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The broad question that interests this article is how does one read and compare the negotiations public and private universities are making with the neo-liberal paradigm of knowledge production with reference to their social science curricula. Michael Apple's (1993, "Teachers College Records," 95(2), 222-241; 2001, "Currículo Sem Fronteiras," 1(1), i-xxvi) argument that curriculum is not a 'neutral assemblage of knowledge' but a crafted vision of 'legitimate knowledge' produced by hegemonic powers within society forms the theoretical foundation for this article. To understand the changes within a university's academic practice, this article analyses and compares the undergraduate and postgraduate sociology curricula of two public universities (Delhi University and Ambedkar University), an international university (South Asian University) and one private university (Shiv Nadar University), as well as engages with its practitioners to assess the everyday within these universities. The undergraduate and postgraduate sociology curricula across public and private universities indicate certain convergences in their academic approaches. The universities in question encouraged foreign university collaborations, reframed the course structure to strengthen the university-industry linkages and increased the employability of the students. Interdisciplinary and contemporary papers are offered through new modes of pedagogy. The mode of assessment also focus on writing research papers/dissertations and frequent visits to the field to develop an application-based approach to learning. The neoliberal paradigm of knowledge production affected the convergence of academic practices of public and private universities despite difference in governance structure. This convergence problematises the meaning of 'public' in a liberalised, privatised and globalised society.

This paper focuses on finding the criteria adopted by users to select free information retrieved from the Web for academic use. A close-ended questionnaire was formulated to record the opinions of the respondents. A survey for various categories of users such as post graduate students, research scholars and faculty members from five universities of Chandigarh, Haryana, and Punjab was administered. The category-wise and discipline-wise analysis depicted that quite a good number of respondents applied various parameters while referring to Web resources, but a reasonable number of users did not apply certain parameters to verify the nature of free information being used for educational purposes. The convenience factor leads them to depend on free Web resources which can be accessed anywhere and saves time. The findings of the study suggest that user education programs should be conducted to create awareness regarding the credibility of the subscribed library resources and their effectiveness in enhancing the quality of teaching, learning, and research.

Blended learning is one of the leading trends in education. Blended learning combines computer-assisted learning with traditional classroom learning. The literature shows that the blended learning often helps the students to achieve better learning outcome. However, a majority of the existing learning platforms do not focus on the problems of weak students. Here our objective is to develop a computer-assisted learning platform that focuses on performance improvement of weak students and study the efficacy of the system. This paper presents the proposed system, "RemedialTutor", that assists the weak students in effective preparation for an examination. The learning platform performs several tasks on demand; for example, providing the meaning of unknown words, sentence simplification, identification of questionable sentences, extraction of summarized content on a specific topic, preparation of question paper and automatic evaluation, identification of less confident sections, etc. To study the effectiveness of the proposed system, it is tested using a blended learning framework. The system is provided to the students as a supplement to the traditional classroom activities and resources. During the comparative study, the experiment group students used this system during their exam preparation but the control group students relied only on their regular resources. It is found that the experiment group students perform better than the control group. The t-value is 2.3466 and p-value is 0.0243. These values indicate that the difference is statistically significant.

This paper examines caste bias in Odia language textbooks prescribed by the Government in middle schools in the State of Odisha, India. The analysis focuses on 10 textbooks for Social Science and Odia literature prescribed for Classes IV to VIII. The framework proposed by Sadker and Zittleman (2007) to study gender bias in educational material in the United States is contextualized for an application to Indian textbooks. Content analysis identified seven types of bias, with 'invisibility' bias being the most important form of bias. This first-ever systematic analysis of caste bias within curricular material in India brings to fore the exclusion of Scheduled Castes. The persistence of caste bias across textbooks is in direct violation of the recommendations of the National Curriculum Framework-2005 and systematically creates an illusion that Indian society is an equitable one. We suggest that there is a need for further evaluation of regional language school textbooks to assess the extent of bias in curricular material.

In India, sexual violence today is a routine form of violence directed against Dalit women--those from the most subordinated castes of India. Dalit is a socio-political identity affirmed by India's ex-untouchable communities, historically considered "service castes" and exploited based on their birth. While all Dalits are exploited for their physical labor and given brutal punishments for challenging or not abiding by the caste hierarchy, Dalit women particularly face gendered violence like sexual violence by upper-caste men. The author emphasizes that researching the phenomenon of caste-based sexual violence becomes essential. In this paper, the author argues that along with researching, even discussing and teaching about this violence through various social sciences like sociology, history, and women's studies becomes crucial. A teacher can transform the classroom as a space to discuss this violence, acknowledge this violence, and even initiate some healing.

This study has been conducted to measure the collaborative research among the social scientist at Jawaharlal Nehru University, India during the year 1998-2017. The sample of 2128 articles has been collected from the Scopus database during the year 1998-2017 and were analyzed to study the collaborative coefficient, collaborative index, year wise degree of collaboration, modified collaboration coefficient, co-authorship index and language wise distribution of articles. From this study, it is found that the growth rate of publications in the social sciences is rapidly increasing. The collaborative coefficient is below 0.5 which implies that single-authored papers are dominating. The co-authorship index for the single-authored paper is higher, and the degree of collaboration is low as the value is 0. The research articles are the preferred format to publish in the journals. This study was limited to the data collected from the Scopus database during the period 1998-2017. The findings have significant implications for the researchers/scholars to know the growth and trend of collaborative research in the social sciences. This study extends the knowledge on the bibliometric tools employed to measure the collaborative research in the social sciences. [ABSTRACT FROM AUTHOR]

Indigenization has been an important nationalist project undertaken by various colonized countries seeking to liberate the existing knowledge systems from colonial hegemony. In India too, one witnesses serious efforts at indigenization that began during the colonial rule as part of the anti-colonial nationalist struggle. This continued after independence with new vigour. It found resonance in the domain of social sciences and the Indian social scientists have been engaged in debates around decolonizing the extant knowledge texts in their respective domains. An essential part of indigenization of social science in the Indian context is their vernacularization, which implies a process of translation and adaptation of the knowledge texts in its diverse local/regional languages. Underscoring the importance of both the processes in decolonizing the social sciences, the paper also highlights the existing and the emerging challenges to them. [ABSTRACT FROM AUTHOR]

Background: Resource allocation decisions for disease categories can be informed by proper estimates of the magnitude and distribution of total spending. In the backdrop of a high burden of Non-Communicable Diseases and Injuries (NCDI) in India, and a paucity of estimates on government spending on NCDI, this paper attempts to analyse public sector expenditure on NCDI spending in India. Methods: Various recent budget documents of the Centre and States/Union Territories have been used to extract expenditure on NCDI. The aggregates thus arrived at have been analysed to estimate aggregate and state level per capita spending. State level spending have been compared against disease burden using DALYs. Patterns of spending on NCDI across states were also analysed together with state level poverty to observe possible patterns. Findings: The total spending on NCDI by the government is low at less than 0.5% of GDP. NCDI spending is little more than one-fourth of total health spending of the country and most spending takes place at the state level (80%). The Ministry of Health and Family Welfare’s share in Central spending on NCDI is around 65%, and currently it spends 20% of its total health spending on NCDI. The gap between spending and DALYs is the most for the economically vulnerable states. Also, the states with high poverty levels also have low per capita expenditure on NCDI Interpretation: India does not depend on donor funding for health. It will have to step up domestic funding to address the increasing disease burden of NCDIs and to reduce the high out-of-pocket expenditure on NCDI. Policies on NCDI need to focus on UHC, service integration and personnel gaps. [ABSTRACT FROM AUTHOR]

The changing population age structure has a significant influence on the economy, society, and numerous other aspects of a country. This paper has innovatively applied the method of compositional data forecasting for the prediction of population age changes of the young (aged 0–14), the middle-aged (aged 15–64), and the elderly (aged older than 65) in China, India, and Vietnam by 2030 based on data from 1960 to 2016. To select the best-suited forecasting model, an array of data transformation approaches and forecasting models have been extensively employed, and a large number of comparisons have been made between the aforementioned methods. The best-suited model for each country is identified considering the root mean squared error and mean absolute percent error values from the compositional data. As noted in this study, first and foremost, it is predicted that by the year 2030, China will witness the disappearance of population dividend and get mired in an aging problem far more severe than that of India or Vietnam. Second, Vietnam’s trend of change in population age structure resembles that of China, but the country will sustain its good health as a whole. Finally, the working population of India demonstrates a strong rising trend, indicating that the age structure of the Indian population still remains relatively “young”. Meanwhile, the continuous rise in the proportion of elderly population and the gradual leveling off growth of the young population have nevertheless become serious problems in the world. The present paper attempts to offer crucial insights into the Asian population size, labor market and urbanization, and, moreover, provides suggestions for a sustainable global demographic development. [ABSTRACT FROM AUTHOR]

Digital humanities is a result of the convergence of digital technology with social sciences and humanities. It is one of the key research areas around the world by the library and information science profession, and in cognate areas such as art and archeology. Focus groups, digital humanities centres are created for intensive researches which are located mainly in libraries as their core programmes. The library techniques and methods such as knowledge organisation, knowledge management, search and retrieval design, education, and emerging areas such as metadata, semantic mapping, ontology, thesaurus construction, digital curation, discovery services, find application in digital humanities. A new area of study, historical informatics complements the digital humanities. India has vast potential application of digital humanities with its diverse culture, customs and languages and so on. India is reckoned as one of the advanced countries in the IT sector, hence recognising the socio-cultural legacy and diverse historical background, it is viewed that digital humanities has many opportunities and applications for LIS professionals in India to contribute substantially. This paper brings together the concepts, tools, and applications of digital humanities and proposes a course of study in LIS curriculum. [ABSTRACT FROM AUTHOR]

In this paper, we explore the problem of establishing a network among the stocks of a market at high frequency level and give an application to program trading. Our work uses high frequency data from the National Stock Exchange, India, for the year 2014. To begin, we analyse the spectrum of the correlation matrix to establish the presence of linear relations amongst the stock returns. A comparison of correlations with pairwise mutual information shows the further existence of non-linear relations which are not captured by correlation. We also see that the non-linear relations are more pronounced at the high frequency level in comparison to the daily returns used in earlier work. We provide two applications of this approach. First, we construct minimal spanning trees for the stock network based on mutual information and study their topology. The year 2014 saw the conduct of general elections in India and the data allows us to explore their impact on aspects of the network, such as the scale-free property and sectorial clusters. Second, having established the presence of non-linear relations, we would like to be able to exploit them. Previous authors have suggested that peripheral stocks in the network would make good proxies for the Markowitz portfolio but with a much smaller number of stocks. We show that peripheral stocks selected using mutual information perform significantly better than ones selected using correlation. [ABSTRACT FROM AUTHOR]

Understanding the causality between energy consumption, carbon emissions and economic growth is helpful for policymakers to formulate energy, environmental and economic policies. For the first time, based on nonlinear dynamics, this paper employs multispatial convergent cross mapping (CCM) to revisit the energy-carbon-economy causation for China, India and the G7 countries using both aggregate data and per capita data. The findings indicate that there are significant differences between developing countries and developed countries. A bidirectional nexus between energy consumption, carbon emissions and economic growth is found in China and India, but various causal relationships are identified in the G7 countries, including bidirectional, unidirectional and neutral nexus. The results confirm that the decoupling phenomenon is common in most G7 countries. By leveraging a variety of samples and a new approach, this study provides new evidence for policy authorities to formulate country-specific policies to obtain better environmental quality while achieving sustainable economic growth. [ABSTRACT FROM AUTHOR]

This paper explores the social inclusiveness of agricultural extension services in India. We estimate the probability and frequency of farmers’ access to extension services and resulting changes in crop income across different caste groups. The literature suggests that caste-based social segregation manifests in various spheres of life, and perpetuates economic inequality and oppression. An econometric analysis of nationally-representative data from rural India verifies this with respect to the agricultural sector. Farmers belonging to the socially-marginalized castes are found to have a lower chance of accessing the public extension services, primarily due to their inferior resource-endowment status. Contacting extension agents at least once increased the average annual crop income by about 12 thousand Indian rupees per household, which is equivalent to 36% of the annual crop income of those without access to extension services. There exists significant impact heterogeneity. Farmers from the socially-marginalized castes hardly benefited from accessing the extension services. Based on these observations, we have developed a number of policy recommendations that could improve the social inclusiveness of agricultural development strategies in rural India. [ABSTRACT FROM AUTHOR]

With the ongoing demographic and epidemiological transition, cancer is emerging as a major public health concern in India. This paper uses nationally representative household survey to examine the overall prevalence and economic burden of cancer in India. The age-standardized prevalence of cancer is estimated to be 97 per 100,000 persons with greater prevalence in urban areas. The evidence suggests that cancer prevalence is highest among the elderly and also among females in the reproductive age groups. Cancer displays a significant socioeconomic gradient even after adjusting for age-sex specifics and clustering in a multilevel regression framework. We find that out of pocket expenditure on cancer treatment is among the highest for any ailment. The average out of pocket spending on inpatient care in private facilities is about three-times that of public facilities. Furthermore, treatment for about 40 percent of cancer hospitalization cases is financed mainly through borrowings, sale of assets and contributions from friends and relatives. Also, over 60 percent of the households who seek care from the private sector incur out of pocket expenditure in excess of 20 percent of their annual per capita household expenditure. Given the catastrophic implications, this study calls for a disease-based approach towards financing such high-cost ailment. It is suggested that universal cancer care insurance should be envisaged and combined with existing accident and life insurance policies for the poorer sections in India. In concluding, we call for policies to improve cancer survivorship through effective prevention and early detection. In particular, greater public health investments in infrastructure, human resources and quality of care deserve priority attention. [ABSTRACT FROM AUTHOR]

In this paper, we model the bus networks of six major Indian cities as graphs in L-space, and evaluate their various statistical properties. While airline and railway networks have been extensively studied, a comprehensive study on the structure and growth of bus networks is lacking. In India, where bus transport plays an important role in day-to-day commutation, it is of significant interest to analyze its topological structure and answer basic questions on its evolution, growth, robustness and resiliency. Although the common feature of small-world property is observed, our analysis reveals a wide spectrum of network topologies arising due to significant variation in the degree-distribution patterns in the networks. We also observe that these networks although, robust and resilient to random attacks are particularly degree-sensitive. Unlike real-world networks, such as Internet, WWW and airline, that are virtual, bus networks are physically constrained. Our findings therefore, throw light on the evolution of such geographically and constrained networks that will help us in designing more efficient bus networks in the future. [ABSTRACT FROM AUTHOR]

Out-of-pocket spending at out-patient departments (OPD) by households is relatively less analyzed compared to hospitalization expenses in India. This paper provides new evidence on the levels and drivers of expenditure on out-patient care, as well as choice of providers, using household survey data from 8 districts in 3 states of India. Results indicate that the economically vulnerable spend more on OPD as a proportion of per capita consumption expenditure, out-patient care remains overwhelmingly private and switches of providers—while not very prevalent—is mostly towards private providers. A key result is that choice of public providers tend to lower OPD spending significantly. It indicates that an improvement in the overall quality and accessibility of government facilities still remain an important tool that should be considered in the context of financial protection. [ABSTRACT FROM AUTHOR]

Introduction: Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India’s vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS) to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign. Materials and Methods: The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre. Results: The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers. Discussion: A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen’s behavioural model of health services use. Conclusion: The findings assisted with refining the intervention prior to large-scale implementation and evaluation. [ABSTRACT FROM AUTHOR]

Dharmottara, one of the most outstanding commentators of Dharmakīrti, re-uses arguments in the Pramāṇaviniścayaṭīkā, his broad commentary on Dharmakīrti's Pramāṇaviniścaya, from his independent essay, the Kṣaṇabhaṅgasiddhi. By analyzing contents of re-used arguments in the Pramāṇaviniścayaṭīkā, this paper clarifies Dharmottara's intention of paraphrasing his arguments in his commentarial work on Dharmakīrti. I argue that, in terms of content, such arguments are original and never fit into Dharmakīrti's own system. It can be said that Dharmottara has a clear intention to display his new innovations not only in his independent monograph, but also in his commentarial work. For Dharmottara, a commentary on Dharmakīrti is a better place than an independent monograph for showing off his advanced notions, since it is only in a commentary that his ideas can stand out directly against those of Dharmakīrti. In this sense, Dharmottara writes his commentary strategically. At the end of the article I discuss the significance of composing independent monographs or essays in the intellectual history of medieval India in the case of Dharmottara. [ABSTRACT FROM AUTHOR]

This study presents a critique of Gopal Guru's "Egalitarianism and the Social Sciences"that focuses on the necessity of the edifice of Dalit theory being built by the Dalits, for the Dalits. It narrates how the hierarchy of the Twice of the Top Born(TTB) has been extended to academics where it operates deviously in the guise of condescending conceptions of the subaltern. The constant theorizing of the TTB deprives the Dalit's opportunities to critique themselves and strengthens the notion of interpretative communities as a policing academy. It comes across that though the theorizing of Dalit experience is supposed to invert the dialectical pair Brahmin/Shudra, it rather enforces it thereby strengthening power structures. The validity of a subjective theory and the denial of an objective unbiased one is brought into question. Guru foregrounds the justification of the egalitarian principle for critiquing the practice of social sciences, and poses the principle as subversive. The history of the Brahmin/Shudra hierarchy in the intellectual domain as put forward by Gopal Guru functions parallel to Marxist class nature of Art -Klassovost. After analysing the main points and counterarguments pertaining to the theorizing of experiences, the paper arrives at a conclusion as to the validity of Guru's argument in favouring subjective criticism over objective criticism. [ABSTRACT FROM AUTHOR]

Abstract The increasing dependence on street vending as a source of livelihood for people across urban spaces in countries like Cambodia and India continues to promote exciting areas of research in social sciences. Our study captures the narratives of street vendors (seen as the 'invisible' entrepreneurs), working in markets across Delhi (India) and Phnom Penh (Cambodia) and analyzes the inventory logistics of products sold by them, thereby, reflecting the complex nature of an inter-twined, existential relationship between what's classified as 'informal' and 'formal' in urban economies. The mutual interdependence seen in the governing dynamics of economic exchange (for example, in selling commodities and services across identified markets in Phnom Penh and Delhi), argues for a need to inclusively study urban ecosystems while addressing the needs of street vendors. This paper does so by incorporating ethnographic methods with a specific reference to street vending (as a commercial urban activity). Further, we emphasize on an epistemic need to cross-fertilize thought(s) and method(s) across social science disciplines to produce more of such urban narratives, exploring the inter-twined relationship between the 'informal' and 'formal' aspects of urban ecosystems. [ABSTRACT FROM AUTHOR]

We estimate the returns (measured by hourly earnings) to education, experience, and social networking in India using individual-level panel data from the India Human Development Surveys. We combined the two latest waves of this survey using individual-level identifiers to generate a balanced panel and merged it with various household characteristics. We provide estimates of private returns for an additional year of education and experience by consumption quintiles, gender, caste, and religion in a fixed-effects Heckman model that controls for selection bias. This methodology improves upon estimates of all earlier studies on earnings in India, as most of the literature has relied on cross-section data or pseudo-panel data. We also examine the impact of social networking on earnings, which is under-explored in nationwide studies in India. We find that education significantly and positively affects earnings for all consumption quintiles, gender, caste (except schedule castes), and religious groups. Among economic groups, the highest returns are observed for the third quintile above the poverty line. Returns to females for an additional year of education are nearly double that of males but the difference in starting earnings keeps earnings of males higher for long periods. Among the castes, scheduled castes have the highest returns to education and other minorities among religious groups. Social networking positively impacts males, Hindus, and the quintile just above the poverty line. Experience positively impacts women's earnings, general caste and scheduled caste, Hindus and Other minorities and two consumption quintiles (two and five) above the poverty line. Plain Language Summary: Impact of Education, Experience, and Social Networks Impact Earnings in India by Class, Gender, Caste and Religion Purpose: Enhancing human capital is critical for India's development. It would help overcome existing labor market hierarchies based on economic class, gender, religion, and caste. We study the impact on private earnings of (a) an additional year of education and experience, and (b) social networking. Methods: We use an individual level panel dataset assembled from the two latest rounds of the Indian Human Development Survey (I&II). Our Heckman type earnings equation controls for selection bias. Results: An additional year of education increased earnings between (a) 2.4% and 8.8% among different consumption quintiles (b) 3.7% for males to 5.2% for females, (c) 1.5% (STs), to 5.9% (SCs), and (d) 2.3% (Muslims), to 9.9% (Other Minorities). Experience increased earnings of two economic groups, females, the General and Scheduled castes, and of Hindus and Other Minorities. Social networking increased earnings of males, Hindus, and one economic quintile. Conclusions: Higher marginal returns to education for females justifies greater investment in women's education. Lower returns on education among STs and Muslims indicate the need for affirmative action for these groups. The positive returns to education for the poor suggests that anti-poverty programs in combination with educational opportunities for the less privileged would meet the goals of social justice. Implications Better education (SDG4) would help achieve gender equality (SDG5), and social justice for marginalized (economic, caste and religious) groups (SDG1, SDG10). Limitations: We were unable to account for ability bias. Stratification by state and sector would provide better estimates. [ABSTRACT FROM AUTHOR]

This paper attempts to analyze the growth of research work in the field of social sciences and humanities in Odisha during the period 1996 to 2015. The analysis has been done taking into account the publication output of Odisha as reflected in Scopus database. The present study analyzes the year wise growth of publications, most productive authors, major subject areas of research, types of publications preferred by the researchers, preferred journals and the major productive institutions in the field of social science and humanities. [ABSTRACT FROM AUTHOR]

This article ethnographically traces the performance of data collection and analysis for a cancer cost-of-illness study in an East Indian Cancer hospital. By reflecting on my experience in this project, I show how the hospital's obligations for philanthropic and business self-sustainability spatially and temporally structured data in a way that produced the conditions of possibility for what was able to be made knowable of patients' experiences in cancer health economics. While collecting and analysing data within the spatial and temporal structuring of this self-sustainable hospital, I argue that our research team attempted to craft an ethical epistemology by incorporating the unique realities of Indian cancer patients based upon assumptions made from our tacit knowledge. Specifically, we called upon this knowledge to exercise a form of tacit epistemological ethics for patients existing in an in-between space of classification within Euro-North America cancer health economics frameworks. Finally, I suggest that in light of an attempt to produce a more ethical economic logic, the results of the cost-of-illness analysis are ultimately returned to larger conditions of possibility within austere health systems and Euro-North America health economics frameworks. [ABSTRACT FROM AUTHOR]

India presents a heterogeneous socio-economic ethos, rooted within structures of patriarchy and caste, rendering any transformation of traditional gender roles, increasingly challenging. Gender socialisation begins in childhood and is assimilated through schools. Students imbibe gender concepts through textbooks and classroom experiences, which either reinforce their social perceptions or influence them to critique inequalities and bias. Adopting a multi-pronged approach through feminist critical discourse analysis (FCDA) and content analysis, this research evaluates the images used in Indian school social science textbooks, for constructs of gender representation, structures, and stereotyping. The research reveals that gender structures depicted in textbooks foster patriarchy and gender bias. There is minimal effort to depict feminist activism and little scope to foster gender reflexivity and social debate, which only sustains stereotypical perceptions of gender roles within Indian society. [ABSTRACT FROM AUTHOR]

The paper analyses the doctoral degrees awarded in library and information science in India during 2006-2011 with the relevant statistical tables. Data on doctoral degrees have been collected from the journal University News. An attempt has been made here to show the quantity of research output in library and information science and the discipline social science as well. The theses on library and information science have been discussed broadly. Study represents the year, university, state, guide, subject wise distribution of the research output in library and information science during the period of the six years of study (2006-2011). [ABSTRACT FROM AUTHOR]

This article makes a case against the export of psychological intervention, as developed and practiced in the Global North, to the Indian sub-continent. It is based on the premise that differences between these places are not only sociological and cultural but also at the level of the structure of subjectivity. Leaning on my theoretical understanding of the Indian female subject's constitution and my empirical work on participants in rural Uttarakhand, India, I posit that our call for decolonization cannot be partial. [ABSTRACT FROM AUTHOR]

Background: Malnutrition among children is one of the most pressing health concerns middle- and low-income countries face today, particularly those in Sub-Saharan Africa and South Asia. Early-life malnutrition has been shown to affect long-term health and income. One hypothesized channel linking early-life malnutrition and long-term outcomes is cognitive development. However, there is limited empirical evidence on the relationship between nutritional status and cognitive achievement in middle childhood. Study design: As part of the South India Community Health Study (SICHS), we collected educational attainment and anthropometric data from 1,194 children in rural Vellore district of Tamil Nadu, India, and assessed their math and reading skills. We analyzed the relationship between continuous and binary anthropometric measures of nutritional status and three measures of cognitive achievement (reading, math, and grade level), adjusting for potential confounders, using a regression framework. Results: Lower height-for-age and weight-for-age and their corresponding binary measures (stunting, underweight) were associated with lower reading scores, lower math scores, and lower grade level, with the exception of the association between weight-for-age and reading, which was marginally significant. A stunted child had one-third of a grade disadvantage compared to a non-stunted counterpart, whereas an underweight child had one-fourth of a grade disadvantage compared to a non-underweight counterpart. Lower BMI-for-age was associated with grade level and marginally associated with lower math scores, and its binary measure (thinness) was marginally associated with lower math scores. Conclusions: Acute and chronic malnutrition in middle childhood were negatively associated with math scores, reading scores, and educational attainment. Our study provides new evidence that cognitive achievement during middle childhood could be an important mechanism underlying the association between early-life malnutrition and long-term wellbeing. [ABSTRACT FROM AUTHOR]

Background: India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services. Methods: We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost. Results: The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers. Discussion and conclusion: The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative. [ABSTRACT FROM AUTHOR]

Background: With India preparing for the next decennial Census in 2021, we compared the disability estimates and data collection methodology between the Census 2011 and the most recent population-level survey for India and its states, to highlight the issues to be addressed to improve robustness of the disability estimates in the upcoming Census. Methods: Data from the Census 2011 and from two complementary nationally representative household surveys that covered all Indian states with the same methodology and survey instruments–the District-Level Household Survey-4 (DLHS-4, 2012–2013) and the Annual Health Surveys (AHS three rounds, 2010–11, 2011–12 and 2012–13) were used. Data from DLHS-4 and AHS 2012–13 round were pooled to generate estimates for the year 2012–13. Data collection methodology between the sources was compared, including the review of definitions of each type of disability. The overall, mental, visual, hearing, speech, and movement disability rate (DR) per 100,000 population were compared between the sources for India and for each state, and the percent difference in the respective rates was calculated. We explored the reliability of these estimates comparing yearly data from the AHS for three successive rounds. Results: Survey data were collected through proxy reporting, however, it is not entirely clear whether the data were proxy- or self-reported or a mix of both in the Census. The overall DR was 25.1% higher in the Census (2,242; 95% CI 2,241–2,243) than the survey (1,791; 95% CI 1,786–1,797) per 100,000 population, with the state-level difference ranging from -64% in Tamil Nadu to 107% in Sikkim state. Despite both sources using nearly similar definitions for overall disability and disability by type, the difference in DR was 125.5%, 54.2%, -25.7%, -19.7%, and 21.9% for hearing, speech, mental, movement, and visual DR, respectively. At the state-level, the difference in disability-specific estimates ranged from -84% to 450%. The extent of variations in the disability-specific estimates in AHS successive rounds ranged from -25% to 929% at the state-level. Conclusions: There is momentum globally towards building disability measurement that is consistent with the data required for monitoring of the Sustainable Development Goals to ensure robust estimation of disability. The current estimates from the Census and surveys seem much lower than would be expected at the population level. We make recommendations that India needs to take serious note of in order to improve the validity and reliability of India’s disability estimates. [ABSTRACT FROM AUTHOR]

There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities. [ABSTRACT FROM AUTHOR]

Introduction: The National Rural Health Mission (NRHM) was launched in India in 2005 to address the health needs of under-served populations in rural areas, and to support universal access to care. Despite this initiative, unaccredited informal providers (IPs) often remain patients’ first point of contact, which has led to inconsistencies in treatment, and has compromised the quality of care. Aim: To explore the factors that influence patients’ decisions about healthcare providers in rural areas of central India. Methods: Nine focus group discussions (FGDs) were held in nine villages in central India. Framework analysis using an inductive approach was used to analyse the data. Results: The crosscutting theme across the discussions was not choice but need—the need for affordable and accessible health care regardless of the provider’s qualification. Results highlighted that IPs play a pivotal role in villagers’ lives. Formal healthcare services were accessed infrequently, and mainly when a condition was judged severe or possibly even fatal. Even then, affordability was carefully weighed. Villagers’ distance from formal providers contributed to high cost and low preference of formal providers. When opting for IPs, familiarity and trust were more important to villagers than qualifications. IPs have operated in rural communities in India for a long time and have adapted their services to meet the needs, preferences, social norms, and economic conditions of villagers. Conclusion: IPs have captured a niche and are often the first contact point in rural settings even when patients ultimately are diagnosed and treated by trained doctors. Merely tackling the undersupply of qualified doctors is not effective or sufficient to impact on the rural healthcare system: the strong and prevalent influence of IPs needs to be addressed also. [ABSTRACT FROM AUTHOR]

Background: As population health and well-being are influenced by multiple factors that cut across sectoral boundaries, an intersectoral approach that acknowledges and leverages the multiple determinants, actors and sectors at play is increasingly seen as critical for achieving meaningful and lasting improvements. In this study, we utilize social network analysis (SNA) to characterize the intersectoral collaboration between the organizations working on maternal & child health (MCH) and water & sanitation (WASH) before and immediately after the implementation of HCL Foundation (HCLF)-funded HCL Samuday Project (2015–2017) in a rural block of Uttar Pradesh state, India. While SNA has been used to examine public health issues, few have used it monitor stakeholder relationships, intervene, improve and facilitate project implementation involving intersectoral partnerships, particularly in the context of a low-and middle-income countries. Method: An organization-level SNA was conducted with 31 key informants from 24 organizations working on MCH and/or WASH in Kachhauna, Uttar Pradesh, India. Data were collected using face-to-face, semi-structured interviews between June and September 2017. Density, centrality and homophily were calculated to describe the network and a qualitative analysis was also conducted to identify the strengths and weaknesses of collaboration between organizations working on MCH and WASH. Results: Overall, our findings showed that the network of organizations working on MCH and WASH in Kachhauna grew in number since the implementation of Samuday. HCLF rapidly achieved centrality, thus positioning the organization to serve as a gatekeeper of information and enabling it to play a coordinator role within the network. Direct collaboration between other organizations working on MCH and WASH was low at both time points. Interviews with key informants indicated widespread interest in increasing interorganizational interactions and engagement throughout the network. Conclusion: This study demonstrates the feasibility and practical application of SNA for projects like Samuday that involve intersectoral collaboration. It also provides lessons about the use of SNA with organizations as the unit of analysis and in the context of rural India, including challenges, practical considerations, and limitations. [ABSTRACT FROM AUTHOR]

Background: Low birth weight is an important predictor of maternal and child health. Birth weight is likely to be affected by maternal health, socioeconomic status and quality of health care facilities. Objective: To assess trends in the birth weight, the proportion of low birth weight, maternal factors and health care facilities for delivery in villages of Western Maharashtra from the year 2004 to 2016 and to analyze factors associated with low birth weight for total birth data of 2004–2016. Methods: Data collected for 19244 births from 22 villages in Vadu Health and Demographic Surveillance System (HDSS), Pune, Maharashtra, India from the year 2004 to 2016 were used for this analysis. Results: There was an overall increase in the annual mean birth weight from 2640.12 gram [95% CI 2602.21–2686.84] in the year 2004 to 2781.19 gram [95% CI 2749.49–2797.95] in the year 2016. There was no secular trend to show increase or decrease in the proportion of low weight at birth. Increasing maternal age (>18 years) compounded with better education, reduced parity and increasing number of institutional deliveries were significant trends observed during the past decade. Low birth weight was found to be associated with female gender, first birth order, poor maternal education and occupation as cultivation. Conclusion: Changes in maternal age, education, occupation, and increased institutionalized deliveries contributed in to increasing birth weights in rural Maharashtra. Female gender, first birth order, poor maternal education and occupation of cultivation are associated with increased risk of low birth weight. [ABSTRACT FROM AUTHOR]

Background: Although most Indians live in rural settings, data on cardiovascular disease risk factors in these groups are limited. We describe the association between socioeconomic position and cardiovascular disease risk factors in a large rural population in north India. Methods: We performed representative, community-based sampling from 2013 to 2014 of Solan district in Himachal Pradesh. We used education, occupation, household income, and household assets as indicators of socioeconomic position. We used tobacco use, alcohol use, low physical activity, obesity, hypertension, and diabetes as risk factors for cardiovascular disease. We performed hierarchical multivariable logistic regression, adjusting for age, sex and clustering of the health sub-centers, to evaluate the cross-sectional association of socioeconomic position indicators and cardiovascular disease risk factors. Results: Among 38,457 participants, mean (SD) age was 42.7 (15.9) years, and 57% were women. The odds of tobacco use was lowest in participants with graduate school and above education (adjusted OR 0.11, 95% CI 0.09, 0.13), household income >15,000 INR (adjusted OR 0.35, 95% CI 0.29, 0.43), and highest quartile of assets (adjusted OR 0.28, 95% CI 0.24, 0.34) compared with other groups but not occupation (skilled worker adjusted OR 0.93, 95% CI 0.74, 1.16). Alcohol use was lower among individuals in the higher quartile of income (adjusted OR 0.75, 95% CI 0.64, 0.88) and assets (adjusted OR 0.70, 95% CI 0.59, 0.82). The odds of obesity was highest in participants with graduate school and above education (adjusted OR 2.33, 95% CI 1.85, 2.94), household income > 15,000 Indian rupees (adjusted OR 1.89, 95% CI 1.63, 2.19), and highest quartile of household assets (adjusted OR 2.87, 95% CI 2.39, 3.45). The odds of prevalent hypertension and diabetes were also generally higher among individuals with higher socioeconomic position. Conclusions: Individuals with lower socioeconomic position in Himachal Pradesh were more likely to have abnormal behavioral risk factors, and individuals with higher socioeconomic position were more likely to have abnormal clinical risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers and women from the general population which integrated horizontal health services for the general population with existing vertical targeted interventions aimed at sex workers with an aim to improve SRH and HIV services. We present an outcome evaluation of the DIFFER project in terms of uptake rates for SRH services among sex workers in Mysore, India. Methods: Ashodaya Samithi, a sex worker-led organization, implemented the DIFFER strategy through their community-based clinic and a Well Women Clinic (WWC), established at a partner private hospital that provided SRH services for women living with HIV. Mixed methods were used to evaluate the intervention that included a baseline (2012–13) and end of project (2015–16) cross sectional surveys (CSS), focus group discussions (FGDs), key informant interviews, and analysis of service statistics from 2013–2016. Results: The CSS found that condom use, STI testing, and treatment were high before, and throughout the intervention; cervical cancer screening and treatment increased significantly, from 11.5% to 56% (aOR 9.85, p<0.001) and HIV testing in the last 3 months increased from 26.3% to 73.3% (aOR 7.25, p<0.001). The proportion of sex workers using any SRH service in the past year doubled from 25.7% to 51.4% (aOR 2.91, p<0.001). Service statistics showed similar trends. The FGDs and key informant interviews showed that women and stakeholders held high levels of satisfaction with the strategy, and affirmed potential for scale up. Conclusion: The DIFFER strategy demonstrated that SRH service uptake can occur in conjuction with HIV services offered to sex workers. This model of integrated service delivery has been accepted by policy makers and needs further analysis for scaling up. [ABSTRACT FROM AUTHOR]

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries. [ABSTRACT FROM AUTHOR]

Background: Private providers dominate health care in India and provide most tuberculosis (TB) care. Yet efforts to engage private providers were viewed as unsustainably expensive. Three private provider engagement pilots were implemented in Patna, Mumbai and Mehsana in 2014 based on the recommendations in the National Strategic Plan for TB Control, 2012–17. These pilots sought to improve diagnosis and treatment of TB and increase case notifications by offering free drugs and diagnostics for patients who sought care among private providers, and monetary incentives for providers in one of the pilots. As these pilots demonstrated much higher levels of effectiveness than previously documented, we sought to understand program implementation costs and predict costs for their national scale-up. Methods and findings: We developed a common cost structure across these three pilots comprising fixed and variable cost components. We conducted a retrospective, activity-based costing analysis using programmatic data and qualitative interviews with the respective program managers. We estimated the average recurring costs per TB case at different levels of program scale for the three pilots. We used these cost estimates to calculate the budget required for a national scale up of such pilots. The average cost per privately-notified TB case for Patna, Mumbai and Mehsana was estimated to be US$95, US$110 and US$50, respectively, in May 2016 when these pilots were estimated to cover 50%, 36% and 100% of the total private TB patients, respectively. For Patna and Mumbai pilots, the average cost per case at full scale, i.e. 100% coverage of private TB patients, was projected to be US$91 and US$101, respectively. In comparison, the national TB program’s budget for 2015 averages out to $150 per notified TB case. The total annual additional budget for a national scale up of these pilots was estimated to be US$267 million. Conclusions: As India seeks to eliminate TB, extensive national engagement of private providers will be required. The cost per privately-notified TB case from these pilots is comparable to that already being spent by the public sector and to the projected cost per privately-notified TB case required to achieve national scale-up of these pilots. With additional funds expected to execute against national TB elimination commitments, the scale-up costs of these operationally viable and effective private provider engagement pilots are likely to be financially viable. [ABSTRACT FROM AUTHOR]

Background: Evidence highlights a global shortage of wheelchair service provision education and training that results in inappropriate wheelchair provision with associated health and economic consequences. Two learning methodologies, a hybrid and an in-person course, based on the World Health Organization Wheelchair Service Training Package Basic Level, currently are available to train wheelchair service providers worldwide. The effectiveness of the in-person methodology, used as the standard of practice, has never been tested. Meanwhile, the Hybrid Course, which combines online and in-person training, was developed to reduce training costs and to scale training interventions and has shown potential effectiveness in increasing basic level wheelchair service provision knowledge. The objective of this study was to compare the effectiveness of both learning methodologies based on knowledge and satisfaction among a group of wheelchair service providers in India and Mexico. Methods: We conducted a controlled quasi-experimental study to evaluate changes in basic wheelchair knowledge and levels of satisfaction between Hybrid and In-person course learners in India and Mexico. A convenience sampling method guided by local stakeholders’ input was used to recruit participants. Outcomes were assessed using self-administered online surveys, the International Society of Wheelchair Professionals Wheelchair Service Provision Basic Test (primary outcome) completed pre- and post- the learning intervention and an anonymous Satisfaction Survey (secondary outcome) completed post- intervention. Baseline characteristics were compared among groups using hypothesis tests based on their assumptions. The primary analysis was intention-to-treat. To address missing values and lost to follow-up, multiple chained imputations were conducted. The primary outcome was analyzed using linear mixed models. The secondary outcome was analyzed using a two-tailed two independent samples t-test. Results: A total of 81 participants, 43 (53.1%) in the In-person group and 38 (46.9%) in the Hybrid group, participated in the study. Mean baseline knowledge scores were below the passing cutoff of the test (53 points) in both groups. Both study groups experienced statistically significant improvements in the primary outcome when comparing pre- and post-test scores (p<0.0001) with total mean scores above the passing cutoff of the test. The in-person group experienced, on average, larger effects on the primary outcome. The difference in mean change from post-test to pre-tests between In-person groups and Hybrid was 3.6 (95% Confidence Interval: 1.7;5.4), Cohen’s d = 0.36, with a small effect size favoring the In-person training. With regards to satisfaction, the difference between the two interventions was 0.23±0.07 in favor of the In-person group (p = 0.0021). Conclusions: Both learning methodologies had a statistically significant effect in increasing wheelchair service knowledge with overall high levels of satisfaction. However, the In-person group reported overall larger effects when compared with the Hybrid methodology. This study provided recommendations on how organizations can improve blended learning interventions to enhance participants’ learning experiences and reduce potential barriers and limitations. [ABSTRACT FROM AUTHOR]

Background: Evidence on where in the hypertension care process individuals are lost to care, and how this varies among states and population groups in a country as large as India, is essential for the design of targeted interventions and to monitor progress. Yet, to our knowledge, there has not yet been a nationally representative analysis of the proportion of adults who reach each step of the hypertension care process in India. This study aimed to determine (i) the proportion of adults with hypertension who have been screened, are aware of their diagnosis, take antihypertensive treatment, and have achieved control and (ii) the variation of these care indicators among states and sociodemographic groups.Methods and Findings: We used data from a nationally representative household survey carried out from 20 January 2015 to 4 December 2016 among individuals aged 15-49 years in all states and union territories (hereafter "states") of the country. The stages of the care process-computed among those with hypertension at the time of the survey-were (i) having ever had one's blood pressure (BP) measured before the survey ("screened"), (ii) having been diagnosed ("aware"), (iii) currently taking BP-lowering medication ("treated"), and (iv) reporting being treated and not having a raised BP ("controlled"). We disaggregated these stages by state, rural-urban residence, sex, age group, body mass index, tobacco consumption, household wealth quintile, education, and marital status. In total, 731,864 participants were included in the analysis. Hypertension prevalence was 18.1% (95% CI 17.8%-18.4%). Among those with hypertension, 76.1% (95% CI 75.3%-76.8%) had ever received a BP measurement, 44.7% (95% CI 43.6%-45.8%) were aware of their diagnosis, 13.3% (95% CI 12.9%-13.8%) were treated, and 7.9% (95% CI 7.6%-8.3%) had achieved control. Male sex, rural location, lower household wealth, and not being married were associated with greater losses at each step of the care process. Between states, control among individuals with hypertension varied from 2.4% (95% CI 1.7%-3.3%) in Nagaland to 21.0% (95% CI 9.8%-39.6%) in Daman and Diu. At 38.0% (95% CI 36.3%-39.0%), 28.8% (95% CI 28.5%-29.2%), 28.4% (95% CI 27.7%-29.0%), and 28.4% (95% CI 27.8%-29.0%), respectively, Puducherry, Tamil Nadu, Sikkim, and Haryana had the highest proportion of all adults (irrespective of hypertension status) in the sampled age range who had hypertension but did not achieve control. The main limitation of this study is that its results cannot be generalized to adults aged 50 years and older-the population group in which hypertension is most common.Conclusions: Hypertension prevalence in India is high, but the proportion of adults with hypertension who are aware of their diagnosis, are treated, and achieve control is low. Even after adjusting for states' economic development, there is large variation among states in health system performance in the management of hypertension. Improvements in access to hypertension diagnosis and treatment are especially important among men, in rural areas, and in populations with lower household wealth. [ABSTRACT FROM AUTHOR]

Childhood pneumonia accounts for 17% of IMR in India, posing a major health burden. With cultural beliefs influencing care seeking behaviour and disparities existing in health infrastructure across the country, an understanding of the underlying issues merits exploration. Study assessed prevalence of probable pneumonia and examined care seeking behaviour of mothers in three states, Madhya Pradesh (MP), Uttar Pradesh (UP) and Tamil Nadu (TN). This mixed methods study involved a household survey and qualitative interviews with mothers in three districts from each state. Households with children aged 2–59 months were screened to identify those with probable pneumonia; sub-sample of mothers participated in qualitative interviews. Care seeking behaviour was explored in the context of recognition of symptoms, nature of first care provided, time when care was sought outside the home and choice of health provider. Overall 17,442 children from 13,544 households were screened, of which 729 (MP), 752 (UP) and 713 (TN) children respectively, were identified with probable pneumonia; 72 mothers participated in the qualitative interviews. Three months period prevalence was estimated in study districts at 22.2%—MP 13.3%—UP and 8.4%—TN. Most mothers in MP and UP were not perceptive to severity of illness; type of care sought was often inappropriate, delayed, with home remedies and visits to unqualified care providers being their first response. In contrast, in TN, use of home remedies was minimal, going to untrained care providers, non-existent and more than 90% mothers sought appropriate care. Private doctors were the preferred choice among all mothers but utilization of government care was highest in TN (20%). Community health workers were underutilized, with less than 10% mothers consulting them. Need for educating mothers about appropriate care seeking and development of good health infrastructure as essential to attainment of better child health indices are advocated. [ABSTRACT FROM AUTHOR]

This study examined the burden of food insecurity in India’s un-notified slums, using an SDG framework to identify correlates of food insecurity. A convenience sampling approach was employed in selecting 38 slums from 675 un-notified slums across four geographic zones. Ten percent of the households in each slum site were selected from each zone, and one household member was interviewed, based on their availability and fulfilment of the eligibility criteria. Eligible individuals included those aged 18 years and above, who were resident in the selected slums and provided consent. Individuals with mental or physical challenges were excluded. A total sample of 907 study participants were included. Results showed that 43% (n = 393) of the participants were food insecure. More than half were females (73%, n = 285), who had not completed any schooling (51%, n = 202). One-third (n = 128) resided in the Northern Region of Delhi. SDG-related predictors of food insecurity included: household educational level (SDG 4 Quality education) (p = 0.03), coverage of health service needs (SDG 3 Good health and well-being) (p = 0.0002), electricity needs (SDG 7 affordable and clean energy) (p<0.0001), and employment needs (SDG 8 Decent and economic growth) (p = 0.003). Having healthcare needs that were partially or fully met was equally associated with higher food insecurity: this could be attributed to high healthcare costs and the lack of federal subsidies in un-notified slums, collectively contributing to high out-of-pocket health costs. Failure to fully meet employment needs was also significantly associated with higher food insecurity. However, met needs for electricity, finance, women’s safety and satisfactory family relationships, were associated with lower food insecurity. Household predictors of food insecurity included: number of household members, and the presence of physically disabled household members. Necessary interventions should include connecting food insecure households to existing social services such as India’s Public Distribution System, and multi-sector partnerships to address the existing challenges. [ABSTRACT FROM AUTHOR]

The present study explored the motivation of rural-urban migrants who moved from the Himalaya foothills of Uttarakhand to its capital city, Dehradun. A survey of 100 migrant families reported their socio-economic profile before and after migration, personal and general reasons for migration, problems in the village and in the city, and perception of push- and pull factors. A remote sensing-based analysis of land cover and forest changes was conducted for two villages of the migrants’ origin, aiming to link the reasons for migration to land cover changes. This was contextualised by reported large scale changes in forest cover. Major reasons for migration mentioned in this study were education, employment opportunities with the associated income, and facilities. These were perceived as both, push and pull factors, whereas environmental factors ranked very low. Declining environment or agriculture were never mentioned spontaneously as personal reason, and only occasionally as a presumed general reason for migration, but were frequently confirmed as a major problem in the village. Thus, although such problems existed, they seemed not a major driver of rural-urban migration. For most of the respondents their migration resulted in a profound change of livelihoods and significantly improved their socio-economic situation. Land and forest cover around the chosen villages fluctuated by up to 15% with a trend to increasing forest cover in recent years. At the district and state scales, forest cover was rather stable. These results question the narrative of deforestation and environmental degradation in the Himalayas as major push-factors for rural-urban migration in Uttarakhand. Even if environmental constraints were felt, it was rather the differences in socio-economic opportunities (education, employment, facilities) that drove people to migrate to the city. Regarding the push-pull paradigm, we conclude that scenarios of external conditions under which people migrate cannot be evaluated without taking the migrants’ attitudes and choices into account. [ABSTRACT FROM AUTHOR]

Based on more recent science spending developments in countries such as China, Korea, India and Brazil, there is a growing sense that the world’s scientific deck of cards is in the midst of a major reshuffle. But it is not clear if this reordering is limited to just the top spenders, or, indeed, how these changes have been playing out over the longer term. The new, more comprehensive research and development (R&D) spending estimates presented and discussed here reveal that we are in the midst of a possibly game-changing, albeit partial and perhaps irregular, reshuffle of the global R&D deck. These changes have potentially profound domestic and international economic development implications over the medium to long term. Notably, the fortunes of many of the world’s poorer countries continue to look bleak. Using the evolving structure of past R&D spending to project forward, and absent marked changes in science policies and spending priorities, we foresee a continuing and substantial shift in the geography of R&D towards parts of Asia, along with a continuing large, and in many respects growing, gap between the world’s scientific haves and have-nots. [ABSTRACT FROM AUTHOR]

Introduction: Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar. Methods: Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs. Results: The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved. Conclusion: SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale. [ABSTRACT FROM AUTHOR]

Commercial surrogacy in emerging countries such as India is often associated with exploitation of vulnerable women, the assumption being that it is performed by poor and uneducated women for rich intended parents. However, the hypothesis that surrogates are poor women has rarely been confronted with field data. The objective was to compare the socioeconomic characteristics of Indian surrogates interviewed in social studies with those of Indian women in the general population in order to provide preliminary data on whether surrogates have a specific profile and are indeed disadvantaged compared with their counterparts. The study analyzes the data from four cross-sectional studies carried out in India among surrogates between 2006 and 2014. Surrogates were recruited through clinics, agencies and agents. Data were collected during face-to-face interviews. The resulting convenience sample included 96 Indian surrogates. Their sociodemographic characteristics were compared with those of the general population extracted from Indian national surveys. The surrogates interviewed had their first child at a younger age than women in the general population, but they tended to have a smaller family. Their social situation tended to be better than that of the general population in terms of education, employment and family income. These results provide first empirical evidence moderating the common assumption that Indian surrogates are the poorest and least educated women. This does not mean, however, that exploitation does not exist. More studies are needed to confirm these results and to explore the issue in new international destinations for surrogacy. [ABSTRACT FROM AUTHOR]

Dowry known social evil prevailing in India since our independence. The most heinous and shocking forms of dowry are dowry death and homicidal deaths of women in India. The Dowry Prohibition Act, 1961 provides the protection against this crime. Even after this Act every year approximately 8000 cases are registered for dowry death under crime against women in India. The aim of present study is bibliometric analysis of dowry in country like India. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.Methods and Findings: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys.Conclusions: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured. [ABSTRACT FROM AUTHOR]

Children in slums are at high risk of acute malnutrition and death. Cost-effectiveness of community-based management of severe acute malnutrition programmes has been demonstrated previously, but there is limited evidence in the context of urban slums where programme cost structure is likely to vary tremendously. This study assessed the cost-utility of adding a community based prevention and treatment for acute malnutrition intervention to Government of India Integrated Child Development Services (ICDS) standard care for children in Mumbai slums. The intervention is delivered by community health workers in collaboration with ICDS Anganwadi community health workers. The analysis used a decision tree model to compare the costs and effects of the two options: standard ICDS services with the intervention and prevention versus standard ICDS services alone. The model used outcome and cost data from the Society for Nutrition, Education & Health Action’s Child Health and Nutrition programme in Mumbai slums, which delivered services to 12,362 children over one year from 2013 to 2014. An activity-based cost model was used, with calculated costs based on programme financial records and key informant interviews. Cost data were coupled with programme effectiveness data to estimate disability adjusted life years (DALYs) averted. The community based prevention and treatment programme averted 15,016 DALYs (95% Uncertainty Interval [UI]: 12,246–17,843) at an estimated cost of $23 per DALY averted (95%UI:19–28) and was thus highly cost-effective. This study shows that ICDS Anganwadi community health workers can work efficiently with community health workers to increase the prevention and treatment coverage in slums in India and can lead to policy recommendations at the state, and potentially the national level, to promote such programmes in Indian slums as a cost-effective approach to tackling moderate and severe acute malnutrition. [ABSTRACT FROM AUTHOR]

With less than 3200 wild tigers in 2010, the heads of 13 tiger-range countries committed to doubling the global population of wild tigers by 2022. This goal represents the highest level of ambition and commitment required to turn the tide for tigers in the wild. Yet, ensuring efficient and targeted implementation of conservation actions alongside systematic monitoring of progress towards this goal requires that we set site-specific recovery targets and timelines that are ecologically realistic. In this study, we assess the recovery potential of 18 sites identified under WWF’s Tigers Alive Initiative. We delineated recovery systems comprising a source, recovery site, and support region, which need to be managed synergistically to meet these targets. By using the best available data on tiger and prey numbers, and adapting existing species recovery frameworks, we show that these sites, which currently support 165 (118–277) tigers, have the potential to harbour 585 (454–739) individuals. This would constitute a 15% increase in the global population and represent over a three-fold increase within these specific sites, on an average. However, it may not be realistic to achieve this target by 2022, since tiger recovery in 15 of these 18 sites is contingent on the initial recovery of prey populations, which is a slow process. We conclude that while sustained conservation efforts can yield significant recoveries, it is critical that we commit our resources to achieving the biologically realistic targets for these sites even if the timelines are extended. [ABSTRACT FROM AUTHOR]