Search

Reproductive and sexual health of women are sensitive areas of enquiry characterized by strong cultural oppression of women. Body mapping, an arts-based participatory research method, has proven useful in research with such sensitive topics. In this paper, I describe my experience of researching women's experience of childbirth through birth maps, an adaptation of body mapping. Live size maps were co-created along with birthing story and body key with women in Bihar, India. Body mapping is a very cost-effective method that ensures better recall, richer narratives, reduced power-based inequalities that enables to explore reproductive, maternal & sexual health topics respectfully. The birth map and birthing story can generate awareness about how women give birth, as an attempt to improve the quality and respectfulness in care provision during labour and childbirth. [ABSTRACT FROM AUTHOR]

Introduction: The role of gender norms in shaping education and work opportunities, distribution of power and resources, and health and wellbeing is well recognised. However, rigorous studies in low- and middle-income countries on when and how norms change over time and what factors shape adolescents' and young adult's gender attitudes are limited. This paper explores the factors that determine adolescents' gender attitudes, as well as patterns in gender attitude shifts over time among younger and older adolescent boys and girls in India. Data and methods: Data presented in this paper were drawn from a unique longitudinal study of adolescents aged 10–19 (Understanding the lives of adolescent and young adults–UDAYA study) in the states of Bihar and Uttar Pradesh in India, conducted during 2015–2016 (wave 1) and 2018–2019 (wave 2). The analysis presented in this paper drew on data from 4,428 boys and 7,607 girls who were aged 10–19 and unmarried at wave 1 and interviewed at both rounds of the survey. We used univariate and bivariate analyses to examine changes in adolescents' gender role attitudes over time and the association between explanatory variables and gender role attitudes. We also used linear fixed effects regression models to identify factors that shape adolescents' gender role attitudes. Results: Gender role attitudes became more egalitarian over time among boys and girls, except among the older cohort of boys in our study. Among both younger and older cohorts, girls/young women held more egalitarian views than boys/young men and this pattern held over time for both cohorts. Factors that influenced gender role attitudes differed for younger and older adolescents, particularly among boys. While some predictors differed for boys and girls, there were substantial similarities as well. Gender attitudes were affected by factors at the individual, family, peer, and societal levels, as well as by community engagement. Conclusions: Our findings show that it is possible to shift gender attitudes toward greater equity and, in so doing, contribute to improved health and rights. [ABSTRACT FROM AUTHOR]

This paper examines various features of energy and groundwater irrigation nexus in a highly irrigated ecosystem of north western India. The study is based both on primary and secondary sources of data. Electric tube-wells account for about 72 percent of the total tube-wells population and consume about 40 percent of the total electricity consumption. Power subsidies account approximately 46 percent of the total subsidies disbursed which stimulate the groundwater development. The area irrigated by means of tube-wells has enlarged from 22 to 58 percent. Rice and sugarcane crops are the key consumers of energy both in terms of average energy consumption as well as per hectare of cultivated land. The average use factor of tube-wells is about 7.5 times high during kharif than in rabi season. Farmers have yielded high economic productivity under all crops with the exception of rice than other states such as Uttar Pradesh, Bihar and Gujarat. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Social Intervention: Theory & Practice is the property of Universiteit Utrecht and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The disease control program is critical to the agenda of social justice. A generalist approach to the disease control program involves understanding its complexity and prevention from various perspectives, including ecological theory. The integration of the disease control program into the existing healthcare delivery system has been advocated over many decades, with an emphasis on the medical model of disease control. Integration has been widely considered as a means to achieve an effective and efficient health system. This approach has been widely adopted in low-middle-income countries to integrate vertical programs such as leprosy, malaria, HIV/AIDs, and others. However, studies suggest that there is a lack of evidence about the effectiveness of health system integration. The available evidence shows that integration of the health system can have a mixed, negative, or no impact on the health system. This growing enthusiasm toward health system integration is primarily based on the perceived benefits of an integrated approach. This discussion paper draws on the experience of the integration of the National Leprosy Elimination Program in India. It highlights the factors that affected the integration of leprosy programs in Bihar and also affected the pursuit of social justice for people who have been marginalized in our modern world. [ABSTRACT FROM AUTHOR]

The dispersed wetlands in the Darbhanga District of northern Bihar, India, provide a diversity of niches supporting substantial floral and faunal richness. The aquatic macrophytes of a representative range of perennial water bodies were surveyed fortnightly from June to September 2019, supported by a market survey undertaken with local stakeholders. A total of 61 species of vascular macrophytes was recorded, the majority of them Angiosperms (33 species of Dicotyledons from 21 families, and 26 Monocotyledons from 13 families) and two were Pteridophytes. This paper highlights the distribution pattern and potential commercial and medicinal values of aquatic macrophytes found in different wetland systems in northern Bihar. It further stresses their importance for subsistence, medicinal and economic purposes supporting the livelihoods of local people. Current trends and risks contributing to the degradation and loss of this diverse flora and its supporting habitats are considered. We recommend further assessment of the occurrence and values of this botanical resource, and extension of valuation to encompass the diverse additional ecosystem service benefits provided by the region's wetland systems, as a basis for wetland conservation strategies founded on sustainable management and wise use, with particular reference to the potential for enhancing livelihood security of indigenous communities. [ABSTRACT FROM AUTHOR]

Tourism policies formulated and implemented by the union and state governments of India and Bihar respectively, over the past five decades, have played a significant role in attracting religious tourists to the Buddhist sites in Bihar from all across the world. This exploratory research is a historiographical narrative of Buddhist tourism in view of tourism development policies and plans. The study finds that favourable and effective policies have increased domestic and foreign tourism in India, especially international Buddhist pilgrimage to Bihar. However, the state of Bihar still needs better policies and marketing to promote Buddhist tourism. The paper explores the overlooked role of government tourism development policies in promoting spiritual and religious tourism in India, in addition to chronicling the development of tourism in Bihar. The study paves the path for further research into a potential tourism resource that the state of Bihar possesses but has not been able to fully realise. This case study is one of very few attempts to relate the role of policies in the development of tourism in South Asia. [ABSTRACT FROM AUTHOR]

Background: Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) is a multicomponent, whole-school health promotion intervention delivered by a lay counsellor or a teacher in government-run secondary schools in Bihar, India. The objective of this study is to examine the effects of the intervention after two years of follow-up and to evaluate the consistency of the findings observed over time.Methods and Findings: We conducted a cluster randomised trial in which 75 schools were randomised (1:1:1) to receive the SEHER intervention delivered by a lay counsellor (SEHER Mitra [SM]) or a teacher (Teacher as SEHER Mitra [TSM]), respectively, alongside a standardised, classroom-based life skills Adolescence Education Program (AEP), compared to AEP alone (control group). The trial design was a repeat cross-sectional study. Students enrolled in grade 9 (aged 13-15 years) in the 2015-2016 academic year were exposed to the intervention for two years and the outcome assessment was conducted at three time points─at baseline in June 2015; 8-months follow-up in March 2016, when the students were still in grade 9; and endpoint at 17-months follow-up in December 2016 (when the students were in grade 10), the results of which are presented in this paper. The primary outcome, school climate, was measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Intervention effects were estimated using mixed-effects linear or logistic regression, including a random effect to adjust for within-school clustering, minimisation variables, baseline cluster-level score of the outcome, and sociodemographic characteristics. In total, 15,232 students participated in the 17-month survey. Compared with the control group, the participants in the SM intervention group reported improvements in school climate (adjusted mean difference [aMD] = 7.33; 95% CI: 6.60-8.06; p < 0.001) and most secondary outcomes (depression: aMD = -4.64; 95% CI: -5.83-3.45; p < 0.001; attitude towards gender equity: aMD = 1.02; 95% CI: 0.65-1.40; p < 0.001; frequency of bullying: aMD = -2.77; 95% CI: -3.40 to -2.14; p < 0.001; violence victimisation: odds ratio [OR] = 0.08; 95% CI: 0.04-0.14; p < 0.001; and violence perpetration: OR = 0.16; 95% CI: 0.09-0.29; p < 0.001). There was no evidence of an intervention effect in the TSM group compared with control group. The effects of the lay counsellor-delivered intervention were larger for most outcomes at 17-months follow-up compared with those at 8 months: school climate (effect size [ES; 95% CI] = 2.23 [1.97-2.50] versus 1.88 [1.44-2.32], p < 0.001); depression (ES [95% CI] = -1.19 [-1.56 to -0.82] versus -0.27 [-0.44 to -0.11], p < 0.001); attitude towards gender equity (ES [95% CI] = 0.53 [0.27-0.79] versus 0.23 [0.10-0.36], p < 0.001); bullying (ES [95% CI] = -2.22 [-2.84 to -1.60] versus -0.47 [-0.61 to -0.33], p < 0.001); violence victimisation (OR [95% CI] = 0.08 [0.04-0.14] versus 0.62 [0.46-0.84], p < 0.001); and violence perpetration (OR [95% CI] = 0.16 [0.09-0.29] versus 0.68 [0.48-0.96], p < 0.001), suggesting incremental benefits with an extended intervention. A limitation of the study is that 27% of baseline participants did not complete the 17-month outcome assessment.Conclusions: The trial showed that the second-year outcomes were similar to the first-year outcomes, with no effect of the teacher-led intervention and larger benefits on school climate and adolescent health accruing from extending lay counsellor-delivered intervention.Trial Registration: ClinicalTrials.gov NCT02907125. [ABSTRACT FROM AUTHOR]

Background: Asymptomatic Leishmania donovani infections outnumber clinical presentations, however the predictors for development of active disease are not well known. We aimed to identify serological, immunological and genetic markers for progression from L. donovani infection to clinical Visceral Leishmaniasis (VL). Methods: We enrolled all residents >2 years of age in 27 VL endemic villages in Bihar (India). Blood samples collected on filter paper on two occasions 6–12 months apart, were tested for antibodies against L. donovani with rK39-ELISA and DAT. Sero converters, (negative for both tests in the first round but positive on either of the two during the second round) and controls (negative on both tests on both occasions) were followed for three years. At the start of follow-up venous blood was collected for the following tests: DAT, rK39- ELISA, Quantiferon assay, SNP/HLA genotyping and L.donovani specific quantitative PCR. Results: Among 1,606 subjects enrolled,17 (8/476 seroconverters and 9/1,130 controls) developed VL (OR 3.1; 95% CI 1.1–8.3). High DAT and rK39 ELISA antibody titers as well as positive qPCR were strongly and significantly associated with progression from seroconversion to VL with odds ratios of 19.1, 30.3 and 20.9 respectively. Most VL cases arose early (median 5 months) during follow-up. Conclusion: We confirmed the strong association between high DAT and/or rK39 titers and progression to disease among asymptomatic subjects and identified qPCR as an additional predictor. Low predictive values do not warrant prophylactic treatment but as most progressed to VL early during follow-up, careful oberservation of these subjects for at least 6 months is indicated. [ABSTRACT FROM AUTHOR]

This paper investigates the underlying causes of poor economic growth of Bihar and Uttar Pradesh (UP), India, despite being endowed with relatively rich natural resources. Against the conventional view, the analysis reveals that poor economic growth is not due to a particular factor but an outcome of a myriad of social, economic and political factors rooted in structural, historical and macro-economic policies. The economic marginalization of Bihar and UP began in the colonial era through the establishment of an exploitative landlord class, which constantly resisted economic and social development even after independence in 1947. The process of marginalization has further been reinforced by the federal central government's policy of 'freight equalization', which nullified the comparative advantage of Bihar and UP in natural resources by subsidizing railway freights of industrial inputs like coal, iron ore, steel, cement and other bulk resources. This, combined with relatively low financial resources received from central government over the consecutive plan periods, has undermined these states' capacity to invest in health, education, and other social and physical infrastructure and resulted in low human development. The poor performance of Bihar and UP may be attributed to low human capital, weak institutions and poor infrastructure coupled with political instability and social conflict rooted in sectarian politics based on caste, class and ethnic division. [ABSTRACT FROM AUTHOR]

Groundwater contamination in India exposes an estimated 70 million people to arsenic. Over 10 million people in the state of Bihar (India) are at risk of arsenic poisoning. As reported 27 districts of the state's thirty-eight districts are under a state of catastrophe. Symptoms noticed by those who have been exposed to the arsenic caused disease are-lack of appetite, neurobehavioral problems, hyperkeratosis, and melanosis on the skin. So, this study's primary objective is to find novel approaches to treat arsenic poisoning in rats using the Charles Foster model. Following permission from the Institutional Animal Ethics Committee, the animals were divided into three groups: one group served as a control, the second group received arsenic treatment, and the third group received Ganoderma lucidum extract after arsenic treatment. For the arsenic group, the rats were given 8 mg/kg body weight of sodium arsenite orally every day for 90 days, and then for 60 days, they were given 80 mg/Kg body weight of Ganoderma lucidum extract via gavage. Their biochemical values, including those of the liver and kidneys, were found to be increased. In addition, their levels of free radicals, including lipid peroxidation, were measured and found to be substantially higher. In addition, the levels of arsenic in the kidney and liver tissue were very high. However, biochemical and lipid peroxidation levels were significantly restored after administration of Ganoderma lucidum ethanolic extract. Arsenic levels in rat liver and kidney tissues were also found to be reduced. Ganoderma lucidum has a therapeutic impact against arsenicinduced toxicity, according to the present research. [ABSTRACT FROM AUTHOR]

Poverty affects many people, but the ramifications and impacts affect all aspects of society. Information about the incidence of poverty is therefore an important parameter of the population for policy analysis and decision making. In order to provide specific, targeted solutions when addressing poverty disadvantage small area statistics are needed. Surveys are typically designed and planned to produce reliable estimates of population characteristics of interest mainly at higher geographic area such as national and state level. Sample sizes are usually not large enough to provide reliable estimates for disaggregated analysis. In many instances estimates are required for areas of the population for which the survey providing the data was unplanned. Then, for areas with small sample sizes, direct survey estimation of population characteristics based only on the data available from the particular area tends to be unreliable. This paper describes an application of small area estimation (SAE) approach to improve the precision of estimates of poverty incidence at district level in the State of Bihar in India by linking data from the Household Consumer Expenditure Survey 2011–12 of NSSO and the Population Census 2011. The results show that the district level estimates generated by SAE method are more precise and representative. In contrast, the direct survey estimates based on survey data alone are less stable. [ABSTRACT FROM AUTHOR]

The goal of public breeding programs is to develop and disseminate improved varieties to farmers. This strategy aims at providing farming communities with superior crop varieties than they are growing. However, the strategy rarely considers the needs and preferences of farmers, especially gendered preferences, failing to solve real field problems by addressing the differences and inequalities prevalent in the farming communities. Our research examines how personal, household, agronomic and ecological characteristics of wheat growers in Bihar, India's eastern Indo-Gangetic Plains, affect women and men's wheat trait choices. Data were obtained from 1,003 households where both male and female respondents from the same household were interviewed. We accounted for 23 traits of wheat from a careful assessment of production, environment, cooking quality, market demand, and esthetic criteria. Binomial logistic regression was used to determine women's and men's trait preferences. The results imply that gender influences the preferences of wheat traits. Some traits are favored by both women and men, however, in other instances, there are striking disparities. For example, men choose wheat varieties that are well adapted to extreme climate conditions, have a higher grain yield, and produce chapati with a superior taste, while women prefer wheat types with superior chapati making quality, higher grain yield, and high market prices. Other socioeconomic, agronomic, cultural, and geolocational factors have a considerable impact on trait preferences. These human dimensions of traits preferred by women and men farmers are important for trait combinations to develop breeding product profiles for certain market segments. [ABSTRACT FROM AUTHOR]

Despite being one of the most conflict-prone species in India, the Nilgai antelope Boselaphus tragocamelus has received little scientific attention. In this study, we address this knowledge gap by conducting an analysis of secondary data extracted from print media reports on Human-Nilgai negative interactions at the regional scale (tehsils and districts) across different states of India. Our findings revealed notable variations in conflict levels among different states, with Bihar emerging as the most affected (86 tehsils and 22 districts), followed by Madhya Pradesh (34 tehsils; 21 districts) and Uttar Pradesh (33 tehsils; 20 districts). Within Bihar, Muzaffarpur and East Champaran districts stand out for their high conflict levels. Crop raiding by different populations of Nilgai is identified as the primary cause of the negative interaction, with a relative frequency of occurrence of 98%. Attacks on humans by nilgai, although rare, accounted for a relative frequency of occurrence of only 1.2%. Additionally, newspapers reported retaliatory killings, with a relative frequency of occurrence of 0.84%. Between 2018 and 2022, nilgai populations were documented raiding 45 distinct crop types. Analysis of these raids revealed varying frequencies across different crop categories, with vegetables being the most heavily targeted (31%), followed by pulses (22%) and cereals (20%). Our study identifies priority tehsils and districts across different states in the country where studies aiming at nilgai-crop interactions, population dynamics, and movement ecology can be carried out to devise effective mitigation measures. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the DDT and deltamethrin susceptibility of Phlebotomus argentipes, the vector of Leishmania donovani, responsible for visceral leishmaniasis (VL), in two countries (India and Nepal) with different histories of insecticide exposure. Methods: Standard WHO testing procedures were applied using 4% DDT and 0.05% deltamethrin impregnated papers. The effect of the physiological status (fed and unfed) of females on the outcome of the bioassays was assessed and the optimal time of exposure for deltamethrin was evaluated on a colony population. Field populations from both countries were tested. Results: Fed and unfed females responded in a similar way. For exposure time on field samples 60 min was adopted for both DDT and deltamethrin. In Bihar, knockdown and mortality with DDT was respectively 20 and 43%. In Nepal almost all sand flies were killed, except at the border with Bihar (mortality 62%). With 0.05% deltamethrin, between 96 and 100% of the sand flies were killed in both regions. Conclusions: Based on literature and present data 4% DDT and 0.05% deltamethrin seem to be acceptable discriminating concentrations to separate resistant from susceptible populations. Resistance to DDT was confirmed in Bihar and in a border village of Nepal, but the sand flies were still susceptible in villages more inside Nepal where only synthetic pyrethroids are used for indoor spraying. The low effectiveness of indoor spraying with DDT in Bihar to control VL can be partially explained by this resistance hence other classes of insecticides should be tested. In both countries P. argentipes sand flies were susceptible to deltamethrin. Author Summary: Visceral leishmaniasis (VL), also know as kala azar, is one of the major public health concerns India, Nepal and Bangladesh. In the Indian subcontinent, VL is caused by Leishmania donovani which is transmitted by Phlebotomus argentipes. To date, Indoor Residual Spraying (IRS) campaigns have been unable to control the disease. Vector resistance to the insecticides used has been postulated as one of the possible reasons explaining this failure. A number of studies in the region have shown a variable degree of resistance to DDT in areas where this insecticide has been widely used for IRS (mainly India). However there is no coordinated and standardized program to monitor resistance to insecticides in the region. In this study we tested P. argentipes susceptibility to DDT and deltamethrin in VL endemic villages in India and Nepal. The results confirmed the DDT resistance in India and in a border village of Nepal. P. argentipes from both countries were in general susceptible to deltamethrin, an insecticide used in some long lasting insecticidal nets. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have demonstrated that high-risk fertility behaviour (HRFB), which includes maternal age below 18 or above 34 years, short birth intervals (less than 24 months), and high parity (birth order above 4), is associated with adverse maternal and child health outcomes. There is a substantial research gap in the domain of high-risk fertility behaviour in the Indian context. Therefore, this study is designed to investigate the current trends and patterns in the prevalence of high-risk births among Indian women, with a primary focus on identifying contributing factors associated with this prevalence. Methods: The study utilized data from the nationally representative National Family Health Survey (NFHS), which has been conducted in five rounds since 1992–93. Data from all rounds were used to assess the overall trend. However, data from the most recent round of NFHS, conducted during 2019–21, were employed to evaluate current levels and patterns of HRFB prevalence and to identify socio-economic and demographic predictors of HRFB using binomial and multinomial logistic regression models. Results: The prevalence of HRFB has exhibited a consistent decreasing pattern from 1992 to 93 to 2019–21 in India. However, 29.56% of married women continue to experience high-risk births with notably higher rates in several states (e.g., 49.85% in Meghalaya and 46.41% in Bihar). Furthermore, socio-demographic factors like wealth index, educational level, social group, religion, mass media exposure, family size, age at marriage, type and region of residence, and reproductive factors like birth intention, place and type of delivery, ANC visits and current contraceptive use were identified as significant predictors of high-risk births among women in India. Conclusion: Despite a 20.4 percentage point decline in HRFB prevalence over the past three decades, a significant proportion of women in specific regions and demographic subgroups continue to experience high-risk births. Therefore, the present study recommends interventions aimed at preventing high-risk births among women in India, with particular emphasis on states with high HRFB prevalence and women from socioeconomically disadvantaged backgrounds. [ABSTRACT FROM AUTHOR]

Purpose: According to the 4th and 5th rounds of National Family Health Survey (NFHS), there is high prevalence of hysterectomies in the three states of Andhra Pradesh Telangana and Bihar. The three said states have more than double the number of hysterectomies taking place than the national average. Our purpose is to analyse whether these rates are increasing, decreasing or have stabilized and their reasons thereof. Such an analyses will help the policy makers in recommending good clinical practices within their states. Material and methods: We used data from NFHS-4 (2015-16) and NFHS-5 (2019-2021) rounds. We calculated the differences in predicted probabilities for various factors, performed a Fairlie Decomposition analyses to quantify the positive and negative contributors in the prevalence of hysterectomy across the three states over two time points, and assessed the association of various socio-demographic characteristics to hysterectomy through a multilevel logistic regression model. Results and conclusion: The results show that out of a total of 80,976 eligible respondents from the states under study, 5826 respondents self-reported that they had a hysterectomy done. It was found that older age, living in rural areas, belonging to other backward classes and higher wealth quintile, and higher parity positively contributed to the increased prevalence of hysterectomies in the three states. Higher educational attainment and previous use of family planning methods acted as protective factors. Characteristics at the household level had the highest intra-class correlation value in the prevalence of hysterectomy among women, followed by the Primary Sampling Unit and District levels, indicating high clustering in the prevalence of hysterectomy at the household level in all three states. Heavy menstrual bleeding/pain was the leading cause of hysterectomies in all three states, followed by fibroids/cysts in Andhra Pradesh and Telangana and Uterine disorder/ prolapse in Bihar. Over 80% of hysterectomies took place in the private hospitals. Recommendations: The study recommends better, more efficient and accountable hysterectomy surveillance to ensure more sustainable woman's reproductive health services in India. Government should adopt and implement standard regulatory guidelines to prevent provider-driven avoidable hysterectomies. Moreover, we recommend informing primary care professionals about the long-term health effects of hysterectomy and promoting alternate therapies for treating uterine fibroids and heavy bleeding. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions. Methods: A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored. Results: In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection. Conclusions: STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases. Author Summary: Deworming is recognised as a cost-effective way to increase the educational attainment and health of school-age children who experience high prevalence and intensity of soil-transmitted helminth (STH) infections and bear the majority of the disease burden. STH transmission is driven by a number of factors including the environment, water availability and lack of sanitation. Previous government surveys in India revealed small geographic areas have extremely heterogeneous prevalence, generating interest in exploring what explains this heterogeneity. Having recently implemented a large deworming progamme, the government of Bihar State was keen to utilise the deworming campaign to undertake complementary activities to reduce transmission and establish an integrated approach to STH control. This paper presents the results of the prevalence and intensity cross-sectional survey and takes an exploratory look at the contribution of key risk factors to transmission. Maternal literacy, caste, open defecation (a common practice) and absence of handwashing stations at schools were associated with increased risk of hookworm or ascariasis. Using this information it is possible to hypothesise about potential key areas of focus during the deworming campaign and interventions that could complement deworming programmes, as well as to develop some key messages to accompany the next deworming programme in Bihar. [ABSTRACT FROM AUTHOR]

The paper examines the nature and development of the participatory water institutions in the eastern Indo-Gangetic plains of India, focusing on the aspects of structure, participation, and devolution. Though the physical development of irrigation has made considerable progress in India, the proper management and distribution of water has poised many difficulties. The consequences of this are poor efficiency in water use, inequity in distribution, disputes, high cost, and substantial under-utilization of the potential created. On the other hand, institutional initiatives that aim to improve water management and distribution are seen in some areas/locations, and show a process of arriving at better institutional arrangements. Water institutions are crucial for eastern India and though there are a few examples of spontaneous bottom-up initiatives, much of this development is driven by external interventions including laws, policies, and government programs. Even though under the government interventions, the guidelines and policies are usually uniform and top-down, the local uptake and adoption show substantial variation and divergence and this deserves study. The research is based on review of the literature as well as on six in-depth case studies, and also responses of 510 households involved with 51 participatory water institutions in the setting of the eastern Indo-Gangetic plains states of Assam and Bihar. The paper first takes a brief look at the literature on the foundations and experiences of participatory irrigation management (PIM), and then examines through the case studies and data, the development and variation in the PIM water institution in the given setting. It examines features such as laws, membership, structure, inclusion, participation/involvement and devolution. It finds that inclusion of various groups of people in the institutions is quite good except for women and youth. However, actual involvement of different people varies substantially. The issue of devolution/decentralization versus centralization in decision-making is very important to PIM, and varies across the structure and functions. The association of involvement and devolution to performance indicates that the active involvement of some functionaries and groups is very important, and that devolution in several decisions can considerably enhance performance. The observations provide many useful insights for policy and institutional design which can help improve water resource management in the eastern Indo-Gangetic plains. [ABSTRACT FROM AUTHOR]

In which settings can bicycles help to improve girls' education in low-income countries? This paper analyzes the complementarity between all-weather roads and a bicycle program in India aimed at increasing girls' secondary school enrollment. Using a triple-difference strategy, I find that the program benefits girls living 3–10 km away from schools with all-weather road connections, increasing their enrollment by 60 percent and reducing the gender enrollment gap by 51 percent. There are no effects for girls in villages without all-weather roads or girls living more than 10 km from school. The findings emphasize the importance and interdependence of road infrastructure, mode of transport, and distance to school for improving girls' education in India. • Bicycle program for girls in Bihar, India, reduces the gender education gap. • Bicycle program is only effective if high-quality road infrastructure is available and schools are nearby. • Interdependence of mode of transport (bicycles), road infrastructure, and nearby schools for girls' education choice in India. • Triple-difference estimation. [ABSTRACT FROM AUTHOR]

Despite having equally vast endowments of natural resources and similar socioeconomic profiles, the Indian states of Bihar and Odisha pursued markedly different development strategies during India's first decade of economic liberalization. Whereas Bihar turned away from its natural resource sector and adopted policies of social empowerment, Odisha courted private investment in extractive industries and aggressively pursued market reforms. To account for this divergence, we argue that the social composition of political power in each state directly shaped the strategies that leaders embraced towards the natural resource sector and overall development. This paper makes contributions to the writings on natural resources and the political economy of India. We show that the presence of abundant natural resources does not necessarily result in a predictable pathway of sectoral and economic policy outcomes. Instead, social factors can be a powerful determinant of how resource-rich states approach their economies. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to analyze the trends and variability in extreme temperature indices and its impact on rice-wheat productivity over two districts of Bihar, India, which is part of the middle Indo-Gangetic Basin. Mann-Kendall non-parametric test was employed for detection of trend and Sen slope was determined to quantify the magnitude of such trends. We have analyzed 10 extreme temperature indices for monthly and seasonally. The influence of extreme temperature indices on rice-wheat productivity was determined using correlation analysis. As far as Patna is concerned, if the number of cool days during September ≥10, the rice productivity will increase due to the availability of sufficient duration to fill up the grain. However, higher warm days during all the months except June will affect the productivity. A significant negative correlation was noticed between maximum value of minimum temperature during September and rice productivity. Highly significant positive correlation was noticed between number of cool days during September with rice productivity while it was highly significant negative correlation in the case of number of warm days during the same month. As far as Samastipur is concerned, a negative correlation was noticed between wheat productivity and maximum value of maximum temperature (TXx) during February, but not statistically significant. The higher temperature may affect the kernel weight and thereby yield. It is seen that a critical value of TXx ≥29.2 °C will be harmful to wheat crop during February. A significant positive correlation of number of cool nights with wheat productivity also supports the above relationship. The critical values of extreme temperature indices during rice and wheat growing months provide an indicator to assess the vulnerability of rice-wheat productivity to temperature for Patna and Samastipur districts and there is a need to prepare an adaptive strategy and also develop thermo-insensitive rice-wheat high yielding varieties suitable for this region to sustain rice-wheat productivity under projected climate change situation. [ABSTRACT FROM AUTHOR]

Thirty seven species of locusts and grasshoppers representing 26 genera, four tribes and 12 subfamilies belonging to the families Pyrgomorphidae, Catantopidae and Acrididae are reported from different localities of Bihar. Their distinguishing characters and bio-ecological data are provided along with keys to tribes and subfamilies. This paper comprising of distribution and field observation along with taxonomy of Acridoid fauna is the first of its kind from the state [ABSTRACT FROM AUTHOR]

Objective Visceral Leishmaniasis (VL) is highly prevalent in Bihar, India. India and its neighbours aim at eliminating VL, but several knowledge gaps in the epidemiology of VL may hamper that effort. The prevalence of asymptomatic infections with Leishmania donovani and their role in transmission dynamics are not well understood. We report data from a sero-survey in Bihar. Methods Demographic and immunological surveys were carried out in July and November 2006, respectively in 16 highly VL endemic foci in Muzaffarpur district in Bihar. Household and individual information was gathered and capillary blood samples were collected on filter papers. Direct agglutination test (DAT) was used to determine infected individuals (cut-off titre 1:1600). DAT results were tabulated against individual and household variables. A multivariate generalized estimating equation (GEE) model was used to study the prevalence of serologically positive individuals taking into account the clustering at household and cluster levels. Results Of study subjects 18% were DAT positive, and this proportion increased with age. Women had a significantly lower prevalence than men >14 years old. Owning domestic animals (cows, buffaloes or goats) was associated with a higher risk of being DAT positive [OR 1.16 (95% CI 1.01–1.32)], but socio-economic status was not. Conclusions Prevalence of leishmanial antibodies was high in these communities, but variable. Demographic factors (i.e. marriage) may explain the lower DAT positivity in women >14 years of age. Within these homogeneously poor communities, socio-economic status was not linked to L. donovani infection risk at the individual level, but ownership of domestic animals was. [ABSTRACT FROM AUTHOR]

Background: Co-endemicity of neglected tropical diseases (NTDs) necessitates that these diseases should be considered concomitantly to understand the relationship between pathology and to support disease management and control programs. The aims of the study were to assess the prevalence of filarial infection in asymptomatic Leishmania donovani infected individuals and the correlation of Wuchereria bancrofti infection with progression to clinical visceral leishmaniasis (VL) in Bihar, India. Methodology/Principal findings: Within the Muzaffarpur-TMRC Health and Demographic Surveillance System (HDSS) area, a cohort of Leishmania seropositive (n = 476) or seronegative individuals (n = 1130) were sampled annually for three years for filarial infection and followed for progression to clinical VL. To corroborate the results from the cohort study, we also used a retrospective case-control study of 36 VL cases and 71 controls selected from a subset of the HDSS population to investigate the relationship between progression to clinical VL and the prevalence of filarial infection at baseline. Our findings suggest a higher probability of progression to clinical VL in individuals with a history of filarial infection: in both the cohort and case-control studies, progression to clinical VL was higher among filaria infected individuals (RR = 2.57, p = 0.056, and OR = 2.52, p = 0.046 respectively). Conclusion: This study describes that progression to clinical VL disease is associated with serological evidence of prior infection with W. bancrofti. The integration of disease programs for Leishmania and lymphatic filariasis extend beyond the relationship of sequential or co-infection with disease burden. To ensure elimination targets can be reached and sustained, we suggest areas of co-endemicity would benefit from overlapping vector control activities, health system networks and surveillance infrastructure. Author summary: India has committed to eliminate two neglected tropical diseases (NTDs) as a public health problem: visceral leishmaniasis (VL) and lymphatic filariasis (LF), both of which are transmitted by vectors and are caused by the parasites Leishmania donovani and Wuchereria bancrofti, respectively. Notably, the majority of L. donovani infections do not lead to a clinical event of VL and asymptomatic infections significantly outnumber the clinical cases. While mixed infections with Leishmania parasites and those causing lymphatic filariasis have been reported, the influence of the immune response triggered by filarial infection on the clinical manifestations and progression of both disorders is not well understood. The Muzaffarpur-TMRC Health and Demographic Surveillance System (HDSS) in Bihar is a well-established demographic platform in an area with the highest incidence of L. donovani infections in India which is also co-endemic for lymphatic filariasis. We used both cohort and case-control study designs within the HDSS population to assess the prevalence of filarial infection in blood samples and examine the association between filarial infection and the progression to clinical VL. Our findings strongly suggest there is an increased risk of progression to clinical VL in individuals with a history of infection with W. bancrofti: in both the study designs, progression to clinical VL was higher among filaria-infected individuals. These results highlight that the co-endemicity of these NTDs necessitates an integrated approach in diagnosis and disease management to ensure elimination targets can be achieved and sustained. [ABSTRACT FROM AUTHOR]

Background: Marriage is a key determinant of health and well-being of adolescent girls and young women (AGYW) in India. It is a key life event in which girls move to their marital households, often co-residing with their in-laws and begin childbearing. The change in the normative environment in conjunction with cultural norms surrounding son preference influences women's overall life course. However, there is scant research about the association between these life transitions and changes in empowerment among AGYW in India. Methods: Using two waves of data from prospective cohort panel dataset that followed unmarried (6,065 observations in each wave) and married AGYW (3,941 observations from each wave) over a three-year period from Uttar Pradesh and Bihar, we examined how marriage, childbearing, and having a son is associated with changes in AGYW's empowerment, especially considering whether AGYW marry into patrilocal households (household with in-laws) as an effect modifier. Empowerment indicators included freedom of movement or mobility, decision-making power, access to economic using Kabeer's framework as our theoretical approach. Results: Marriage was associated with lower freedom of movement with a pronounced effect on those who co-resided with their in-laws. Marriage was associated with greater decision-making power for AGYW who did not co-reside with the in-laws. Motherhood was positively correlated with greater freedom of movement, marginally higher intrahousehold decision-making power, and better access to economic resources. No statistically significant evidence that having at least one son compared to having daughters only (or no daughters) conferred additional changes in girls' freedom of movement, intrahousehold decision-making power, and access to economic resources. Conclusion: Findings highlight the importance of understanding the vulnerabilities of being newly married in adolescence and emphasize the need for having interventions that target newly married AGYW along with mothers-in-law to empower them. [ABSTRACT FROM AUTHOR]

Objectives: There is insufficient evidence about the determinants of alcohol use amongst young people in India and other low‐and middle‐income countries, despite alcohol's high contribution to disease burden and increasing consumption in this population. We aimed to identify and estimate the determinants of alcohol use in a representative sample of 2716 young men from Bihar and Uttar Pradesh who participated in the 'Understanding the Lives of Adolescents and Young Adults' (UDAYA) study. Methods: First, we developed an exploratory conceptual framework of potential alcohol use determinants in the study settings based on available literature. We then estimated the effects of 35 potential alcohol use determinants identified in the conceptual framework (including 14 latent factors identified through exploratory factor analysis) on any alcohol use in the past 3 years and regular alcohol use amongst past three‐year drinkers, using mixed‐effects logistic models. The determinants explored were operationalised using longitudinal data from the UDAYA study. Results: Our adjusted models identified 18 determinants for past 3‐year alcohol use and 12 determinants for regular use. Distal determinants (e.g., socioeconomic status), intermediate determinants (e.g., parental alcohol use, media use), and proximal determinants (e.g., emotional regulation, early tobacco use) were identified. Geographical variations in both outcomes indicate potential differences in unmeasured community‐level determinants (e.g., alcohol availability and acceptability). Conclusions: Our findings extend the generalizability of several known determinants across settings, yet highlight the importance of addressing alcohol use in young people as a complex and context‐dependent issue. Many identified determinants (e.g., education, media use, poor parental support, early tobacco use) are amenable to intervention through multi‐sectoral prevention programs/policies. Such determinants should be the focus of ongoing policy/intervention development efforts in the region, and our revised conceptual framework may inform further research in India or similar South Asian settings. [ABSTRACT FROM AUTHOR]

One way to meet growing food demand is to increase yields in regions that have large yield gaps, including smallholder systems. To do this, it is important to quantify yield gaps, their persistence, and their drivers at large spatio-temporal scales. Here we use microsatellite data to map field-level yields from 2014 to 2018 in Bihar, India and use these data to assess the magnitude, persistence, and drivers of yield gaps at the landscape scale. We find that overall yield gaps are large (33% of mean yields), but only 17% of yields are persistent across time. We find that sowing date, plot area, and weather are the factors that most explain variation in yield gaps across our study region, with earlier sowing associated with significantly higher yield values. Simulations suggest that if all farmers were able to adopt ideal management strategies, including earlier sowing and more irrigation use, yield gaps could be closed by up to 42%. These results highlight the ability of micro-satellite data to understand yield gaps and their drivers, and can be used to help identify ways to increase production in smallholder systems across the globe. [ABSTRACT FROM AUTHOR]

Purpose: In the developing world, the adoption of new technology in agriculture has emerged as a tool to address the problem of investment-disincentive effect of capital investment on smallholders. In Indian agriculture, which is dominated by smallholders, technological adoption becomes very essential. In this regard, along with the government, local level organizations also provide training and other support to adopt the new agricultural technique. The present study is an attempt to assess the counterfactual impact of this sort of initiative in the context of Bihar, a state in India. Design/methodology/approach: The study uses field survey data which are collected from the Gaya district of Bihar. Overall, 249 sample farmers are surveyed from 23 villages of four blocks of the Gaya district. There are two groups of selected farmers: treatment and control groups. Farmers who adopted the new technique belong to the treatment group, and otherwise, the control group. For analytical purpose, a propensity score matching method has been used to estimate the counterfactual impact of the adoption of the new technique of farming on farmers' agricultural income. Findings: The study observes a significant improvement in the agricultural income of the farmers who adopted the new technique. New agricultural techniques, propagated through the local level organization, might be instrumental to enhance farmer's skill as well as income. Research limitations/implications: This type of approach may be adopted, complementary to the government's extension initiative to enhance farmers' income through adoption of the advanced farming process, as well as to improve the human capital of agriculture production. Originality/value: The study laid a framework of assessing the counterfactual impact of intervention of local level organization and adoption of new farming techniques in the context of Bihar, India. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-09-2022-0606 [ABSTRACT FROM AUTHOR]

Background: Production-to-consumption linkages are important to improve consumption of nutrient-rich foods to tackle malnutrition. However, understanding specific contextual factors influencing production, distribution, and consumption in rural communities is necessary. Objective: To explore household-, farm-, and market-level factors affecting consumption of nutrient-rich foods among producer and nonproducer households in Bihar, India. Methods: We conducted focus group discussions (FGDs) and key informant interviews (KIIs) in producer and nonproducer households of Gaya and Nalanda districts in Bihar to examine factors affecting production and consumption of red lentils, green leafy vegetables (GLVs), milk, eggs, and chicken. Through the KIIs, we identified distribution chains and elicited market-level challenges faced by producers, sellers, and consumers. Data were translated, transcribed, and analyzed thematically using NVivo version 9. Results: Findings from 27 FGDs indicate that consumers and producers were aware of the importance of nutrient-rich foods to health and the necessity of prioritizing their consumption in children. Food preferences, social factors, seasons, religions, and livestock epidemics influenced consumption. Among producers, consumption was mainly dependent on own production. Nonproducers perceived that production could help overcome the barrier of affordability and improve consumption. Data from 69 KIIs indicated that markets were unfavorable in terms of profitability for producers, spoilage and losses for market players, issues of accessibility, and availability for consumers. Conclusions: A local context-specific multipronged approach such as understanding sociocultural factors, own production, and local markets influencing consumption needs to be examined further to improve consumption of nutrient-rich foods among agricultural communities in India. Plain language title: Constraints and Facilitators in Production, Markets, and Consumption of Nutrient-Rich Foods in Bihar, India Plain language summary: Consumption of nutrient-rich foods such as red lentils, green leafy vegetables, milk, eggs, and chicken are essential to maintain balanced diet intake. In this qualitative study, we examined household-, farm-, and market-level factors that affected consumption of nutrient-rich foods among households that produced and not produced these food items in Bihar state, India. Group discussions were conducted among members of households that produced nutrient-rich foods and those that did not produce these food items. The group discussions helped identify challenges in production and consumption. Interviews were conducted with people involved in selling the nutrient-rich food items in the markets. These interviews enabled us to map the various levels food items have to pass from the food producer till it reached the consumer and the challenges faced during the course. From the group discussion, we found that consumers and producers were aware of the importance of nutrient-rich foods to maintain good health and the necessity of prioritizing their consumption in children. Food preferences, social factors, seasons, religions, and livestock epidemics influenced consumption at the household level. Producers of a particular food item were dependent on own production for consumption. Affordability was a key barrier to consumption, particularly among nonproducers. The common perception was that if they were able to produce a food item, it could help overcome the barrier of affordability and improve consumption. There were various unfavorable components in markets that interfered with the profitability for producers, including spoilage and losses, accessibility, and availability for consumers. We conclude that there is a need to understand local-context specific factors such as sociocultural factors, own production, and local markets that influence the consumption of nutrient-rich foods among agricultural communities in India. [ABSTRACT FROM AUTHOR]

Background: Circular migration is the dominant pattern of movement in India and is a livelihood strategy used by many food insecure rural households. Repeated shifts in food environments have important implications on household food security and dietary patterns but have not been studied. Objective: To explore differences in the food environment, food security, and food availability between home and destination spaces. Methods: Mixed-methods research was conducted among circular migrant families working and residing on brick kilns in the state of Bihar. Utilizing stratified cluster sampling, 2 rounds of cross-sectional data were collected from 2564 families. Additionally, 25 in-depth interviews were conducted with circular migrant parents, kiln owners, and labor contractors. The Food Insecurity Experience Scale was validated for use in our study population. Bivariate analyses were conducted to estimate the association of food insecurity with sociodemographic variables. Qualitative data were analyzed using descriptive thematic methods. Results: Seventy percent of respondents utilized at least one nonmarket source of food at the origin; at the destination, sources of food were limited to the private market. Despite higher food prices at the destination, perceived food affordability was higher during periods of migration, resulting in improved food security. Tubers, rice, and wheat were typically available in the household daily, whereas fruits, eggs, and dairy were typically unavailable during the week. Conclusions: Circular migration can enable short-term food security by improving food affordability. Policy frameworks must address the root causes of chronic food insecurity, especially among rural-to-rural circular migrant families. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL) is a vector-borne protozoan disease, which can be fatal if left untreated. Synthetic chemical insecticides are very effective tools for controlling of insect vectors, including the sand fly Phlebotomus argentipes, the vector of VL in the Indian subcontinent. However, repeated use of the same insecticide with increasing doses potentially can create high selection pressure and lead to tolerance and resistance development. The objective of this study was to determine the lethal concentrations and assess levels of susceptibility, diagnostic doses and times to death of laboratory-reared P. argentipes to five insecticides that are used worldwide to control vectors. Using the Center for Disease Control and Prevention (CDC) bottle bioassay, 20–30 sand flies were exposed in insecticide- coated 500-ml glass bottles. Flies were then observed for 24 hours and mortality was recorded. Dose-response survival curves were generated for each insecticide using QCal software and lethal concentrations causing 50%, 90% and 95% mortality were determined. A bioassay was also conducted to determine diagnostic doses and diagnostic times by exposing 20–30 flies in each bottle containing set concentrations of insecticide. Mortality was recorded at 10-minute intervals for 120 minutes to generate the survival curve. Phlebotomus argentipes are highly susceptible to alpha-cypermethrin, followed by deltamethrin, malathion, chlorpyrifos, and least susceptible to DDT. Also, the lowest diagnostic doses and diagnostic times were established for alpha-cypermethrin (3μg/ml for 40 minutes) to kill 100% of the flies. The susceptibility data, diagnostic doses and diagnostic times presented here will be useful as baseline reference points for future studies to assess insecticide susceptibility and resistance monitoring of field caught sand flies and to assist in surveillance as VL elimination is achieved in the region. Author summary: Synthetic chemical insecticides are mainly used for controlling sand flies via indoor residual spraying (IRS) and insecticide treated nets. Sand flies had developed resistance against DDT in endemic areas of Bihar, India, and was replaced by synthetic pyrethroids (alpha-cypermethrin) in the second phase of IRS in 2015. The substantial increase in the use of synthetic pyrethroids will potentially lead to increased resistance because DDT and pyrethroids both have the same target site. To monitor insecticide resistance in field caught sand flies, susceptibility status and diagnostic doses and times are warranted, as no diagnostic dose for resistance detection has been established for Indian sand flies. A laboratory reared P. argentipes was used to quantify insecticide susceptibility and determination of diagnostic doses and times. The CDC bottle bioassay was used with five insecticides viz., alpha-cypermethrin, deltamethrin, malathion, chlorpyrifos and DDT. Results indicate that the P. argentipes were highly susceptible to alpha-cypermethrin followed by deltamethrin, malathion, chlorpyrifos and least susceptible to DDT. This study provides critical base line reference data for further studies to assess insecticide susceptibility and resistance monitoring in field populations, as well as determining diagnostic doses and times for other insecticide susceptible sand fly populations undergoing surveillance to sustain VL elimination. [ABSTRACT FROM AUTHOR]

Despite dramatic reductions in global risk exposures to unsafe water sources, lack of access to clean water remains a persistent problem in many rural and last-mile communities. A great deal is known about demand for household water treatment systems; however, similar evidence for fully treated water products is limited. This study evaluates an NGO-based potable water delivery service in rural Bihar, India, meant to stand-in for more robust municipal treated water supply systems that have yet to reach the area. We use a random price auction and discrete choice experiment to examine willingness to pay (WTP) and stated product preferences, respectively, for this service among 162 households in the region. We seek to determine the impact of short-term price subsidies on demand for water delivery and the extent to which participation in the delivery program leads to changes in stated preferences for service characteristics. We find that mean WTP for the first week of service is roughly 51% of market price and represents only 1.7% of median household income, providing evidence of untapped demand for fully treated water. We also find mixed evidence on the effect of small price subsidies for various parts of the delivery service, and that one week of initial participation leads to significant changes in stated preferences for the taste of the treated water as well as the convenience of the delivery service. While more evidence is needed on the effect of subsidies, our findings suggest that marketing on taste and convenience could help increase uptake of clean water delivery services in rural and last-mile communities that have yet to receive piped water. However, we caution that these services should be seen as a stopgap, not a substitute for piped municipal water systems. [ABSTRACT FROM AUTHOR]

Introduction: India has the largest adolescent population in the world. However, many unprivileged Indian adolescents are still unable to complete schooling. Hence, there is a need to understand the reasons for school dropout among this population. The present study is an attempt to understand the determinants of school dropout among adolescents and identify the factors and reasons that contribute to it. Material and methods: Longitudinal survey data- Understanding Adults and Young Adolescents (UDAYA) for Bihar and Uttar Pradesh has been used to identify the determinants of school dropout among adolescents aged 10–19. The first wave of the survey was conducted in 2015–2016, and the follow-up survey in 2018–2019. Descriptive statistics along with bivariate and multivariate analysis was used to observe school dropout rates and factors associated with it among adolescents. Results: Results show that the school dropout rate was highest among married girls aged 15–19 years (84%), followed by unmarried girls (46%), and boys (38%) of the same age group. The odds of school dropout among adolescents decreased with an increase in household wealth status. School dropout was significantly less likely among adolescents whose mothers were educated as compared to mothers who had no education. Younger boys [AOR: 6.67; CI: 4.83–9.23] and girls [AOR: 2.56; CI: 1.79–3.84] who engaged in paid work were 6.67 times and 2.56 times more likely to drop out of school than those who were not. The likelihood of school dropout was 3.14 times more likely among younger boys [AOR: 3.14; CI: 2.26–4.35], and it was 89% more likely among older boys [AOR: 1.89; CI: 1.55–2.30] who consumed any substances as compared to those who did not consume any substances. Both younger [AOR: 2.05; CI: 1.37–3.05] and older girls [AOR: 1.30; CI: 1.05–1.62] who acknowledged at least one form of discriminatory practice by parents were more likely to drop out of school than their counterparts. Lack of interest in studies/education not necessary (43%) was the predominant reason among younger boys for school dropout, followed by family reasons (23%) and paid work (21%). Conclusions: Dropout was prevalent among lower social and economic strata. Mother's education, parental interaction, participation in sports and having role models reduce school dropout. Conversely, factors such as being engaged in paid work, substance abuse among boys, and gender discriminatory practices towards girls, are risk factors for dropout among adolescents. Lack of interest in studies and familial reasons also increase dropout. There is a need to improve the socio-economic status, delay the marital age of girls, and enhance the government incentives for education, give rightful work to girls after schooling, and provide awareness. [ABSTRACT FROM AUTHOR]

The paper examines the nature and performance of participatory water institutions in eastern India using structural equation modelling. There is a crisis in the management of water in India, and this is often not about having too little water but about managing it poorly. It is now being widely recognized that engineering structures and solutions are not enough, and having effective water institutions is critical. These are urgently needed in eastern India for helping lift the region out of low incomes and poverty. However, creating good institutions is complex, and in this context, the fundamentals of new institutional economics, and management governance theory have suggested the importance of a number of key factors including five institutional features and eight rationalities. Based on this, a study was conducted in eastern India, sampling from the states of Assam and Bihar, covering 510 farm households across 51 water institutions. In order to understand and map the relationship and pathways across these key factors, a structural equation model is hypothesized. In the model, the five institutional features are considered determinants of the eight rationalities, and the rationalities are considered determinants of four performance goals. The performance on the goals determines the overall performance/success of the institution. Besides this, the institutional features and rationalities can also directly influence performance on the goals and the overall performance. The model is tested with data from the survey and different pathways that are robust are identified. The results can provide useful insights into the interlinkages and pathways of institutional behavior and can help policy and institution design for delivering more robust performance. The results show that one of the most important factors determining overall performance/success is technical rationality, and this deserves great attention. It includes technical expertise, sound location and quality of structures and equipment, and good maintenance. However, success is also strongly linked to performance on production/income goals, equity, and environment goals. These are, in turn, strongly related to achievement of economic, social, technical, and organizational rationalities, which call for attention to economic aspects such as crop choice and marketing, besides social aspects such as inclusion of women and poorer social groups, and organizational aspects such as member involvement and regular meetings. Further, the institutional features of clear objectives, good interactions, adaptive, correct scale, and compliance are important for achievement of almost all rationalities through various pathways, and should be strongly focused on in all the institutions. [ABSTRACT FROM AUTHOR]

The paper examines the extent, nature, and factors affecting women's involvement in participatory irrigation institutions of eastern India. Effective participatory water institutions are urgently needed to improve water management in eastern India, and a significant aspect of this is the involvement of women. There is inadequate representation, participation, and involvement of women in most water institutions. From the participatory and social point of view, this is a significant concern. The relevant data are obtained from the states of Assam and Bihar through a focused survey administered to 109 women in 30 water institutions, and a larger farmer-institutional survey covering 510 households and 51 water institutions. The research examines the extent and nature of the involvement of women in these institutions, as well as in farm decision-making, and the factors that prevent or foster their participation. Additionally, it examines the gender congruence in views regarding water institution activities and their performance, and the perceived benefits of formal involvement of women. The results show that their inclusion is very low (except required inclusion in Bihar), and the concerns of women are usually not being taken into account. Women are involved in farming and water management decisions jointly with men but not independently. Findings indicate that the views of women and men differ on many aspects, and so their inclusion is important. Responses indicate that if women participate formally in water user associations, it would enhance their social and economic standing, achieve greater gender balance, expand their awareness of water management, and contribute to better decision-making in the water institutions. [ABSTRACT FROM AUTHOR]

The paper examines the performance of participatory water institutions in India's Eastern Indo-Gangetic plains region using new institutional economics and management governance fundamentals. Water institutions are of great importance for water resource management in India's Eastern Indo-Gangetic plains since the region has relatively abundant water but lags behind significantly in economic development and growth with a high incidence of poverty. Engineering solutions to water management have been implemented but have not given good results principally because of weak institutional development and design in the region. Effective and efficient participatory water institutions are urgently needed. The research uses concepts from new institutional economics and management governance theory to build a conceptual framework for explaining the performance of participatory water institutions. The framework identifies eight institutional rationalities: technical, environmental, economic, social, political organizational, financial and government; as well as five institutional features: clear objectives, good interaction, adaptiveness, right scale, and compliance, as linked to performance. Based on this, a survey instrument was developed and a survey conducted obtaining responses from more than 500 households across 51 such institutions in the eastern Indo-Gangetic plains states of Assam and Bihar. The data were analyzed through statistical and econometric techniques including Ordered-Probit. The results support the relevance of the concepts in explaining performance of water institutions, and a number of drivers of performance were identified through Ordered-Probit, particularly, four rationalities—technical, economic, social and organizational, (with coefficients (0.4622, 0.3803, 0.4303, 0.2457) and three institutional features—good interaction, adaptiveness and appropriate scale (with coefficients 0.4242, 0.2703, 0.6756) (based on a 5-point Likert scale), as playing a positive and significant role in enhancing performance. The results provide a number of useful insights which can help guide interventions and policy towards better design and development of the water institutions, and help improve water resource management and livelihoods in the region. [ABSTRACT FROM AUTHOR]

Objectives: Child dietary diversity is very low across rural communities in Bihar. Based on the experience of behavior change communication (BCC) module roll out in self-help group (SHG) sessions in rural Bihar, this study aims to assess the impact of the intervention on child dietary diversity levels in the beneficiary groups. Methods: The study is based on a pre-post study design whereby child dietary diversity is examined for a sample of 300 children (6–23 months old from 60 village organizations) during both pre-intervention as well as post-intervention phase. The latter consists of two types of group viz. a) children whose mothers were directly exposed to BCC module in SHGs sessions and b) those who were non-participants but may have indirect exposure through spillovers of BCC activities. Econometric analysis including logistic regression as well as propensity score matching techniques are applied for estimating the changes in dietary diversity in the post-intervention phase. Results: During the pre-intervention phase, 19% of the children (6–23 months) had adequate dietary diversity (eating from at least 4 out of 7 different food groups) and this increased to 49% among the exposed group and to 28% among the non-exposed group in the post-intervention phase. The exposed group have an odds ratio of 3.81 (95% CI: 2.03, 7.15) for consuming diverse diet when compared to the pre-intervention group. The propensity score matching analysis finds a 33% average treatment effect on the treated (ATT) for the group participating in BCC sessions at SHG events. Conclusion: BCC roll out among SHG members is an effective mode to increase dietary diversity among infants and young children. The impact on child dietary diversity was significantly higher among mothers directly exposed to BCC modules. The BCC module also improved knowledge and awareness levels on complementary feeding and child dietary diversity. [ABSTRACT FROM AUTHOR]

Background: Simulation has been shown to improve clinical and behavioral skills of birth attendants in low-resource settings at a low scale. Populous, low-resource settings such as Bihar, India, require large cadres of simulation educators to improve maternal and newborn health. It's unknown if simulation facilitation skills can be adopted through a train of trainers' cascade. To fill this gap, we designed a study to evaluate the simulation and debrief knowledge, attitudes and skills of a third generation of 701 simulation educators in Bihar, India. In addition, we assessed the physical infrastructure where simulation takes place in 40 primary healthcare facilities in Bihar, India. Methods: We performed a 1 year before–after intervention study to assess the simulation facilitation strengths and weaknesses of a cadre of 701 nurses in Bihar, India. The data included 701 pre-post knowledge and attitudes self-assessments; videos of simulations and associated debriefs conducted by 701 providers at 40 primary healthcare centers. Results: We observed a statistically significant difference in knowledge and attitude scores before and after the 4-day PRONTO simulation educator training. The average number of participants in a simulation video was 5 participants (range 3-8). The average length of simulation videos was 10:21 minutes. The simulation educators under study, covered behavioral in 90% of debriefs and cognitive objectives were discussed in all debriefs. Conclusion: This is the first study assessing the simulation and debrief facilitation knowledge and skills of a cadre of 701 nurses in a low-resource setting. Simulation was implemented by local nurses at 353 primary healthcare centers in Bihar, India. Primary healthcare centers have the physical infrastructure to conduct simulation training. Some simulation skills such as communication via whiteboard were widely adopted. Advanced skills such as eliciting constructive feedback without judgment require practice. [ABSTRACT FROM AUTHOR]

The COVID‐19 crisis re‐shaped many livelihood options and placed significant burdens on those with precarious incomes exacerbating persisting vulnerabilities, especially among a large section of the migrant population. This group faced a dual threat – both to their livelihood and health. To understand the consequences of this pandemic on the income of the migrant population, a household level survey was conducted in the state of Bihar, India, which is one of the highest migrant‐sending states. We examine the role of differences in the socio‐economic status of migrants and their households in determining the extent of vulnerability caused by the COVID‐19 crisis. Vulnerability is proxied by the income lost by migrants during the lockdown. The results suggest that households with diversified income portfolio, larger landholdings, and those receiving government benefits suffered significantly lower income loss whereas, larger household size and greater distance from town tended to escalate income loss. Additionally, private salaried workers faced higher income loss and an increment in years of education lowers the losses significantly. It is observed that individual‐level characteristics also played a significant role in determining economic loss due to the lockdown. Our findings suggest a binding necessity to actively shape policies considering the financial insecurity of vulnerable migrants at their destination and the household members at the origin. [ABSTRACT FROM AUTHOR]

Background: The study examined the prevalence of self-reported menstrual irregularities during adolescence and explored the association of depressive symptoms with self-reported menstrual irregularities in adolescents in two major states of Uttar Pradesh and Bihar in India. Methods: This study is based on the data obtained from the first round of the "Understanding the lives of adolescents and young adults" (UDAYA, 2016) survey. The effective sample size for the study was 12,707 adolescent girls aged 10–19 years. A bivariate analysis with chi-square test was conducted to determine the self-reported menstrual irregularity by predictor variables. Multivariable logistic regression models were employed to examine the associations between self-reported menstrual irregularity, depressive symptoms and other explanatory variables. Results: A proportion of 11.22% of adolescent girls reported menstrual irregularity and 11.40% of the participants had mild depressive symptoms. Adolescent girls with mild (AOR: 2.15, CI: 1.85–2.51), moderate (AOR: 2.64, CI: 2.03–3.42) and severe depressive symptoms (AOR: 2.99, CI: 2.19–4.10) were more likely to have menstrual irregularity as compared to those who had minimal depressive symptoms. Physically active adolescent girls were less likely to report menstrual irregularity (AOR: 0.82, CI: 0.73–0.93) than physically inactive girls. Adolescent girls who used piece of cloth for menstrual hygiene practices (AOR: 1.17; CI: 1.02–1.35) and those who used either napkin or cloth or other materials (AOR: 1.32; CI: 1.14–1.54) had higher likelihood of menstrual irregularity as compared to those who used only sanitary napkins. Conclusion: A significant association of depressive symptoms with self-reported menstrual irregularity among adolescent girls was observed. Therefore, while treating females with irregular menstrual cycles, clinicians may need to pay greater attention to thir mental health peoblems. [ABSTRACT FROM AUTHOR]

Introduction: In the recent decade, the study of social norms has become popular as it can explain and change harmful social behaviours, such as Open Defecation (OD). Open defecation is is a threat to public health. It causes diarrheal infections. Households formed the unit of study as they constitute an essential social institution to adopt and use latrines. Aim: To compare the social norms of the latrine user and OD practitioners of households with regard to disgust, purity and pollution, latrine and OD beliefs, and the preference for latrines that differ in cost. Materials and Methods: The cross-sectional study was conducted among 486 participants at Aurangabad district, Bihar, India, from July 2019 to January 2020. The district is one of the worst performers in latrine adoption in the country, according to the census of India 2011, Swachh Bharat Mission 2016, and NFHS-5 2019-21 data. A pretested questionnaire prepared by Research Institute for Compassionate Economics (RICE) was used as a tool for data collection. Data collected were entered into Statistical Package for Social Sciences (SPSS) version 25.0. Descriptive data analysis was performed and represented in tabular forms. The categories of households were made on the basis of the defecation practices (latrine user and OD practitioners). Results: The study found that social norms regarding purity and pollution were the same across the two groups. Both the groups (latrine user and OD practitioners) agreed that OD was disgusting and polluting behaviour. The two groups were coherent in the preference for latrines based on cost. Conclusion: The social norms are evolving in the study setting. Households have recognised the relevance of latrine use in contemporary times. The gap in practice is the only difference between the two groups of households. [ABSTRACT FROM AUTHOR]

Background: Cyberbullying victimisation is considered a global public health issue concerning the psychological development of adolescents that oftentimes persists into adulthood. The current study explored the longitudinal relationship between cyberbullying victimisation and depression and suicidal ideation among adolescents and young adults, given the scarcity of such studies in poor-resource settings like India. Methods: Data were drawn from the "Understanding the Lives of Adolescents and Young Adults" (UDAYA- 2015-16 and 2018–19) surveys conducted in two most-populated Indian states of Uttar Pradesh and Bihar. Bivariate and logistic regression analysis was conducted to fulfil the objectives of the study using a sample of 4428 and 11,864 adolescent (aged 10–19 years) male and female cohorts, respectively. Results: The prevalence of cyberbullying victimization increased from 3.8% to 6.4% among female respondents and 1.9% to 5.6% among male respondents over three years. About 33% of females and 16.6% of males had depressive symptoms in their young adulthood. Nearly 7.5% females compared to 2.3% of males, reported that they have seriously considered attempting suicide in the past one year. Adolscents who experienced cyberbullying victimization were 2.07 times more likely to have depressive symptoms comapared to those who did not experience cyberbullying victimization. Similarly, adolescents who experienced cyberbullying victimization were 2.50 times more likely to have suicidal ideation than their counterparts with no experience of cyberbullying victimization. Conclusion: The findings suggest that cyberbullying victims are at higher risk of depressive symptoms and suicidal thoughts and these adverse effects persist for longer period. Therefore, cyberbullying and related mental health problems need to be addressed with more efficient strategies such as increased awareness of nuances of online harassments among adolescent and young adult population. [ABSTRACT FROM AUTHOR]

In adolescents, anaemia has been linked to affecting physical disorders, growth, and mental retardation and also increases reproductive morbidities among adolescent girls during their womanhood. It is believed that with increasing age, females are more prone to anaemia than their male counterparts. Unfortunately, the anaemia intervention program, such as the National Nutrition Anaemia Prophylaxis Programme, primarily targets infants, young children, pregnant and lactation women, and not adolescents. Therefore, this study tries to fill this gap and study the prevalence of anaemia and the associated factors among adolescent boys and girls residing in Uttar Pradesh and Bihar, India. Secondary data analysis was performed on cross-sectional survey data from the Understanding the Lives of Adolescents and Young Adults survey. The sample size was 20,594 adolescents aged 10–19 years in Uttar Pradesh and Bihar, India. The outcome variable was anaemia, and the explanatory variables were age, education, working status, media exposure, marital status, received IFA and deworming tablets, BMI status, stunting status, wealth index, caste, religion, residence, and States. Descriptive statistics and bivariate analysis were used to find the preliminary results. Multinomial regression analysis was carried out to provide the adjusted estimates. Overall, anaemia was more prevalent among adolescent girls than adolescent boys (20% vs. 8.7%). Moderate/severe anaemia was 0.24 and 0.49 times less likely among adolescent boys and girls, respectively, who had 10 and above years of schooling than adolescents with no schooling (p < 0.01). Rural adolescent boys were 1.49 times (p < 0.05) more likely to suffer from moderate/severe anaemia than urban counterparts. The odds for moderate/severe anaemia among adolescent boys were relatively higher among late adolescents, with no mass-media exposure, stunted, and rural adolescents. Similarly, odds for moderate/severe anaemia among adolescent girls were higher among late adolescents and adolescents without schooling and mass-media exposure. Prevalence of anaemia was higher among adolescent girls than in boys. Lower education status, rural residence, late adolescence, no exposure to mass media, and stunting were the predictors of moderate/severe anaemia among adolescents. Anaemia among adolescents must be addressed through effective public health policy targeting adolescents residing in rural areas. There is a need to disseminate information about anaemia-related programs, such as National Iron Plus Initiative (NIPI), through mass media, and subsequently, the public health system may be prepared to tailor the needs of adolescent boys and girls. [ABSTRACT FROM AUTHOR]

In India in recent decades, groundwater has emerged as a principal source for meeting drinking and irrigation needs. As a result, groundwater depletion and overextraction are acknowledged as a major concern. Different policy interventions are being explored to augment the management of aquifers. Aquifer storage and recovery (ASR) is one such intervention that is becoming popular among government agencies, developmental actors, and even farmers for recharging and recovering water from aquifers. However, the selection of a suitable location and appropriate aquifer for recharge is challenging. The main objective of this study was to classify site selection criteria for ASR installations in different types of aquifers in North India. In this study, both scientific indicators (i.e., rainfall, elevation, soil and aquifer characteristics, surface and groundwater quality) and social characteristics (tacit knowledge, land ownership, willingness to participate) were evaluated to create an integrated ASR site selection criterion. The results indicated that ASR sites could not be appropriately identified solely based on available metrological, geospatial, and geohydrological data. Socioeconomic parameters should be an integral part of the decision-making process for the site selection for ASR. Based on these scientific indicators and social characteristics, a total of seven potential ASR sites (three in the village of Nekpur and four in the village of Meyar) were selected at Rajgir, Nalanda, Bihar, India. Although this integrated site-assessment framework was designed based on 12 indicators in the context of the marginal alluvial plains for the mid-Ganga regions in this study, the general principles adopted in this study can be applicable to other regions. [ABSTRACT FROM AUTHOR]

Background: Glucocorticoids (GCs) are anti-inflammatory steroid medications prescribed globally by doctors for various illnesses and they are known to produce quick symptom relief. In India, they are among the cheapest and easily accessible over-the-counter medications. Thus, it can be misused, leading to many life-threatening illnesses such as diabetes mellitus, hypertension, overwhelming infections, Cushing's syndrome, and hypo-adrenal crisis. Objective: This study reports the misuse of GCs in a rural community in the state of Kerala, India, and compares it with the only other community GC misuse study in India, from the state of Bihar. Methods: A community-based cross-sectional survey of 452 households comprising 1,734 people was conducted in rural Konni, Kerala, during June and July of 2019. In each house, people who had been taking medications over the previous 6 months were interviewed. Results: Almost 2% (n = 31) had consumed one or more GCs in the last 6 months (95% CI: 1.3–2.5%). Of these, 26% (n = 8) were taking oral GCs and 36% (n = 11) of them were inappropriately using them based on current clinical guidelines. 29% (n = 9) had used GCs for more than 1 month. Conclusions: GC misuse exists in Kerala but not to the extent seen in Bihar. In Kerala, inhaled GCs are more common than oral GCs, and the prescription is obtained predominantly from qualified medical practitioners. The prevalence of prolonged GC use could be implicated as an underlying factor for diabetes, hypertension, osteoporosis, and cataracts. It is possible that approximately 220,000 people in Kerala may have a suppressed hypothalamus-pituitary-adrenal axis which can predispose them to a fatal hypo-adrenal crisis. [ABSTRACT FROM AUTHOR]

Background: Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals.Objective: 1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women's expectations of respectful care.Methods: 'Body mapping', an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis.Findings: Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt 'good' and 'bad'. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy.Discussion: The body maps capturing birth experiences, created through a participatory method, accurately portray women's respectful and disrespectful births and are useful to understand women's experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women's choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences. [ABSTRACT FROM AUTHOR]

Seasonal climate forecasts (SCFs) have gained popularity in agriculture for climate risk management studies. The available forms of SCFs are not conducive to decision making because of a mismatch in scales over space and time. In this study, available SCFs were disaggregated using the FResampler1 technique to simulate rice yield (cultivar PR 114) under different nitrogen levels and planting dates using DSSAT (Decision Support System for Agrotechnology Transfer) for Sitamarhi district, Bihar, India. Results showed that the late planting of rice predicted the highest yield (3800 kg ha-1) with high variability under SCF (wet) and 200 kg ha-1 application of nitrogen fertilizer. Similarly, for SCF (dry), the late planting of rice simulated high yield (3100 kg ha-1) attributes with 200 kg ha-1 of nitrogen fertilizer. However, rice yield under climatology (3450 kg ha-1) was more than SCF (dry) (3100 kg ha-1). Planting of rice on 15th June 2019 under the SCF (normal) predicted low uncertainty with high mean yields as compared to the mid (05th July 2019), and late (25th July 2019) planting. The present study showed that by applying SCF, we can have a better understanding on "relative" changes in yield attributes with fertilizer doses and planting dates, which may be adopted by the climate adviser to offset the climate risk without compromising productivity. [ABSTRACT FROM AUTHOR]

In 2002 the Mahabodhi Temple Complex in Bodhgaya was declared a UNESCO World Heritage site. As the alleged site of Buddha's enlightenment it is one of the most revered and sanctified places for Buddhists around the world. This international designation has also set in motion a series of development proposals and heritage policies that seek to rehabilitate and recreate this centre of world Buddhism that provides glimpses of the land of enlightenment as it used to be in the times of the Buddha. Central to these initiatives are plans on behalf of the Bihar state tourism department to promote Brand Buddhism and spiritual tourism through the establishment of an 18 hole golf course and five-star hotels. These development proposals along with the recent UNESCO World Heritage designation have brought to the foreground the multiplicity of stakeholders in competition over the site's spiritual capital today. This paper will explore some of the contradictions and entanglements over Bodhgaya's present and uncertain future. [ABSTRACT FROM AUTHOR]