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For many years now, a variety of studies have proven the strong relationship between productivity and profitability. However, simply earning a profit does not necessarily mean that the firm is productive. Many highly productive firms face financial losses, whereas less productive ones’ experience significant profits. This paper examines the dynamics of how productivity really matters for profitability. The paper uses a non-parametric index number approach to estimate the productivity, profitability, and price performance of a publicly owned, once world’s largest, bus transport corporation operating in the Indian state of Andhra Pradesh to examine these dynamics. The paper finds that when public organizations are constrained from raising the prices of their services, productivity gains may not be adequate to counterbalance the impact of rising prices of major inputs. Moreover, loss-making organizations, even if they are publicly owned, would find it hard to improve both the quality and quantity of their services. [ABSTRACT FROM AUTHOR]

Rapid growth in dairy consumption and food scandals in India in the 2000s increased awareness of food safety issues among consumers and policymakers. This led to the introduction of new standards. However, there is li ttle information about how they affected farm-level activities and whether value chains played any role. Our paper addresses these questions using a two-round panel survey of dairy farms in Punjab and Andhra Pradesh. We find significant improvements in adoption of farm-level hygienic practices, especially in Punjab. Value chain innovations do not play a significant role in stimulating safety and quality improvements among dairy smallholders in India. [ABSTRACT FROM AUTHOR]

The paper reviews a range of global aquaculture health and safety literature to inform and contribute to the development of a socio-economic profile of Indian shrimp farm workers including the occupational hazards and injuries they face. In addition, 60 shrimp farm workers were interviewed from each of the states of Andhra Pradesh, Maharashtra, Gujarat and Tamil Nadu. The study revealed that all shrimp farm workers were male, 58% were migrants, and ages ranged from 23 to 53 years with work experience of 5 to 24 years. Few workers (14%) had no formal schooling and many had secondary-level education. Reported physical hazards were high (93%) followed by biological (82%), chemical (77%), ergonomic (71%) and psycho-social (71%) hazards. The majority of physical injuries reported related to slips, falls and cuts (51%), electric shocks (44%), sunburn (41%), dehydration/ headaches (40%) and fractures (27%). Approximately 30%-39% had some chemical injury with skin infections/breathing problems. Indian shrimp farm workers face similar occupational hazards and injuries to shrimp farm workers in other countries. The occupational health and safety of shrimp farm workers should be integrated into the concept of 'One Health' to ensure aquaculture sustainability and safe, meaningful and good quality employment to workers. [ABSTRACT FROM AUTHOR]

This paper sets out some findings of a research project carried out in private unaided schools in low-income areas of Hyderabad, India. The part of the research project documented here was designed to examine the question: ‘Is the regulatory regime conducive to entrepreneurial action and market discovery’ with particular reference to the low-income schools in Hyderabad. This paper is narrowly focused, setting out the results of pattern matching empirical data with the Austrian economic concepts of entrepreneurship, rivalry, and market discovery. The research discovered that two regulatory regimes exist, one that is set out ‘on paper’ in the Education Acts and associated rules, and another that operates ‘in practice’. That is, there is a combination of regulations ‘on paper’ and regulations existing in an ‘extra-legal’ sector. Generally it was found that the regulations ‘in practice’ are consistent with market principles. Conversely the regulations set out ‘on paper’ are not conducive to entrepreneurial innovation and market discovery. Recommendations for potential policy initiatives include the possibility of legitimising the ‘extra-legal’ sector by introducing self-regulation possibly via self-evaluation systems for the private unaided schools. [ABSTRACT FROM AUTHOR]

Background: Globally, mental health problems are a growing public health concern. Resources and services for mental disorders are disproportionately low compared to disease burden. In order to bridge treatment gaps, The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project was implemented across 12 villages in West Godavari district of the southern Indian state of Andhra Pradesh. This paper reports findings from a process evaluation of feasibility and acceptability of the intervention that focused on a mental health services delivery model to screen, diagnose and manage common mental disorders (CMDs). Methods: A mixed methods evaluation was undertaken using quantitative service usage analytics, and qualitative data from in-depth interviews and focus group discussions were conducted with stakeholders including primary care physicians, community health workers, field staff and community members. Barriers to and facilitators of intervention implementation were identified. Andersen's Behavioral Model for Health Services Use was the conceptual framework used to guide the process evaluation and interpretation of data. Results: In all, 41 Accredited Social Health Activists (ASHAs) and 6 primary health centre (PHC) doctors were trained in mental health symptoms and its management. ASHAs followed up 98.7% of screen positive cases, and 81.2% of these were clinically diagnosed and treated by the PHC doctors. The key facilitators of implementation were adequate training and supervision of field staff, ASHAs and doctors, use of electronic decision support, incorporation of a door-to-door campaign and use of culturally tailored dramas/videos to raise awareness about CMDs, and organising health camps at the village level facilitating delivery of intervention activities. Barriers to implementation included travel distance to receive care, limited knowledge about mental health, high level of stigma related to mental health issues, and poor mobile network signals and connectivity in the villages. Lack of familiarity with and access to mobile phones, especially among women, to accessing health related messages as part of the intervention. Conclusions: The evaluation not only provides a context to the interventions delivered, but also allowed an understanding of possible factors that need to be addressed to make the programme scalable and of benefit to policy makers. [ABSTRACT FROM AUTHOR]

This paper presents the use of thematic collages as a methodological innovation to participatory photography as a research framework. Participatory photography was used to understand the subjective "off-script" motivations behind the full or partial adoption of Zero Budget Natural Farming (ZBNF) by members of women's self-help groups in Andhra Pradesh, India. The addition of thematic collages to existing participatory photography methods was developed as a mechanism to better support the dialogic generation of new Freirean "generative themes" for investigation by a group. Further, the use of thematic collages invites the integration of "renegade" or non-thematic images into participant group analysis. ZBNF is an agricultural practice that has become an extension priority in Andhra Pradesh. It emphasizes the use of defined chemical-free inputs and regenerative farming techniques as a holistic approach toward socio-ecological resilience. As part of an interdisciplinary research project, this participatory photography design was piloted parallel to a soil science experiment in three geographically distinct agroecological zones in Andhra Pradesh. We show how participatory photography, with the novel addition of thematic collages, can be integrated into interdisciplinary research as a method to discover the underlying motivations to adopt agricultural practices and participate in agricultural movements like Zero Budget Natural Farming. [ABSTRACT FROM AUTHOR]

This paper describes the flooding of Kurnool town in Andhra Pradesh, India, in October 2009 and explains how several factors combined to cause one of the worst floods in 100 years. Several areas were submerged in more than 30 feet of water and it took more than three days for the water to recede completely from the town. Drawing on official information and on the responses of affected people, the paper discusses the situation during and after the floods, especially around water and sanitation services, the distribution of relief materials and the post-flood recovery process. Based on this information, the paper proposes several recommendations that are relevant to the policy framework to handle urban floods in similar situations. [ABSTRACT FROM PUBLISHER]

The accumulation of fluoride (F) in groundwater is a common phenomenon in India and worldwide. Its location can be identified through a direct hydrochemical analysis, which was carried out in Kurmapalli watershed (located 60 km SE of Hyderabad city), Nalgonda district, Andhra Pradesh, India affected by F contamination. The results of the hydrochemical analysis showed that F varied from 0.71 to 19.01 mg/l and its concentration exceeded the permissible limit (i.e., 1.5 mg/l) in 78% of the total 32 samples analyzed. The highest F value (19.01 mg/l) was found near Madnapur village, which is located in the central part of the watershed. Resistivity and induced polarization (IP) surveys were also carried out to reveal the zones where elevated F-contaminated groundwater exists. The objective of this paper was to highlight the utility of resistivity and IP surveys, using hydrochemical constituents as constraint, for the successful delineation of such contaminated/polluted groundwater zones in the granite area. [ABSTRACT FROM AUTHOR]

There is a growing concern over the potential accumulation of trace element concentration in groundwater of coastal aquifer owing seawater encroachment in the last several decades. A total of 29 groundwater samples collected from Pesarlanka Island, Krishna delta, Andhra Pradesh, India were analyzed for 13 trace elements (B, V, Mn, Fe, Ni, Co, Cu, Zn, As, Sr, Cd, Ba, and Pb) using inductively coupled plasma mass spectrometry. The results reveal that B, Fe, Ni, As, Sr, and Pb vary from 11.22 to 710.2, 1.25 to 684.6, 0.02 to 37.33, 27.8 to 282.3, 164.1 to 7,009, and 1.97 to 164.4 μg/l, respectively. Ba, Cd, Co, Cu, Ni, V, and Zn are almost within permissible limits for drinking water, but As, Fe, Mn, Pb, B, and Sr are above the permissible limit. The toxic element Pb is 1.64 times more than the maximum permissible limits of drinking water. The minimum value of As is also 2.78 times more, whereas the maximum is 28.2 times the permissible limit. The spatial distributions of alkaline earths (Sr, Ba), transition metals (V, Co, Ni, Fe), metallic elements (Cu, Pb), and (As) were found in considerable variation in the entire Island. Good cross-correlations were found between As, B, Co, and Sr with total dissolved solids and among other trace elements such as B, As, Co, and Sr. The variability observed within the groundwater samples is closely connected to the sea spray input; hence, it is primarily a consequence of geographical and meteorological factors, such as distance from the ocean and time of year. The trace element levels, in particular those of heavy metals, are very low, suggesting an origin from natural sources rather than from anthropogenic contamination. A few trace elements (Sr and B) are found as sensitive parameters responding to changes in fresh to saline groundwater environment. The highly elevated trace elements in this area which may be attributed to marine sediments or death and decay of plants are presented in this paper. [ABSTRACT FROM AUTHOR]

Abstract: Actor-centred institutional analysis can gain through an expanded focus from a focal action situation to the adjacent situations that make up its structure. Equilibrium outcomes in game models of a focal action situation may not be explainable without considering linked games. The concepts of an ‘ecology of games’, ‘nested games’ or economic network analysis indicate the relevance of this move, but a structured approach to heterogeneous networks of adjacent action situations encountered in resource and infrastructure governance has only recently been developed. This paper draws on the adjacency concept and proposes four types of links, a potential boundary for adjacency networks, and a condition for bidirectional causation between linked action situations. The relevance of the theoretical propositions laid out is empirically supported for the analysis of electricity governance of irrigation in Andhra Pradesh. The actual and empirically observed outcomes, as well as the potential capacity of an adjacent action situation to influence focal outcomes, are analysed through a set of stylised game theory models and their links. [Copyright &y& Elsevier]

Abstract: The practical viability of performance-based pay programs for teachers depends critically on the extent of support the idea will receive from teachers. We present evidence on teacher opinions with regard to performance-based pay from teacher interviews conducted in the context of an experimental evaluation of a program that provided performance-based bonuses to teachers in the Indian state of Andhra Pradesh. We report four main findings in this paper: (1) over 80% of teachers had a favorable opinion about the idea of linking a component of pay to measures of performance, (2) exposure to an actual incentive program increased teacher support for the idea, (3) teacher support declines with age, experience, training, and base pay, and (4) the extent of teachers’ stated ex ante support for performance-linked pay (over a series of mean-preserving spreads of pay) is positively correlated with their ex post performance as measured by estimates of teacher value addition. This suggests that teachers are aware of their own effectiveness and that implementing a performance-linked pay program could not only have broad-based support among teachers but also attract more effective teachers into the teaching profession. [Copyright &y& Elsevier]

Participatory approach in forest management emerged as most preferred policy option in most of the developing countries. Participation of communities in forest management has been perceived as panacea for reduction of poverty in forest based economies. In this backdrop, robust reform process by making community a centre for forest management programmes was initiated in India. After two decades of inception, community based forest management could not achieve envisaged results. This situation necessitated for serious revamp of existing policy formulations. In this context, a comparative analysis of community forest management (CFM) in colonial and post-colonial India is useful to trace the micro and macro level dynamics of the policy process. By examining CFM in colonial and post colonial Andhra Pradesh (AP), this paper proposes that community cantered forest management in India had strong colonial legacy consequent upon which the policy initiatives could not delivered expected results. [ABSTRACT FROM AUTHOR]

This paper seeks to identify and analyze the factors that explain differential outcomes of joint forest management (JFM) in the Indian state of Andhra Pradesh. Factors affecting the performances of JFM communities are analyzed using an ordered logit model. The results indicate that JFM communities are more likely to perform well when they are smaller in size and when forest resources in the JFM community are scarce. Presence of social capital and high value forests are also likely to promote good forest growth. Effective protection of forests is likely to contribute to the growth of forests. JFM communities that were initiated by NGOs are more likely to manage forests effectively than the one initiated by the Forest Department. [Copyright &y& Elsevier]

Background: Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75-95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed.Methods: We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived-a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation.Expected Outcomes: The primary study outcome is the difference in mean behaviour scores at 12 months in the combined 'high-risk' and 'non-high-risk' cohort and the mean difference in PHQ-9 scores at 12 months in the 'high-risk' cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations.Significance: The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings.Trial Registration: Clinical Trial Registry India CTRI/2018/08/015355 . Registered on 16 August 2018. [ABSTRACT FROM AUTHOR]

Background: Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change.Methods: We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results.Results: Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD - 1.3 percentage points, 95% CI - 2.6-0.1], on neonatal mortality at age 7 days [DiD - 1.6, 95% CI - 9-6.2] or 28 days [DiD - 3.0, 95% CI - 12.9-6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms.Conclusion: Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective. [ABSTRACT FROM AUTHOR]

Purpose: Oral health literacy (OHL) is a relatively unexplored construct in the Indian context. Most of the few previous studies estimating OHL among different populations of India used instruments that were either previously validated in a different country or not tested for psychometric properties. With this background, the objective of this study was to develop an Indian oral health literacy measure and to evaluate the psychometric properties of the instrument among Telugu speaking population of Andhra Pradesh (IOHLM-T).Materials and Methods: The initial version of the instrument after evaluated for face and content validity was tested for psychometric properties among 200 adult patients visiting the outpatient department of SIBAR Institute of Dental Sciences. Predictive validity of the instrument was checked by the association between IOHLM-T score and oral health impact profile (OHIP-14), decayed-missing-filled teeth (DMFT) scores. Convergent validity was tested by assessing the correlation between IOHLM-T score and rapid estimate of adult literacy in dentistry (REALD-30) score.Statistical Analysis: SPSS version 20 software was used to analyse the data. Independent samples t-test, Pearson's correlation, one-way ANOVA and stepwise multiple linear regression were done to analyse the data.Results: IOHLM-T demonstrated good internal consistency reliability (Cronbach's alpha 0.75), convergent validity (r = 0.34 between Reald-30 and IOHLM-T scores) and predictive validity (significant negative correlation of IOHLM-T with OHIP-14 and DMFT scores).Conclusion: IOHLM-T demonstrates good face validity, content validity, predictive validity, convergent validity and internal consistency reliability and thus can be used among different populations in India after translation to the corresponding languages and evaluation of psychometric properties. [ABSTRACT FROM AUTHOR]

Background: Many LMICs have implemented Publicly Funded Health Insurance (PFHI) programmes to improve access and financial protection. The national PFHI scheme implemented in India for a decade has been recently modified and expanded to cover free hospital care for 500 million persons. Since increase in annual cover amount is one of the main design modifications in the new programme, the relevant policy question is whether such design change can improve financial protection for hospital care. An evaluation of state-specific PFHI programmes with vertical cover larger than RSBY can help answer this question. Three states in Southern India - Andhra Pradesh, Karnataka and Tamil Nadu have been pioneers in implementing PFHI with a large insurance cover.Methods: The current study was meant to evaluate the PFHI in above three states in improving utilisation of hospital services and financial protection against expenses of hospitalization. Two cross-sections from National Sample Survey's health rounds, the 60th round done in 2004 and the 71st round done in 2014 were analysed. Instrumental Variable method was applied to address endogeneity or the selection problem in insurance.Results: Enrollment under PFHI was not associated with increase in utilisation of hospital care in the three states. Private hospitals dominated the empanelment of facilities under PFHI as well as utilisation. Out of Pocket Expenditure and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PFHI in the three states. The size of Out of Pocket Expenditure was significantly greater for utilisation in private sector, irrespective of insurance enrollment.Conclusion: PFHI in the three states used substantially larger vertical cover than national scheme in 2014. The three states are known for their good governance. Yet, the PFHI programmes in all three states failed in fulfilling their fundamental purpose. Increasing vertical cover of PFHI and using either 'Trusts' or Insurance-companies as purchasers may not give desired results in absence of adequate regulation. The study raises doubts regarding effectiveness of contracting under PFHIs to influence provider-behavior in the Indian context. Further research is required to find solutions for addressing gaps that contribute to poor financial outcomes for patients under PFHI. [ABSTRACT FROM AUTHOR]

Fluoride (F) content varies from 0.60 to 1.80 mg/L in the coastal region between Chirala and Ongole of Andhra Pradesh, India. It exceeds the threshold limit of 1.20 mg/L in 20 % of the total groundwater samples. The aim of the present study is to assess the controlling factors of F content. The study area experiences a dry climate and is underlain by Charnockite Group of rocks over which the river and coastal alluvium occur. The results of the study identify the four factors that control the high F content. First one is related to alkalinity, leading to active dissolution and leaching of F-bearing minerals, which supports the positive correlation of F with pH and HCO . A longer water residence time in the clays is the second factor, which activates not only solubility and dissolution of F-bearing minerals, but also anion exchange between F and OH. Third factor is a result of higher Na due to impact of saline water, ion exchange between Na and Ca, and precipitation of CaCO. This reduces the Ca content, causing dissolution of CaF to maintain the chemical equilibria, which is supported by positive correlation between Na and F. The influence of anthropogenic activities is the last factor, which acts as an additional source of F. Thus, the shallow groundwater shows higher content of F and the hydrogeochemical facies also support this hypothesis. The study suggests the remedial measures to reduce the F content. [ABSTRACT FROM AUTHOR]

The present study was conducted to analyze tree species diversity in the tropical forests of the Eastern Ghats of northern Andhra Pradesh, India. A total of 270 species of trees (=15cm girth at breast height) pertaining to 177 genera belonging to 55 families were recorded. Among the 270 species, 141 species were observed to be common, 78 were occasional and 51 species were rare in the study area. Fabaceae was the dominant family with 33 species followed by Rubiaceae with 15 species and Malvaceae, Moraceae and Phyllanthaceae with 13 species each. The genera with the highest number of species include Ficus (12 species), Diospyros (8 species), Albizia and Grewia (6 species each), Acacia and Bauhinia (5 species each). Forty-five percent of the species were indigenous. This illustrates the diversity of the tree species in the studied area of the Eastern Ghats and also emphasizes the need for their conservation. [ABSTRACT FROM AUTHOR]

Background A decline in HIV prevalence among female sex workers (FSWs) has been reported from the Indian state of Andhra Pradesh between the two rounds of integrated biological and behavioural assessment (IBBA) surveys in 2005–06 and 2009, the first of these around the time of start of the Avahan HIV prevention intervention. In order to facilitate further planning of FSW interventions, we report the factors associated with HIV prevalence among streetbased FSWs. Methods Behavioural data from the two rounds of IBBA surveys, district-level FSW HIV prevention program data, and urbanisation data from the Census of India were utilized. A multilevel logistic model was used to investigate factors associated with inter-district variations in HIV positivity among street-based FSWs in the districts by fitting a two-level model. Results The estimated HIV prevalence among street-based FSWs changed from 16% (95% confidence interval [CI] 14.2 – 17.7%) to 12.9% (95% CI 11.5 – 14.2%) from 2005–06 to 2009. HIV positivity was significantly higher in districts with a high proportion of FSWs registered with targeted interventions (odds ratio [OR] 2.02; 95% CI 1.18-3.45), and in districts with medium (OR 2.54; 95% CI 1.58-4.08) or high (OR 1.55; 95% CI 1.05-2.29) proportion of urban population. Districts which had met the condom requirement targets for FSWs had significantly lower HIV positivity (OR 0.50; 95% CI 0.26-0.97). In round 2 survey, the districts with medium level urbanisation had significantly higher proportion of FSWs registered with HIV intervention programmes and also reported higher consistent condom use with regular partner (p < 0.001). Conclusions Variations in HIV positivity among street-based FSWs were seen at the district level in relation to HIV intervention programs and the degree of urbanization. These findings could be used to enhance program planning to further reduce HIV transmission in this population. [ABSTRACT FROM AUTHOR]

Background Two rounds of integrated biological and behavioural assessment (IBBA) surveys were done among men who have sex with men (MSM) in Andhra Pradesh during 2006 and 2009. Avahan, the India AIDS initiative, funded by the Bill and Melinda Gates Foundation implemented HIV prevention interventions among MSM starting around the time of the first round of IBBA. Methods Data on socio-demographic, sex behaviour characteristics and HIV status of MSM from the two IBBA rounds were used. Changes in the rates of consistent condom use over the past one month by MSM with various types of partners between the two rounds were assessed. Multivariate analysis was performed to assess associations between various factors and inconsistent condom use for sex with regular partners as well as HIV in MSM. Results A significant increase in consistent condom use by MSM was noted from 2006 to 2009 for paid male partners (19.5% to 93.8%), occasional male partners (13.2% to 86.2%), and paid female partners (25.9% to 94.2%). Consistent condom use with regular sex partners also increased but remained lower with regular male partner (75.8%) and very low with regular female partners (15.7%). MSM who used condoms inconsistently with their regular male partner were also more likely to use condoms inconsistently with their regular female partner. Multivariate analysis showed MSM who used condoms inconsistently with regular male partner had higher odds of HIV (odds ratio 1.8; 95% CI 1.2-2.7). MSM who received condoms from Avahan had the lowest odds (odds ratio 0.3; 95% CI 0.1-0.5) of inconsistent condom use with regular male partners. Conclusions Condom use by MSM increased markedly after implementation of Avahan, though a causal association cannot be assessed with the available data. The relatively lower condom use with regular partners of MSM suggests that additional programme effort is needed to address this aspect specifically. [ABSTRACT FROM AUTHOR]

In 2007 the state of Andhra Pradesh in southern India began rolling out Aarogyasri health insurance to reduce catastrophic health expenditures in households 'below the poverty line'. We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that within the first nine months of implementation Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population. [ABSTRACT FROM AUTHOR]

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In India, groundwater assessment units are classified as overexploited areas, critical areas, semi-critical, or safe areas based on the stage of groundwater development and long-term water level trends. Intuitively, in the safe units, wells are expected to function and have good yields. Besides, in the safe units, new wells are expected to be successful. Conversely, the expectation of a successful well or wells with good yields is much lesser in the overexploited units. However, when these expectations are not met in the field, doubts are raised about the quality of assessment and its usefulness, and there is outright distrust on the agencies assessing groundwater resource by the common man as well as on the planners, administrators, and the politicians. Therefore, there is a need to present the results in a way that does not create confusion. One of the methods is to combine the assessment results with aquifer characters using geographic information system (GIS); when this is done, a whole set of newer classes emerge, which can be mapped. These classes are termed as groundwater typologies in this study. Each typology has some characteristics or traits in common, which include basic aquifer character as well as the stage of groundwater development. Thus, a class may be safe, but if the aquifer is poor, then it is separated from a class that is safe and where the aquifer is good and so on. In Andhra Pradesh, which is taken as the case study for this purpose, eight main typologies emerged, and two of these main typologies were further divided into four subtypologies each. This new way of understanding the pattern of groundwater abstraction (using GIS) has a better visual impact. Groundwater typologies are found to be much more rational and useful in developing management strategies, rather than simple listing as overexploited areas, critical areas, semi-critical areas, and safe areas as is commonly done. The typologies so delineated indicate on the map (or table) that balanced usable groundwater is in between 5 and 6 bcm/a as against the estimated balance of 20.5 bcm/a, and it is largely in poor hard rock type of aquifers, which occupy about a third of the area of the state. [ABSTRACT FROM AUTHOR]

Child stunting, an outcome of chronic undernutrition, contributes to poor quality of life, morbidity and mortality. In South Asia, the low status of women is thought to be one of the primary determinants of undernutrition across the lifespan. Low female status can result in compromised health outcomes for women, which in turn are related to lower infant birthweight and may affect the quality of infant care and nutrition. Maternal autonomy (defined as a woman's personal power in the household and her ability to influence and change her environment) is likely an important factor influencing child care and ultimately infant and child health outcomes. To examine the relationship between maternal autonomy and child stunting in Andhra Pradesh, India, we analysed data from National Family Health Survey (NFHS)-2. We used cross-sectional demographic, health and anthropometric information for mothers and their oldest child <36 months ( n = 821) from NFHS-2. The main explanatory variables of autonomy are presented by four dimensions – decision making, permission to travel, attitude towards domestic violence and financial autonomy – constructed using seven binary variables. Logistic regression models were used to test associations between indicators of female autonomy and the risk of having a stunted child. Women with higher autonomy {indicated by access to money [odds ratio (OR) = 0.731; 95% confidence interval (CI) 0.546, 0.981] and freedom to choose to go to the market [OR = 0.593; 95% CI 0.376, 0.933]} were significantly less likely to have a stunted child, after controlling for household socio-economic status and mother's education. In this south Indian state, two dimensions of female autonomy have an independent effect on child growth, suggesting the need for interventions that increase women's financial and physical autonomy. [ABSTRACT FROM AUTHOR]

Groundwater chemistry has been studied to examine the associated hydrogeochemical processes operating for the development of salinity in the groundwater in parts of Guntur district, Andhra Pradesh, India. The study area is underlain by charnockites and granitic gneisses associated with schists of the Precambrian Eastern Ghats. Groundwater is the main resource for irrigation besides drinking. Chemical parameters, pH, EC, TDS, Ca2+, Mg2+, Na+, K+, $$ {\text{CO}}^{{{\text{2}} - }}_{{\text{3}}} $$ , $$ {\text{HCO}}^{ - }_{{\text{3}}} $$ , Cl−, $$ {\text{SO}}^{{{\text{2}} - }}_{{\text{4}}} $$ , $$ {\text{NO}}^{ - }_{{\text{3}}} $$ , F− and SiO2, are taken into account. Groundwater is of brackish type. Na+−Cl− facies dominates the groundwater. Examination of compositional relations and mineral saturation states shows that the ion exchange of Ca2+ for adsorbed Na+, evapotranspiration, dissolution of soil salts, dissolution of NaCl and CaSO4, and precipitation of CaCO3 are the dominant hydrogeochemical processes associated with the groundwater composition in the area. Evapotranspiration causes accumulation of salts in the soil/weathered zone. These salts reach the water table by leaching through infiltrating recharge water. A positive relation between depth to water table and TDS with season supports this inference. The effects of human activities, such as intensive and long-term irrigation, irrigation-return-flow, application of unlimited agricultural fertilizers and recycling of saline groundwater, act to further increase the salinity in the groundwater. Therefore, the groundwater quality increases towards the flow path, while the post-monsoon groundwater shows higher concentrations of TDS, Na+, Mg2+, Cl−, $$ {\text{SO}}^{{{\text{2}} - }}_{{\text{4}}} $$ , $$ {\text{NO}}^{ - }_{{\text{3}}} $$ , F− and SiO2 ions. The study could help to understand the hydrogeochemical characteristics of the aquifer system for taking effective management measures to mitigate the inferior groundwater quality for sustainable development. [ABSTRACT FROM AUTHOR]

Trace elements are essential for human health. However, excess concentrations of these elements cause health disorders. A study has been carried out in Visakhapatnam environs, Andhra Pradesh, India to ascertain the causes for the origin and distribution of iron content in the groundwaters. Fifty groundwater samples are collected and analyzed for iron. The content of iron ranges from 400 to 780 μg/l. A comparison of groundwater data with rock and soil chemistry suggests that the concentration of iron (400–530 μg/l) in the groundwaters is derived from the rocks and soils due to geogenic processes. This concentration is taken as a natural occurrence of iron in the groundwaters of the study area for assessing the causes for its next higher content (>530 μg/l). Relatively higher concentration of iron (540–550 μg/l) is observed at some well waters, where the wells are located nearby municipal wastewaters, while the very high concentration of iron (610–780 μg/l) is observed in the industrially polluted groundwater zones, indicating the impact of anthropogenic activities on the groundwater system. These activities mask the concentration of iron caused by geogenic origin. Hence, both the geogenic and anthropogenic activities degrade the groundwater quality. Drinking water standards indicate that the iron content in all the groundwater samples exceeds the permissible limit (300 μg/l) recommended for drinking purpose, causing the health disorders. Necessity of close monitoring of groundwater quality for assessing the impact of geogenic and anthropogenic sources with reference to land use/land cover activities is emphasized in the present study area to protect the groundwater resources from the pollution. [ABSTRACT FROM AUTHOR]

Objectives:To describe prevalence of malnutrition and their correlates of nutrient and traditional food consumption in rural Dalit mothers.Design:In a cross-sectional study, we used socio-cultural questionnaires, anthropometric measurements and clinical eye examinations during the rainy season in 2003. Food frequency questionnaires and 24-h recalls were conducted during both summer and rainy seasons.Setting:Dalit mothers with young children were recruited from 37 villages in the Medak District of rural Andhra Pradesh, India.Subjects:Dalit mothers (n=220) participated.Results:The prevalence of chronic energy-deficient (CED) mothers (body mass index <18.5 kg/m2) was 58%. Illiterate women and active women were more likely to have CED than those literate and non-active (relative risks (RR)=1.6 and 1.4, respectively, P0.05), but literacy and activity level were not significant in multivariable analyses including sanitation and number of children 5 years of age. Increasing levels of fat intake, as a percent of total energy, was significantly associated with lower risk of CED (RR of the lowest 25th percentile compared to those in the 75th percentile or above was 1.6, P0.05), findings that remained significant in multivariable analyses. Consumption of pulses (g/day) was also inversely related to CED in univariate and multivariable analyses. Carbohydrate intake, as a percent of total energy, was inversely related to percent energy from fat (r=−0.96, P0.01), and, although positively related to CED in univariate analyses, carbohydrate consumption was not significant in multivariable analyses. Mothers' age in years and income was positively related to vitamin A deficiency.Conclusions:These results confirm that CED and vitamin A malnutrition among Dalit women are predominant problems in this area. Increased consumption of local traditional Dalit food (particularly sorghum, pulses, vegetables and animal source food) should be incorporated as an important component of intervention strategies to improve nutritional status.Sponsorship:Supported by the International Development Research Centre, Ottawa and the Swiss Foundation for Nutrition Research, Zürich.European Journal of Clinical Nutrition (2006) 60, 1277–1283. doi:10.1038/sj.ejcn.1602449; published online 24 May 2006 [ABSTRACT FROM AUTHOR]

Background: Schoolchildren are good agents of change and need to be educated and sensitized to specific issues of hunger and malnutrition through a question-and-answer process. Feeding Minds and Fighting Hunger (FMFH), a global project initiated by the Food and Agriculture Organization and partner organizations, attempts to help schoolchildren learn about these issues by introducing concepts in the prevention of hunger and malnutrition to teachers, and by facilitating transfer of knowledge to the children through a set of model lessons.Objective: To test the feasibility of the FMFH approach to improve the nutrition knowledge of rural schoolchildren in three rural schools in Medak District of the South Indian state of Andhra Pradesh.Methods: Participatory workshops for teachers were conducted to facilitate knowledge transfer to the children through interactive classroom teaching and other activities. The change in knowledge and thinking of children in the seventh and eighth grades was assessed by a ques- tionnaire administered before and after the intervention. The questionnaire also assessed, in part, the status of local food security based on the sources of different food items in the households.Results: The responses to the questionnaire suggested that the children's knowledge of nutrients and their functions was not good initially but improved after the intervention. However, their understanding of the social factors responsible for hunger and malnutrition was fairly good prior to the intervention. Improvement in responses to the question of what should be done to combat malnutrition also occurred after intervention. The community had village-level food security for rice and maize but depended partially or fully on outside sources for pulses, fruits and vegetables, and animal products.Conclusions: The FMFH approach can be applied in rural schools where "the poorest of the poor" children can improve their understanding of balanced diets, better nutrition, the causes of malnutrition, and approaches to combat malnutrition. [ABSTRACT FROM AUTHOR]

High resolution satellite imagery and modern machine learning methods hold the potential to fill existing data gaps in where crops are grown around the world at a sub-field level. However, high resolution crop type maps have remained challenging to create in developing regions due to a lack of ground truth labels for model development. In this work, we explore the use of crowdsourced data, Sentinel-2 and DigitalGlobe imagery, and convolutional neural networks (CNNs) for crop type mapping in India. Plantix, a free app that uses image recognition to help farmers diagnose crop diseases, logged 9 million geolocated photos from 2017–2019 in India, 2 million of which are in the states of Andhra Pradesh and Telangana in India. Crop type labels based on farmer-submitted images were added by domain experts and deep CNNs. The resulting dataset of crop type at coordinates is high in volume, but also high in noise due to location inaccuracies, submissions from out-of-field, and labeling errors. We employed a number of steps to clean the dataset, which included training a CNN on very high resolution DigitalGlobe imagery to filter for points that are within a crop field. With this cleaned dataset, we extracted Sentinel time series at each point and trained another CNN to predict the crop type at each pixel. When evaluated on the highest quality subset of crowdsourced data, the CNN distinguishes rice, cotton, and "other" crops with 74% accuracy in a 3-way classification and outperforms a random forest trained on harmonic regression features. Furthermore, model performance remains stable when low quality points are introduced into the training set. Our results illustrate the potential of non-traditional, high-volume/high-noise datasets for crop type mapping, some improvements that neural networks can achieve over random forests, and the robustness of such methods against moderate levels of training set noise. Lastly, we caution that obstacles like the lack of good Sentinel-2 cloud mask, imperfect mobile device location accuracy, and preservation of privacy while improving data access will need to be addressed before crowdsourcing can widely and reliably be used to map crops in smallholder systems. [ABSTRACT FROM AUTHOR]

In total, 123 groundwater samples were collected to evaluate the suitability for drinking purpose in a rural part of Andhra Pradesh, India. The groundwater is alkaline in nature and pH varying from 7.18 to 9.32 with a mean value of 8.36. The hydrogeochemical analysis reveals that the fluoride concentration varies from 0.4 to 5.8 mg/L with a mean of 1.98 mg/L. Higher fluoride concentration is found in west-central parts of Markapur region. The villagers have been exposed to the intake of high fluoride-bearing groundwater for the prolonged period and suffering from the deadly disease fluorosis. However, with respect to groundwater chemistry, the fluoride concentration is high in Na+–HCO3−-type groundwater and low in Ca2+–HCO3−-type groundwater in the Markapur region. Data plotted in Gibbs diagram show that all groundwater samples fall under rock weathering dominance group with a trend toward the evaporation dominance category. Therefore, rock–water interaction is the primary cause of elevated fluoride in the groundwater of the study region. Furthermore, a significant positive correlation exists between F− and pH, HCO3- as well as negative correlation exists between F- and Ca2+ and NO3−, which supports that the alkaline nature of water is the main cause for dissolving fluoride-bearing minerals. [ABSTRACT FROM AUTHOR]