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Background The present study aimed to compare the efficacy, safety, and cost-effectiveness of quick penetrating solution (QPS) heparin, QPS diclofenac, and heparin gel in the prevention of superficial thrombophlebitis (ST). Materials and Methods This randomized controlled trial was conducted after approval from the Institutional Ethics Committee and registration to Clinical Trial Registry of India. Patients of 18–60 years age, American Society of Anesthesiologists I/II, and who needed venous cannulation for at least 72 h were included in the study. Patients were randomly divided into three groups receiving study drugs (heparin gel, QPS heparin, and QPS diclofenac) every 8 hourly for a period of 72 h. Venous cannulation site was graded using the Visual Infusion Phlebitis Scale. Patients developing no ST, mean time to reach ST Grade 1 and 2, prevention of ST probability, and cost-effectiveness of interventions during the study period were assessed. Results Out of 219 included patients, development of no ST in the study groups at 72 h of treatment were heparin gel (11%), QPS heparin (9.6%), and QPS diclofenac (2.7%). The mean time (hours) to develop any grade ST in the study arms was heparin gel (36.2 [11.9]), QPS heparin (40.0 [13.4]), and QPS diclofenac (37.0 [13.2]). The Kaplan–Meier analysis did not reveal significant differences for the prevention of any grade ST or severe ST in three treatment arms. The average cost-effectiveness ratio for preventing thrombophlebitis was 14.2 in heparin gel-, 13.2 in QPS heparin-, and 95.6 in QPS diclofenac-treated patients. Conclusion Based on efficacy, safety, and cost-effectiveness, heparin gel or QPS heparin can be used to prevent ST due to intravenous cannulation in surgical patients. QPS diclofenac is not a cost-effective option to prevent ST.

Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with “very low” to “moderate” quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02‒208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55‒185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25‒238.58; I2 = 99%; GRADE approach evidence- high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60‒2.41; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63‒10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than clonidine.

Abstract Background Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India. Methods A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10–24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use. Results The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement. Conclusions High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.

IntroductionExposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.MethodologyMulticentric case–control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).ResultsA total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29–4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43–3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.DiscussionThe results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Summary: Background: NVX-CoV2373, a Covid-19 vaccine was developed in the USA with ∼90% efficacy. The same vaccine is manufactured in India after technology transfer (called as SII-NVX-CoV2373), was evaluated in this phase 2/3 immuno-bridging study. Methods: This was an observer-blind, randomised, phase 2/3 study in 1600 adults. In phase 2, 200 participants were randomized 3:1 to SII-NVX-CoV2373 or placebo. In phase 3, 1400 participants were randomized 3:1 to SII-NVX-CoV2373 or NVX-CoV2373 (940 safety cohort and 460 immunogenicity cohort). Two doses of study products (SII-NVX-CoV2373, NVX-CoV2373 or placebo) were given 3 weeks apart. Primary objectives were to demonstrate non-inferiority of SII-NVX-CoV2373 to NVX-CoV2373 in terms of geometric mean ELISA units (GMEU) ratio of anti-S IgG antibodies 14 days after the second dose (day 36) and to determine the incidence of causally related serious adverse events (SAEs) through 180 days after the first dose. Anti-S IgG response was assessed using an Enzyme-Linked Immunosorbent Assay (ELISA) and neutralizing antibodies (nAb) were assessed by a microneutralization assay using wild type SARS CoV-2 in participants from the immunogenicity cohort at baseline, day 22, day 36 and day 180. Cell mediated immune (CMI) response was assessed in a subset of 28 participants from immunogenicity cohort by ELISpot assay at baseline, day 36 and day 180. The total follow-up was for 6 months. Trial registration: CTRI/2021/02/031554. Findings: Total 1596 participants (200 in Phase 2 and 1396 in Phase 3) received the first dose. SII-NVX-CoV2373 was found non-inferior to NVX-CoV2373 (anti-S IgG antibodies GMEU ratio 0.91; 95% CI: 0.79, 1.06). At day 36, there was more than 58-fold rise in anti-S IgG and nAb titers compared to baseline in both the groups. On day 180 visit, these antibody titers declined to levels slightly lower than those after the first dose (13–22 fold-rise above baseline). Incidence of unsolicited and solicited AEs was similar between the SII-NVX-CoV2373 and NVX-CoV2373 groups. No adverse event of special interest (AESI) was reported. No causally related SAE was reported. Interpretation: SII-NVX-CoV2373 induced a non-inferior immune response compared to NVX-CoV2373 and has acceptable safety profile. Funding: SIIPL, Indian Council of Medical Research, Novavax.

Objectives: This study aims to assess the urban–rural difference in prevalence of hypertension (HT) and to explore the disparities in lifestyle risk factors of HT among urban and rural individuals aged 15–49 years in India. Study Design: The cross-sectional data collected as a part of the fourth round of National Family Health Survey (NFHS-4) was analysed in this observational study. NFHS-4 was conducted between January 2015 and December 2016 amongst men aged 15–54 years and women aged 15–49 years. In order to maintain uniformity, age group of 15–49 years was considered. Descriptive analyses were performed for sociodemographic and lifestyle factors. Binary logistic regression was conducted to assess the predictors of HT in men and women in urban and rural settings. The presence of HT was considered as the outcome variable. Results: The overall age adjusted prevalence of HT was 17.2% and was greater in urban (18.3%) than in rural population (15.5%). The age adjusted prevalence was also higher in males (18.2%) as compared to females (16.1%). Age and wealth were associated with HT in both urban and rural population. Education and dietary habits played a role in all except rural men. Alcohol consumption, diabetic status and marital status were significantly associated with HT in both urban and rural women. Occupation was associated with HT only in urban women. Conclusions: The study has shown higher HT prevalence in urban areas despite higher prevalence of lifestyle risk factors in rural settings. This calls for more robust screening and health education in the entire population, especially in rural areas.

Background: Despite the fact that hypertension is increasing, merely 50% are aware of the disease. Being aware of hypertension is important to control it. Aim: The study's objective was to estimate the level of hypertension awareness in India and explore its associated sociodemographic factors. Materials and Methods: The data collected in National Family Health Survey 4 (2015–2016) among men aged 15–54 years and women aged 15–49 years were analyzed. Taking awareness of hypertension as an outcome variable, descriptive analysis, and multivariable logistic regression model were performed, by gender. Results: Of 1,41,215 hypertensive individuals analyzed, 34.7% of men and 53.6% of women were aware of being hypertensive. The control among those aware was 67.1% in men and 74.6% in women. The awareness varied among states ranging from 29.6% in Chhattisgarh to 75.6% in Tamil Nadu. The multivariable logistic regression model explained the awareness of hypertension in males increased with age (odds ratios [OR]: 0.226 for 95% confidence interval [CI]: 0.139–0.366 for 25–29 years of age increased to 0.599 for 95% CI: 0.48–0.74 for 40–44 years of age), education (OR of 0.66 for 95% CI: 0.51–0.85 for primary increased to 0.69 for 95% CI: 0.54–0.89 for secondary school level), and wealth status (OR of 0.407 for 95% CI: 0.309–0.535 for poor wealth quintile increased to 1.030 for 95% CI: 0.863–1.230 for the richest wealth quintile). For women, the awareness increased with age (OR of 0.306 for 95% CI: 0.119– 0.791 for the age of 20–24 years increased to 0.736 for 95% CI: 0.570–0.951 for the age of 45–49 years) and wealth status (OR of 0.28 for 95% CI: 0.18–0.44 for poor wealth quintile increased to 1.262 for 95% CI: 0.859–1.855 for the richest wealth quintile). Conclusion: Improving access to hypertension screening and awareness especially among men, with lower wealth and younger age is needed.

Purpose: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. Methods: A cross-sectional study was conducted among school-going children of age group 6–16 years of standard I–XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value

Background: Estimating seroepidemiolgical prevalence of SARS-CoV-2 antibody is an essential public health strategy. There is insufficient evidence of prevalence among those belonging to young age population in India. Objective: To compare the SARS-CoV-2 seropositivity rate between children and adults in selected sites from India. Materials and Methods: This was a multicentric population-based seroepidemiological study conducted in selected urban and rural areas of five sites selected from four states (Delhi, Odisha, Uttar Pradesh, Tripura) of India. Participants aged ≥1 year were included from different clusters of each area. Total serum antibody against SARS-CoV-2 virus was assessed qualitatively by using a standard enzyme-linked immunosorbent assay (ELISA) kit.Results: Data collection period was from 15 March 2021 to 10 June 2021. Total available data was of 4509 participants, of whom 700 were

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Novel coronavirus named COVID-19 that emerged in late December from Wuhan affected almost the entire globe. Recent studies provided new insight into the high transmission of the disease. This review explores the current evidence of epidemiological and environmental factors associated with high transmission of COVID-19. Even transmission and symptoms found among cats, dogs, ferrets, and tiger suggested low species barrier of the virus. The airborne transmission was found even up to 4 m, and fecal transmission with virus particles and RNA in sewage and wastewater suggests rethinking containment strategies. However, temperature, humidity, and pollution were also associated with transmission and mortality trends of COVID-19. To better mitigate and contain the current pandemic, it is a need of hours to consider the recent shreds of evidence to prevent further spread and require detailed investigations of these evidences by extensive epidemiological and meteorological studies.

Background: Psychosocial problems occur in a wide variety of settings, and they often have a negative impact on adolescents' mental health. The family environment influences the psychosocial development of adolescents in this transitional phase. This study was conducted to find the association between psychosocial problems and the family environment. Materials and Methods: We conducted a cross-sectional study for 6 months among school-going adolescents of urban Rishikesh, Uttarakhand. In this study, a self-administered questionnaire consisting of Youth-Pediatric Symptom Checklist and family-related factors was given to the students. The data were compiled and analyzed using appropriate statistical analysis. Results: A total of 400 adolescent students participated in the study. The prevalence of psychosocial problems was 40.7%. Psychosocial problems were significantly associated with family-related factors which were further divided into three subgroups. First, the family environment which includes problems in the family (61.8%), parents understanding each other (61.8%), and participants feeling happy at home (34.2%). The second subgroup was parent–child relationships such as parents pay attention (27.9%), understanding parents (30.3%), and parents unhappy with participant's academic performance (63.6%). The third subgroup was parenting style such as parents allow children to take their own decisions (23.4%), parents comparing their child with other children (63.6%), parents are strict (63.1%), getting pocket money (35.7%), and interfering parents (64.3%). There was no significant association found between getting pocket money and psychosocial problems. Conclusion: Family-related factors have a significant impact on adolescents' psychosocial health; thus, targeted interventions are required. It is of paramount importance to educate parents, community stakeholders, and schools regarding psychosocial problems in adolescents.

Context: Anaemia is defined as a decreased concentration of blood haemoglobin. It is one of the most common nutritional deficiency diseases observed globally affecting both developing and developed countries. Aims: To find out the prevalence of anaemia among the beneficiaries of Anaemia Mukt Bharat and its association with age and gender. Settings and Design: A cross-sectional study was conducted in Uttarakhand by AIIMS Rishikesh in a month-long campaign including 5,776 beneficiaries. Camps were organized at the hospital campus, schools, district hospitals, Community Health Centre (CHC), Primary Health Centre (PHC), subcentres (SC), Anganwadi Centres (AWCs), slum areas, adolescent health day celebration sites and Village Health and Nutrition Day (VHND) sites. Methods and Material: Data on age and gender along with haemoglobin level using HemoCue Haemoglobinometer was collected. Statistical Analysis Used: These data were entered into Microsoft Excel and analysed to calculate the prevalence of anaemia and its association with age and gender using Epi Info software version 7. Pearson's Chi-square test was applied. P value < 0.05 was considered as significant. Results: Out of 5,776 participants 53.2% were anaemic. Females (54.6%) were more anaemic than males (45.1%). 33.5% of pregnant females were found to be anaemic. Conclusions: Prevalence of anaemia was very high among the study participants. It shows that anaemia is a major public health problem so efforts should be taken to reduce the prevalence of anaemia and promote the health of an individual, community as well as the country.

Context: India has adopted active case finding (ACF) as an additional strategy to find its missing tuberculosis (TB) cases since 2017. Treatment outcomes of patients identified through ACF may be similar or different from those detected through routine passive case finding (PCF); currently, there are limited studies on this in India. Aim: The aim of this study was to assess differences in treatment outcomes of patients detected through ACF and PCF under the national TB program. Study Design: A study was conducted in six TB units of Haridwar district where ACF campaigns were conducted in 2017–2018. Methods: Data from patients detected by ACF (n = 72) and PCF (n = 184) were extracted from program records. Results: Of 72 patients detected by ACF, only 54 (75%) were initiated on treatment. A high proportion of initial loss to follow-up (25% vs. 0%) and delay in treatment initiation (4 days vs. 0 days) was observed in ACF patients as compared to PCF. The proportion of unsuccessful treatment outcome was 33% (n = 18) among ACF patients compared to 14% (n = 25) among PCF patients (adjusted relative risk: 2.6, 95% confidence interval: 1.7–4.0). Conclusion: High initial loss to follow-up, delay in treatment initiation, and poor treatment outcome among ACF patients are a major concern. The study results call for active follow-up after diagnosis and close monitoring during treatment for patients detected by ACF.

Background and Objectives: Patient-centered care refers to the provision of care for patients' comprehensive needs, perspectives, and preferences. In health security, communication between patient and physician is the main key through which we plan and implement to threats that can affect huge population. Aim: The aim of this study was to assess the patient-centered care in medical disinformation era among patients attending tertiary care teaching hospital, Rishikesh. Materials and Methods: A descriptive cross-sectional study was planned by enrolling 240 patients attending tertiary care teaching hospital. Total consecutive sampling technique was chosen to recruit the patients for the study. Tools: Tools used were case reporting form and components of primary care index (CPCI). Results: The results show statistically significant association between chronic history of illness of patient (P = 0.02), education of patient (P = 0.008), and habitat of patient (P = 0.05) with interpersonal communication between patient and physician, and the results also show statistically significant association between accumulated knowledge (P = 0.000), coordination of care (P = 0.001), continuity belief (P = 0.000), comprehensiveness of care (P = 0.001), and first contact (P = 0.001) with interpersonal communication between patient and physician. The lowest mean percentage of patient-centered care score was observed for accumulated knowledge (65.70%) and the highest mean percentage (85.15%) score of patient-centered care was observed for interpersonal communication. Conclusions: This study concluded that patient-centered care improves interpersonal communication between patient and physician. Threats arising due to present medical disinformation era can be combat by patient-centered care.

Context: Since the implementation of Weekly Iron and Folic acid Supplementation (WIFS) program in India in 2013, little effort has been made to comprehensively evaluate the program. Aims: This study was carried out to assess the coverage of WIFS among adolescent girls, explore implementation barriers, and suggest solutions to improve WIFS through public schools in Rishikesh, India (2018–19). Methods and Materials: This was a sequential explanatory mixed-methods study. Quantitative component was a community-based cross-sectional survey to determine the prevalence of anemia and coverage of WIFS. Qualitative component added an explanation to understand WIFS implementation through document review and nonparticipant observation of WIFS session. We invited stakeholders for nominal group discussion on barriers and solutions. Statistical Analysis Used: Variables were described as proportion and mean. Group discussion transcript was analyzed using content analysis. Results: Of 400 adolescent girls, 16% (95% CI: 12.4, 19.6) received weekly and 45% ever received iron tablets over the last 3 months and 79% were anemic. From ten schools, one school never implemented WIFS. There was iron-folic acid (IFA) stock out for 10 months last year. Major barriers identified were nonavailability of IFA, and irregularity in submitting IFA consumption report. Suggested solutions were ensuring IFA stock, strengthening supervision, ownership, training, and regular meetings of stakeholders. Conclusions: To conclude, in a setting with high anemia prevalence, WIFS was poorly implemented. Ownership and strengthening supervision is essential for the success of the program.

Background: In India, the active case-finding (ACF) strategy began in 2017 under the Revised National Tuberculosis Control Programme to find its missing tuberculosis (TB) cases. Few studies have been conducted in India to assess the treatment outcome of TB patients detected by ACF. Aim: The aim of this study was to assess the treatment outcomes of patients detected through ACF campaigns during the year 2018 in Haridwar district, Uttarakhand. Study Design: This was a cross-sectional study which used the existing data and records. Materials and Methods: The ACF campaign records of 2018 were extracted from six TB units of Haridwar district. Details of sociodemographic, clinical profile, and treatment outcome of 100 diagnosed patients were obtained and analyzed. Results: Out of the total 100 TB patients detected, the site of disease was pulmonary in 98% of patients. Almost all (92%) the patients were diagnosed microbiologically and treatment was initiated by 78% of the patients. The proportion of successful treatment outcome was found in 64% of the patients. The median time interval from diagnosis to treatment was found to be 2 days. Conclusion: In spite of these efforts of ACF, a high proportion of initial loss to follow-up (22%) and unsuccessful treatment outcome (18%) among ACF patients is a major concern. Findings of ACF campaign pose a concern for active follow-up after diagnosis and close monitoring during treatment.

Background: Diabetes mellitus is a worldwide health problem with more than 80% diabetics living in LMIC. Biological and psychosocial factors are also responsible for gender diversity in T2DM which highlights the need for action to combat T2DM in India. The current study was undertaken to evaluate the gender diversity of insulin sensitivity markers among patients of T2DM in northern India and secondly, to assess and compare the quality of life among T2DM patients in northern India. Material and Methods: It was a cross-sectional analytical study enrolling 78 patients from tertiary care teaching hospital, India. Inclusion criteria was patients within the age group of 18–60 years, diagnosed with T2DM and on insulin therapy. Case reporting form, anthropometric measures, laboratory investigations, and diabetes quality of life (DQoL) instruments were used for data collection for the period of 3 months. Results: The mean age of T2DM patients for males was 48.00 ± 9.92 years and for females was 49.96 ± 10.39 years. Male and female patients were 50% and 50%, respectively. WHR (P = 0.032), DBP (P = 0.000), body fat % (P = 0.04), and duration of diabetes (P = 0.001) had statistically significant association with insulin resistance (binary logistic regression analysis (P- value

Context: Nutrition is one of the most important factors that affect a child's health. It plays a vital role in the prevention and control of disease morbidity and mortality. It is a major public health problem in a developing country like India. Aims: To assess undernutrition in under-five children and various sociodemographic factors affecting it. Settings and Design: A community-based cross-sectional study was conducted among under-five children of rural and urban Rishikesh. A total sample size of 400 under-five children was taken. Multistage sampling was done to select the areas and systematic random sampling was done for selection of households. Subject and Methods: A predesigned, pretested, and semistructured questionnaire was used to collect information on the sociodemographic characteristics and status of undernutrition in study participants. Statistical Analysis Used: Data was entered into excel sheets and analyzed using SPSS version 23 utilizing appropriate statistical methods. Results: The prevalence of underweight was 37.3%, stunting 43.3% and wasting 24.5%. Underweight (40.5% v/s 35.0%), stunting (46.5% v/s 40.0%), and wasting (27.0% v/s 22.0%) was more prevalent in urban areas as compared to rural areas. Sociodemographic factors such as religion, caste, parental education, father's occupation, and family size emerged as significant predictors of under nutrition. Conclusion: Undernutrition in under-five children was quite high. Since childhood malnutrition is multifactorial, there is no single cause big enough to blame but a multifaceted approach is required to combat malnutrition.

Context: Population of elderly in India is growing day by day. Elderly population of India is 8.6% and in Uttarakhand it is 8.9%. Health needs of geriatric people differs from others. This study was an attempt to study the morbidity profile of geriatric people that may serve as a baseline data and also help in planning the health services. Aims: To study Morbidity profile of geriatric population in Uttarakhand. Settings and Design: Acommunity-based cross-sectional study was conducted among geriatric people in rural and urban areas of Uttarakhand. Study participants aged 60 years and above were included in the study and a sample size of 400 was calculated. Methods and Materials: Predesigned, pretested and semistructured questionnaire was used to collect information on sociodemographic characteristics and morbidity status of study participants. Statistical Analysis Used: Data was entered into excel sheets and analyzed using SPSS version 23 utilizing appropriate statistical methods. Results: Among 400 elderly people most common organ system affected was musculoskeletal (77.20%). Other commonly affected health systems were psychological (75.90%), digestive (73.60%), eye (56.67%), endocrine (35.90%), cardiovascular (33.08%), general and unspecified health problems (32.05%), ear (24.62%) and respiratory system (19.74%). Very few elderlies had neurological (6.67%) and urological (1.28%) problems. Conclusions: As shown in the present study very high percentage of morbidities were found in the study population. As a result, there is a need to further strengthen existing geriatric health care services at primary, secondary and tertiary level.

The pandemic of COVID-19 is a global public health emergency which has seriously affected India. Poor and marginalized sections of the society have been affected the most. This relatively new disease is still evolving in various parts of the world with lots of implications like global socioeconomic disruption. In this article we have attempted to enumerate and discuss the evidence, for and against, regarding some of the commonly reported controversies regarding our management strategies in India. We collected information from various databases published by the World Health Organization (WHO), Indian Council of Medical Research (ICMR) and Ministry of Health and Family Welfare. Newer clinical, epidemiological and laboratory guidelines to control the corona virus are constantly being generated and updated but there is less understanding of the urgent need for strengthening our public health infrastructure.

Context: Adolescent girls are at higher risk of mortality and morbidity due to childbirth. Government of India therefore initiated Adolescent girls' scheme since year 2000. However, since its inception program received various setbacks. Aims: This study was carried out to assess the utilization of ICDS program for adolescent girls through Anganwadi centers (AWC) and implementation barrier from providers point of view. Also study assessed gaps in knowledge, attitude, and practice of anemia. Settings and Design: Mixed-method sequential explanatory approach was adopted. Quantitative data was collected by community-based cross-sectional survey in Urban Rishikesh, Uttarakhand. This was followed by in-depth interview of Anganwadi worker (AWW). Methods and Materials: Twenty adolescent girls from each of 20 clusters were selected by cluster sampling. Data was collected by structured validated questionnaire using Epicollect 5. AWWs were interviewed with help of interview guide. Statistical Analysis: Variables were described as proportion and mean. The interview transcript was analyzed using content analysis. Results: Out of 400 adolescent girls, 10% were school dropouts and 59% were undernourished. Seven percent had ever visited AWC in last year. The main reason for nonutilization was unawareness. 38% had knowledge regarding symptoms of anemia. AWW faces problems due to nonavailability of iron tablet, untrained for health education sessions, and service not meeting demand of beneficiaries. Conclusions: Poor utilization of ICDS services by adolescent girls due to unawareness. There is gap in knowledge regarding anemia among adolescent girls. Adolescent girls' scheme is not as per felt need of beneficiary and poorly implemented.

Background: Viral hepatitis is preventable, yet a global health priority. As hepatitis B (Hep B) remains an occupational risk for healthcare workers (HCWs), the Government of India recently mandated universal adult Hep B vaccination for all HCWs. However, in the absence of institutional policy, its real-time utilization in a hospital was dependent on individual's general awareness. Therefore, this study was designed to assess baseline knowledge, attitude, and practices among undergraduate medical and nursing students, the future HCWs, regarding Hep B at an apex healthcare institute at Uttarakhand. Materials and Methods: A descriptive survey was carried out using self-administered questionnaire among undergraduate medical and nursing students of a medical college between July and September 2018. Statistical Package for Social Sciences (SPSS Ver 22.0) was used for analysis. Results: The study comprised 180 medical and 183 nursing students. About 55.0% of medical and 33.9% of nursing students were correctly aware about the disease; 98.3% of medical and 86.9% of nursing students were aware about vaccine. About 80.6% of medical and 87.4% of nursing students showed positive attitude, recognizing disease as a public health problem. However, only 82.8% of medical and 70.0% of nursing students underwent vaccination; mere 62.4% and 49.2% of vaccinated completed three-dose vaccination schedule, respectively. Furthermore, around 7% of them checked their titer post vaccination. Conclusion: Despite comparatively low awareness level about the disease, most students had sufficiently high knowledge about vaccine and underwent vaccination. However, only half of them could complete three-dose vaccination schedule. Only a handful of subjects underwent post-vaccination titer assessment, an instrumental approach to safeguard them against accidental Hep B exposure.

Introduction: In an era of increasing accountability throughout our society, it is not surprising that questions about the efficacy and efficiency of our health care system are also being raised. Both functional and technical qualities have to be monitored and managed effectively. Objectives: To enhance service effectiveness CHC/PHC health delivery systems. To evaluate the quality of care rendered by CHC, PHCs, Sub centres, AWCs by IPHS guidelines, Likert’s scale and WHO Assessment tool. To assess the health workforce in their capabilities. Patient satisfaction in the quality of care. Methodology: Out of the thirteen districts of Uttarakhand, the district of Dehradun has six blocks of which Doiwala is the largest block. A qualitative study design: One Community Health Centre namely CHC Doiwala, which has five Primary Health centres were studied using three different tools. (i) IPHS standards (ii) SARA (WHO) (iii) Likerts scale for patient satisfaction. However, in the COVID scenario some limitations have been considered in the study. Results: The quality of health care in the healthcare delivery system has been assessed as per scale and has been found that factors of patient satisfaction, infrastructure and outcomes for assessment of quality are strong contending variables. Conclusion: The PPP model has upgraded the healthcare system with substantial contribution from the private sector.

Context: The Bhore Committee in 1946 gave the concept of PHC as comprehensive primary health care to the community and maintain an acceptable standard of quality of care. The study was conducted to assess the implementation of National Health Programmes at PHCs in Uttarakhand. Methodology: An observational cross-sectional study was conducted at two PHCs (Thano and Raiwala) from March 2019 to April 2019. Interviews of health functionaries and beneficiaries of national health programmes were done based on standard Indian Public Health Standards (IPHS) guidelines and check list, for both PHCs. Beneficiaries under each programme were also observed. Result: Various programmes such as Universal Immunization Programme, School Health Programme, and Pulse Polio Programme, National nutrition Programme, National family welfare Programme, NPCDCS and Jansankhya Niyantran Yojna were implemented successfully at both PHCs. Although knowledge among peripheral health workers was found to be little inadequate. Conclusion: The functioning and execution of some of the National Health Programs at PHCs Thano and Raiwala were found to be inclined with IPHS guidelines.

Introduction: ICDS scheme was launched on October 2nd 1975 to address high infant mortality, malnourishment and poor learning outcomes. Since its inception was playing its role effectively, but still there were some shortcomings which were needed to be addressed. Uttarakhand was one among the states with poor health indicators with respect to child and mother, there is need to search for reasons effecting the implementation of programs intended for woman and child development. The present study aims to asses functioning of ICDS scheme in select Uttarakhand. Methodology: A cross sectional study was conducted selected areas of Uttarakhand state during October 2018 to June 2019, among 16 anganwadi centers from urban and rural areas of Dehradun and Haridwar districts. Results were expressed in percentages and proportions with 95% confidence interval. Relevant statistical tested applied wherever necessary. Results: Functioning of ICDS scheme in Uttarakhand varied for different services provided under it. Supplementary nutrition service was uninterrupted but medicine kits and referral slips were not supplied to anganwadi centers at the time of study. Conclusions: Study identified various insufficiencies regarding the functioning of ICDS scheme. There is a need to improve facilities at anganwadi centers for proper implementation of ICDS scheme.

Background: Our country is adding to one-fifth of live births globally and an enormous number of neonatal deaths (

Context: Under nutrition has long been a major public health concern in developing country like India as a leading cause of child morbidity and mortality. The study was aimed to assess the malnutrition and factors associated with it. The study was conducted to assess under nutrition in under five children and various associated factors affecting it. Methodology A community based cross sectional study was conducted among 400 under five children of rural and urban Rishikesh. Multistage sampling method was used to select the areas and systematic random sampling was used to select households. A predesigned, pre tested & semi structured questionnaire was used to collect information on various associated factors and status of under nutrition in study participants. Data was entered into excel sheets and analyzed using SPSS utilizing appropriate statistical test. Results: The prevalence of underweight was 37.3%, stunting was 43.3% and wasting was 24.5% respectively. Socio-demographic factors, child birth weight and birth order, hand washing practice by mother and common morbidity emerged as significant predictors of under nutrition. Conclusion: The burden of common morbidities and prevalence of malnutrition among under-five children in this community is very high. Our policies should aim to improve child health nutrition and growth.

Introduction: There are various problem which have harmful impact on health, these problem are mainly behavioural with multifunctional causation. Amongst such problem, addiction of substance abuse is on rising trend, overall globally. The study conducted to determine the prevalence of substance abuse in the community. Methods: A community based cross sectional study was conducted in Rishikesh Tehsil. People of age group between 15-60 years residing in study area were recruited as study participants. Total sample size covered in this study was 804.Since the population of urban and rural area is almost equal, so to get equal representative from urban and rural area, 402 study participant were selected from each strata as rural and urban area respectively. The validated interview schedule were then analysed using appropriate statistical techniques like percentage, chi-square test and p-value. Results: overall prevalence of substance abuse was found to be 37.4% out of which the prevalence of current users was 31.34% respectively. Conclusion: The study revealed that in spite of having strict law for prohibition of substance abuse, people are still addicted. There is a need to change either in law or in behaviour of people at large.

Context: Elderly have increased frequency of awakenings of longer durations, lower sleep efficiency, early bedtimes and wake times as compared to younger subjects. The study was conducted to assess the quality of sleep using Pittsburgh Sleep Quality Index (PSQI), sleeping habits and changing sleep pattern among elderly and their associated factors. Material and Methods: A cross-sectional study was conducted for a period of 3 months among all the elderly population residing in village Thano situated in Raipur block of district Dehradun, Uttarakhand. A total of 96 elderly were surveyed. Data was collected on sociodemographic characters of elderly as well as questions on Quality of sleep was asked based on PSQI questionnaire. Data was collected using Epi-collect5 application on phone. Data was analysed and presented utilizing appropriate statistical methods. Results: Among the 96 elderly, 57.3% of the participants were females and 40.6% were from 60-69-year age group. The mean PSQI score was 5.6±1.9. Sleep quality was poor among females, smokers, widow and those with no physical activity. With advancing age sleep quality came out to be significantly poor. Conclusions: Sleep disturbances are commonly seen among the elderly. Treatment of primary sleep problems can improve the quality of life.

Aims: The present study evaluates association between physical activity and Gestational Diabetes Mellitus (GDM), for it can be an effective intervention for its management. Though physical activity helps maintain glucose homeostasis, evidences of GDM risk are less extensive. Therefore, this study also identifies its correlation with maternal blood glucose levels. Materials and Methods: A prospective case-control study was carried out among pregnant women attending regular antenatal clinic at two private hospitals. The study comprised of 100 cases and 273 matched controls. Data was collected by personal interviews using a standard questionnaire. Physical activity was assessed using long form of International Physical Activity Questionnaire (IPAQ) reported as Metabolic Equivalent-Minutes per week (MET-Minutes/Week). Statistical Package for Social Sciences (SPSS) was used for analysis. Results: Results shows high exposure rates for low-to-moderate physical activity among cases, across all domains and sub-activities. The odds of GDM engaged in domestic and gardening activities for

Introduction: Experiential learning assumes learning to be a continuous process and learner enters in the process according to his preferable learning style. Considering the complex nature of epidemiology and loss of interest in students due to ageold traditional lecturing, it has been only limited to complete the course by just memorising without getting insight into its utilisation in real life. Aim: To assess the effectiveness of teaching epidemiology using experiential learning method in developing interest, improved level of satisfaction and better competency in basic epidemiology among undergraduate students exposed to experiential learning than those exposed to traditional lecture. Materials and Methods: A mixed method design for an educational intervention consisting of a new teaching approach i.e., experiential learning was planned. After selection of topic, the module was prepared followed by an orientation to facilitators and student in new teaching methodology. The module was completed in 12 sessions, two hours per session. The students went through all the four stages of the Kolb cycle depending on the topic. Students were later given the Multiple Choice Questions (recall and higher order level) and satisfaction questionnaire and told to reflect on learning. Another batch was exposed to traditional lectures (20 hours) and given MCQ’s at the end. The learning outcome was assessed by nonparametric test i.e., Mann-Whitney U test. Satisfaction with new methodology was analysed by proportion. Results: Students developed an interest in learning epidemiology as depicted through their written reflections. All the students showed a high level of satisfaction. Student exposed to experiential learning scored much higher than those exposed to lecture more so on higher-order questions. Conclusion: Experiential education activities provide an effective alternative for teaching epidemiology to medical undergraduates.

BACKGROUND: Menstruation is a normal physiological process among reproductive age group females. Although some of them show the abnormal menstrual pattern, which is influenced by several factors, including sociodemographic status, psychosocial stress, improper sleep level, etc. The identification of these risk factors associated with abnormal menstrual patterns may permit risk stratification among adolescent girls. This study was planned to determine various factors which depict menstrual cycle pattern among adolescent girls in urban India. MATERIALS AND METHODS: A school-based case–control study was carried out in urban India from May to December 2019. Urban locality and schools were randomly selected, and data were collected in two phases. Adolescent girls in the age group of 10–19 years studying in government and private (both Hindi medium and English medium) schools of urban India were screened for the abnormal menstrual pattern. Equal numbers of age-matched controls were also enrolled. Data were collected with the help of self-administered predesigned pretested semi-structured questionnaire. Chi-square test, Fisher's exact test, unpaired t-test, and McNemar tests were used to analyze data using SPSS version 23.0. RESULTS: A total of 100 cases and 100 age-matched controls (mean age 14.8 ± 1.5 years) were included in the study, almost half of the cases and controls have normative menarche. Improper sleep patterns increased stress levels, and low education status of mothers show statistically significant (P = 0.047) association with abnormal menstrual patterns. CONCLUSION: More stress, improper sleep levels, and low education status of mothers among school-going adolescent girls were strongly associated with abnormal menstrual patterns with more symptoms during menstruation.

Context: Janani Suraksha Yojana (JSY), launched on 12th April,2005 under the umbrella of NRHM has shown it’s impact in terms of increase in number of institutional deliveries and decrease in maternal and neonatal mortality rates but still the awareness about the scheme is low in women from rural areas and urban slums, especially in low performing states. Aims: To assess the differences in awareness of married women from rural areas and urban slums regarding JSY and to study the effect of socio-demographic factors on the level of awareness. Settings and Design: A cross-sectional study was carried out in the rural areas and urban slums of field practice areas of Himalayan Institute of Medical Sciences, Dehradun, for a period of one year. Methods and Material: all the married women (15-49 years) of reproductive age group were included in the study. After taking informed consent from the head of the families and targets, the study subjects were interviewed by a pre-designed and pre-tested questionnaire. Statistical analysis used: SPSS 10 and Epi Info software (with Yate’s correction). Results: Awareness was more among women belonging to rural areas i.e 79%.Age, educational status, occupation, socio-economic status and place of residence showed a significant statistical association with the level of awareness. Conclusions: There is an urgent need to strengthen IEC campaigns and monitoring strategies.

Background: Janani Suraksha Yojana (JSY) –a new maternity benefit scheme - was launched by Govt. of India in April 2005 with the objective of reducing maternal and neonatal mortality by promoting institutional deliveries by providing cash incentive to beneficiaries as well as promoter. Ante –natal services are one of the most important component of JSY. Study was designed to assess the ante-natal characteristic of JSY beneficiaries. Materials and Methods: A cross-sectional study was conducted under rural health training centre and urban health training centre of the field practice area of department of Community Medicine, HIMS, Dehradun. Results: A total of 2221 married women (15-49 years) were interviewed out of which 1290(58.08%) women were from urban slums and 931(41.92%) women belonged to rural areas. Out of the total number of married women who delivered at govt. hospital i.e. 227 (75.17%), majority (78.42%) of the women were registered with the some health personals. Out of these, 74.15% women were registered with ASHA .Only 29.21% women went for three or more ANC visits. Only 48.31% women consumed hundred IFA tablets and the proportion was high (79.41%) in rural women. All the women received complete TT immunization. Conclusion: It was found that registration of the women with some health personnel was influenced by women’s religion and socio-economic status the level of education and socio-economic status was found to have a positive effect on the number of ANC visits. The consumption of IFA tablets was also found to be influenced by the educational status of the women.