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Abstract Background Antenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21. Methods This study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother’s age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data. Results The findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019–2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women’s education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media. Conclusion Despite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women’s care experiences.

Abstract Background Early marriage and motherhood have long been prevalent in India, with 44.5% of women aged 20–24 reporting marriage before 18 in NFHS 3 (2005–2006), dropping to 26.8% in NFHS 4 (2015–2016). Early motherhood has also seen a significant decline, with first births by age 18 decreasing from 34.3% in NFHS I to 8.2% in NFHS V. Despite these improvements, significant regional disparities persist due to social, normative, and legal factors. This study investigates the spatial heterogeneity of early marriage and motherhood across Indian districts, offering a multilevel analysis that reveals critical local variations often obscured at broader levels. Understanding these patterns is crucial for targeted policy interventions and addressing the root causes of early marriage and motherhood. Methods Utilizing data from the fifth round of National Family Health Survey, this study employs multilevel logistic regression and geospatial analysis to assess the determinants and spatial distribution of early marriage and early motherhood among ever-married women in India. The analysis incorporates individual, household, and community-level variables, complemented by spatial analysis techniques, including Empirical Bayes Bivariate Moran’s I values and LISA cluster maps, to identify regional patterns and hotspots. Results This study revealed that educational attainment emerged as a critical determinant, with uneducated women significantly more likely to marry early. Socioeconomic factors, such as poverty and limited mass media exposure, also heightened the risk of early marriage and motherhood. Caste and religion were significantly associated with these events, with marginalized groups facing higher prevalence. Spatial analysis revealed significant geographic disparities, with central and eastern regions showing higher concentrations of early marriage and motherhood. District-level characteristics and the influence of neighboring districts were also significant, highlighting the importance of localized interventions. Conclusions The findings underscore the critical role of education, economic empowerment, and media literacy in mitigating early marriage and motherhood risks. The study calls for multi-sectoral interventions in geographical hotspots to break the cycle of early family formation and promote reproductive health. Policies enhancing educational opportunities, addressing economic disadvantages, and considering district-specific factors are essential. Comprehensive strategies are necessary to empower women, foster reproductive health, and address the multifaceted nature of early marriage and motherhood in India.

Introduction Colorectal cancer (CRC) poses a significant global health threat, necessitating early detection. Traditional diagnostic tools like optical colonoscopy have limitations prompting our ‘5G-SUCCEEDS’ initiative to explore a novel approach involving remote colon capsule endoscopy (CCE).Methods This prospective feasibility study was conducted at a single hospital in England. Between December 2022 and September 2023, we introduced a remote CCE service within the 5G-SUCCEEDS framework. We undertook a feasibility study of CCE in patients with low-risk/moderate-risk CRC stratified by faecal haemoglobin. Outcomes included carbon footprint analysis (outlined through three potential clinical pathways) and patient-reported outcomes through structured questionnaires and interviews.Results Among 25 participants, 88% expressed satisfaction with remote CCE. 82% were willing to have remote CCE if clinically indicated in future. CCE findings included adenomatous polyps (58%), normal results (17%) and diverticulosis (21%), with no cancers identified in this pilot. Notably, we found that the carbon footprint associated with delivery of CCE at home (pathway 3) was lower compared with CCE delivered in a clinical setting (pathway 2). A fully optimised, automated scaled-up pathway would combine the delivery and collection of CCE equipment within a local area to reduce the carbon footprint of the travel element by 75%. Moreover, the conversion rate into a colonoscopy pathway is not static and clinicians acknowledge that this could be as low as 28%. Carbon footprint is more favourable for home-delivered CCE in the optimised scenario, while less so when considering the need for additional procedures (colonoscopy conversion).Conclusion The 5G-SUCCEEDS initiative highlights the feasibility and advantages of home-based diagnostics using CCE.

Abstract Putting an end to the silent pandemic of unsafe abortion is a major public health concern globally. Adoption of post-abortion contraception is documented as a significant contributor to reduce the number of unintended pregnancies and number of induced abortions. This study aimed at investigating the post abortion contraceptive behavior of Indian women exploring the determinants of post-abortion contraceptive uptake. Retrospective calendar data for 6,862 women aged 15–49 years from fifth round of National Family Health Survey (2019–2021) was used for the study. Multinomial logistic regression method was used to model the determinant factors to post-abortion contraceptive uptake. 72.6% women reported adopting no method of contraception after the abortion procedure. A total of 27.4% women adopted some method of contraception after abortion. 14% women preferred adopting short term modern methods. Women in early reproductive age group which is the most vulnerable group in experiencing unintended pregnancies are less likely to adopt any contraceptive method after abortion. Uptake of post abortion contraception is quite low in India. Effort should be taken in the direction of bringing awareness through provision of targeted contraceptive counselling after abortion.

Abstract Background Women in their reproductive age have tremendous health implications that affect their health and well-being. Anaemia is an indicator of inadequate dietary intake and poor health. Maternal malnutrition significantly impacts maternal and child health outcomes, increasing the mother's risk of dying during delivery. High-risk fertility behaviour is a barrier to reducing mother and child mortality. This study aims to examine the level of high-risk fertility behaviour and anaemia among ever-married urban Indian women and also examine the linkages between the both. Methods Based on the National Family Health Survey's fifth round of data, the study analyzed 44,225 samples of ever-married urban women. Univariate and bivariate analysis and binary logistic regression have been used for the analysis. Results Findings suggested that more than half (55%) of the urban women were anaemic, and about one-fourth (24%) of women had any high-risk fertility behaviour. Furthermore, the results suggest that 20% of women were more vulnerable to anaemia due to high-risk fertility behaviour. For the specific category, 19% and 28% of women were more likely to be anaemic due to single and multiple high-risk fertility. However, after controlling for sociodemographic factors, the findings showed a statistically significant link between high-risk fertility behaviour and anaemia. As a result, 16% of the women were more likely to be anaemic due to high-risk fertility behaviour, and 16% and 24% were more likely to be anaemic due to single and multiple high-risk fertility behaviour, respectively. Conclusions The findings exposed that maternal high-risk fertility behaviour is a significant factor in raising the chance of anaemia in ever-married urban women of reproductive age in forms of the short birth interval, advanced maternal age, and advanced maternal age & higher order. Policy and choice-based family planning techniques should be employed to minimize the high-risk fertility behaviour among Indian urban women. This might aid in the reduction of the malnutrition status of their children.

Abstract Aim Recent National Family Health Survey results portray striking improvements in most population and health indicators, including fertility, family planning, maternal and child health, gender treatment, household environments, and health insurance coverage of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), with all India resonance. However, the prevalence of any anaemia (

Abstract In recent years, developing and developed countries are witnessing delayed childbearing among women contributing to the overall decline in fertility rates. The age at which a woman has her last child impacts maternal and child health, especially in a country with high maternal and perinatal mortality rates. This study aims to investigate the trends of age at the last birth among Indian women and to identify the potential factors contributing towards higher maternal age. The present study uses the data from five consecutive rounds (1992–1993, 1998–1999, 2004–2005, 2015–2016, and 2019–2021) of the National Family Health Survey (NFHS). We have used descriptive statistics, bivariate, Cox proportional hazard regression analysis, multiple classification analysis (MCA), Kaplan–Meier curve, life table survival analysis, hierarchical clustered heat map, multivariate decomposition analysis (MDA) and geospatial mapping to fulfill the objective of the study. Results show that the proportion of women with age at last birth before reaching the age of 30 years was less than half (nearly 35%) during NFHS-I while during NFHS-V proportion becomes more than half and reaches 64.3% among 40–49 years women. Within three decades (1992–2021) there has been a decline of 15.8% in median age at last birth among women aged 40–49 years. Additionally, the highest percentage decline in predicted mean age at last birth was noted among individuals from rural area (10.7%, 3.3 years), Hindu religion (10.8%, 3.3 years), poor wealth quantile (12.5%, 4.0 years) and those with mass media exposure (10.6%, 3.2 years) from NFHS-I (1992–1993) to NFHS-V (2019–2021). Although there exists the need to delay age at first childbirth, the age at last childbirth also plays an important role in women’s and child health status. Hence, it is important to address the healthcare needs of those delaying their childbirth.

Abstract The disproportionate share of contraceptive use by women makes family planning services women-centric in India. The meagre and declining share of male-based contraceptive use, along with the overwhelming prevalence of female sterilization, has its underpinning in the lack of emphasis on fertility regulation with the use of temporary methods. The recent trends in the share of contraceptive choices not only contest the most touted cafeteria approach but also serves counter to the National Health Policy target of increasing vasectomy prevalence. Hence an inspection of trends in vasectomy may help in course correction needed to realise NHP targets.

Abstract Introduction Reproductive health events have changed fertility and family planning needs, depicting the changing life patterns of women and the population to which they belong. Understanding the pattern at which these events occur helps in understanding the fertility pattern, family formation and the idea about health essential needs for women. This paper attempts to see the variation in reproductive events (first cohabitation, first sex and first birth) over three decades and also to see potential contributing factors among the reproductive age group of women using secondary data from Data Source: All rounds of the National Family Health Survey (1992-93 to 2019–2021) have been utilized. Methods and Results Cox Proportional Hazard Model illustrates that all regions have initiated their first birth later than women who belong to the east region similar pattern has been obtained for first cohabitation and first sex except for the central region. Multiple Classification Analysis (MCA) depicts the increasing pattern in the predicted mean age at first cohabitation, sex and birth for all demographic characteristics; the highest increment was found in SC women, Uneducated women and Muslim women. Kaplan Meier Curve demonstrates that women with no education, primary or secondary education are shifting towards higher educated women. Most importantly, the results of the multivariate decomposition analysis (MDA) revealed that education played the largest contribution among the compositional factors in the overall increase in mean ages at key reproductive events. Conclusions Though reproductive health has long been essential in women’s lives, they are still very confined to specific domains. Over time the government has formulated several proper legislative measures relating to various domains of reproductive events. However, given that the large size and heterogeneity in social and cultural norms result in changing ideas and choices regarding the initiation of reproductive events, national policy formulation needs to be improved or amended.

Background and aims Bleeding from parastomal varices causes significant morbidity and mortality. Treatment options are limited, particularly in high-risk patients with significant underlying liver disease and other comorbidities. The use of EUS-guided embolisation coils combined with thrombin injection in gastric varices has been shown to be safe and effective. Our institution has applied the same technique to the treatment of parastomal varices.Methods A retrospective review was performed of 37 procedures on 24 patients to assess efficacy and safety of EUS-guided injection of thrombin, with or without embolisation coils for treatment of bleeding parastomal varices. All patients had been discussed in a multidisciplinary team meeting, and correction of portal hypertension was deemed to be contraindicated. Rebleeding was defined as stomal bleeding that required hospital admission or transfusion.Results All patients had significant parastomal bleeding at the time of referral. 100% technical success rate was achieved. 70.8% of patients had no further significant bleeding in the follow-up period (median 26.2 months) following one procedure. 1-year rebleed-free survival was 80.8% following first procedure. 7 patients (29.1%) had repeat procedures. There was no significant difference in rebleed-free survival following repeat procedures. Higher age was associated with higher risk of rebleeding. No major procedure-related complications were identified.Conclusions EUS-guided thrombin injection, with or without embolisation coils, is a safe and effective technique for the treatment of bleeding parastomal varices, particularly for patients for whom correction of portal venous hypertension is contraindicated.

Reproductive health and well-being of a woman are associated with factors such as menarche, first marriage, first sex, first birth, and menopause. The beginning of these events also brings about significant changes in women's lives. Despite marrying early being acknowledged as a detrimental and discriminatory socio-cultural global practice, a huge proportion of girls are being married at an early age, often detrimental to maternal and child health. Adding to the current national debate for the revision of the minimum age at marriage for girls from 18 to 21 years it becomes important to understand the past scenario and current situation of age at marriage in India. In this study, first five rounds of the National Family Health Survey (NFHS) have been used as a data source. Cox Proportional Hazard Model, Multiple Classification Analysis (MCA), Kaplan Meier Curve, Life table survival analysis, hierarchical clustered heat map, Multivariate Decomposition Analysis (MDA), and geospatial mapping were used to fulfill the objective of the study. The results showed that almost 65.9% of women got married before reaching the age of 18 years in the year 1992–93 which reduced to 23.2% among women aged 20–24 years in 2019–21. Region, respondent’s level of education, caste, religion, wealth, and mass media exposure were significantly associated with the age at first marriage. The hazard of age at marriage declined significantly with higher educational attainment [higher education- AHR:0.37; CI:0.36 to 0.37], improving household wealth [richest wealth- AHR:0.91; CI:0.90 to 0.91], and mass media exposure [AHR:0.96; CI:0.95 to 0.96]. Since, the age at marriage has a substantial impact on fertility pattern and has a strong association with maternal & child health, policies regarding improving the age at marriage and better enforcement of the concerned laws are required to meet the SDG targets.

Abstract Background Vitamin D deficiency has been found to associated with numerous skeletal and non-skeletal diseases including Diabetes Mellitus. Insulin Resistance (IR) is considered as one of the primary reasons of Type-2 Diabetes Mellitus (T2DM). The association between vitamin D deficiency and IR has been extensively explore in previous studies, but none of them focused on Indian adolescents, and none of them used the TyG index as IR marker. Hence, this population-based cross-sectional study investigates the relationship between insulin resistance (IR) assessed using the Triglycerides Glucose Index (TyG index) and vitamin D measured by serum 25-hydroxyvitamin-D (25(OH)D). Methods For this study, we utilized data from the Comprehensive National Nutrition Survey (CNNS, 2016–18). The study is based on a sample size of 10,167 adolescents aged 10–19 years. The TyG index cut-off value of 4.65 was used to classify IR. We examined associations between the TyG index and serum 25(OH)D using multiple linear regression models adjusted for potential confounders. Odds of Insulin Resistance among vitamin D deficient/insufficient adolescents were assessed using multivariable logistic regression. Results A significant negative association was found between serum 25(OH)D and the TyG index, where a 10% increase in serum 25(OH)D was associated with 0.56 (95% CI = -0.67, -0.45) unit decrement in the TyG index. The odds of having IR were 90% higher among vitamin D deficient adolescents (OR: 1.90; 95% CI = 1.62—2.23) compared to adolescents with adequate levels of vitamin D. The association between vitamin D deficiency and IR was independent of sex; in other words, the association between vitamin D and IR was significant in both the sexes. Conclusion Independent of sex, this study found a significant inverse association between vitamin D and insulin resistance in Indian adolescents. The findings of this study highlight the utility of TyG index and the importance of vitamin D in lowering the risk of T2DM in future generations of the country.

Abstract Background In a patriarchal society, women often keep their use of contraceptives secret in order to meet their reproductive goals and satisfy their reproductive preferences. Nevertheless, to our knowledge, women’s covert contraceptive use and its association with husband’s gender attitude have not been studied in the Indian settings. The present study estimates the extent of covert modern contraceptive use (CCU) among women and its linkage with husbands’ gender attitudes in India. Methods The study is based on fecund and monogamous couples using modern, reversible contraceptive methods. The numbers of such couples were 4,825 and 7,824 in the national family health surveys 2005–06 and 2015–16 respectively. The outcome variable in the study was CCU, while the independent variables were husband’s gender attitude, women’s education, freedom of mobility, freedom to spend money independently, surviving number of children, concordance regarding additional children, couple-level information such as age and educational gap between spouses, and some socioeconomic status (SES) variables. We used latent class analysis to measure the gender attitude and used bivariate descriptive analysis and multivariate binary logistic regression to assess the linkages between husband’s gender attitude and CCU. Results This study found that the prevalence of CCU increased from 15% in 2005–06 to 27% in 2015–16. In both the time periods, contraceptive pills were the most preferred covert method, followed by intrauterine device (IUD). The results of the multivariate logistic regression show that women with husbands of moderate and low egalitarian gender attitudes were, respectively, 50% and 40% more likely to hide their contraceptive use than those with husbands of a high gender attitude. Women’s education, wealth index, number of living children, and region of residence were also found to be significantly associated with CCU. Conclusion The study reveals that husband’s low egalitarian gender attitude can be a potential barrier between spouses, preventing them from opening up about their fertility preferences and contraceptive needs to each other. A couple-oriented approach to family planning is needed so that both members of a couple can satisfy their fertility desires and preferences eventually.

Vitamin D deficiency is a serious issue in developing nations, including India. This study investigates the determinants of vitamin D deficiency among Indian adolescents and assesses their relative importance using dominance analysis. Data from the Comprehensive National Nutrition Survey (CNNS) conducted between 2016 and 2018 were utilized in this study. Vitamin D levels were assessed based on serum 25-hydroxyvitamin D concentration, with a sample size encompassing 13,065 adolescents aged between 10 and 19 years. Backward stepwise multivariate logistic regression was used to identify the correlates of vitamin D deficiency, and the relative importance of these factors was assessed using dominance analysis. The study identified nine predictors that were significantly associated with vitamin D deficiency at a 1% level of significance (α = 0.001). Among these factors, sex was found to be the most significant predictor, with female adolescents being 2.66 (95% CI: 95% CI: 2.39–2.96) times more likely to be vitamin D deficient compared to male adolescents. Lifestyle and behavioral factors, such as “sex,” “wealth index,” and “place of residence,” were more dominant in predicting vitamin D deficiency than biological indicators like “BMI” and “serum creatinine.” This underscores the vital role of sunlight exposure in maintaining sufficient vitamin D levels. In summary, this study sheds light on the multifaceted factors contributing to vitamin D deficiency among Indian adolescents, emphasizing the significance of targeted interventions and public health awareness campaigns to mitigate this pressing issue.

Abstract Background Primary Health Centers (PHCs) are crucial in providing primary and secondary level healthcare services in rural India. Despite immense efforts and huge funding, a very small proportion of deliveries are carried out at PHCs. The present study aims to explore the availability of facilities at PHCs and its association with likelihood of delivering the child at PHC. Methods We extracted PHC level health infrastructure data from Health Management and Information system (HMIS) and created ‘Facility Index’ using exploratory factor analysis. We merged the ‘Facility Index’ with data of the 4th National Family Health Survey (NFHS-4) to explore the relationship between availability of facilities and healthcare-seeking behavior. Bivariate analysis and multilevel logistic regressions were employed to analyze the association between Facility Index and the likelihood of delivering the child at PHC. Results Availability of facilities (Facility Index) was found to be positively associated with utilization of PHC for childbirth but up to only a certain level of Facility Index. Women living in districts with ‘good’ Facility index were having 2.45 (OR = 2.45; 95% CI: 2.12–2.84) times higher odds of delivering the child at PHC compared to women living in districts with ‘very poor’ Facility Index; however, the odds ratio decreased to 2.11 (95% CI: 1.83–2.43) for ‘Very Good’ Facility Index. The regression line and predicted probabilities also exhibited similar results. Conclusion Based on the findings, we conclude that improvement in availability and quality of facilities might help in improving healthcare utilization from PHCs up to a certain level.

Abstract Background Maternal and child health services, like antenatal care, skilled birth attendance and postnatal care, are crucial to improve maternal and neonatal health outcomes. Numerous studies have been conducted on the distribution of utilization of maternal and child healthcare (MCH) services in India with respect to socioeconomic and demographic characteristics. But no study has analyzed the utilization of MCH services with a focus on the topography of a given region (hilly/plain). The present study analyzes the utilization of MCH services in the hilly-Himalayan region of India in comparison to the rest of the country. Methods Data from India’s National Family Health Survey-4 (2015–16), on 190,898 women, was utilized for analysis in the present study. The association between the utilization of MCH services and the topography of the region of residence (hilly/plain) was analyzed by calculating adjusted odds ratios (AOR) with 95% confidence interval (95%CI) and predicted probabilities using a two-level random intercept logistic regression model. Results It was found that the utilization of MCH services was significantly lower in the hilly regions compared to the plain regions. Women living in hilly areas (AOR: 0.42, 95%CI: 0.39–0.45) had 58% lower odds of receiving skilled birth attendance (SBA) than those living in plain areas. Similarly, the odds of receiving PNC, ANC, and full immunization were also lower in the hilly regions compared to the plain regions. The utilization of MCH services was alarmingly low in the rural-hilly regions. The odds of receiving two tetanus injections before birth were 71% lower for women in the rural-hilly areas (AOR: 0.39, 95% CI: 0.36–43) than those in the rural-plain areas. Predicted probabilities also showed that women in the hilly regions were less likely to receive MCH services compared to their counterparts in the plain regions. Conclusion Except for the consumption of Iron Folic Acid (IFA) and the utilization of AWC services/ICDS (Integrated Child and Development Services), all other MCH services were significantly underutilized in the hilly regions compared to the plain regions. This calls for the attention of and concentrated efforts by policy makers and stakeholders, with a special focus on the rural-hilly regions. We firmly believe that the results of the present study have important policy implications.

Abstract Background Vitamin D is an essential micronutrient for the overall health and well-being of individuals. For strong musculoskeletal and neurological development of human body, vitamin D levels during childhood and adolescence have key importance. This is the first national-level study that analyzes the deficiency and concentration of serum 25-Hydroxyvitamin D [25(OH)D)] among Indian children and adolescents with respect to various demographic and socioeconomic characteristics. Methods Data of Comprehensive National Nutrition Survey (CNNS, 2016–18) was utilized for the present study. Vitamin D levels were assessed based on serum 25-hydroxyvitamin D concentration. Prevalence of vitamin D deficiency has been shown for the three age groups: 0–4 years (n = 12,764), 5–9 years (n = 13,482), 10–19 years (n = 13,065). Vitamin D deficiency was defined as: serum 25(OH)D

In this work, the synthesis of pure and (Ce, Ag) co-doped ZnO was successfully accomplished using a solvothermal process. The synthesized samples were characterized by ultraviolet–visible spectroscopy, X-ray diffraction, and scanning electron microscopy. The photocatalytic ability of the samples is estimated through degradation of tartrazine in aqueous solution under photocatalytic conditions. The degradation study carried out for a reaction period of 90 min at and a free pH = 6.0 found that dye degradation is 44.82% for pure ZnO and 98.91% for (Ce, Ag) co-doped ZnO samples, indicating its excellent photocatalytic ability. Tartrazine mineralization was also studied by calculating the degradation of chemical oxygen demand. The effect of operating parameters such as catalyst dose, initial concentration of tartrazine, initial reaction pH, and nature of light source has been optimized for tartrazine degradation as a function of time. The reusability of ZnO and (Ce, Ag) co-doped ZnO catalysts was studied and its photocatalytic efficiency was found to be unchanged, even after six cycles of use. The mechanism of photocatalytic activity was also proposed. HIGHLIGHTS The (Ce, Ag)/ZnO catalyst exhibited outstanding photocatalytic activity.; The effect of tartrazine concentration on photocatalysis performance was studied.; The degradation time of tartrazine using (Ce, Ag)/ZnO catalyst is 90 min.; The reusability of our catalysts ZnO and (Ce, Ag)/ZnO was also explored.;

Objective: The present study aims to analyze the association between the availability of facilities at PHCs and their association with healthcare-seeking from PHCs in rural India. Data and methods: The data used in the study were extracted from HMIS (Health Management Information System) and NFHS-4. Using ‘HMIS rural health infrastructure data’ we constructed the ‘Facility Index’ at the district level by performing Exploratory Factor Analysis. Multilevel logistic regression and concentration curve were employed to analyze the association between the availability of facilities at PHCs (Facility Index) and healthcare-seeking from PHCs. Results: Facility Index was found to be positively associated with healthcare-seeking from PHCs. The results of multilevel regression analysis showed that people from districts with ‘very good’ facility index were four times (AOR: 4.01, CI: 3.54–4.52) more likely to visit PHC compared to districts with ‘very poor’ facility index while controlling the effect of background variables. The concentration curve showed that in the districts with higher facility index people were more prone to seek healthcare from PHC compared to districts with lower facility index (Concentration Index: 0.175, standard error: 0.0026). Conclusion: Based on our findings we can expect that if the government improves the quality and availability of facilities at PHCs then it is more likely that people will choose PHCs for general healthcare-seeking. We believe that the findings of the present study have important policy implications.

Background: Registration of vital events has been low coverage in India since long, especially registration of marriages. Studies and data on marriage registration are very limited in India. Therefore, the present study tried to examine critical determinants of the under-registration of marriage. Methods: The present study is cross-sectional and exploratory in nature based on primary data collected from Jhunjhunu district of Rajasthan. Using a mixed-method approach, a total of 150 currently married women and men each were selected purposively and interviewed face-to-face for quantitative data. Two focus group discussions (FGDs) with currently married women was conducted for qualitative insights. Bivariate, principal component analysis (PCA) and multivariate analysis were performed to analyse the data. In this research article, we have conducted analysis only for the sampled women. Results: The study found that only two of every fifth married women register their marriage. The respondents from rural residence (31%), Scheduled castes and Scheduled tribes (SC/STs) group (24%), low education (24%) and wealth index (8.5%) showed a lower level of marriage registration than their counterparts. Lack of awareness, no requirement of marriage certificates, social norms, and early marriages are the major cause of the under-registration of marriage. Conclusion: The finding of the study concluded that socio-economic status, lack of awareness about marriage registration and no necessity of marriage certificates are the leading determinants of under-registration of marriages in district Jhunjhunu of Rajasthan. The government should create awareness of existing marriage registration legislation and the necessity marriage certificate as proof of document wherever possible.

Introduction: Yoga and meditation are believed to start with the very inception of civilization and have munificent effects physically as well as mentally. As the entire world is facing dreadful COVID-19 pandemic, the concept of Yoga and meditation is the best way to keep a person in good shape, physically and mentally. Yoga along with meditation, as an integral part of our lifestyle tells us how to control the basic thought process and to stabilize oneself and integrate the state of health. Methods: Keeping the COVID-19 pandemic in mind, it is time for us to look back to utilize the treasure of Yoga and meditation for immunity, strengthening our willpower to stand the challenges of pandemic and develop resilience against negativity. Yoga usually emphasizes Asana, Pranayama, Dhyana and if practiced on daily basis will increase endorphins-feel-good-chemicals within the body and reduces cortisol levels that cause stress. Result and Conclusion: This pandemic has shown worldwide devastating effects on health-care-system, so Yoga and meditation practices could be utilized to counter the negatives of individual's physical, emotional as well as social health. In the current scenario, it is of utmost importance to deal the negative emotions with nonpharmacological interventions. The current paper focuses on the ways to protect ourselves in COVID-19 pandemic and live healthy life with regular practice of Yoga and meditation. It also highlights the role of Yoga and meditation in controlling a person's body, mind and soul. It also combines physical and mental discipline of the body and mind; to aid in managing stress, anxiety, and keep ourselves relaxed. Hence, developing a positive state of mind and promote better health to fight against the pandemic.

Treatment-seeking behaviour is closely associated with the health status of individuals and countries. About 800 million people have no access to health services in the developing world. Though the situation has been improving, the inequalities across geographical regions, socioeconomic status, and disease types continued to persist. The available literature suggests research gaps in examining the unmet need for treatment-seeking from public health facilities across sociodemographic characteristics, regions, and specific diseases. Data for this study comes from the three rounds of National Sample Survey (NSS) (2004, 2014, 2018). We applied descriptive, bivariate, and multivariable analysis to investigate the unmet need for treatment-seeking for public health facilities across sociodemographic characteristics, regions, and specific diseases between 2004 and 2018. The unmet need for treatment-seeking from public health facilities remained high at 60% in 2004 to 62% in 2018. However, the proportion of respondents who did not seek treatment has reduced 12% to 3% from 2004 to 2018. In states like Andhra Pradesh, Madhya Pradesh, Maharashtra, Punjab, Telangana, Uttar Pradesh, and West Bengal, the unmet need for treatment-seeking from public health facilities was more than 60% in 2018. For 2018, the quality of services at public health facilities was the main reason for showing a higher unmet need for treatment-seeking in the richer MPCE quintiles. On the other hand, the ailment not considered serious as the main reason for the unmet need for treatment-seeking from any sources has got nearly doubled from 36% in 2004 to 71% in 2018. This study concludes that improving the availability of various kinds of services at public health facilities should be a priority under India's universal health coverage program. Education plays a vital role in treatment-seeking. Thus, there is an urgent need for increasing awareness among people for treatment-seeking. Ensuring a minimum quality of health care services and reducing long waiting timing would reduce the apathy to receive services from the public health facilities.

ObjectivesThe transition to small family size is at an advanced phase in India, with a national TFR of 2.2 in 2015-16. This paper examines the roles of four key determinants of fertility-marriage, contraception, abortion and postpartum infecundability-for India, all 29 states and population subgroups.MethodsData from the most recent available national survey, the National Family Health Survey, conducted in 2015-16, were used. The Bongaarts proximate determinants model was used to quantify the roles of the four key factors that largely determine fertility. Methodological contributions of this analysis are: adaptations of the model to the Indian context; measurement of the role of abortion; and provision of estimates for sub-groups nationally and by state: age, education, residence, wealth status and caste.ResultsNationally, marriage is the most important determinant of the reduction in fertility from the biological maximum, contributing 36%, followed by contraception and abortion, contributing 24% and 23% respectively, and post-partum infecundability contributed 16%. This national pattern of contributions characterizes most states and subgroups. Abortion makes a larger contribution than contraception among young women and better educated women. Findings suggest that sterility and infertility play a greater than average role in Southern states; marriage practices in some Northeastern states; and male migration for less-educated women. The absence of stronger relationships between the key proximate fertility determinants and geography or socio-economic status suggests that as family size declined, the role of these determinants is increasingly homogenous.ConclusionsFindings argue for improvements across all states and subgroups, in provision of contraceptive care and safe abortion services, given the importance of these mechanisms for implementing fertility preferences. In-depth studies are needed to identify policy and program needs that depend on the barriers and vulnerabilities that exist in specific areas and population groups.

Background: Hypertension has been described as an “iceberg disease” as those who suffer are usually unaware and hence usually seek healthcare services at a very late stage. It is estimated that more than two million Indians are suffering from hypertensive heart diseases that contributed to above 0.13 million deaths in 2016. Objectives: The present study aims to know the prevalence of Hypertension in India and its variation by socioeconomic backgrounds, and to find out risk factors discriminating hypertension with special emphasis on tobacco and alcohol consumption among men aged 15–54 years in India. Methods: In this study, NFHS (2015–16) data were analyzed by applying binary logistic regression and discriminant analysis in the attempt to find significant predictors and discriminants of interest. Results: The prevalence of hypertension was 16.5% in the study population. The results suggested that the consumption of alcohol and tobacco are significant discriminant characteristics associated with hypertension irrespective of the socioeconomic background characteristics of the respondents. Hypertension is a chronic disease and is itself a causative factor for several other diseases like renal impairment, other cardiovascular diseases, and stroke. Conclusions: The findings are expected to have direct implications on public health interventions and policy formulation to reduce diseases caused by tobacco and alcohol, particularly hypertension among men in the potential economically productive age group in India and similar settings.

Global warming has increased the temperature significantly over a large extent both spatially and temporally. The threat of heat stress during the germination and seedling establishment stages in the wheat crop is now more prevalent than ever before. The present experiment assessed the effect of elevated temperature on the germination and early seedling growth of wheat genotypes. The seeds were sown under four temperatures, viz., 20 °C, 25 °C, 30 °C and 35 °C; the germination, seedling vigor and enzyme activities in 8-day-old seedlings were assessed. The temperature significantly influenced germination and early seedling growth. The germination percentage at 20 and 25 °C was statistically on par with and higher than at 30 and 35 °C. The seedling vigor parameters were maximum at 25 °C and showed a reduction at higher temperatures. Genotypic differences were observed for early heat stress as the genotypes WH 730, WH 1123 and HD 2967 showed tolerance towards heat stress during germination, whereas the genotypes PBW 725 and WH 1105 were susceptible. Antioxidant enzyme activities in seedlings increased with the rise in temperature. Catalase, peroxidase and superoxide dismutase enzymes showed increased activities at higher temperature levels.

Introduction: Maternal undernutrition plays a critical role in influencing maternal, and child health outcomes and magnifies the risk of death of the mother at the time of delivery. High-risk fertility behaviour is an obstacle to tackle maternal and child mortality. Objectives: The aim of this study is to understand the level of high-risk fertility behaviour and chronic undernutrition among ever-married women, and also to examine the association between the two. Methods: Data for 190,581 ever-married women (15–49) giving at least one birth during five years prior to the National Family and Health Survey (2015-16) was used. Descriptive statistics and modified Poisson regression were applied to examine the association between high-risk fertility behaviour and chronic undernutrition. Results: Results show that 24% women were undernourished and 32% were subject to have at least one of the high-risk fertility behaviour. Collectively, 26% and 6% of the women were susceptible to single and multiple high-risk behaviour, respectively. After adjusting sociodemographic backgrounds, results showed a significant association between high-risk fertility behaviour and chronic undernutrition. As such, 5% of women were likely to be undernourished due to high-risk fertility behaviour on the whole, and 4% and 6% of the women, respectively, were likely to be undernourished due to single and multiple high-risk fertility behaviour. Conclusions: This study finds that maternal high-risk fertility behaviour is an important factor in increasing the likelihood of women to be in a state of chronic undernourishment. Therefore, policy and programme should be implemented to reduce high-risk fertility behaviour among Indian women.

Giant-cell tumors (GCTs) or osteoclastomas of the bone are locally aggressive tumors with tendency for local recurrence. The tumors show predilection for women with majority of patients in the third or fourth decades of life. Usually, GCT involves the ends of long bones. The most common sites involved are the distal femur, proximal tibia, distal radius, and the sacrum. Unusual locations such as scapula, skull, and small bones of the hand and feet are involved in approximately 2% of cases. Involvement of metacarpal has been reported in few cases so far. We report a case of GCT in the first metacarpal in a 16-year-old girl. We discuss the clinical, pathological, and radiological features. Awareness of this location is important, and GCT should be included in the differential diagnosis of expansile lesions of the small bones of the hand.

Abstract Background Evidence of hysterectomy in India is limited mainly due to lack of information in large-scale nationally representative health surveys. In 2015–16, the fourth National Family Health Survey (NFHS-4) – a cross-sectional survey – collected for the first time direct information on hysterectomy and self-reported reasons for undergoing the procedure among women in the reproductive age group. This paper examines the prevalence and determinants of hysterectomy in India among women aged 30–49 years in 29 states and seven union territories (UTs) of India using the NFHS-4 dataset. Methods Percentage weighted by sampling weights was used for estimating the prevalence of hysterectomy. The paper used crosstabulations and percentage distributions to estimate the prevalence of hysterectomy across different socioeconomic backgrounds and reasons for undergoing hysterectomy respectively. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. Results In India as a whole, 6 % of women aged 30–49 years had undergone a hysterectomy. The percentage of women who had undergone the procedure was found to vary considerably across the states and the UTs (from a minimum of 2% in Lakshadweep to a maximum of 16% in Andhra Pradesh). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector except in the northeast region. Years of schooling, caste, religion, geographic region, place of residence, wealth quintiles, age, parity, age at first cohabitation, marital status, and body mass index of women were found to be the sociodemographic determinants statistically associated with hysterectomy in India. The reasons reported frequently for hysterectomy were excessive menstrual bleeding/pain (56%), followed by fibroids/cysts (20%). Conclusion The percentage and likelihood of undergoing hysterectomy are relatively high among women from older age groups (45–49), those who reside in rural areas, those without schooling, those who are obese, those having high parity, those with a low age at first marriage, and those who reside in the eastern and southern parts of India. The policy implication of these findings is that the reproductive health program managers should ensure regular screening and timely treatment of the problems resulting in hysterectomy.

The study was aimed at developing an accessible laboratory animal model to elucidate protective and pathological roles of immune mediators during Peste des petits ruminants virus (PPRV) infection. It is because of the critical roles of type I IFNs in anti-viral defense, we assessed the susceptibility of IFN receptor knock out (IFNR KO) mice to PPRV infection. IFNR KO mice were exceedingly susceptible to the infection but WT animals efficiently controlled PPRV. Accordingly, the PPRV infected IFNR KO mice gradually reduced their body weights and succumbed to the infection within 10 days irrespective of the dose and route of infection. The lower infecting doses predominantly induced immunopathological lesions. The viral antigens as well as the replicating PPRV were abundantly present in most of the critical organs such as brain, lungs, heart and kidneys of IFNR KO mice infected with high dose of the virus. Neutrophils and macrophages transported the replicating virus to central nervous system (CNS) and contributed to pathology while the elevated NK and T cell responses directly correlated with the resolution of PPRV infection in WT animals. Using an array of fluorescently labeled H-2Kb tetramers, we discovered four immunogenic epitopes of PPRV. The PPRV-peptides interacted well with H-2Kb in acellular and cellular assay as well as expanded the virus-specific CD8+ T cells in immunized or infected mice. Adoptively transferred CD8+ T cells helped control PPRV in infected mice. Our study therefore established and employed a mouse model for investigating the pathogenesis of PPRV. The model could be useful for elucidating the contribution of immune cells in disease progression as well as to test anti-viral agents.

The Ghaggar river which is also known as ancient Sarasvati river is noted for her mysterious disappearance. The scholars from different field are studying the river channel since the 18th century. Archaeologists were intrigued by the Ghaggar river channel due to the presence of archaeological sites all along the river basin. Explorations in the past resulted in locating hundreds of archaeological sites, particularly Harappan culture sites. A large number of Harappan sites along Ghaggar banks is evidence that Harappan culture flourished richly on Ghaggar river than on Indus river. The present research focuses on the middle reaches of Ghaggar river where the author conducted a systematic exploration to revisit previously reported sites and report new sites in the process. The main objective of this research paper is to discuss the site distribution pattern of explored sites in the region and to come up with probable explanations for the distribution pattern of the sites.

The weather variables impact the crop differently throughout the various stages of development. The weather effect on crop yield thus can be determined not only by the magnitude of weather variables but also on the variability of weather over crop season. Crop yield forecasting methods incorporating weather information provide a better prediction of yield accounting the relative effects of each weather component. Regression analysis is the most frequently used statistical technique for investigating and modelling the relationship between variables. Building a multiple regression model is an iterative process. Usually several analyses are required for checking the data quality as well as for improvement in the model structure. The use and interpretation of multiple linear regression models depends on the estimates of individual regression coefficients. However, in some situations the problem of multicollinearity exists when there are near linear dependencies between/among the independent variables. The Principal Component Analysis (PCA) method has been proposed to address the problem of multicollinearity. Using principal component scores (PC) derived from weather variables as predictor variables helps to obtain better estimate the yield. The discriminant analysis is a multivariate technique involving the classification of separate sets of objects (or sets of observations) and assigning of new objects (or observations) to the groups defined previously. Forecasting of crop yield can also be done using discriminant analysis scores based on the weather variables as regressor.

In previous studies it has been found that spending too much time on social media can have negative effects on social and mental wellbeing of the users. Average time spent on social media increased drastically during covid-19 lockdown in India. The present study thus aims to analyze the direct and indirect effects of extensive social media and social networking services’ usage during the lockdown in India. A nationwide online survey was conducted through a ‘Google Forms’ questionnaire between 30th June 2020 to 27th July 2020. A total of 818 respondents took part in the study. ‘Social media effect index’ was constructed using exploratory factor analysis. Ordinal logistic regression was employed to analyze the effect of social media consumption on social and mental wellbeing of respondents. The average time spent on social networking sites in a day increased from 3.08 hours to 5.17 hours.75% people reported an increased time spent on social media and other services during the lockdown. 60% had reported procrastinating due to extensive SNS usage and had also experienced irregularities in sleep pattern. Respondents from age group ‘21 – 30’ (OR: 0.22, 95% CI: 0.08 - 0.62) were 78% less likely of having a higher index value compared to ‘>30 years’ age group. During the lockdown there has been a significant increase in social media consumption. The study finds mixed effects of social media consumption during lockdown on users however younger participants reported a negative effect of the consumption on their social and mental well being.

Abortion has been legal under broad criteria in India since 1971. However, access to legal abortion services remains poor. In the past decade, medication abortion (MA) has become widely available in India and use of this method outside of health facilities accounts for over 70% of all abortions. Morbidity from unsafe abortion remains an important health issue. The informal providers who are the primary source of MA may have poor knowledge of the method and may offer inadequate or inaccurate advice on use of the method. Misuse of the method can result in women seeking treatment for true complications as well as during the normal processes of MA. An estimated 5% of all abortions are done using highly unsafe methods and performed by unskilled providers, also contributing to abortion morbidity. This paper provides new representative abortion-related morbidity measures at the national and subnational levels from a large-scale 2015 study of six Indian states—Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu and Uttar Pradesh. The outcomes include the number and treatment rates of women with complications resulting from induced abortion and the type of complications. The total number of women treated for abortion complications at the national level is 5.2 million, and the rate is 15.7 per 1000 women of reproductive age per year. In all six study states, a high proportion of all women receiving postabortion care were admitted with incomplete abortion from use of MA—ranging from 33% in Tamil Nadu to 65% in Assam. The paper fills an important gap by providing new evidence that can inform policy-makers and health planners at all levels and lead to improvements in the provision of postabortion care and legal abortion services—improvements that would greatly reduce abortion-related morbidity and its costs to Indian women, their families and the healthcare system.

Background: To inform actions at the district level under the National Nutrition Mission (NNM), we assessed the prevalence trends of child growth failure (CGF) indicators for all districts in India and inequality between districts within the states. Methods: We assessed the trends of CGF indicators (stunting, wasting and underweight) from 2000 to 2017 across the districts of India, aggregated from 5 × 5 km grid estimates, using all accessible data from various surveys with subnational geographical information. The states were categorised into three groups using their Socio-demographic Index (SDI) levels calculated as part of the Global Burden of Disease Study based on per capita income, mean education and fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using coefficient of variation (CV). We projected the prevalence of CGF indicators for the districts up to 2030 based on the trends from 2000 to 2017 to compare with the NNM 2022 targets for stunting and underweight, and the WHO/UNICEF 2030 targets for stunting and wasting. We assessed Pearson correlation coefficient between two major national surveys for district-level estimates of CGF indicators in the states. Findings: The prevalence of stunting ranged 3.8-fold from 16.4% (95% UI 15.2–17.8) to 62.8% (95% UI 61.5–64.0) among the 723 districts of India in 2017, wasting ranged 5.4-fold from 5.5% (95% UI 5.1–6.1) to 30.0% (95% UI 28.2–31.8), and underweight ranged 4.6-fold from 11.0% (95% UI 10.5–11.9) to 51.0% (95% UI 49.9–52.1). 36.1% of the districts in India had stunting prevalence 40% or more, with 67.0% districts in the low SDI states group and only 1.1% districts in the high SDI states with this level of stunting. The prevalence of stunting declined significantly from 2010 to 2017 in 98.5% of the districts with a maximum decline of 41.2% (95% UI 40.3–42.5), wasting in 61.3% with a maximum decline of 44.0% (95% UI 42.3–46.7), and underweight in 95.0% with a maximum decline of 53.9% (95% UI 52.8–55.4). The CV varied 7.4-fold for stunting, 12.2-fold for wasting, and 8.6-fold for underweight between the states in 2017; the CV increased for stunting in 28 out of 31 states, for wasting in 16 states, and for underweight in 20 states from 2000 to 2017. In order to reach the NNM 2022 targets for stunting and underweight individually, 82.6% and 98.5% of the districts in India would need a rate of improvement higher than they had up to 2017, respectively. To achieve the WHO/UNICEF 2030 target for wasting, all districts in India would need a rate of improvement higher than they had up to 2017. The correlation between the two national surveys for district-level estimates was poor, with Pearson correlation coefficient of 0.7 only in Odisha and four small north-eastern states out of the 27 states covered by these surveys. Interpretation: CGF indicators have improved in India, but there are substantial variations between the districts in their magnitude and rate of decline, and the inequality between districts has increased in a large proportion of the states. The poor correlation between the national surveys for CGF estimates highlights the need to standardise collection of anthropometric data in India. The district-level trends in this report provide a useful reference for targeting the efforts under NNM to reduce CGF across India and meet the Indian and global targets.

We examine the behaviour and attitudes towards superannuation of 25-34 year old Australians. Our results suggest that they are generally uninterested in their superannuation accounts. They seldom read the information provided by their funds, rarely change their fund, and a majority of them do not make voluntary contributions. Overall the results suggest significant lack of interest in, and engagement and concern with issues related to their retirement planning.

Summary: Background: Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017. Methods: We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposure–response relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss. Findings: The annual population-weighted mean exposure to ambient particulate matter PM2·5 in India was 89·9 μg/m3 (95% uncertainty interval [UI] 67·0–112·0) in 2017. Most states, and 76·8% of the population of India, were exposed to annual population-weighted mean PM2·5 greater than 40 μg/m3, which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2·5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 μg/m3. The proportion of population using solid fuels in India was 55·5% (54·8–56·2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1·24 million (1·09–1·39) deaths in India in 2017, which were 12·5% of the total deaths, were attributable to air pollution, including 0·67 million (0·55–0·79) from ambient particulate matter pollution and 0·48 million (0·39–0·58) from household air pollution. Of these deaths attributable to air pollution, 51·4% were in people younger than 70 years. India contributed 18·1% of the global population but had 26·2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1·7 years (1·6–1·9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana. Interpretation: India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Summary: Background: The burden of diabetes is increasing rapidly in India but a systematic understanding of its distribution and time trends is not available for every state of India. We present a comprehensive analysis of the time trends and heterogeneity in the distribution of diabetes burden across all states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) of diabetes in the states of India from 1990 to 2016 using all available data sources that could be accessed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, and assessed heterogeneity across the states. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed the contribution of risk factors to diabetes DALYs and the relation of overweight (body-mass index 25 kg/m2 or more) with diabetes prevalence. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: The number of people with diabetes in India increased from 26·0 million (95% UI 23·4–28·6) in 1990 to 65·0 million (58·7–71·1) in 2016. The prevalence of diabetes in adults aged 20 years or older in India increased from 5·5% (4·9–6·1) in 1990 to 7·7% (6·9–8·4) in 2016. The prevalence in 2016 was highest in Tamil Nadu and Kerala (high ETL) and Delhi (higher-middle ETL), followed by Punjab and Goa (high ETL) and Karnataka (higher-middle ETL). The age-standardised DALY rate for diabetes increased in India by 39·6% (32·1–46·7) from 1990 to 2016, which was the highest increase among major non-communicable diseases. The age-standardised diabetes prevalence and DALYs increased in every state, with the percentage increase among the highest in several states in the low and lower-middle ETL state groups. The most important risk factor for diabetes in India was overweight to which 36·0% (22·6–49·2) of the diabetes DALYs in 2016 could be attributed. The prevalence of overweight in adults in India increased from 9·0% (8·7–9·3) in 1990 to 20·4% (19·9–20·8) in 2016; this prevalence increased in every state of the country. For every 100 overweight adults aged 20 years or older in India, there were 38 adults (34–42) with diabetes, compared with the global average of 19 adults (17–21) in 2016. Interpretation: The increase in health loss from diabetes since 1990 in India is the highest among major non-communicable diseases. With this increase observed in every state of the country, and the relative rate of increase highest in several less developed low ETL states, policy action that takes these state-level differences into account is needed urgently to control this potentially explosive public health situation. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Summary: Background: The burden of cardiovascular diseases is increasing in India, but a systematic understanding of its distribution and time trends across all the states is not readily available. In this report, we present a detailed analysis of how the patterns of cardiovascular diseases and major risk factors have changed across the states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) due to cardiovascular diseases and the major component causes in the states of India from 1990 to 2016, using all accessible data sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. We placed states into four groups based on epidemiological transition level (ETL), defined using the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed heterogeneity in the burden of major cardiovascular diseases across the states of India, and the contribution of risk factors to cardiovascular diseases. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: Overall, cardiovascular diseases contributed 28·1% (95% UI 26·5–29·1) of the total deaths and 14·1% (12·9–15·3) of the total DALYs in India in 2016, compared with 15·2% (13·7–16·2) and 6·9% (6·3–7·4), respectively, in 1990. In 2016, there was a nine times difference between states in the DALY rate for ischaemic heart disease, a six times difference for stroke, and a four times difference for rheumatic heart disease. 23·8 million (95% UI 22·6–25·0) prevalent cases of ischaemic heart disease were estimated in India in 2016, and 6·5 million (6·3–6·8) prevalent cases of stroke, a 2·3 times increase in both disorders from 1990. The age-standardised prevalence of both ischaemic heart disease and stroke increased in all ETL state groups between 1990 and 2016, whereas that of rheumatic heart disease decreased; the increase for ischaemic heart disease was highest in the low ETL state group. 53·4% (95% UI 52·6–54·6) of crude deaths due to cardiovascular diseases in India in 2016 were among people younger than 70 years, with a higher proportion in the low ETL state group. The leading overlapping risk factors for cardiovascular diseases in 2016 included dietary risks (56·4% [95% CI 48·5–63·9] of cardiovascular disease DALYs), high systolic blood pressure (54·6% [49·0–59·8]), air pollution (31·1% [29·0–33·4]), high total cholesterol (29·4% [24·3–34·8]), tobacco use (18·9% [16·6–21·3]), high fasting plasma glucose (16·7% [11·4–23·5]), and high body-mass index (14·7% [8·3–22·0]). The prevalence of high systolic blood pressure, high total cholesterol, and high fasting plasma glucose increased generally across all ETL state groups from 1990 to 2016, but this increase was variable across the states; the prevalence of smoking decreased during this period in all ETL state groups. Interpretation: The burden from the leading cardiovascular diseases in India—ischaemic heart disease and stroke—varies widely between the states. Their increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Hyperimmunoglobulin E syndrome (HIES), also known as Job′s syndrome, is a rare primary immunodeficiency characterized by eczema, recurrent skin and lung infections, elevated serum IgE, and connective tissue and skeletal abnormalities. Individuals with HIES share a characteristic facial appearance and many oral manifestations including retained primary dentition, a high-arched palate, variations of the oral mucosa and gingiva, and recurrent oral candidiasis. An 18-year-old lady presented with gingival swelling, bleeding from the gums, recurrent skin infections, and recurrent respiratory infections with intermittent fever. After thorough extra oral, intra oral and radiographic examination, serological investigations were performed. Growth of candida hyphae in the biopsy specimen of gingiva and increased levels of serum IgE with typical extra oral findings established the diagnosis as Job′s syndrome (hyper IgE syndrome). Treatment with anti-fungal antibiotics and phase-I therapy including scaling and root planing followed by gingivoplasty using diode laser (980 nm) was performed. HIES was previously defined on the basis of clinical manifestations and laboratory markers that were not specific to the disease. With the identification of STAT3 mutations as the cause of HIES, we can definitively characterize the disease at molecular and immunologic levels. This case emphasizes the role of the dentist in the diagnosis of rare syndromes which alters the treatment plan.

A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibility of anaplastic transformation should be kept in the differential diagnosis of rapidly enlarging painful mass in a known case of metastatic thyroid carcinoma to prevent misdiagnosis.

Unintended pregnancy accounts for more than 40% of the total pregnancies worldwide. An Unintended pregnancy can have serious implications on women and their families. With more than one-fourth of the children in India born out of unintended pregnancies such pregnancies are considered to be one of the major public health concerns today. The present study is aimed at determining major predictors of unintended pregnancy among currently pregnant ever-married women in India. The present study has used National Family Health Survey (NFHS) data, conducted by the International Institute for Population Sciences (IIPS), Mumbai, to show the trend, pattern and determinants of mistimed and unwanted pregnancies. Bivariate and multinomial logistic regression model have been used with the help of Stata 13 software. The results show that the likelihood of a mistimed pregnancy is more prevalent among young women whereas the prevalence of unwanted pregnancy is observed more among the women aged 35 years or more. The results also show that the risk of experiencing mistimed pregnancy decreases if the woman belongs to 'other' castes and has higher education. The likelihood of unwanted pregnancy decreases among married women aged 18 years and above, those women having higher education, some autonomy and access to any mode of mass communication. Knowledge of these predictors of mistimed and unwanted pregnancy will be helpful in identifying the most vulnerable group and prioritize the intervention strategies of the reproductive health programmes for the population in need.

A wide gap exists between potential and actual yields of mustard in India. Mustard is highly sensitive to weather variables and thus attempts need to be focused on determining the most yield limiting weather parameter so as to bridge the yield gap. To accomplish this task, mustard (c.v. RH-30) yields recorded for 26 rabi seasons (1984-85 to 2009-10) at Hisar, Haryana state were related with weather parameters during crop period. Maximum temperature during 1-6 week after sowing (WAS), minimum temperature during 1-5 WAS and again 16-20 WAS were found to influence mustard yields significantly. The mustard yields were less than 2000 kg ha-1 when maximum temperature was less than 30°C during 1-6 WAS and minimum temperature was less than 12°C during 1-5 WAS. Higher yields (2400 to 3000 kg ha-1) was obtained when minimum temperature during 16-20 WAS was less than 6°C.

Field experiment was carried out at Research Farm of Department of Agricultural Meteorology, CCS Haryana Agricultural University, Hisar located during rabi season of 2006 and 2007 on a sandy loam soil to study the evaluation of SOYGRO model of PK- 416 soybean cultivar for Hisar conditions. Yield attributes like pods per plant, number of seeds per pod and 100-seed weight decreased with subsequent delay in sowing from 7 June onward during both the seasons. Seed yield, straw yield and biological yield were highest in 7 June sowing as compared to late sown. The predicted deviation of seeds per pod was underestimated during both the crop seasons. This deviation varied from -4.47 to -8.95 seeds per pod in 2006 and -5.12 to -8.15 seeds per pod in 2007. The comparison of observed and simulated yield parameters viz., seed and straw yield showed that the model overestimated under all sowing dates. The straw yield was mostly overestimated but it was underestimated when crop sown delayed.