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Summary: Background: Childhood obesity (5–9 years) in India is likely to contribute 11% to the global burden by 2030. Methods: Data from India's Comprehensive National Nutrition Survey (CNNS, 2016–2018) was used to assess the prevalence and key associated factors of overweight and obesity. Multivariable logistic regression models were applied to identify potential determinants associated with being overweight and obese. Results: Overweight prevalence (including obesity) varied from 1.6% (0–4 years) to 4.8% (10–19 years). The majority of states reported a higher proportion of adolescents overweight and obese, than younger age group 5–9 years. A significantly higher prevalence of children and adolescents with obesity was reported in higher wealth quintiles and residents of urban areas. The prevalence of overweight and obesity and associated demographic and health factors in India included: the presence of NCD risk factor (adolescents: 1.68, 95% CI [1.31–2.14]), micronutrient deficiency (5–9 years children: 1.72, 95% CI [1.30–2.28]), mother's education (5–9 years children: 4.84, 95% CI [2.92–8.03]; adolescents: 2.17, 95% CI [1.42–3.32]), wealth (adolescents: 1.92, 95% CI [1.16–3.19]), place of residence (5–9 years children: 1.68, 95% CI [1.39–2.03]; adolescents: 1.39, 95% CI [1.16–1.66]), child age (5–9 years children: 1.64, 95% CI [1.40–1.93], and screen‐time (adolescents: 1.63, 95% CI [1.22–2.19]. Conclusion: The findings set out policy and research recommendations to pave the path for curtailing the increasing prevalence of overweight and obesity and achieving the World Health Assembly's Global Nutrition target of 'no increase in childhood overweight (Target 4) by 2025'. [ABSTRACT FROM AUTHOR]

Background: Stunting is a significant public health problem in childhood in developing countries. Sustainable Developmental Goals have mandated that each country reduce stunting by 50% by 2030. However, despite various nutrition and health programs, India still faces a massive burden of stunting. With the increasing urbanization in the country and its typical challenges related to health and nutrition, chronic malnutrition is a massive problem in urban areas, especially among people in the lower wealth quintile. Hence, current study has attempted to estimate the prevalence of stunting among children (0–6 years) and its determinants. Methodology: A cross-sectional study was conducted in the Urban Anganwadi centers of Rishikesh, Uttarakhand, for 6 months, from December 2021 to May 2022. Three hundred ten children from 13 selected Anganwadi centers were included using random sampling. Data were collected using a semi-structured validated and pretested questionnaire using Epicollect 5.0. Data were analyzed using the SPSS 23.0 version to estimate the prevalence of stunting and associated risk factors. Results: Out of 310 participants, 71 (22.9%) were stunted. Female children were slightly more stunted (24.7%) than males (21.1%). Maximum stunting (33.4%) was observed among children in the 5–6-year age group, and children with higher birth order were much more stunted. Stunting was reported more in children who were breastfed on demand (33.8%) than those fed every 2 hours (19.3%). Conclusion: Stunting prevalence in urban areas of Rishikesh is 22.9%, which is almost similar to the state average of 24.3% for urban areas; however, it was higher in comparison to the SDG 2030 global target of ending malnutrition of all forms. Stunting was significantly associated with feeding on demand and eating frequency less than twice a day. [ABSTRACT FROM AUTHOR]

COVID-19 has caused mayhem in the life of people. It has disrupted the social fabric of life. The children and adolescent population has been particularly affected by its direct and indirect effects. This systematic review aims to find the prevalence of depression and anxiety in children and adolescent age groups. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for finding the prevalence of depression and anxiety. We found the total number of participants to be 71,016. A random effect model was used for conducting meta-analysis. The prevalence of depression was mentioned in 17 studies of 23 and the pooled prevalence was 27% [95% confidence interval: 21%-36%] and heterogeneity (I 2 statistics; P <.00001) was 100%. The prevalence of anxiety was found in 20 studies of 23 and the pooled anxiety prevalence was 25% (95% confidence interval: 16%-41%) and heterogeneity (I 2 statistics; P < .00001) was found to be 100%. The summary of the findings has been provided. Due to high heterogeneity, moderator analysis was performed separately for depression and anxiety subgroups. The study design consisted of cross-sectional studies and some studies conducted through online surveys. The age range varied considerably from 1 year to 19 years; 5 studies had participants aged more than 19 years, but the mean age of the total sample was less than 18 years. We conclude that indeed there is a mental health epidemic among the child and adolescent population. We recommend early intervention and tailored made strategies should for management. As the pandemic is enduring, rigorous monitoring should be done. This age group is under extra pressure owing to a large uncertainty about their studies as well their future. [ABSTRACT FROM AUTHOR]

Scrub typhus is being reported as the most common cause of childhood meningoencephalitis (ME) in India. Hence, we planned to estimate the proportion of scrub typhus infection among children aged 1 month to 12 years with the clinical diagnosis of ME and to evaluate their demographic, clinical and laboratory characteristics. This cohort study was conducted in the Department of Pediatrics of a tertiary care teaching hospital in south India. One hundred and twenty-seven consecutive children aged 1 month to 12 years with the clinical diagnosis of ME were the participants. Their socio-demographic factors, clinical details, laboratory reports and outcomes were analyzed. The etiological agent was identified in 71 (56%) children. Orientia tsutsugamushi (Scrub typhus) was the most common infection (24.4%), of all children with ME. Children aged ≥5 years were frequently affected by scrub typhus ME. Eschar, capillary leak, hepatomegaly and splenomegaly were the predominant clinical features of scrub typhus ME. Thrombocytopenia and deranged liver function tests were common in scrub typhus ME. To conclude, Orientia tsutsugamushi was the most common organism identified in our study. Prompt recognition of some tell-tale clinical signs of scrub typhus (such as eschar, thrombocytopenia and hepatosplenomegaly), and timely initiation of antibiotics would lead to better outcomes as evident from the study. [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]

This study aimed to identify the prevalence and physical health consequences of family structure transitions among children in Ethiopia, India, Peru, and Vietnam. In many high-income countries, family structure transitions are common, and research suggests that they can lead to worse physical health for children. However, we know little about either the prevalence or consequences of family structure transitions for children in low-and middle-income countries, who make up the vast majority of the world's children. First, we estimated the number of family structure transitions by age 12 using four rounds of Young Lives data from four low-and middle-income countries (N = 8062, Ethiopia, India, Peru, and Vietnam) and validated our prevalence estimates with another dataset from these same countries. The proportion of children experiencing a family structure transition by age 12 was: 14.8% in Ethiopia, 5.6% in India, 22.0% in Peru, and 7.7% in Vietnam. We put these estimates in context by comparing them to 17 high- and upper-middle-income countries. Second, using linear mixed models, we found that family structure transitions were not directly associated with worse physical health for children in Ethiopia, India, Peru, and Vietnam. Children in Peru experienced higher rates of family structure transitions relative to children in the other Young Lives countries, and similar rates to many of the 17 comparison countries, yet physical health was unaffected. It is possible that in low-and middle-income countries, the environment may overwhelm family stability as a determinant of physical health. Highlights: The prevalence of children experiencing a family structure transition by age 12 in Ethiopia, India, Peru, and Vietnam was 5.6–22.0%: a wide-range, similar to what has been observed in high-income contexts. Family structure transitions are not directly associated with children's general physical health in Ethiopia, India, Peru, or Vietnam. Family structure transitions do not influence children's general physical health trajectories over time in Ethiopia, India, Peru, or Vietnam. [ABSTRACT FROM AUTHOR]

Background: Most centers in developing countries prefer chelation therapy with D-penicillamine for the management of Wilson's disease (WD) because of its easy availability and affordability. Neurological worsening following treatment with D-penicillamine is not uncommon. However, there is a paucity of Indian data on the incidence of neurological worsening in children and adolescents with WD following chelation therapy. Our study objectives were to identify the prevalence of neurological worsening in children and adolescents with WD following chelation with D–penicillamine therapy and to describe the management options and outcomes in these patients. Materials and Methods: In this retrospective chart review, children and adolescents with an established diagnosis of WD from 2010 to 2020 were identified from the hospital electronic database. Among these patients, data of children and adolescents with neurological worsening following D–penicillamine therapy were extracted and analyzed. Results: Neurological worsening was observed in 27/122 (22.1%) children and adolescents with WD on chelation therapy with D-penicillamine. Fifteen patients with neurological worsening following D-penicillamine therapy were managed with zinc monotherapy. Four patients were managed with a combination therapy of zinc and trientine. Five patients were treated with trientine monotherapy. Re-challenging with D-penicillamine at a lower dose followed by a slow dose escalation was attempted in three patients. Gradual clinical and functional status improvement was observed in 24 cases while one patient succumbed to pneumonia. Conclusion: Children and adolescents with WD who had neurological worsening on D-penicillamine therapy may be managed with trientine. Zinc monotherapy with copper restricted diet was also found to be effective in non-affordable patients. [ABSTRACT FROM AUTHOR]

Background: India Global Youth Tobacco Survey 2019 observed that 8.5% of the young age group (13-15 years) consume tobacco (9.6 % are boys and 7.4 % are girls). No interventional studies among adolescents were conducted before the initiation of the SLT use. Aims & Objectives: To estimate the prevalence of consumption of tobacco and non-tobacco products and to provide school based interventions to bring behavioral changes. Materials and Methods: An interventional study was carried out in Primary Schools. For estimation of the prevalence of tobacco and non tobacco use all the students of 1st to 5th while for the interventions, 4th and 5th standard were selected. Baseline data and change in the behavior at the end of one year was collected. FGD with key informants were also conducted. Descriptive Statistics was conducted. Results: The prevalence of smokeless tobacco consumption and non-tobacco product was found to be 1.3% and 36.5% respectively. After intervention 40.5% students had quit non tobacco products. Findings of FGD suggested that children should not be sent to purchase tobacco products on behalf of their parents. Conclusion: School based intervention and sensitization of the field workers along with knowing their perceptions for the predictors of consumption could be useful. [ABSTRACT FROM AUTHOR]

Context: Childhood injuries are a less explored area of public health. In the presence of public health problems such as communicable and noncommunicable diseases, childhood injury has gained less attention from the health system. Aims: The aim of the study was to assess the prevalence of various types of unintentional injuries (UI) amongst children and to assess the factors associated with same. Settings and Design: The study was conducted at Ahmedabad District of Gujarat State, and this is a cross-sectional sStudy. Subjects and Methods: The current study was a part of a multicentric national level research supported by Indian Council of Medical Research. Total 11 sites were selected across India, which all followed a uniform methodology. One of the selected sites was Dholka taluka of Ahmedabad district, Gujarat. This cross-sectional study was conducted in 2341 households. The study participants were children aged from 6 months up to 18 years. A total of 3018 children and their caretakers were interviewed using software-based questionnaire. Statistical Analysis Used: Statistical analysis was performed by frequencies and Percentage, Chi-square Test, Z-Test. Results: The overall prevalence of injuries was 7.62%. Gender and area of residence were significantly associated with UI. Fall-related injuries had the highest prevalence (3.38%), followed by road traffic injuries (RTI) (1.62%). The prevalence of burn-related injuries and poisoning was higher among females compared to males. No mortality was observed due to UI. Conclusions: Majority of the injuries were of minor or trivial type. Fall-related injury and RTI were the most common types of UIs among children. [ABSTRACT FROM AUTHOR]

Background: The HLA associations of celiac disease (CD) in north Indians differ from that in Europeans. Our dietary gluten is among the highest in the world. Data on CD in people with diabetes (PWD) in north India is scant. Objective: To estimate the prevalence and clinical profile of CD in children with type 1 diabetes (T1D). Research Design and Methods: Retrospective review of case records of PWD with onset ≤18 years of age, registered between 2009 and 2020, having at least one anti tissue‐transglutaminase (anti‐tTG) serology report. Results: Of 583 registered PWD, 398 (68.2%) had celiac serology screening. A positive report was obtained in 66 (16.6%). Of 51 biopsied people, 22 (5.5%) were diagnosed to have CD, 12 in the first 2 years of diabetes onset. Symptomatic CD at diagnosis was seen in 63% (14/22). Age at diabetes onset (median [IQR] age 5.5 years, [2–12]) was lower in PWD and CD compared to PWD alone (10 years, [7–14], p < 0.016). Of 36 biopsied children with anti‐tTG >100 au/ml, 20 (55.5%) had CD, while 2 out of 15 (13.3%) of those with lower anti‐tTG titer had histopathology suggestive of CD. Of 23 seropositive children not diagnosed with CD, 5 of 8 with anti tTG >100 au/ml, and all 15 with lower anti‐tTG, had normalization of titers over the 24 (10–41) months. Conclusions: Our prevalence of CD is comparable to international data. Celiac disease was common with younger age at onset of T1D and higher titer of celiac serology. A high proportion was symptomatic of CD at diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Renal dysfunction and progression to end stage renal disease is well known in human immunodeficiency virus (HIV) infection. We studied the role of microalbuminuria and urinary NGAL levels in children with HIV infection for the prediction of renal dysfunction. Design and Methods: A cross-sectional study was carried out and 60 HIV infected children, aged (18 months to 15 years) were screened for microalbuminuria by nephelometry and for uNGAL by ELISA. Thirty healthy children were screened for uNGAL for normative data in Indian children. Results: The prevalence of microalbuminuria in studied population was 3.3%. The mean uNGAL and uNGAL/creatinine in study population was higher than controls (26.94 ± 93.12 ng/ml vs. 88.94 ± 345.20 mcg/g, and 15.53 ± 37.52 ng/ml vs. 30.12 ± 78.66 ng/ml; P = 0.003, P = 0.002). Children with lower CD4 counts had significant higher mean Albumin Creatinine Ratio (ACR) and mean uNGAL; P = 0.03, P = 0.01. Conclusions: uNGAL and urine microalbumin are useful biomarkers of early tubular and glomerular injury in children with HIV infection. [ABSTRACT FROM AUTHOR]

Background: Under-nutrition is a big risk factor for increasing the morbidity and mortality burden in the society. Acute malnutrition contributes to almost 61% of diarrheal and 53% of pneumonia deaths. In urban slums like M-East ward, Mumbai, acute malnutrition prevalence ranges from 16% to 59.8%. Objectives: To assess the outcome of weight gain by providing nutritional supplements to the undernourished children along with nutritional counseling. Materials and Methods: RUTF (Ready-to-Use Therapeutic Food) and Hyderabad mix with nutritional counselling to parents of children were used to reduce the undernourishment among the under-five children in slums of this ward. Six hundred and fifty malnourished children and their caregivers were provided nutritional supplement and nutritional counselling over 6 months. Results: There was steady wight gain of enrolled children. Highest weight gain occurred over 13th week of the program. Conclusion: A minimum of thirteen weeks nutritional supplement program including fortnightly counselling is necessary and sufficient for converting undernourished children to normal. [ABSTRACT FROM AUTHOR]

Background: Vitamin A deficiency (VAD) and Anemia are important public health nutritional problems in India. Objective: To assess nutritional status and prevalence and correlates of undernutrition, anemia, and VAD among children. Materials and Methods: A community-based cross-sectional study was carried out adopting systematic random sampling. Information on socio-demographic particulars was collected and 20 µL blood was collected for hemoglobin and free-flowing drop on Whatman filter paper for Vitamin A estimation. Hemoglobin was estimated using indirect cyanmethemoglobin and Vitamin A by high-pressure liquid chromatography. Nutritional status was assessed using the WHO Child Growth Standard. Results: The overall prevalence of anemia and VAD was 68% and 59%, respectively, while underweight, stunting, and wasting was 30%, 55%, and 11%, respectively, among under 5 year children. Stepwise logistic regression analysis revealed no significant association of anemia and VAD with any sociodemographic variables, while the odd of stunting was four times higher among children of mothers engaged in labor and two times among children from low-income group, while underweight was two times higher among children from households not having sanitary latrine. Exclusive breastfeeding was observed to be associated with undernutrition among infants. Conclusions: Anemia, VAD, and stunting were high among children. Low intakes of green leafy vegetables and milk and milk product may be the reasons for the higher prevalence of anemia and VAD. There is a need to strengthen supplementation of iron and folic acid tablets and Vitamin A and also public distribution system. [ABSTRACT FROM AUTHOR]

Aim: Children with sickle cell disease (SCD) are at high risk of vitamin D deficiency (VDD). The prevalence of VDD in different countries is between 65-100% in these patients. The present study was undertaken to find the prevalence of VDD among sickle cell children and to assess the association of co-morbidities with VDD. Materials and Methods: Total 89 children who were attending a sickle cell clinic/admitted to paediatric wards of a Tertiary Care Centre were enrolled in this study. After their history, clinical examination and anthropometry were investigated, samples were taken for serum 25-hydroxy vitamin D ng/mL and calcium level assessment. The outcome was morbidity in sickle cell children in terms of frequency of pain episodes, number of febrile episodes, number of blood transfusions and total number of admissions. Results: Out of 89 cases, 58 (65.17%) cases were deficient in vitamin D (<20 ng/dL), 22 (24.72%) cases had insufficiency (20-30 ng/dL) and 9 (10.11%) cases had normal vitamin D levels (>30 ng/dL). The mean vitamin D level was 19.42ng/dL. Morbidity in SCD was more in VDD children compared to vitamin D sufficient children with significance in the number of pain episodes and the total number of hospital admissions but not in the number of admissions for acute febrile illness or the total number of blood transfusions. Conclusion: VDD was prevalent in 65.17% of children with SCD. Children between 4-12 years were more affected with a male predominance. As this study involved children with SCD alone, future studies need to be carried out involving children without SCD to establish a better possible link between vitamin-D and SCD morbidity. [ABSTRACT FROM AUTHOR]

Context: Skin diseases are a major cause of public concern among underprivileged people residing in orphanages. There is a need for community-based study for dermatoses in orphanages as the literature is scarce at the national and international levels. Aims: For profiling of various dermatoses to generate information on general health, nutritional status, and sanitation, and to educate about personal skin hygiene and care to inmates in urban child orphanages. Settings and Design: A cross-sectional study was conducted at 18 urban child orphanages in Tirunelveli city for 1 month. Methods and Material: A predesigned proforma was prepared and the demographic details regarding the inmates were obtained and they were screened under natural light for skin, hair, nail, and oral disorders as well as their built, nourishment, height, and weight were measured and recorded in tabulations. Statistical Analysis Used: Descriptive statistical analysis was followed for describing the prevalence of dermatoses and the age group affected which are explained in percentages and ratios. Results: Out of a total of 850 inmates, 93 (11%) were of 5–9 years and 757 (89%) were of 10–19 years. Among them, 330 (39%) were males and 520 (61%) were females. Overall, the inmates affected with dermatoses were 360 (42.4%) and infectious dermatoses were seen in 218 inmates (60.5%) and non-infectious dermatoses were seen in 142 inmates (39.5%). Adolescent females were more commonly affected and the commonest dermatoses observed were pediculosis capitis (13.6%) followed by acne vulgaris (8.1%) and in adolescent males, scabies (7.1%) was the commonest. No psychocutaneous disorders were encountered. Conclusions: Infections and infestations are common in orphanages due to a lack of awareness of personal hygiene and self-care practices. They should be given health education in order to reduce the disease burden in children living in orphanages which in turn decreases the disease burden at the community level. [ABSTRACT FROM AUTHOR]

Purpose: This was a population-based study to determine the prevalence and causes of visual impairment in children less than 16 years in Urban North India.Methods: This cross-sectional study was conducted in 40 clusters of urban Delhi. 20,955 children aged less than 16 years underwent visual acuity screening using age-appropriate visual acuity charts. Unaided visual acuity of enumerated children aged over 2 years was assessed by using Lea symbols chart in 3-5 years age group and logMAR tumbling E charts for the 6-15 years age group. For children aged 0-2 years, fixation and following to torch light was assessed. All the children with unaided visual acuity of <6/12 in any eye in age group 3-15 years and inability to follow the light in age <3 years were referred for detailed ophthalmic examination.Results: Amongst 20,955 children examined for visual acuity a total of 789 children were referred to the central clinic for detailed ophthalmic examination. Of these referred children, a total of 124 had presenting visual acuity <6/18 in the better eye. The prevalence of visual impairment (VI) was 5.92 per thousand (95% CI: 4.96-7.05). The prevalence of moderate to severe visual impairment was maximum in the age group of 11 to 15 years. The main cause of avoidable VI in these children was a refractive error (75.7%). The prevalence of blindness was 0.42 per thousand.Conclusion: Optic nerve abnormalities were the most important cause of blindness in children. Refractive error is the most important cause of visual impairment amongst children and needs to be addressed. [ABSTRACT FROM AUTHOR]

Multiple micronutrient deficiencies (MNDs) co‐exist, often because of poor intakes and adversely impact health. Habitual diets were assessed in 300 school children (6–17 years old) recruited from two government schools by simple random sampling. Probability of adequacy (PA) for 11 micronutrients and mean probability of adequacy (MPA) was calculated. Haemoglobin, plasma ferritin, folic acid, vitamin B12 and C‐reactive protein were estimated. Descriptive statistics and regression analysis were used to estimate magnitude and factors associated with MNDs. The contribution of fortified foods and/or supplements in addressing inadequacies and excessive intakes was modelled. The PA ranged from 0.04 for folate to 0.70 for zinc, and the MPA was 0.27. Prevalence of anaemia (53%), iron deficiency (57%; ID), iron deficiency anaemia (38%; IDA), folate deficiency (24%) and B12 deficiency (43%) was high. Dietary inadequacy of iron, zinc and a low MPA was associated with anaemia and IDA. Inclusion of double fortified salt (DFS), fortified rice (FR) or iron folic acid (IFA) supplements individually in habitual diet reduced probability of iron inadequacy significantly from 82% to ≤13%. Inclusion of DFS and FR simultaneously led to disappearance of iron inadequacy, but risk of excessive intake increased to 16%. Inclusion of DFS, FR and IFA together increased risk of excess iron intake to 40%. Nevertheless, intakes of folate and B12 remained inadequate even with FR and/or IFA. These results indicate a high risk of dietary MNDs in children and suggest need for more systematic intake measurements in representative sample and adjustment of iron dosages to avoid excessive intakes. [ABSTRACT FROM AUTHOR]

Meitei is the main ethnic community that belongs to the north‐eastern state of Manipur in India. This community is bestowed with rich biodiverse resources with indigenous foods still form an integral part of their diet. However, limited data on the food and nutrient consumption as well as nutritional status of this community are available. This study was carried out on the children, adolescents and women of reproductive age (WRA) of this community from 12 villages, to determine their food consumption pattern and nutritional status. Basic anthropometry and 24‐h dietary intake assessment was conducted. The prevalence of underweight was 27%, stunting was 45% and wasting was 12% in children below 5 years. Stunting was observed among 34% of children 5–17 years of age. About 7% of WRA were undernourished, while 28% were overweight or obese. About 55% of 1–7 year‐old children had mean probability adequacy of 12 micronutrients <0.5, and the adequacy of individual micronutrients namely vitamin A, E and calcium were low. Dietary determinants such as low dietary diversity score, dietary species richness and the lowest tertiles of different food groups' intake (except for sugars, fish and sea foods and spices and condiments) predicted micronutrient inadequacy. In addition to a high prevalence of undernutrition in children and adolescents and overnutrition in WRA, the effect of various dietary determinants on micronutrient adequacy in the study group of the Meitei community are reported. [ABSTRACT FROM AUTHOR]

Delayed presentation to care of perinatally infected children in India continues to be a hindrance to achieving the "end pediatric HIV by 2020" goal. In this study, we characterize this issue by describing the prevalence, risk factors and temporal trends of delayed presentation to care of perinatally infected, antiretroviral therapy (ART) – naïve children using programmatic data from a tertiary care center in western India. Delayed presentation was defined as children presenting in moderate or severe WHO immunodeficiency categories. Of 269 children eligible for inclusion in the analysis, the median age at presentation was 4 years (IQR: 3–6 years) and prevalence of delayed presentation was 52%. Multivariable logistic regression identified domicile distance ≥20km from the ART center (OR: 2.2, 95% CI: 1.02–4.7) to be a risk factor for delayed presentation. An inverse association with increasing age (OR: 0.8, 95% CI: 0.7–0.9) was also seen. The proportion of children with delayed presentation between 2006 and 2016 remained unchanged (p = 0.36), although the median age at presentation over the same time period increased significantly (p < 0.001). Our results indicate the urgency of identifying strategies to improve linkage of perinatally infected ART-naïve children to care, earlier than what is currently observed. [ABSTRACT FROM AUTHOR]

Background: Children with type 1 diabetes having dyslipidemia are at increased risk of developing premature atherosclerosis and cardiovascular disease. The present study aims to determine the prevalence of dyslipidemia and its predictors in poorly controlled Indian children with type 1 diabetes. Methods: The cross‐sectional study included 235 children and youth (3‐18 years) with type 1 diabetes having disease duration of at least 1 year. Demographic data and laboratory findings were obtained from patients' records. Results: The prevalence of dyslipidemia in our study was 47.2% with abnormal low‐density lipoprotein cholesterol being the most common lipid abnormality. Poor glycemic control and higher thyroid stimulating hormone values were important predictors of likelihood of dyslipidemia and hypertriglyceridemia. Despite a low percentage of overweight and obese children in our study, body fat percentage was a significant predictor of likelihood of high total cholesterol and abnormal high‐density lipoprootein. Interestingly, 28 children under the age of 10 years were found to have dyslipidemia, which constitutes 11.9% of the total study group. Conclusions: We found a high prevalence of dyslipidemia in children with type 1 diabetes including children under age of 10 years, which emphasize the need for early screening and regular monitoring of lipid profile in these children. [ABSTRACT FROM AUTHOR]

The global burden of injuries in 2017 showed that 57.2 million people were affected. The study aimed to assess the patterns of injuries and costs related to the treatment of injuries. Injury in rural areas tends to be underreported, which hinders estimation of the true prevalence of physical injuries for implementing injury prevention strategies at the community level. A community-based, cross-sectional study was conducted in the field practice area of a private medical college from May to August 2019. Physical injuries sustained by 1723 individuals over three months were collected and were classified based on ICD-10. Descriptive data were expressed using frequencies and percentages and median (Interquartile Range). Independent T-test, Mann Whitney U test, Chi-square test was used to determine statistical differences between the variables. The total number of injuries recorded was 105(6.9%) among 1723 individuals. The most common injuries were superficial injuries in 77 (70.0%), of which 98(89.1%), of which the upper 55(50.0%) limb was more affected than lower limbs 43(39.1%). The overall 3-month injury rate was 60.94(49.6-72.23) per 1000 persons. The median amount of money spent on the treatment of injuries was INR 225.0(50.0-1000.0). [ABSTRACT FROM AUTHOR]

Background: Under-nutrition in young children has long-term negative effects on physical and cognitive development. Under nutrition problems are affecting overall development of the country. Aim and Objectives: This study was undertaken to assess the prevalence and to examine predictors of undernutrition among children of less than 5 years of age in urban slum of Gwalior district. Materials and Methods: A community based cross sectional study was conducted on 550 children with age group 6 months to 5 years residing in urban slum. Chi square test and logistic regression were performed to see association and to predict risk factors. Results: Undernutrition was prevalent among 68% children. Unreserved category(UR) was found to be at lesser risk as compared to SC/ST (OR: 0.238 ;CI : 0.133-0.423).Nuclear families had more risk for undernutrition as compared to Joint families (OR:1.947;CI: 1.352-2.803),Illiterate mothers showed more risk (OR:5.696,CI:2.791-11.625),Similar results were obtained for illiterate fathers (OR: 3.950; CI:1.868-8.353) as compared to fathers having qualification of at least graduation. Females with one parity were protective for undernutrition (OR: 0.411; CI: 0.182-0.928).Low birth weight (OR: 1.996; CI: 1.332-2.991) and total member in family also played a significant role. Conclusion: Poverty and education predispose undernutrition in slum children. There is a need to undertake intervention through community education regarding breastfeeding, ANC, birth spacing and to adopt practices that favour good nutrition of child. [ABSTRACT FROM AUTHOR]

Background: Under-nutrition in young children has long-term negative effects on physical and cognitive development. Under nutrition problems are affecting overall development of the country. Aim and Objectives: This study was undertaken to assess the prevalence and to examine predictors of undernutrition among children of less than 5 years of age in urban slum of Gwalior district. Materials and Methods: A community based cross sectional study was conducted on 550 children with age group 6 months to 5 years residing in urban slum. Chi square test and logistic regression were performed to see association and to predict risk factors. Results: Undernutrition was prevalent among 68% children. Unreserved category(UR) was found to be at lesser risk as compared to SC/ST (OR: 0.238; CI : 0.133-0.423).Nuclear families had more risk for undernutrition as compared to Joint families (OR: 1.947; CI: 1.352-2.803), Illiterate mothers showed more risk (OR:5.696, CI: 2.791-11.625), Similar results were obtained for illiterate fathers (OR: 3.950; CI: 1.868-8.353) as compared to fathers having qualification of at least graduation. Females with one parity were protective for undernutrition (OR: 0.411; CI: 0.182-0.928). Low birth weight (OR: 1.996; CI: 1.332-2.991) and total member in family also played a significant role. Conclusion: Poverty and education predispose undernutrition in slum children. There is a need to undertake intervention through community education regarding breastfeeding, ANC, birth spacing and to adopt practices that favour good nutrition of child. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (Ptrend =.020) and 1.00, 0.64, 047, and 0.64 for high body fat (Ptrend =.012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries. [ABSTRACT FROM AUTHOR]

Screen dependency disorder is on a rising trend and being less researched, the study tried to find out the prevalence and pattern of screen viewing (SV) among children less than two-years of age. Data was collected through in-person interviews from their mothers. Increasing child-age and type of family were significantly associated with higher prevalence of SV. Smart phones had similar usage rates as TVs. Parental knowledge and practices were found to influence the SV and screen-time in children. Modifiable factors like parental knowledge on SV, parental SV practices can help in designing health promotion strategies and recommendations on SV. [ABSTRACT FROM AUTHOR]

Objective: To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. Methods: A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. Results: Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. Conclusions: Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood. [ABSTRACT FROM AUTHOR]

To study the prevalence of chronic suppurative otitis media among school children in Belagavi, rural area of South India. A community based descriptive cross sectional survey was conducted in 7 schools of rural areas of Belagavi district in Karnataka over a period of 2 months between 15th July and 15th September 2018. A survey demographic data collection was done on 694 school children aged between 6 and 14 years attending these schools. A detailed history and otoscopic examination was done in the school premises. Data received from the study was entered and statistical analysis was done. CSOM was present in 36 (5.2%) out of 694 students examined among which 22 (6.8%) of them lived in families with overcrowding. H/o cleaning the ear with various materials was given by 27 (7.4%) of them. 29 (9.3%) of them had recurrent respiratory tract infection, 7 students had active disease. The prevalence of CSOM in this study is relatively lower in this part of the rural South India. There is a higher prevalence of safe disease with central perforation than unsafe disease. Recurrent respiratory tract infections and history of cleaning of ear were the predictors of CSOM among school children. There is a need for better knowledge of illness and screening programme for early detection and management. [ABSTRACT FROM AUTHOR]

Objectives: The key to newer therapeutic and eradication approaches often lies in understanding slow disease progression in HIV infection. The paediatric population has been poorly studied in this regard. We aimed to describe a cohort of perinatally infected long‐term nonprogressor (LTNP) children living with HIV in India and to evaluate the immune biomarkers of disease progression. Methods: LTNPs (ART‐naïve, with a CD4 count ≥ 500 cells/μL at age ≥ 7 years) among the cohort of HIV‐infected children were identified and monitored longitudinally, and their CD4 T‐cell counts and plasma viral loads were measured every 6 months. The plasma monocyte/macrophage activation markers, namely soluble CD14 (sCD14), soluble CD163 (sCD163) and interferon‐inducible protein‐10 (IP‐10) were measured by enzyme‐linked immunosorbent assay (ELISA) in LTNPs and progressors. The Mann–Whitney U‐test was used to compare the two groups and P values < 0.05 were considered statistically significant. Spearman's rank or Pearson's correlation coefficient (r) was calculated to determine the associations between variables. Results: Among 378 children living with HIV‐1 surveyed in our cohort, 40 (10.6%) were LTNPs. Longitudinal analysis of the LTNP data showed that both CD4 count and viral load declined significantly with age (P < 0.0001 for both). Plasma sCD14 levels were significantly (P < 0.005) higher in progressors and sCD163 levels were significantly (P < 0.0001) higher in LTNPs. Conclusions: The prevalence of LTNPs in our cohort of perinatally infected children living with HIV was 10.6%. We observed a trend for associations between the increasing sCD163 monocyte/macrophage activation marker levels, declining CD4 counts and the gradual loss of nonprogressor status with age in the LTNPs. These findings underscore the need for early antiretroviral therapy in those children with proven slow disease progression. [ABSTRACT FROM AUTHOR]

Objective To estimate of the number of children younger than 5 years who were household contacts of people with tuberculosis and were eligible for tuberculosis preventive treatment in 2017. Methods To estimate the number of eligible children, we obtained national values for the number of notified cases of bacteriologically confirmed pulmonary tuberculosis in 2017, the proportion of the population younger than 5 years in 2017 and average household size from published sources. We obtained global values for the number of active tuberculosis cases per household with an index case and for the prevalence of latent tuberculosis infection among children younger than 5 years who were household contacts of a tuberculosis case through systematic reviews, meta-analysis and Poisson regression models. Findings The estimated number of children younger than 5 years eligible for tuberculosis preventive treatment in 2017 globally was 1.27 million (95% uncertainty interval, UI: 1.24-1.31), which corresponded to an estimated global coverage of preventive treatment in children of 23% at best. By country, the estimated number ranged from less than one in the Bahamas, Iceland, Luxembourg and Malta to 350 000 (95% UI: 320 000-380 000) in India. Regionally, the highest estimates were for the World Health Organization (WHO) South-East Asia Region (510 000; 95% UI: 450 000-580 000) and the WHO African Region (470 000; 95% UI: 440 000-490 000). Conclusion Tuberculosis preventive treatment in children was underutilized globally in 2017. Treatment should be scaled up to help eliminate the pool of tuberculosis infection and achieve the End TB Strategy targets. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence of various types of childhood glaucomas, their clinical features and treatment methods.Methods: We prospectively included consecutive children with glaucoma presenting to glaucoma clinic for the first time between March 2013 and May 2014. We classified childhood glaucomas as per the classification proposed by Congenital Glaucoma Research Network.Results: Of the 275 children (449 eyes) with glaucoma during this period, primary glaucomas constituted 56% (n = 252 eyes of 145 children), including 169 eyes (37.64%) of 97 children with primary congenital glaucoma (PCG), 16 eyes (3.56%) of 10 children with infantile glaucoma, and 67 eyes (14.9%) of 38 children with juvenile open angle glaucoma. Among these, 85% (214 eyes of 107 children) had bilateral involvement. Secondary glaucomas constituted 44%; they were glaucoma associated with ocular anomalies 18% (n = 80 eyes), glaucoma associated with acquired conditions (steroid induced and traumatic glaucoma) 14% (n = 61 eyes), glaucoma following congenital cataract surgery 7.6% (n = 34 eyes), and glaucoma associated with systemic or syndromic conditions 5% (n = 22 eyes). In primary glaucomas, boys and girls were equally affected (1:1), and more boys (3.8:1) had acquired glaucomas. Close to 80% PCG eyes were managed surgically with combined trabeculotomy and trabeculectomy (CTT). Majority of secondary glaucomas were managed medically.Conclusion: In our cohort, PCG was the most common childhood glaucoma and CTT was the most common surgery performed in these eyes. Steroid-induced and traumatic glaucomas were the most common acquired glaucomas; appropriate measures should be taken to avert these preventable glaucomas in children. [ABSTRACT FROM AUTHOR]

Tobacco use among school children is becoming a serious problem. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. The present study was undertaken to assess (i) the prevalence and pattern of tobacco use among school children in India (ii) relation of tobacco use prevalence and pattern with socio-economic status (SES) of student’s family. This is a cross sectional 16 months study done in school going Indian students aged ≥ 6 years with sample size of 1460. The prevalence of tobacco use in children from lower SES families was 9.4% compared to 5.7% in children from middle SES families (p = 0.017). Among children who used tobacco, mean age of onset was younger among children from lower SES (9.97 year vs 11.85 year, p = < 0.01) and they were more likely to use smokeless tobacco only (79.1% vs 61.3%, p = .0.006). However there was no significant difference between two groups in factors which motivated them towards first experience of tobacco. Also there was no significant difference between family histories of two groups in terms of tobacco use. The high prevalence of tobacco consumption, especially smokeless tobacco among children highlights the need for early intervention like regular screening at school level. Also tobacco use cases need to be followed up with intensive treatment. [ABSTRACT FROM AUTHOR]

Purpose: Compliance to spectacle wear is vital to elimination of avoidable blindness among schoolchildren. This study aims to understand the barriers to compliance and strategies to overcome the barriers from the perspectives of the service providers of the school vision-screening model.Methods: A snapshot qualitative study using focus group discussions (FGDs) was conducted among the service providers including eye care professionals (ECPs) and social workers that are part of the school screening program. Sessions were audio recorded and transcribed. Themes were formed following inductive coding using a conceptual framework.Results: Out of the three FGDs, two were with ECPs and one with social workers. Four subthemes identified under the barriers were poor awareness, spectacle-related, psychosocial, and financial barriers. Unique barriers according to the service providers included nonuse of spectacles by asymptomatic children, children with unilateral refractive errors and those with emmetropic parents. Service providers also brought out parent's feelings of guilt, doubts about their children's impaired vision, the negative self-image among children, and difficulties in obtaining funding to support the costs of screening. Solutions that emerged included the personal visit of professionals for spectacle distribution and counseling parents, demonstration of improvement in vision for activities that were difficult for the children without spectacles and rewarding, and role modeling of compliant children.Conclusion: This study had identified unique barriers and solutions from the perspectives of the service providers. The suggested strategies would aid in an effective schoolchildren vision screening practice to enhance compliance to spectacle wear. [ABSTRACT FROM AUTHOR]

Abstract: Anaemia and stunting are prevalent nutritional problems among children of low‐income countries that have profound effects on development, morbidity, and mortality. Many use a single conceptual framework to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co‐occur in affected individuals to a greater degree than by chance. In 2 populations of children—ages 6–18 months in Bihar, India, (n = 5,664) and 6–36 months in Lambayeque, Peru (n = 688)—we measured the frequency of the co‐occurrence of anaemia and stunting. We compared this value with the value expected by chance, the product of the prevalence of anaemia and stunting, using a chi‐square test. We also built logistic regression models for each condition. The frequency of co‐occurrence in the Indian population was 21.5%, and in the Peruvian population, it was 30.4%, which are similar to frequencies expected by chance, 21.3% (p = .97) and 31.5% (p = .85). In Peru, anaemia was associated with age and consumption of treated water. Stunting was associated with age, sex, dietary diversity, hand washing, language spoken, and wealth. In India, anaemia was associated with age, sex, caste, dietary diversity, and household hunger. Stunting was associated with age, sex, caste, wealth, and maternal illiteracy. Despite some basic shared factors, anaemia and stunting are more independent than commonly assumed. Interventions that target children based on 1 condition may miss children with the other form of malnutrition. [ABSTRACT FROM AUTHOR]

Background: Intestinal parasitism(IP) remains a common problem in school going children. Aims & Objectives: To study the prevalence IP infestation in school going children and to study the relation with type of water supply and sanitation. Material and Methods: A cross sectional study was carried out and a total of 461 stool samples were collected from children under ten years of age from various schools of Rishikesh. The normal saline and iodine mounts of fresh and saturated salt solution concentrated samples were examined. Modified Ziehl Neelsen staining was done for detection of coccidian parasites. The statistical significance within gender, age, drinking water supply, sanitation and other socio-demographic parameters was assessed by Chi-square test. Results: 112 (24.3%) out of 461 were positive for intestinal parasites. Giardia lamblia was the commonest parasite (15.2%) followed by Hymenolepis nana (2.38%), Hookworm (2.17%), Enterobius vermicularis (2.17%), Entamoeba histolytica (2.17%), Ascaris lumbricoides (0.86%), and Cryptosporidium parvum (0.86%). Conclusions: Due to lack of proper sanitation & education along with low socioeconomic background, IP infections are still prevalent among school children. Regular awareness program on promoting good health, maintenance of proper personal hygiene and carrying out regular deworming in schools should be instituted for control. [ABSTRACT FROM AUTHOR]

Abstract: A community‐based cross‐sectional study was carried out with 603 children ages 5 and under and 500 of their mothers from 510 households to examine the prevalence of undernutrition and chronic diseases among the Khasis of North‐East India. Anthropometric measurements including Mid‐Upper Arm Circumference, height, and weight were taken. Dry blood spots to estimate haemoglobin and vitamin A were collected from children and women separately by finger prick. Mothers provided data about household socio‐demographic particulars and infant and young child feeding practices. The prevalence in children of underweight was 31%, stunting was 57%, and wasting was 10%. Undernutrition was higher among boys as compared to girls. Nutrient intakes were below recommended levels. The prevalence of anaemia among children ages 1 to 5 years old was 68%, and vitamin A deficiency was 59%, and they were 83% and 48%, respectively, among women. Hypertension was observed in 15% of women, whereas diabetes was less than 1%. Only about 20% of households were food secure, and this was associated with parental literacy, per capita income, and family size. Undernutrition was unacceptably high among the Khasis despite rich food biodiversity. Proper implementation of nutritional intervention programs such as Integrated Child Development Services, Mid Day Meal, and the Public Distribution System will improve the nutrient intake and nutritional status of the population. Additionally, preservation of forest lands and products paired with judicious use of the rich food biodiversity available will promote dietary diversity and ultimately better nutrition and health. [ABSTRACT FROM AUTHOR]

Purpose: Ocular trauma constitutes an important cause of preventable visual morbidity worldwide. This study was done to study the incidence, sociodemographic pattern, and clinical profile of ocular trauma in pediatric age group. Also to evaluate the factors influencing final visual outcome in these patients.Methods: This was a prospective interventional study concerning ocular trauma in pediatric patients up to 16 years of age of either sex. Various variables having an impact on final visual outcome were studied, and results were analyzed using statistical indices - relative risk, Chi-square test, P value, and linear regression analysis.Results: A total of 220 cases of trauma were evaluated with the mean age being 8.74 ± 3.93 years, males were predominantly affected and open globe injuries outnumbered blunt injuries. Penetrating injuries accounted for 67.79% cases of open globe injury, rupture being the least (2.54%). Stepwise multiple linear regression analysis executed, showed the best predictors in the descending order for final visual outcome were presenting visual acuity, size of corneal tear, type of injury, zone of injury, time period between injury and treatment with a variance of 35.9%, 6.3%, 5.3%, 3.7%, and 2.7%, respectively. All above variables were also found to be statistically significant (P < 0.05) on Chi-square test.Conclusion: We report the first study on the epidemiology and clinical outcomes of pediatric ocular trauma in central India. Poor initial Visual Acuity and posterior segment involvement adversely affect the visual outcome. Early medical treatment and globe-salvaging repair should be done in all eyes suffering from trauma. [ABSTRACT FROM AUTHOR]

Abstract: A community‐based cross‐sectional study was carried out with 603 children ages 5 and under and 500 of their mothers from 510 households to examine the prevalence of undernutrition and chronic diseases among the Khasis of North‐East India. Anthropometric measurements including Mid‐Upper Arm Circumference, height, and weight were taken. Dry blood spots to estimate haemoglobin and vitamin A were collected from children and women separately by finger prick. Mothers provided data about household socio‐demographic particulars and infant and young child feeding practices. The prevalence in children of underweight was 31%, stunting was 57%, and wasting was 10%. Undernutrition was higher among boys as compared to girls. Nutrient intakes were below recommended levels. The prevalence of anaemia among children ages 1 to 5 years old was 68%, and vitamin A deficiency was 59%, and they were 83% and 48%, respectively, among women. Hypertension was observed in 15% of women, whereas diabetes was less than 1%. Only about 20% of households were food secure, and this was associated with parental literacy, per capita income, and family size. Undernutrition was unacceptably high among the Khasis despite rich food biodiversity. Proper implementation of nutritional intervention programs such as Integrated Child Development Services, Mid Day Meal, and the Public Distribution System will improve the nutrient intake and nutritional status of the population. Additionally, preservation of forest lands and products paired with judicious use of the rich food biodiversity available will promote dietary diversity and ultimately better nutrition and health. [ABSTRACT FROM AUTHOR]

Background:The prevalence of drug-resistant (DR) tuberculosis (TB) in children is increasing. Although, in India, multi-drug-resistant (MDR) TB rates have been relatively stable, the number of children with pre-extensively drug-resistant and extensively drug-resistant (XDR) TB is increasing. Aim:To determine whether the prevalence of DR TB in children in Mumbai is changing and to study the evolving patterns of resistance. Methods:A retrospective study was undertaken in 1311 paediatric patients referred between April 2007 and March 2013 to the Paediatric TB clinic at B. J. Wadia Hospital for Children, Mumbai. Children were defined as having DR TB on the basis of drug susceptibility testing (DST) ofMycobacterium tuberculosisgrown on culture of body fluids (in the case of extra pulmonary TB) or from gastric lavage/bronchi-alveolar lavage/sputum in patients with pulmonary TB or from DST of the contacts. The prevalence of DR TB was calculated and the type of DR was evaluated yearly and in the pre-2010 and post-2010 eras. Results:The overall prevalence of DR TB was 86 (6.6%) with an increase from 23 (5.6%) patients pre-2010 to 63 (7%) post-2010 (P = 0.40). Nine (10.4%) patients were diagnosed on the basis of contact with a parent with DR TB. Overall fluoroquinolone resistance increased from 9 (39.1%) pre-2010 to 59 (93.7%) post-2010 (P = 0.0001): moxifloxacin resistance increased from 2 (8.7%) to 29 (46%) (P = 0.0018) and ofloxacin resistance increased from 7 (30.4%) to 30 (47.6%) (P = 0.14). Ethionamide resistance also increased from 6 (26.1%) to 31 (49.2%) (P = 0.04), aminoglycoside resistance was one (4.3%) pre-2010 and 12 (19%) post-2010 (P = 0.17) and resistance remained virtually the same for both amikacin [0 pre-2010 and 6 (9.5%) after 2010] and kanamycin [one (4.3%) pre- and 6 (9.5%) post-2010]. Of the first-line drugs, resistance remained the same for isoniazid [23 (100%) to 61 (96.8%)], rifampicin [22 (95.7%) to 51 (80.9%),P = 0.17], pyrazinamide [15 (65.2%) to 35 (55.6%),P = 0.47], ethambutol [14 (60.9%) to 38 (60.3%),P = 1.00] and streptomycin [19 (82.6%) to 50 (79.4%),P = 1.00]. Resistance to PAS remained unchanged [2 (8.7%) to 5 (7.9%),P = 1.00]. Conclusion:There is increasing resistance to second-line anti-tuberculosis (ATT) drugs, particularly flouroquinolones and ethionamide. Hence, there is an urgent need to avoid the use of ATT drugs for non-tuberculous infection and to increase surveillance for DR TB in adults as MDR TB in children is usually through contact with an adult with infectious MDR TB. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess the prevalence of sleep disorders among children aging between 4 and 9 years using Hindi version of Pediatric Sleep Questionnaire (PSQ). Methods: This study had two parts first, translation and validation of PSQ into Hindi language, and second, assessment of the prevalence of sleep disorders using PSQ Hindi version. Hindi PSQ was distributed in randomly chosen primary schools in a semi-urban area. The children were requested to get them filled by their parents. When the questionnaires were returned, responses were analyzed. Results: Most of the items of the Hindi version had perfect agreement with original questionnaire in a bilingual population (κ=1). Totally, 435 children were included in the field study having average age of 6.3 years. Obstructive sleep apnea was reported in 7.5% children; symptoms suggestive of restless legs syndrome were reported by 2%-3%; teeth grinding by 13.9% and sleep talking by 22.6% children. Conclusion: PSQ Hindi version is a validated tool to screen for sleep disorders among children. Sleep disorders are fairly prevalent among young children in India. [ABSTRACT FROM AUTHOR]

Summary Background Dengue surveillance data in India are limited and probably substantially underestimate the burden of disease. A community-based study was undertaken to assess the prevalence of dengue-specific immunoglobulin G (IgG) antibodies in children across India and to examine historical dengue exposure rates. Potential associations between socio-economic factors and dengue seroprevalence were also assessed (registered at ctri.nic.in: CTRI/2011/12/002243). Methods A convenience sample of 2609 healthy children aged 5–10 years was enrolled; these children were registered at or were living in the vicinity of eight centres located at six geographically distinct sites across India. Blood samples were drawn to test for the presence of dengue IgG antibodies using ELISA. Serotype-specific neutralizing antibody titres were measured in dengue IgG-positive children using dengue plaque reduction neutralization tests. Socio-demographic and household information was collected using a questionnaire. Results Overall, 2558/2609 children had viable samples with laboratory results for dengue IgG. Dengue IgG seroprevalence across all sites was 59.6% (95% confidence interval 57.7–61.5%): the lowest (23.2%) was in Kalyani, West Bengal, and the highest (80.1%) was in Mumbai. Seroprevalence increased with age. Multivariate analysis suggested associations with household water storage/supply and type of housing. Half of the subjects with positive IgG results presented a multitypic profile, indicating previous exposure to more than one serotype. Conclusions The overall dengue seroprevalence suggests that dengue endemicity in India is comparable to that in highly endemic countries of Southeast Asia. Additional prospective studies are required to fully quantify the disease burden, in order to support evidence-based policies for dengue prevention and control in India. [ABSTRACT FROM AUTHOR]

• The EAG states of India, namely Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, Uttarakhand, Odisha, Jharkhand and Chhattisgarh, including Assam, have higher prevalence of undernutrition among children under the age of five as compared to non-EAG states. • EAG states are at a disadvantage in almost all the socio-economic determinants. • The majority of the gap in undernutrition between EAG and non-EAG states is explained by household wealth, education level of mothers and religion. • Child undernutrition gap between EAG and non-EAG states could be solved by raising the level of education of mothers, awareness, and raising the economic empowerment of mothers. In India, the Empowered Action Group (EAG) states (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, Uttarakhand, Odisha, Jharkhand, and Chhattisgarh, including Assam) have a higher prevalence of undernutrition among children under the age of five (U5) than non-EAG states. However, no research has attempted to explain the difference in U5 child undernutrition between EAG and non-EAG states. To fill this gap, this study used data from the fourth round of the National Family Health Survey (NFHS-4) and applied modified Blinder–Oaxaca decomposition (also known as Fairlie decomposition). This decomposition helps quantify the relative contribution of various factors explaining the gap between EAG and non-EAG states in U5 child undernutrition. In EAG states, nearly four out of ten U5 children suffered from being underweight and stunted, and one out of five suffered from wasting. The prevalence of undernutrition was relatively higher in the EAG states than in the non-EAG states. The decomposition results revealed that almost two-thirds of the gap in U5 undernutrition between EAG and Non-EAG states was explained by the variables used in the analysis. Household wealth explained about half the difference in stunting and wasting, while religion accounted for a quarter of the difference in underweight and wasting. Maternal education explained a fourth of the difference in stunting between EAG and Non-EAG states. The disparity in undernutrition between EAG and non-EAG states could be reduced by introducing suitable long- and short-term interventions and programs. Increasing access to the public distribution system (PDS), raising awareness among low-income mothers regarding optimal inter-birth intervals, proper health and hygiene, appropriate family planning, and the importance of maternal and child health care services by frontline workers (ASHAs, Anganwadi workers, etc.) could be some of the ways to bridge the gap in undernutrition between EAG and non-EAG states in the near future. [ABSTRACT FROM AUTHOR]

• Early marriage has been declined over the decade, but still, the particle remains high in Rajasthan compared to India. • Wealth index and education contribute significantly to the inequality in early marriage among women. • Achieving further improvements in reducing early marriage among girls requires to focus on increasing birth and marriage registration. Child marriage in India is still a major concern to attain the sustainable development goal. Although child marriage or early marriage is a violation of human rights and has many demographic and health consequences, it remains high in many parts of the country, and the state of Rajasthan, one among them, needs attention. Hence, this study attempted to analyze the trend in child marriage and used a social-ecological framework to examine predictors of early marriage in Rajasthan. The study used various rounds of NFHS data collected from 1992/93 to 2015/16. The study is focused on currently married women of 20–24 years. The results revealed that although child marriage has declined over the period, a higher prevalence is in Rajasthan. Results from the logistic regression delineate that being not educated either of the partners and belonging to a poor household increased the risk of getting married early. Regionally, the high rural population, and the gender gap in literacy followed by social tradition practices increase the risk of early marriages in the districts of Rajasthan. Findings suggest that facilitating educational opportunities for girls, economic support to poor families, and increasing awareness in rural areas will push to a positive impact. [ABSTRACT FROM AUTHOR]

Despite the rapid growth of social franchising, there is little evidence on its population impact in the health sector. Similar in many ways to private-sector commercial franchising, social franchising can be found in sectors with a social objective, such as health care. This article evaluates the World Health Partners (WHP) Sky program, a large-scale social franchising and telemedicine program in Bihar, India. We studied appropriate treatment for childhood diarrhea and pneumonia and associated health care outcomes. We used multivariate difference-indifferences models to analyze data on 67,950 children ages five and under in 2011 and 2014. We found that the WHP-Sky program did not improve rates of appropriate treatment or disease prevalence. Both provider participation and service use among target populations were low. Our results do not imply that social franchising cannot succeed; instead, they underscore the importance of understanding factors that explain variation in the performance of social franchises. Our findings also highlight, for donors and governments in particular, the importance of conducting rigorous impact evaluations of new and potentially innovative health care delivery programs before investing in scaling them up. [ABSTRACT FROM AUTHOR]

Background: We report the prevalence of recommended physical activity levels (RPALs) and examine the correlates of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes.Methods: This analysis on rural South Asian children aged 5-14 years (n = 564) is a part of the Chronic Disease Risk Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores).Results: The majority of children (71.8 %) belonged to households where a parent had at least a secondary education. Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had ≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10-14 years, OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3; 95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5-9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education (OR = 2.1; 95 % CI: 1.1, 4.1). In multivariate analyses, sedentary activity ≤ 2 h/day was associated with lower BMI-z-scores (β = -0.3; 95 % CI: -0.5, -0.08) and lower waist-z-scores (β = -1.1; 95 % CI: -2.2, -0.07).Conclusion: Only one quarter of children in these rural areas achieved RPAL in active travel, leisure and sedentary activity. Improved understanding of RPAL in rural South Asian children is important due to rapid socio-economic transition. [ABSTRACT FROM AUTHOR]

Introduction: Otitis media (OM) is one of the most frequent diseases affecting humans and is prevalent in both developed and developing countries. It is the leading cause of hearing loss and is associated with significant morbidity. Children are at a greater risk and suffer most frequently from Otitis media. Studies show that 80% of children would have experienced at least one episode of Otitis media by their third birthday and 40% would have six or more recurrences by the age of 7 years. Materials and Methods: Study was carried out from Department of Otorhinolaryngology & Pediatrics at Era’s Lucknow Medical College and Hospital, Lucknow during a time period of January 2014 to June 2015. A total 850 subjects were included in our study between 1 – 5 years with symptoms such as ear discharge, ear pain and itching in ear. Observations and Results: Out of 851 children under study 186 (21.9%) were diagnosed as Acute Otitis Media cases, 462 (54.3%) as Chronic Otitis Media cases and rest 203 (23.9%) children were diagnosed to be affected by Otitis Media With Effusion. Out of 851 cases 510 cases were found to be malnourished i.e. 59.9%. Conclusion: Otitis media has a strong positive association with malnutrition. (P < 0.001). [ABSTRACT FROM AUTHOR]

Introduction: Overweight and obesity are a public health problem in India not only in adults but also in children. The authors sought to estimate the prevalence of overweight and obesity in school-going children of 6–17 years of age and examine its demographic and dietary correlates in context of their urban-rural status and socio-economic status. Methods: In this cross-sectional survey height and weight were measured in 1266 school children in government and private schools of urban and rural areas. Dietary assessment was done using single day 24-hour dietary recall method. The data were analyzed using SPSS (IBM SPSS Statistics Version 19) and WHO AnthroPlus Software. Factorial ANOVA was used for testing interaction within and between subgroups for continuous variables and Chi-square test was used for categorical variables. Results: It was found that the overall prevalence of overweight was 15.6% of which 5.4% were obese, with maximum prevalence in boys attending urban private schools. The mean caloric intake in the study population with 24-hour dietary recall method was 1558.2 kilocalories (SD: 428 kilocalories). Conclusion: Overweight and obesity is a significant problem in school-going children. Higher socio-economic status continues to remain an important driver of this epidemic in the younger generation and affects demographic and dietary determinants of this problem. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence of primary monosymptopomatic nocturnal enuresis (PMNE) in children aged 5–10 year and to find its association with sleep disordered breathing (SDB) by using a 22 item pediatric sleep related breathing disorder (SRBD) scale. Methods: This was a school based cross sectional epidemiological study from July 2015 to November 2015. A questionnaire seeking information on socio-demographic variables, nocturnal enuresis (NE) frequency, school performance and a validated 22 item pediatric sleep related breathing disorder scale (SRBDs) was distributed to 1820 pupils in three primary schools. Results: A total of 1528(83.95%) questionnaires were retrieved. Out of 1528 forms, 182(11.9%) forms were incomplete for requested information and hence 1346 (73.9%) questionnaires were finally analyzed. The prevalence of NE was found to be 12.7% (95% CI; 11–14.6), whereas prevalence of primary nocturnal enuresis (PMNE) was 8.2% (95% CI; 7.1–10.1). SRBD scale score >0.33 (adjusted OR: 2.87; 95%CI: 1.67–4.92), paternal history of enuresis in childhood (adjusted OR:4.96; 95% CI: 2.36–10.45), and inappropriate toilet training (adjusted OR: 1.64; 95% CI: 1.01–2.66) were independently associated with PMNE. Conclusion: Sleep disordered breathing, inappropriate toilet training and a history of childhood NE in father were found to be significant risk factors for PMNE in the present study. Thus, these findings suggest that it is imperative to rule out SDB in PMNE patients as they may require different therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: India is the second most populous country of the world. A large portion of the population of this country is below 20 years of age but still there is a paucity of information about the prevalence and incidence of many developmental disorders. This study was planned to estimate the prevalence of autism spectrum disorders (ASDs) in the selected areas (tribal, rural, and urban) of a northern state of India, Himachal Pradesh. Methods: A cross-sectional two-phase study was conducted covering all the children in the range of 1-10 years of age. Phase one included screening of all the children in the age group of 1-10 years, with the help of an indigenous assessment tool for autism. The sociodemographic profile of the participants was also recorded during phase one. Phase two involved the clinical evaluation of individuals who were suspected of autism on screening. Results: The results show a prevalence rate of 0.9/1000. The highest prevalence rate was observed in the rural area. Conclusions: Socioeconomic status (SES) may be one of the fundamental indicators for ASDs in India. [ABSTRACT FROM AUTHOR]

Objective: To assess the co-morbidity of obsessive-compulsive disorder (OCD) and other anxiety disorders in child and adolescent mood disorders. Methods: A total of 100 patients aged < 18 years with mood disorders according to the DSM-IV-TR were screened for OCD and other anxiety disorders using Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version. Results: The prevalence of co-morbid anxiety disorders was 22%; OCD was present in 4%, and subthreshold obsessive-compulsive symptoms were present in 2%. Among others, 8% had panic disorder, 7% had generalised anxiety disorder, 3% had separation anxiety disorder, and 1% had social phobia; multiple anxiety disorders were present in 3% of patients. Conclusion: Co-morbid anxiety disorder was found in one-fifth of children and adolescents with mood disorder. [ABSTRACT FROM AUTHOR]