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Background: Progress has been made in the reduction of under-five mortality in India; however, neonatal mortality is reducing at a slower rate. Efforts are required to bring down neonatal mortality in order to attain the Sustainable Development Goal-3. Prevention of sepsis among the high-risk, vulnerable low birth weight neonates by a newer intervention with probiotic supplementation is promising.Methods: A phase III, multicenter, randomized, double-blind, placebo-controlled study is being conducted at six sites in India. A total of 6144 healthy low birth weight (LBW) infants fulfilling the eligibility criteria would be enrolled within the first week of life, after obtaining written informed consent from the parents of the infant. Randomization in 1:1 ratio, stratified by site, sex, and birth weight, would be done through an interactive web response system (IWRS) using a standard web browser and email service. Vivomixx®, a probiotic containing a mix of 8 strains of bacteria, in a suspension form standardized to deliver 10 billion CFU/ml, or an organoleptically similar placebo would be fed to enrolled infants in a 1-ml/day dose for 30 days. The follow-up of enrolled infants for 60 days would take place as per a pre-specified schedule for recording morbidities and outcome assessments at the six participating sites. Screening for morbidities would be conducted by trained field workers in the community, and sick infants would be referred to designated clinics/hospitals. A physician would examine the referred infants presenting with complaints and clinical signs, and blood samples would be collected from sick infants for diagnosis of neonatal sepsis by performing sepsis screen and blood culture. Appropriate treatment would be provided as per hospital protocol. The study would be implemented as per the MRC guideline for the management of Global Health Trials in accordance with ICH-GCP and Indian Regulatory guidelines. A contract research organization would be engaged for comprehensive monitoring and quality assurance. The final analysis would be conducted in a blinded manner as per the statistical analysis plan (SAP) to estimate the primary outcomes of sepsis, possible serious bacterial infection (PSBI), and secondary outcomes. The codes will be broken after DMC permission. The protocol has been reviewed by the Research Ethics Committee of the Liverpool School of Tropical Medicine (REC-LSTM), from Research Ethics Committees of the six subject recruitment participating sites.Discussion: This adequately powered and well-designed trial would conclusively answer the question whether probiotics can prevent neonatal sepsis in the high-risk group of low birth weight infants as indicated by a pilot study in 1340 LBW infants, evidence from systematic reviews of hospital-based studies, and a primary study on healthy newborns in Orissa. Results of the study would be generalizable to India and other low-middle-income countries.Trial Registration: Clinical Trial Registry of India (CTRI) CTRI/2019/05/019197 . Registered on 16 May 2019. [ABSTRACT FROM AUTHOR]

Background: Community participation is one of the core principles of primary healthcare. The village health nutrition and sanitation committee (VHNSC), one of the elements in implementation of the National Health Mission (NHM), is an example of community participation. There are not many studies conducted to assess the actual participation of VHNSC in health-care delivery at the village level. Objective: The objective of the study is to develop a VHNSC Maturity Index (VMI) and pilot it to assess the institutional maturity of VHNSC. Materials and Methods: This community-based, cross-sectional study was conducted in 83 villages under four Primary Health Centres (PHCs) of the Wardha Community Development block. VMI was developed, Through several discussion sessions with VHNSC members and staff of the DCM; observations of VHND; attending VHNSC monthly meetings; the VMI was finalized after piloting it in all the four PHC areas. Results: All the 83 VHNSCs were constituted as per norms led down under NHM. Forty-eight (57.8%) VHNSCs had developed an annual Village Health Action Plan, 72 (86.7%) VHNSCs had ≥4 meetings held in the past 6 months, and ≥70% attendance in the past 6 months was observed in 40 (48.2%) VHNSCs. A majority of 82 (98.8%) VHNSCs helped in organizing the village health and nutrition day, 59 (71.1%) VHNSCs monitored the implementation of national health programs. The entire untied fund received in the previous year was utilized by 68 (81.9%) VHNSCs. Conclusion: The study shows that VMI can be used for continuous monitoring and assessment tool for VHNSC to evaluate and plan different health activities. [ABSTRACT FROM AUTHOR]

Background: Depression is the most common psychiatric disorder among elderly population in India, yet, it is commonly misdiagnosed and undertreated. The exact burden of depression among the elderly population in rural India was not known. Objectives: To study the magnitude of depression among the elderly masses in rural Maharashtra and to find its correlates. Material and Methods: This is a cross sectional study, carried out among the elderly (≥60 years) population of both sexes residing in the field practice area of the department of community medicine. Geriatric depression scale was used for screening depression among the study population. Data collection was completed within 2 months using convenience sampling. Ethical approval was taken before beginning the study. Magnitude was expressed in percentage along with its 95% confidence interval (CI). Univariate and multivariate logistic regression was carried out to study associated correlates. Odds ratio and 95% CI was used to express association. Results: The magnitude of depression among the elderly population was found to be 41.7% (95% CI 36.1-47.4). We got the significant positive association of female sex, living without spouse, lacking in decision making capability, a victim of abuse or neglect, or suffering from chronic illnesses with depression among elderly population in univariate analysis that did not hold good in the multivariate logistic regression. Our study showed the prevalence of mild depression among elderly to be 26.72% and that of severe depression to be 15.17%. Conclusion: To deal with this huge social problem of depression among the elderly population, more enthusiastic steps should be undertaken. [ABSTRACT FROM AUTHOR]

Background & objectives: In India, health expenditure accounts for less than 5 per cent of the Gross Domestic Product and the level of out-of-pocket (OOP) spending is 69.5 per cent of total health expenditures. OOP expenditure exacerbates poverty and has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. This study was conducted to estimate the OOP expenditure on health and catastrophic health expenditure and their socio-demographic determinants in a rural area of Maharashtra, India. Methods: This was a prospective observational study involving monthly follow up visits, done in 180 households of three villages under a primary health centre in Wardha district, India. Results: Of the 180 families, 18.9 per cent had catastrophic health expenditure over a period of one year. The median total out-of-pocket health expenditure was ₹ 1105.00 with median medical expenditure being ₹ 863.85 and median non-medical health expenditure being ₹ 100.00. A total of 151 (83.9%) had enough money, 27 (15%) borrowed money and two (1.1%) of them sold assets. The significant correlates for the ratio of out-of-pocket health expenditure to total annual income of the family were the occupation of head of family, caste category and type of village. The significant correlate for catastrophic health expenditure was type of village. Interpretation & conclusions: Around one-fifth of the households had catastrophic health expenditure. People with no healthcare facility located in their village had higher odds of having catastrophic health expenditure. Private providers were preferred for the treatment of acute illnesses and medical college hospitals for hospitalization. [ABSTRACT FROM AUTHOR]