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Objectives: Diabetes is a significant public health concern in India, with Kerala being labeled as the diabetes capital of the country. The study aims to evaluate the prevalence, treatment, and management of diabetes to examine the unmet need for care to propose cost-effective strategies. Design: A cross-sectional study was conducted on a geographically defined cohort population in Ernakulam. Sample: This paper presents diabetes data of adults ≥30 years enrolled from the community cohort. The interviews were conducted with 997 participants at their residence. Measurement: Random blood glucose was assessed for each participant using a finger prick test. Results: The overall prevalence of diabetes was 30.1%, of which 4.1% of participants had undiagnosed diabetes. Among those with diabetes, 86.3% were aware of their diagnosis; among those aware, 86.5% were on treatment. Among those on treatment for diabetes, 54% achieved controlled blood sugar. Conclusion: The challenge in diabetes management is controlling the blood glucose levels of people who adhere to treatment. Younger employed females from lower-income quartiles have the highest risk. The study also raises questions about quality and strategies for medication compliance. The findings inspire future research on care needs, policies, and program responses to reduce the diabetes disease burden. [ABSTRACT FROM AUTHOR]

Aim: The present paper aims to understand the fear of falling (FOF) and risk factors associated with FOF in community-dwelling individuals aged over 60 years in Pune, India. Subjects and methods: The study examined a random sample of 351 community-dwelling older adults. Data on demographic characteristics, health conditions, history of falls, and psychological factors were collected using a pre-tested, structured questionnaire. The Falls Efficacy Scale International (FES-I) was used to measure FOF. Univariate and bivariate logistic regression analyses were carried out to examine associations between various factors and FOF. Results: A high FES-I score was significantly associated with older age, females, unmarried status, education less than 6 years, living alone, unstable balance and gait, hypertension, arthritis, previous falls, self-reported loss of confidence, and depression. Adults older than 70 years of age (odds ratio, OR = 2.411), those with a history of falls (OR = 2.285), those reporting loss of confidence in the past 6 months (OR = 6.766), who had answered yes to the direct question of FOF (OR = 4.632), and had unstable balance (OR = 2.522) were also more likely to have higher FES-I values. Conclusion: A large number of older adults expressed concerns about falling and we also found several factors to be associated with developing FOF, supporting the need for screening. Thus, further research is needed in order to understand the relationship between severity of FOF and actual fall events for developing preventive measures which can be implemented before FOF becomes a problem. [ABSTRACT FROM AUTHOR]

This paper examines the association between alcohol use and HIV-related sexual risk behaviors among men who have sex with men (MSM). A cross-sectional bio-behavioral survey was conducted among 3,880 MSM, recruited using time-location cluster sampling from cruising sites in three Indian states. Nearly three-fifths of the participants reported alcohol use. Among frequent users (40 % of the sample), defined as those who consumed alcohol daily or at least once a week, 66 % were aged 25 years and above, 53 % self-identified as kothi (feminine/receptive), and 63 % consistently used condoms with male paying partners. Multivariate logistic regression demonstrated that frequent users were more likely to be aged 25 years and above, less likely to self-identify as kothi, and less likely to consistently use condoms with male paying (AOR = 0.7; 95 % CI 0.5-0.9) and male regular (AOR = 0.7; 95 % CI 0.6-0.9) partners. HIV prevention interventions for MSM need to provide tailored information on alcohol use-related sexual risk, especially for MSM in sex work and MSM with male regular partners. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the prevalence and attributable burden of headache disorders in India is sparse, with only two recent population-based studies from South and East India. These produced conflicting results. A study in North India is needed. We report the methodology of such a study using, and validating, a Hindi translation of the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire developed by Lifting The Burden (LTB). Almost half of the Indian population speak Hindi or one of its dialects. Methods: The study adopted LTB's standardized protocol for population-based studies in a cross-sectional survey using multistage random sampling conducted in urban Delhi and a surrounding rural area. Trained interviewers visited households unannounced, randomly selected one adult member from each and applied the Hindi version of HARDSHIP in face-to-face interviews. The most bothersome headache reported by participants was classified algorithmically into headache on ≥ 15 days/month (H15 +), migraine (including definite and probable) or tension-type headache (including definite and probable). These diagnoses were mutually exclusive. All participants diagnosed with H15 + and a 10% subsample of all others were additionally assessed by headache specialists and classified as above. We estimated the sensitivity and specificity of HARDSHIP diagnoses by comparison with the specialists' diagnoses. Results: From 3,040 eligible households, 2,066 participants were interviewed. The participating proportions were 98.3% in rural areas but 52.9% in urban Delhi. In the validation subsample of 291 participants (149 rural, 142 urban), 61 did not report any headache (seven of those assessed by HARDSHIP, eight by headache specialists and 46 by both) [kappa = 0.83; 95% CI: 0.74-0.91]. In the remaining 230 participants who reported headache in the preceding year, sensitivity, specificity and kappa with (95% CI) were 0.73 (0.65-0.79), 0.80 (0.67-0.90) and 0.43 (0.34-0.58) for migraine; 0.71 (0.56-0.83), 0.80 (0.730.85) and 0.43 (0.37-0.62) for TTH and 0.75 (0.47-0.94), 0.93 (0.89-0.96) and 0.46 (0.34-0.58) for H15 + respectively. Conclusion: This study validates the Hindi version of HARDSHIP, finding its performance similar to those of other versions. It can be used to conduct population surveys in other Hindi-speaking regions of India. [ABSTRACT FROM AUTHOR]

Sexual partner mixing among men who have sex with men (MSM), based on both gender and partnership status, is an understudied theme in India. Using data from Round 2 of the Integrated Bio-behavioral Survey, this paper reports on gender and partnership status-based sexual mixing and levels of consistent condom use (CCU) among MSM in Maharashtra. A total of 689 MSM were sampled using probability-based sampling. Bivariate and regression analyses were carried out on condom use and partnership mixing. Over half (52%) of all MSM reported having only male partners while about one-third (34.5%) reported having partners of both gender. Over 70% of MSM engaged in sex with a mix of casual, regular, commercial and non-commercial partners. MSM with only male partners reported lower CCU as compared to MSM with partners of both genders (47.3% and 62%, respectively,p= 0.11). CCU levels differed significantly by status of sex partner. Overall, MSM having ‘men only’ as partners and those with partners of mixed status have greater risk behaviour in terms of low CCU. HIV prevention interventions need to focus attention on men in ‘exclusively male’ sex partnerships as well as MSM with a mix of casual, regular and commercial partners. [ABSTRACT FROM AUTHOR]

This paper examines the associations between male migration and mobility with HIV among married couples in India. Cross-sectional analyses of a nationally representative household survey conducted across all 29 states of India from 2005 to 2006 via the National Family Health Survey-3 (NFHS-3) included a subsample of 27,771 married couples who were tested for HIV as a part of their participation. Both bi-variate and multi-variate analyses were conducted. About 0.5% of the total married couples in the current study included an HIV-infected partner; 0.11% were HIV concordant and 0.38% were HIV serodiscordant couples. Adjusted logistic regression analyses demonstrated that HIV infection in couples (seroconcordant or serodiscordant) was significantly more likely among those couples where the man was migrant but not mobile and those couples where the man was migrant as well as mobile, relative to those couples where the man was neither migrant nor mobile. Male migration increases the risk for HIV among married couples in India, largely in the form of serodiscordance in which men are HIV infected. These findings document the need for not only primary prevention efforts to reduce HIV acquisition among migrant male workers, particularly more mobile migrants, but also efforts are needed to reduce subsequent transmission to their wives. [ABSTRACT FROM AUTHOR]

Leukoplakia is a white mucosal thickening and perhaps undermining change in the oral mucosa transcendently found in tobacco users. Since the tobacco utilization is extensively higher with the indigenous groups in the Asia Pacific locale, the current examination implicated the prevalence of tobacco consumption and leukoplakial lesions and the relationship between the two. This cross-sectional study was conducted through six tribal hamlets of Chithalayath Forest range at Wayanad district of Kerala, South India. Leukoplakia screening was led by a senior consultant on the basis of a visual investigation and pathological evaluation was not done. An organized questionnaire was utilized to gather data on demographic details and tobacco usage status and frequency. The prevalence of clinical oral lesions among tobacco users and non users was determined using statistical analysis. Clinical oral leukoplakia was diagnosed in 27 (8.5%) subjects among the 317 individuals screened. The prevalence of lesions was considerably higher among tobacco consumers in comparison with non users (11 vs. 3.7%). Also, the tobacco chewers group had a higher percentage of leukoplakia. Another significant finding of this study is that the incidence of provisional leukoplakia was observed to be comparatively high among the most frequent tobacco consumers 15 (65.2%) in comparison with 8 (34.8%) in the frequent and nonfrequent users. Prevalence of abusive habits and clinical oral leukoplakial was substantial among the tribes. The cause and effect relationship and dose-response were also shown to have a significant association. [ABSTRACT FROM AUTHOR]

Background The World Health Organization recommends vaccines for prevention and control of typhoid fever, especially where antimicrobial-resistant typhoid circulates. In 2018, the Navi Mumbai Municipal Corporation (NMMC) implemented a typhoid conjugate vaccine (TCV) campaign. The campaign targeted all children aged 9 months through 14 years within NMMC boundaries (approximately 320 000 children) over 2 vaccination phases. The phase 1 campaign occurred from 14 July 2018 through 25 August 2018 (71% coverage, approximately 113 420 children). We evaluated the phase 1 campaign's programmatic effectiveness in reducing typhoid cases at the community level. Methods We established prospective, blood culture–based surveillance at 6 hospitals in Navi Mumbai and offered blood cultures to children who presented with fever ≥3 days. We used a cluster-randomized (by administrative boundary) test-negative design to estimate the effectiveness of the vaccination campaign on pediatric typhoid cases. We matched test-positive, culture-confirmed typhoid cases with up to 3 test-negative, culture-negative controls by age and date of blood culture and assessed community vaccine campaign phase as an exposure using conditional logistic regression. Results Between 1 September 2018 and 31 March 2021, we identified 81 typhoid cases and matched these with 238 controls. Cases were 0.44 times as likely to live in vaccine campaign communities (programmatic effectiveness, 56%; 95% confidence interval [CI], 25% to 74%; P =.002). Cases aged ≥5 years were 0.37 times as likely (95% CI,.19 to.70; P =.002) and cases during the first year of surveillance were 0.30 times as likely (95% CI,.14 to.64; P =.002) to live in vaccine campaign communities. Conclusions Our findings support the use of TCV mass vaccination campaigns as effective population-based tools to combat typhoid fever. [ABSTRACT FROM AUTHOR]

Background: The causal impact of income shocks on mental well-being in developing countries is an under-researched area. The COVID-19 pandemic, along with the economic recession caused by the lockdowns to reduce transmission, provides a natural experimental setting to examine the causal impact of a decline in monthly per capita expenditure (MPCE) on mental health of the general population in India during the pandemic. Aim: To evaluate the impact of income shocks on mental health of adults in metro cities during the COVID-19 pandemic. Materials and Methods: The data were collected using the abridged version of the Depression Anxiety Stress Schedule administered through a telephonic survey on adult residents of six metropolitan cities in September-August 2020 and July-August 2021. Results: In the present study, 994 adults participated from six metropolitan cities. Average treatment effects were estimated using Propensity Score Matching. The mean normalized scores are significantly higher for respondents whose MPCE had fallen (treated) vis-à-vis respondents whose MPCE had remained same or increased (control): anxiety (0.21 for treated vs -0.19 for control), stress (0.16 vs -0.14), and depression (0.04 vs -0.19). Propensity score matching reveals that the normalized scores for anxiety, stress, and depression were 33 (95% confidence intervals, CI: 20.0-46.7), 25 (95% CI: 12.9-36.9), and 36 (95% CI: 18.6-53.1) higher among the treated group vis-a-vis control group. The ATET was 34 (95% CI: 18.9-48.9), 26 (95% CI: 10.1-42.9), and 32 (955 CI: 12.3-50.7) for these three outcomes, respectively. The post-estimation tests indicated that the results are valid. Conclusions: The study advocates that policies to ensure income security should be made an integral part of the response packages to tackle pandemics like COVID-19. [ABSTRACT FROM AUTHOR]

Background: Cement dust is a significant source of occupational exposure affecting lung function and respiratory health. A higher burden of respiratory morbidity is known among factory workers involved in cement production. Globally or from India, there are no estimates of this burden from informal workers exposed to cement dust. Objective: To assess difference in lung function and respiratory symptoms among informal workers exposed to cement and those unexposed, using a comparative community based cross-sectional study from purposively selected areas in Delhi, India. Methods: Using a portable spirometer we measured lung function and collected respiratory symptoms from conveniently sampled informal workers (n = 100) exposed to cement dust, 50 indoor informal workers (tailors), and 50 outdoor (vegetable) vendors. Regression analyses were performed to compare respiratory symptom score and lung function parameters, adjusted for age, body mass index, smoking, socioeconomic status, and years of occupational exposure. Findings: Exposed workers had significantly lower lung function (PEF = –750 ml/s and –810 ml/s and FEV1/FVC (%) = –3.87 and –2.11) compared to indoor and outdoor groups, with three times higher chronic respiratory symptoms when compared to the unexposed groups. The cement dust exposure was observed to be associated with PEF (mean difference (MD) = –0.75L, 95%CI = –1.36 to –0.15, p = 0.01), %FEV1/FVC (MD = –3.87, 95%CI = –6.77 to –0.96, p = 0.03) and respiratory symptoms (p < 0.001). Conclusion: This study generates evidence regarding the respiratory burden of occupational exposure among vulnerable informal workers. There is an urgent need for policy reforms to safeguard health from occupational exposures, especially among informal workers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Circumstances requiring medical attention are common at schools. Teachers are often the first individuals to witness and handle situations requiring first aid and medical emergencies. AIM: To determine awareness, attitudes and practices of school teachers and the facilities available at schools with respect to administration of first aid. METHODS: Data were obtained from 146 teachers in nine schools in Mangalore, India, using a self-administered questionnaire. The schools were also inspected for first aid equipment and facilities. RESULTS: Only 69 (47%) teachers had received first aid training previously. Poor and moderate knowledge of first aid was observed among 19 (13%) and 127 (87%) teachers, respectively. Only eight teachers knew the correct procedure for cardiopulmonary resuscitation. Most teachers 96 (66%) were willing to administer first aid if provided with the required training. A total of 74 teachers reported having practised first aid in response to a situation arising at their school. Wounds (36%) and syncopal attack (23%) were among the commonly encountered situations requiring first aid management at schools. Teachers' confidence level in administering first aid was significantly associated with prior training in first aid (p=0.001). First aid kits were available in only five of the nine schools surveyed. DISCUSSION: The current competency level among teachers in Mangalore to administer first aid is inadequate. Measures need to be taken at schools to ensure initiation of first aid training followed by periodic training for teachers in first aid. [ABSTRACT FROM AUTHOR]

Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examined multifactorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India. Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, consumption of iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation. During pregnancy, women consumed 28 IFA and 8 calcium tablets, 18% consumed diverse diet, and 17% were weighed ≥3 times. Nutrition knowledge was associated with consumption of diverse diet (odds ratio [OR] = 2.2 times), IFA (2.3 times), calcium (11.7 times), and weight monitoring (1.3 times). Beliefs and self‐efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better nutrition practices. Under optimal program implementation, we estimate that 51% of women would have adequate diet diversity, an average consumption of 98 IFA, and 106 calcium tablets, and women would be weighed 4.9 times during pregnancy. Strengthening existing program operations and increasing demand for services has the potential to result in large improvements in maternal nutrition practices from current baseline levels but may not be sufficient to meet World Health Organization‐recommended levels without creating an enabling environment including improvements in education and income levels to support behaviour change. [ABSTRACT FROM AUTHOR]

Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10–19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age‐ and sex‐specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%–46%; boys 11%–28%) and state (girls 7%–62%; boys 4%–32%). Iron deficiency (ferritin < 15 μg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 μg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors. Key messages: The Comprehensive National Nutrition Survey (CNNS) 2016–2018 is the only nationally representative survey to measure haemoglobin, haemoglobinopathies, biomarkers of micronutrient deficiencies, diet and social factors in Indian adolescents aged 10–19 years.Using CNNS data, we found that 28.5% of adolescents (girls: 39.6%, boys: 17.6%) were anaemic, with variation by region or state.Our prevalence estimates translate to 72 million adolescents being anaemic, with Uttar Pradesh having twice as many anaemic adolescents as any other state.Iron deficiency, haemoglobinopathies, vitamin A deficiency and zinc deficiency were associated with an increased risk of anaemia; these associations may vary subnationally. [ABSTRACT FROM AUTHOR]

Coercive control behaviors central to the abuse of power appear more frequent than other types of domestic violence, but little is known about its frequency, features, and consequences for women in India. We aimed to examine the prevalence of domestic coercive control and its association with physical, sexual, and emotional domestic violence in the preceding year and symptoms of depression, anxiety, and suicidal thinking. In a cross-sectional survey, we interviewed 4,906 ever-married women aged 18-49 years living in urban informal settlements in Mumbai, India. We developed a 24-item scale of coercive control, assessed physical, sexual, and emotional violence using existing questions, and screened for symptoms of depression with the Patient Health Questionnaire (PHQ9), anxiety with the Generalized Anxiety Disorder (GAD7) questionnaire, and suicidal thinking with questions developed by the World Health Organization. Estimates involved univariable and multivariable logistic regression models and the prediction of marginal effects. The prevalence of domestic coercive control was 71%. In total, 23% of women reported domestic violence in the past 12 months (emotional 19%, physical 13%, sexual 4%). Adjusted models suggested that women exposed to controlling behavior had greater odds of surviving emotional (aOR 2.1; 95% CI 1.7, 2.7), physical (1.4; 1.0, 1.9), and sexual (1.8; 1.1, 3.0) domestic violence in the past 12 months; and higher odds of a positive screen for moderate or severe depression (1.7; 1.3, 2.2), anxiety (2.1; 1.3, 3.1), and suicidal thinking (1.7; 1.2, 2.3), and increased with each additional indicator of coercive control behavior. When women reported 24 indicators of coercive control, the adjusted predicted proportion with moderate or severe depressive symptoms was 60%, anxiety 42%, and suicidal thinking 17%. Inclusion of coercive control in programs to support domestic violence, would broaden our understanding of domestic abuse to resemble most victims experience and improve interventions. [ABSTRACT FROM AUTHOR]

Aims: Healthcare utilization is a major challenge for low- and middle-income countries, especially for the publicly funded facilities. The study has tried to explore the women's opinion behind the non-utilization of public healthcare facilities in India. Subjects and methods: This was a cross-sectional study using nationally representative samples of 351,625 women of reproductive age (15–49 years) from the 29 States and seven Union Territories. Indian National Family Health Surveys NFHS-4 (2015–2016) was the data source. The respondents were asked why the members of their households do not utilize public healthcare facilities when members of their households are sick. They have options to respond either 'yes' or 'no'. Five reasons for non-utilization of public healthcare were asked: (i) 'there is no nearby facility'; (ii) 'facility timing is not convenient'; (iii) 'health personnel are often absent'; (iv) 'waiting time is too long'; and (v) 'poor quality of care'. Results: The majority of the women in India (88%) said that their family members did not use public healthcare facilities. The reasons behind this were 'no nearby facilities' (42.4%), 'inconvenient facility timing' (29.6%), 'poor quality of care' (52.3%), 'health personnel often absent' (16.8%) and 'long waiting time' (39.9%). Conclusions: importantly, during the last 10 years, the utilization of public health care facilities has dropped significantly, which should be taken seriously as the Indian Parliament has been placing emphasis on equity. [ABSTRACT FROM AUTHOR]

Background: Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015–2016. Aim: To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India. Methods: NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees. Results: The weighted lifetime prevalence of 'any mental morbidity' was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10–F19; 22.44%), mood disorders (F30–F39; 5.61%) and neurotic and stress-related disorders (F40–F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%. Conclusion: NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country. [ABSTRACT FROM AUTHOR]

Aim To determine the effectiveness of individual-based, nurse-delivered, on-campus screening and brief intervention (SBI) for hazardous alcohol use among college students. Methods It was a parallel-design, double-blind, randomized controlled trial. Out of 793 students screened, 130 met the selection criteria of hazardous alcohol use, defined by alcohol use disorder identification test (AUDIT) score 8–19. Participants were randomly allocated to either SBI or general advice group. Both interventions were delivered by one specially trained nurse. Outcome was assessed after 3 months. Primary outcome was the change in the mean AUDIT score and the secondary outcome was difference in the proportion of students transited from the high- to low-risk category of AUDIT. General linear model with repeated measures and logistic regression were used to determine the primary and secondary outcome, respectively. Results Majority (80.7%) of the participants were men. Among all the baseline demography and clinical characteristics, only family history of alcohol use was significantly different in the groups. Intention to treat analysis showed a significant but small effect (0.16) of SBI on the mean AUDIT score. Gender did not moderate the effect. SBI was also observed to have a significant effect (adjusted odds ratio 3.7 95% CI 1.529–8.850) on shifting the students from high- to low-risk AUDIT zone. Conclusion SBI among college students is acceptable and has a small but significant effect on alcohol use. In countries like India, where despite the increasing magnitude of hazardous drinking in students no formal system exists to deal with the problem, SBI might be useful. [ABSTRACT FROM AUTHOR]

Evidence on strategies to improve infant and young child feeding in India, a country that carries the world's largest burden of undernutrition, is limited. In the context of a programme evaluation in two districts in Uttar Pradesh, we sought to understand the multiple influences on breastfeeding practices and to model potential programme influence on improving breastfeeding. A cross‐sectional survey was conducted among 1,838 recently delivered women, 1,194 husbands, and 1,353 mothers/mothers‐in‐law. We used bivariate and multivariable logistic regression models to examine the association between key determinants (maternal, household, community, and health services) and breastfeeding outcomes [early initiation of breastfeeding (EIBF)], prelacteal feed, and exclusive breastfeeding (EBF). We used population attributable risk analysis to estimate potential improvement in breastfeeding practices. Breastfeeding practices were suboptimal: EIBF (26.3%), EBF (54%), and prelacteal feeding (33%). EIBF was positively associated with maternal knowledge, counselling during pregnancy/delivery, and vaginal delivery at a health facility. Prelacteal feeds were less likely to be given when mothers had higher knowledge, beliefs and self‐efficacy, delivered at health facility, and mothers/mothers‐in‐law had attended school. EBF was positively associated with maternal knowledge, beliefs and self‐efficacy, parity, and socio‐economic status. High maternal stress and domestic violence contributed to lower EBF. Under optimal programme implementation, we estimate EIBF can be improved by 25%, prelacteal feeding can be reduced by 25%, and EBF can be increased by 23%. A multifactorial approach, including maternal‐, health service‐, family‐, and community‐level interventions has the potential to lead to significant improvements in breastfeeding practices in Uttar Pradesh. [ABSTRACT FROM AUTHOR]

Objectives mHealth interventions for MNCH have been shown to improve uptake of antenatal and neonatal services in low- and middle-income countries (LMICs). However, little systematic analysis is available about their impact on infant health outcomes, such as reducing low birth weight or malnutrition among children under the age of five. The objective of this study is to determine if an age- and stage-based mobile phone voice messaging initiative for women, during pregnancy and up to 1 year after delivery, can reduce low birth weight and child malnutrition and improve women's infant care knowledge and practices. Methods We conducted a pseudo-randomized controlled trial among pregnant women from urban slums and low-income areas in Mumbai, India. Pregnant women, 18 years and older, speaking Hindi or Marathi were enrolled and assigned to receive mMitra messages (intervention group N = 1516) or not (Control group N = 500). Women in the intervention group received mMitra voice messages two times per week throughout their pregnancy and until their infant turned 1 year of age. Infant's birth weight, anthropometric data at 1 year of age, and status of immunization were obtained from Maternal Child Health (MCH) cards to assess impact on primary infant health outcomes. Women's infant health care practices and knowledge were assessed through interviews administered immediately after women enrolled in the study (Time 1), after they delivered their babies (Time 2), and after their babies turned 1 year old (Time 3). 15 infant care practices self-reported by women (Time 3) and knowledge on ten infant care topics (Time 2) were also compared between intervention and control arms. Results We observed a trend for increased odds of a baby being born at or above the ideal birth weight of 2.5 kg in the intervention group compared to controls (odds ratio (OR) 1.334, 95% confidence interval (CI) 0.983–1.839, p = 0.064). The intervention group performed significantly better on two infant care practice indicators: giving the infant supplementary feeding at 6 months of age (OR 1.4, 95% CI 1.08–1.82, p = 0.009) and fully immunizing the infant as prescribed under the Government of India's child immunization program (OR 1.531, 95% CI 1.141–2.055, p = 0.005). Women in the intervention group had increased odds of knowing that the baby should be given solid food by 6 months (OR 1.89, 95% CI 1.371–2.605, p < 0.01), that the baby needs to be given vaccines (OR 1.567, 95% CI 1.047–2.345, p = 0.028), and that the ideal birth weight is > 2.5 kg (OR 2.279, 95% CI 1.617–3.213, p < 0.01). Conclusions for Practice This study provides robust evidence that tailored mobile voice messages can significantly improve infant care practices and maternal knowledge that can positively impact infant child health. Furthermore, this is the first prospective study of a voice-based mHealth intervention to demonstrate a positive impact on infant birth weight, a health outcome of public health importance in many LMICs. [ABSTRACT FROM AUTHOR]

Background Evidence on the effectiveness of community-based interventions in improving vaccination uptake in migrant populations is limited. This study aims to evaluate the effectiveness of a community-based intervention to improve access to and uptake of childhood vaccinations among urban slum-dwelling migrant communities in Ludhiana, India. Methods A mixed-methods evaluation was conducted involving a post-intervention comparison of vaccination uptake in six randomly selected intervention and control slum communities. Multilevel logistic regression to account for clustering of effects was used to investigate the impact of the intervention on vaccination uptake. Thematic analysis was used to analyse qualitative data. Results Overall, vaccination uptake was significantly higher in the intervention clusters and the likelihood of full immunization by the age of 1 year was more than twice that in the control clusters [OR: 2.27 (95%CI: 1.12-4.60); P = 0.023]. Qualitative findings showed that stakeholders felt ownership of the intervention and that it was effective in increasing accessibility to and uptake of vaccinations. However, they emphasized the importance of continued government support for the intervention. Conclusions Community-based interventions can significantly increase vaccination coverage in deprived populations with previously low uptake of childhood immunization but such initiatives need to be delivered in partnership with the government. [ABSTRACT FROM AUTHOR]

Adoption disclosure is an important indicator of the healthy development and psychological well-being of adopted children. However, findings from studies conducted among Asian domestic adoptive parents have highlighted some concerns. Using Kirk's theoretical proposition, a study was conducted among 86 Indian domestic adoptive parents to determine the societal and familial factors related to adoption disclosure. The results showed that while many of the parents had talked openly about their adoption to their immediate families (95.3%) and others of their social network (88.4%), they were hesitant in telling the child. Only 12.8% of the Indian parents had told their child about adoption, and 31.4% were planning to tell. The results of the logistic regression analysis revealed that children who were above 6 months at adoption were more likely to have had disclosures from their parents about their adoption. Further, adoptive parents who had told or were planning to tell their child about adoption perceived less about the loss of the biological parenthood and were more likely to perceive the beneficial effects of adoption disclosure to the child. These findings have implications for the provision of appropriate strategies, resources and support to adoptive families seeking to deal with adoption disclosure. [ABSTRACT FROM AUTHOR]

Background: To expand access to safe deliveries, some developing countries have initiated demand-side financing schemes promoting institutional delivery. In the context of conditional cash incentive scheme and free maternity care in public health facilities in India, studies have highlighted high out of pocket expenditure (OOPE) of Indian families for delivery and maternity care. In this context the study assesses the components of OOPE that women incurred while accessing maternity care in public health facilities in Uttar Pradesh, India. It also assesses the determinants of OOPE and the level of maternal satisfaction while accessing care from these facilities. Method: It is a cross-sectional analysis of 558 recently delivered women who have delivered at four public health facilities in Uttar Pradesh, India. All OOPE related information was collected through interviews using structured pre-tested questionnaires. Frequencies, Mann-Whitney test and categorical regression were used for data reduction. Results: The analysis showed that the median OOPE was INR 700 (US$ 11.48) which varied between INR 680 (US$ 11.15) for normal delivery and INR 970 (US$ 15.9) for complicated cases. Tips for getting services (consisting of gifts and tips for services) with a median value of INR 320 (US$ 5.25) contributed to the major share in OOPE. Women from households with income more than INR 4000 (US$ 65.57) per month, general castes, primi-gravida, complicated delivery and those not accompanied by community health workers incurred higher OOPE. The significant predictors for high OOPE were caste (General Vs. OBC, SC/ST), type of delivery (Complicated Vs. Normal), and presence of ASHA (No Vs. Yes). OOPE while accessing care for delivery was one among the least satisfactory items and 76 % women expressed their dissatisfaction. Conclusion: Even though services at the public health facilities in India are supposed to be provided free of cost, it is actually not free, and the women in this study paid almost half of their mandated cash incentives to obtain delivery care. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child’s primary immunization status (indicative of preventive health care use) and treatment seeking for child’s acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child’s acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children. [ABSTRACT FROM PUBLISHER]

In recent times, there has been great pressure on physiotherapists to become accountable for their practices and to provide evidence for effectiveness of their treatment. Therefore, it has become necessary to integrate standardised outcome measures (OMs) into clinical practice and boost evidence-based practice. The aim of this study was to determine the extent of use of outcome measures among physiotherapists in India and to identify the commonly used measures. A survey was conducted using a questionnaire consisting of 23 closed-ended questions. It was administered face-to-face and via email to Indian physiotherapists working with musculoskeletal patients. The response rate was 54% ( n = 81). The results indicated 80% of the respondents used OMs with impairment-based measures being the most commonly used. Education qualifications, years of work experience and workplace setting were not significantly associated with utilisation of OMs. Various benefits and barriers to use of OMs were also identified. The findings of this study give insight into possible changes that could be incorporated in clinical practice and educational system for developing a standardised level of assessing patients and to tailor future implementation strategies. [ABSTRACT FROM AUTHOR]

Quantifying sexual activity of sub-populations with high-risk sexual behaviour is important in understanding HIV epidemiology. This study examined inconsistency of seven outcomes measuring self-reported clients per month (CPM) of female sex workers (FSWs) in southern India and implications for individual/population-level analysis. Multivariate negative binomial regression was used to compare key social/environmental factors associated with each outcome. A transmission dynamics model was used to assess the impact of differences between outcomes on population-level FSW/client HIV prevalence. Outcomes based on 'clients per last working day' produced lower estimates than those based on 'clients per typical day'. Although the outcomes were strongly correlated, their averages differed by approximately two-fold (range 39.0-79.1 CPM). The CPM measure chosen did not greatly influence standard epidemiological 'risk factor' analysis. Differences across outcomes influenced HIV prevalence predictions. Due to this uncertainty, we recommend basing population-based estimates on the range of outcomes, particularly when assessing the impact of interventions. [ABSTRACT FROM AUTHOR]

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age ( N = 355) who had experienced stillbirth ( n = 178) and compared to those who had not ( n = 177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women. [ABSTRACT FROM AUTHOR]

Inadequate dietary intake is a critical underlying determinant of child undernutrition. This study examined the association between anthropometric‐based and food‐based nutritional failure among children in India. We used the 2015–2016 National Nutrition Monitoring Bureau data where anthropometric outcomes and food intake were both measured for each child. We followed the World Health Organization child growth reference standards to define anthropometric failures (i.e., height‐for‐age z score < −2 SD for stunting, weight‐for‐age z score < −2 SD for underweight, and weight‐for‐height z score < −2 SD for wasting), and the Indian Council of Medical Research recommended dietary allowance (RDA) to define adequacy in intake of calorie, protein, and fat. We used descriptive and regression‐based assessments to test the association between the two indicators of nutritional failure and also computed the area under the receiver operating characteristic curve (AUC). The prevalence of stunting, underweight, and wasting was 28.6%, 24.3%, and 12.8%, respectively, whereas 78.2%, 27.4%, and 50.8% of the children had below RDA norms consumption of calorie, protein, and fat, respectively. We found weak‐to‐null correlation between anthropometric failures and food failures (Pearson correlation ranging from −0.013 to 0.147) and poor discriminatory accuracy (AUC < 0.62), suggesting that in the Indian context, anthropometric failures are not directly associated with food intake. This finding highlights the need for improving adequate intake of macronutrients and draws attention toward adopting a multifactorial approach to improve child nutrition in India. Poor food intake itself merits exclusive policy focus as it is an important nutrition and health concern. [ABSTRACT FROM AUTHOR]

In Karnataka state, South India, we analyzed the role of membership in peer groups in reducing HIV-related risk and vulnerability among female sex workers (FSWs). Data from three surveys conducted in Karnataka, a behavioral tracking survey and two rounds of integrated biological and behavioral assessments (IBBAs), were analyzed. Using propensity score matching, we examined the impact of group membership on selected outcomes, including condom use, experience of violence, access to entitlements, and the prevalence of sexually transmitted infections, including HIV infection. Focus group discussions were conducted with the FSWs to better understand their perceptions regarding membership in peer groups. Peer group members participating in the IBBAs had a lower prevalence of gonorrhea and/or chlamydia (5.2 vs 9.6%, p<0.001), and of syphilis (8.2 vs 10.3%, p<0.05), compared to non-members. The average treatment effect for selected outcome measures, from the propensity score matching, showed that FSWs who were members of any peer group reported significantly less experience of violence in the past six months, were less likely to have bribed police to avoid trouble in the past six months, and were more likely to have obtained at least one formal identification document in the past five years, compared to non-members. In focus group discussions, group members indicated that they had more confidence in dealing with situations of forced sex and violence. Including community mobilization and peer group formation in the context of HIV prevention programing can reduce HIV-related risk and vulnerability among FSWs. [ABSTRACT FROM AUTHOR]