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Background: Iron-deficiency anemia among school-aged children is widespread in India. The efficacy of micronutrient and iron fortified school-served meals in reducing iron deficiency anemia has been demonstrated in randomized controlled trials in other parts of the globe. The current study evaluates its effectiveness in real-world Indian settings. Methods: Mid-day-Meal (MDM) programme provides free lunch to students of grade 1 to 8 in all public-funded Indian schools. An implementation research project fortified MDM of all public schools of 4 out of 8 sub-districts (“blocks”) of Dhenkanal district of Odisha state with fortified rice kernel (FRK). All the schools of the other 4 blocks fortified with micronutrient powders (MNP)—both FRK and MNP containing equal amounts of supplementary iron and other micronutrients. Schools of 4 matched blocks of neighboring nonimplementing Angul district served as control. Cross-sectional representative samples of students were drawn from the 3 arms, before and after intervention (n = 1764 and n = 1640 respectively). Pre-post changes in anemia prevalence and hemoglobin levels were estimated in the sampled children using difference-in-difference analysis after controlling for inter-arm differences in socioeconomic status, and iron and deworming tablet consumptions. Results: Factoring in pre-post changes in control and adjusting for potential confounders, the proportion of children without anemia and mean hemoglobin improved by 1.93 (1.38, 2.24, P < .001) times and 0.24 (−0.03, 0.51, P = .083) g/dL in MNP; and 1.63 (1.18, 2.24, P = .002) times and 0.18 (−0.09, 0.45, P = .198) g/dL in FRK arms. Conclusions: Fortified MDM could effectively improve anemia status among Indian school-aged children under real-world conditions.

Behaviour change is an important aspect of the successful implementation of any national health program. Social behaviour change among end-user can be possible by imparting the right information in the right quantity to the right audience, at frequent intervals through the proper medium. Mass media, both electronic and print are considered useful modes to deliver all public health-related messages to the people. However, the key is to provide correct information to the media for dissemination. On the other hand, medical colleges have a depth of knowledge on technical know-how but reaching a larger population is quite challenging. Therefore, a team approach should be planned by establishing a partnership between media and medical colleges and then the social behaviour change can be achieved in the desired direction. In lieu of this novel partnership, the Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Bhubaneswar had taken the initiative to bring together media personnel and faculty of medical colleges to chalk and roll out the behaviour change communication for nutrition interventions. This program was highly successful as the liaison helped disseminate the right information to the people. Also, the faculty and residents gained insight into dealing with media and thereby serving the community.

Background The available treatments for frozen shoulder yield variable results. Physical therapy and analgesics are considered as the first-line treatment for this disorder, but the effects are not uniform. There is some evidence to support that alternative medicine may have a role in its management. This study was designed to examine the short-term effects of yoga therapy in patients with frozen shoulder of mild to moderate severity. Materials and methods A prospective randomized controlled trial was conducted on patients with frozen shoulder between 30 and 60 years of age. They were divided into two groups: yoga (Y) and control (NY). A set of Asana exercises called “Standing Group of Asana” was practiced by the yoga group in addition to the conventional therapy as received by the control group. The patients were reviewed at 1, 2 and 4 weeks. The pain and functional assessment were done at baseline and at each review using the Shoulder Pain and Disability Index (SPADI). Results There were 16 male and 20 female participants in the Y group, and 15 males and 21 females in the NY group. There was no statistically significant difference in age, sex, and pre-treatment SPADI score between the groups. At the end of the four weeks, the SPADI pain scores in the Y and NY group were 20.47 and 20.14, respectively (p = 0.666). The SPADI disability scores in the Y and NY group were 20.4 and 19.7, respectively (p = 0.599). Overall SPADI scores were 40.67 and 40.03 in the Y and NY group, respectively (p = 0.736). Both groups had a significant reduction in SPADI pain and disability scores. However, there was no significant difference between the groups in terms of SPADI scores. Conclusion The effect of the Standing Group of Asana has no added advantage relative to standard frozen shoulder treatment when practiced for one month.

ObjectiveTo generate national estimates of key non-communicable disease (NCD) risk factors for adolescents (15–17 years) identified in the National NCD Monitoring Framework and, study the knowledge, attitudes and practices towards NCD risk behaviours among school-going adolescents.Design and settingA community-based, national, cross-sectional survey conducted during 2017–2018. The survey was coordinated by the Indian Council of Medical Research—National Centre for Disease Informatics and Research with 10 reputed implementing research institutes/organisations across India in urban and rural areas.ParticipantsA multistage sampling design was adopted covering ages between 15 and 69 years—adolescents (15–17 years) and adults (18–69 years). The sample included 12 000 households drawn from 600 primary sampling units. All available adolescents (15–17 years) from the selected households were included in the survey.Main outcome measuresKey NCD risk factors for adolescents (15–17 years)—current tobacco and alcohol use, dietary behaviours, insufficient physical activity, overweight and obesity.ResultsOverall, 1402 households and 1531 adolescents completed the survey. Prevalence of current daily use of tobacco was 3.1% (95% CI: 2.0% to 4.7%), 25.2% (95% CI: 22.2% to 28.5%) adolescents showed insufficient levels of physical activity, 6.2% (95% CI: 4.9% to 7.9%) were overweight and 1.8% (95% CI: 1.0% to 2.9%) were obese. Two-thirds reported being imparted health education on NCD risk factors in their schools/colleges.ConclusionThe survey provides baseline data on NCD-related key risk factors among 15–17 years in India. These national-level data fill information gaps for this age group and help assess India’s progress towards NCD targets set for 2025 comprehensively. Though the prevalence of select risk factors is much lower than in many developed countries, this study offers national evidence for revisiting and framing appropriate policies, strategies for prevention and control of NCDs in younger age groups.

Managing of radiotherapy department in many cancer centers in India has become very challenging during the COVID-19 pandemic. A radiotherapy center has to deal with multiple problems such as long treatment duration of each patient, high caseload on each radiotherapy machine, a limited number of qualified technical staff available, and equipment maintenance. For the department's smooth running, both the patient and healthcare worker must be safe from contacting COVID-19. A robust and planned strategy is required for prevention, screening, and awareness among all. To access our preparedness and evolve by gaining from other radiotherapy centers, a study was conducted using questionnaires and responses collected from different cancer centers in India.

Objective: The objective is to determine prevalence and risk factors for soil-transmitted helminth (STH) infection among school-going age children from slums of Bhubaneswar. Design: Cross-sectional observational study. Setting: Microbiology laboratory of a tertiary care hospital, Bhubaneswar, during May 1–October 30, 2015 (6 months) including 360 children of 3–15 years from two populated slums of Bhubaneswar, assuming STH prevalence - 50%, confidence interval 95% and 10% relative precision. Purposively sampling by house to house visit was adopted to collect stool samples along with risk factors through questionnaires from each child after written informed consent of parents/guardians. Materials and Methods: Direct saline mount and egg counting by Kato-Katz (KK) method for STH-positive samples was done. Results: STH prevalence was 13.3%, more in males (68.8%), and significantly high (62.5%. P < 0.05) in school-going children between 6 and 12 years of age. Predominant STH was Ancylostoma duodenale (56.2%), 15% of parents were illiterate, 80% of houses had toilets, 70% were washing hand with soap and using footwear. STH infection was much less (12.5%) in those practicing handwashing with soap. Fifty percent of children had STH infection even after receiving deworming within the past 6 months. More egg counts - 216 eggs/gram of feces were found in 29 cases by KK method. Entamoeba histolytica (56.5%) was predominant among non-STH infections. Conclusion: STH prevalence of Bhubaneswar slums was minimum (13.3%), school-going children of 6–12 years were more affected and handwashing habit with soap was the key factor to prevent STH infection. The proportion of participants having toilet facility and using footwear regularly had no role in STH prevention.

Background The primary objective of National NCD monitoring survey (NNMS) was to generate national-level estimates of key NCD indicators identified in the national NCD monitoring framework. This paper describes survey study protocol and prevalence of risk factors among adults (18–69 years). Materials and methods NNMS was a national level cross-sectional survey conducted during 2017–18. The estimated sample size was 12,000 households from 600 primary sampling units. One adult (18–69 years) per household was selected using the World Health Organization-KISH grid. The study tools were adapted from WHO-STEPwise approach to NCD risk factor surveillance, IDSP-NCD risk factor survey and WHO-Global adult tobacco survey. Total of 8/10 indicators of adult NCD risk factors according to national NCD disease monitoring framework was studied. This survey for the first time estimated dietary intake of salt intake of population at a national level from spot urine samples. Results Total of 11139 households and 10659 adults completed the survey. Prevalence of tobacco and alcohol use was 32.8% (95% CI: 30.8–35.0) and 15.9% (95% CI: 14.2–17.7) respectively. More than one-third adults were physically inactive [41.3% (95% CI: 39.4–43.3)], majority [98.4% (95% CI: 97.8–98.8)] consumed less than 5 servings of fruits and / or vegetables per day and mean salt intake was 8 g/day (95% CI: 7.8–8.2). Proportion with raised blood pressure and raised blood glucose were 28.5% (95% CI: 27.0–30.1) and 9.3% (95% CI: 8.3–10.5) respectively. 12.8% (95% CI: 11.2–14.5) of adults (40–69 years) had ten-year CVD risk of ≥30% or with existing CVD. Conclusion NNMS was the first comprehensive national survey providing relevant data to assess India’s progress towards targets in National NCD monitoring framework and NCD Action Plan. Established methodology and findings from survey would contribute to plan future state-based surveys and also frame policies for prevention and control of NCDs.

Undernutrition continues to be a major public health challenge for ages. Under-five age children are still at risk of undernutrition even though there exist many policies and programs at various levels. The lower–middle-income countries (LMIC) struggle hard to combat the undernutrition epidemic. The unprecedented advent of the COVID-19 pandemic has worsened the existing undernutrition scenario. This article reviews the burden and impact of the COVID-19 on undernutrition among children. Necessary measures have to be taken to mitigate the crisis and thereby reduce the risks due to morbidity and mortality related to undernutrition. A manual search of relevant data has been taken from the website of the World Health Organization (WHO), UNICEF, Ministry Health and Family Welfare (MOHFW), government of India. (GOI). A search of relevant publications was done through electronic databases such as PUBMED.

Context: Progress of any nation depends on the health status of the population. A nation's health directly and indirectly depends on the quality of health-care facilities and how healthy the health care workforce is in that country. To achieve the health for all goal and to provide for most of the health services like maternal health services, child health services, nutrition, vaccination, and family planning services, the Indian health system have multipurpose health workers (female and male) and Accredited Social Health Activist to provide these services at the grass-root level. There is a paucity of literature revealing the health problems or the health status of grassroot level primary health care worker in India or abroad. Methods and Material: All the grass-root level health workers, i.e., MPHWF and ASHAs in the BMC area were included in this cross-sectional study. Data was collected using a semi-structured interview schedule, followed by general examination and anthropometry using standard procedures. Results: Half of the study participants 111 (50.2%) were having some or other kind of health issues during the data collection time; among them, 107 (48.4%) had a chronic disease condition. 10% of them had diabetes mellitus. More than half of the study participants 141 (63.8%) were found to be obese and hypertension was found in 27 (12.2%) study participants. 21 (9.5%) study participants were under high depression. One-fourth of the health workers among those who could conceive had not gone for antenatal check-ups and more than one-third (33.5%) never consumed iron and folic acid (IFA) tablets during their first pregnancy. 19.1% have children with incomplete immunization as per age. One-fifth of the participants know about the balanced diet and half of them could not ensure that their family eat a balanced diet and in the majority, the diet was calorie deficient as per the daily requirement. Conclusions: There is an urgent need to formulate a policy to improve the health of the primary care grass-root level health-care workers and regular on-the-job training on nutrition needs to be given to them.

Background Hepatitis C is a global public health problem. As many as 12 million people may be chronically infected in India and most are unaware of it. Aims To determine the incidence of hepatitis C in the Ratia block of the Fatehabad district, Haryana, India. Method This cross-sectional study was carried out by house-to- house visits over 2 weeks. After obtaining written consent, a blood sample was drawn from suspected cases by a laboratory technician maintaining all necessary safety precautions and sterilization.

Health communication forms an important link in a doctor patient relationship. Public health awareness lectures are organised across the world to disseminate key messages related to health and to improve the doctor patient interaction. With a plethora of information in this age of social media, which are many a time incomplete and erroneous, it is all the more important that people get the right information based on scientific evidence. In this article we intend to describe our experience of public awareness lectures held at AIIMS Bhubaneswar over the last one year.

Context: Janani Suraksha Yojna (JSY), a conditional cash transfer scheme aims to encourage women to deliver their babies in medical facilities. Aims: To study the utilization of financial assistance under JSY. Settings: Rural areas of Haryana. Study Design: Cross-sectional study. Participants: Mothers who delivered within last 12 months (January to December 2010) and were entitled for benefits under JSY. Subjects and Methods: This cross-sectional study was conducted in two districts of Haryana. One district each was selected randomly from amongst high and low performing districts, depending upon rate of institutional deliveries. A total of 48 sub-centers were selected by multistage random sampling. Out of the 1476 enlisted JSY beneficiaries, 1386 mothers were interviewed by house-to-house visits, after getting informed consent. Data were collected on a pre-designed, pre-tested, semi-structured questionnaire, and analyzed using the SPSS (version 17.0). Results: About 14% ( n = 189) mothers had not received the financial assistance until the time of interview. Only 7.6% mothers got the financial assistance within 1 month after delivery. In nearly half (48.8%) study subjects, financial assistance was delayed beyond 3 months after delivery. More than half (52.7%) got the JSY assistance in cash and 34.8% by check. The incentive was not properly utilized as it was given to the family pool (70.2%) or put in savings account (5%). Only in about one-fifth of mothers, it was used for mother's care (I7.8%) and child care (5.8%). Conclusion: JSY is an ambitious scheme serving as a safe motherhood intervention under the National Rural Health Mission. It has been reasonably successful in promoting institutional deliveries, but the discrepancy in payment of funds was found in home deliveries as well as institutional deliveries. Therefore, the program managers should make the monitoring system for disbursement of funds more effective.

Objective: To study the utilization of health services by mothers during antenatal, natal and post-natal period under Janani Suraksha Yojna (JSY). Materials and Methods: This cross-sectional study was conducted in rural areas of two districts of Haryana as per the rate of institutional deliveries. A total of 48 sub-centers were selected by multistage random sampling. 1386 JSY beneficiary mothers were interviewed by house-to-house visits, after obtaining informed consent. Results: Majority 1216 (87.5%) of the study subjects were registered between 12-26 weeks of pregnancy whereas only 170 (12.3%) of them were registered within first 12 weeks. Around one-fourth of the mothers did not receive the recommended minimum three antenatal check-ups. The coverage of TT immunization was 92.1%. Majority 1253 (90.4%) of the deliveries were institutional. More than three-fourth of the home deliveries were conducted by trained dais and 15% of the home deliveries were conducted by untrained persons. Out of the 1253 institutional deliveries, 84.6% were conducted in Government institutions while 15.4% deliveries were conducted in Private hospitals. About two-third mothers received at least three post-natal care visits by the health functionaries. Discussion: Janani Suraksha Yojna is an ambitious scheme serving as a safe motherhood intervention under NRHM. It has been fairly successful in promoting institutional deliveries but the key components of Essential Obstetric Care i.e., early antenatal registration, minimum three antenatal care visits, three post-natal care visits still need strengthening.