potential barriers to nutrition promotion provide useful directions for healthy school food policy implementation. Successful implementation of healthy school food policies can inculcate lifelong healthy eating habits among adolescents.

Recurrent heat waves, already a concern in rapidly growing and urbanizing South Asia, will very likely worsen in a warming world. Coordinated adaptation efforts can reduce heat's adverse health impacts, however. To address this concern in Ahmedabad (Gujarat, India), a coalition has been formed to develop an evidence-based heat preparedness plan and early warning system. This paper describes the group and initial steps in the plan's development and implementation. Evidence accumulation included extensive literature review, analysis of local temperature and mortality data, surveys with heat-vulnerable populations, focus groups with health care professionals, and expert consultation. The findings and recommendations were encapsulated in policy briefs for key government agencies, health care professionals, outdoor workers, and slum communities, and synthesized in the heat preparedness plan. A 7-day probabilistic weather forecast was also developed and is used to trigger the plan in advance of dangerous heat waves. The pilot plan was implemented in 2013, and public outreach was done through training workshops, hoardings/billboards, pamphlets, and print advertisements. Evaluation activities and continuous improvement efforts are ongoing, along with plans to explore the program's scalability to other Indian cities, as Ahmedabad is the first South Asian city to address heat-health threats comprehensively.

Improved cook stoves (ICS) have been widely touted for their potential to deliver the triple benefits of improved household health and time savings, reduced deforestation and local environmental degradation, and reduced emissions of black carbon, a significant short-term contributor to global climate change. Yet diffusion of ICS technologies among potential users in many low-income settings, including India, remains slow, despite decades of promotion. This paper explores the variation in perceptions of and preferences for ICS in Uttar Pradesh and Uttarakhand, as revealed through a series of semi-structured focus groups and interviews from 11 rural villages or hamlets. We find cautious interest in new ICS technologies, and observe that preferences for ICS are positively related to perceptions of health and time savings. Other respondent and community characteristics, e.g., gender, education, prior experience with clean stoves and institutions promoting similar technologies, and social norms as perceived through the actions of neighbours, also appear important. Though they cannot be considered representative, our results suggest that efforts to increase adoption and use of ICS in rural India will likely require a combination of supply-chain improvements and carefully designed social marketing and promotion campaigns, and possibly incentives, to reduce the up-front cost of stoves.

The objectives of the study were to monitor and assess the road traffic noise in its spatial-temporal aspect in an urban area. The paper discusses the observations, results and their interpretation based on the study. Noise recordings from site, collected from April 2006 to March 2006, were used for statistical analysis and generation of various noise indices. Noise maps were also created for impact analysis and formulation of Noise Risk Zones. Mean Ldn value ranged between 55.1 and 87.3 dB (A). Day time Leq level ranged between 51.2 and 89.0 dB (A), where it ranged between 43.5 and 81.9 dB (A) during night. The study reveals that present noise level in all the locations exceeds the limit prescribed by CPCB. Based on the finding it can be said that the population in this industrial town are exposed to significantly high noise level, which is caused mostly due to road traffic.

The study reports the use of three biomarkers i.e. total arsenic in hair and nails, total arsenic in blood, and total arsenic in urine to identify or quantify arsenic exposure and concomitant health effects. The main source of arsenic was inorganic exposure through drinking water. The arsenic levels and the health effects were analyzed closely in a family having maximum symptoms of arsenic. Based on the result of this study it is reported that there exist a correlation between the clinically observable symptoms, the blood and urine arsenic level, and the arsenic intake through drinking water. An intensive study on the urinary arsenic levels was carried out in which the urine levels of arsenic and the urine sufficiency tests were performed. A composite picture of body burden of arsenic has been obtained by carrying out a complete biochemical analysis of a maximum affected family. This confirms pronounced chronic exposure of the arsenic to these people. A combined correlation study on the arsenic levels measured in whole blood, urine, hair, nails and age present a remarkable outcome. Accordingly, the arsenic levels in blood are negatively correlated with the urine arsenic levels, which indicate either the inadequacy of the renal system in cleaning the blood arsenic or a continuous recirculation of the accumulated arsenic. This is an important conclusion about arsenical metabolism in humans. The study also raises the issues of the prospects of complete elimination of the accumulated arsenic and the reversibility of the health effects. Based on the work in Kourikasa village we report that there are very remote chances of complete purging of arsenic and thus reversibility of the health effects owing to various factors. The paper also discusses the various issues concerning the chronic arsenic poisoning management in the affected locations.

The Human Immunodeficiency Virus / Acquired Immunodeficiency syndrome (HIV/AIDS) is spreading rapidly in all regions of the world. But in India it is only 20 years old. Within this short period it has emerged as one of the most serious public health problems in the country, which greatly affect the socio-economical growth. The HIV problem is very complex and ill defined from the modeling point of view. Keeping in the view the complexities of the HIV infection and its transmission, it is difficult to make exact estimates of HIV prevalence. It is more so in the Indian context, with its typical and varied cultural characteristics, and its traditions and values with special reference to sex related risk behaviors. Therefore, it is necessary to develop a good model which will help in making exact estimates of HIV prevalence that may be used for planning HIV / AIDS prevention and control programs. In this paper Neuro-Fuzzy approach has been used to develop dynamic model of HIV population of Agra region.