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Cancer registries are an integral part of cancer surveillance and play a vital role in collecting and managing surveillance data. The National Cancer Registry Programme in India, which has been functional since 1981, has a wide network of 269 hospital-based and 38 population-based cancer registries functioning throughout the country. Cancer registries monitor and describe the trends in cancer incidence and mortality over time. They also provide vital information on the cancer caseload, such as the number of cancer patients in a specified location or the number of patients availing of care at a specific hospital. As a part of cancer surveillance, registries also play a critical role in designing cancer control plans, gauging the impact of primary and secondary preventive measures, and strengthening health systems. The data on cancer incidence have provided critical inputs to the central, state, and local government to plan, prioritize, and mobilize health resources for cancer control interventions. The role of cancer registries as a surveillance tool could be further strengthened by long-term sustainability through strong political will, making cancer a notifiable disease to facilitate reporting and linking cancer registries with medical records for better data capture.

Background Intimate partner violence (IPV) is recognized as an important public health problem globally as well as in India. It may result in adverse physical and mental health consequences for the victim or unfavourable pregnancy outcomes if it happens during pregnancy. The possible risk factors for IPV can be explained by four levels of ecological factors: individual, partner, household and community. We estimated the prevalence of IPV and its association with selected ecological risk factors among pregnant women availing of antenatal care at a public sector hospital in Bengaluru, southern India. Methods We included 350 women above the age of 18 years with a confirmed pregnancy of less than 24 weeks and having no obstetric complication. We used the Conflict Tactics Scale to determine the presence of IPV. The risk factors measured were—individual level: respondent’s age, education, occupation, gravidity, planned or unplanned pregnancy, substance abuse, presence of depression and anxiety; partner-related: spouse’s education, occupation and marital discord; household/community-related: socioeconomic status, social support, religion and consanguinity. Results The prevalence of IPV was 3.7%. Factors that were significantly associated on multivariate analysis were higher age (above 20 years) (adjusted odds ratio [AOR] 1.82 [1.12–2.97], p=0.016) and presence of depression (AOR 6.84 [1.76–26.61], p=0.005). Conclusion The prevalence of IPV was less in our study population compared to figures reported from other Indian study settings.

The increasing burden of non-communicable diseases in rural areas poses new challenges to an already overburdened health systems. We detail these challenges and identify opportunities to address them. The major challenges in service delivery in rural areas include poor accessibility, shortage of adequate manpower especially specialists in rural areas, irregular supply of medicines and lack of adequate diagnostic facilities. This has led to an increased dependency on the private sector resulting in high out-of-pocket and catastrophic health expenditure. The challenges are amplified by lower health literacy, large pool of informal or untrained healthcare practitioners, and lack of proper referral and follow up. The health system opportunities identified include task-shifting by training of mid-level healthcare providers and practitioners from Indian systems of medicine, widening use of e-health and m-health, community engagement and public–private partnerships. Participatory health governance through community engagement has been shown to improve accountability and quality in health systems. Civil society organizations (CSO) can also improve awareness and health-seeking behaviour. New and evidence-based strategies need to be implemented to address health system challenges for tackling non-communicable diseases in rural areas.

Anita Nath,1 Shubhashree Venkatesh,1 Sheeba Balan,1 Chandra S Metgud,2 Murali Krishna,3 Gudlavalleti Venkata Satyanarayana Murthy4,51Indian Institute of Public Health Hyderabad-Bangalore Campus, Public Health Foundation of India, Bangalore, Karnataka, India; 2Department of Community Medicine, J.N. Medical College, KLE University, Belgavi, Karnataka, India; 3FRAMe, Mysore, Karnataka, India; 4Indian Institute of Public Health Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India; 5Department of Clinical Research, International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UKBackground: A pregnant woman undergoes physiological as well as psychological changes during this phase of life during which anxiety is a commonly faced mental condition. There is sufficient evidence on the association of pregnancy specific anxiety with adverse pregnancy outcomes. Studies on anxiety during pregnancy from low and middle income countries are limited.Methods: This study included 380 pregnant women, having a confirmed pregnancy of less than 24 weeks without any obstetric complication, who were availing of antenatal care at a public sector hospital in Bangalore city. Pregnancy-related thoughts (PRT) scale was used to screen for anxiety. Details pertaining to sociodemographic data, obstetric history, psychosocial factors including social support, marital discord, domestic violence, consanguinity, history of catastrophic events, history of mental illness, current presence of depression and anxiety was obtained by means of electronic data capture using an Android-based App.Results: Out of 380 pregnant women, 195 (55.7%) were found to have pregnancy-related anxiety. Lower socioeconomic status, low social support and depression emerged as significant determinants of anxiety.Conclusion: The prevalence of anxiety was fairly high in the study population and isp therefore an important public health concern. Pregnancy-related anxiety must be identified early during routine antenatal care to prevent any untoward pregnancy outcomes.Keywords: anxiety, pregnancy, prevalence, determinants, India

Maternal mental stress during pregnancy is an important public health concern. There is strong evidence from the Western world to support the presence of a significant association between maternal stress in pregnancy and adverse outcomes in the offspring. There are fewer studies from the South and East regions of Asia. The search was conducted according to the PRISMA criteria. Databases which included NCBI PubMed, Scopus, and Embase were used to search for relevant studies according to the eligibility criteria. Most of the studies have shown a significant relation between stress, depression, and anxiety during various stages of pregnancy with delayed mental, motor, and behavioral development of the child. Although studies from the region show a significant relation between various stress factors during pregnancy and child development, more such studies are needed, especially those using potential biomarkers as indicators of pregnancy-related stress.

Background: Hypertension in pregnancy is a major challenge in antenatal practice due to its impact on obstetric and foetal outcomes. Objective: To assess the prevalence of hypertension during pregnancy and its associated risk factors among pregnant women availing of antenatal care at public sector hospitals in Bengaluru, Southern India. Methods: The sample frame included pregnant women who were attending the antenatal clinic at three public sector hospitals. The data were analyzed for 783 pregnant women who had completed their baseline visit over a period of 18 months (September 2017 to March 2019). The blood pressure was categorized based on the American College of Cardiology/American Heart Association 2017 guidelines. Results: Out of the 783 respondents who were examined, 13.9% were found to be hypertensive. The adjusted Odd's ratio was significantly higher for those who were employed outside the house and obese respondents. Other factors such as higher maternal age, lower socioeconomic status, pregnancy-related anxiety, prenatal depression, nulliparity appeared to increase the risk. Conclusion: Hypertension during pregnancy continues to be a matter of concern. Risk factor profiling of pregnant women is of utmost importance to identify those who may be likely to develop hypertensive disorders during pregnancy.

Introduction: Poisoning is a major public health problem and one of the most common causes of child mortality, particularly in developing countries. Incidences of poisoning are variable according to the cultural and economic characteristics of particular communities. Objective: The purpose of this study was to analyze cases of poisoning in children under 6 years of age underwent hospitalization in a health center of Rasht. Materials and Methods: This study was conducted as a case-control study. The study included 2160 cases of hospitalized children under 6 years old. The study duration was 4 months. There were 2 groups, 70 children hospitalized because of poisoning (case group) and a control group of 105 people (1.5 times that of the case group) that consisted of children under 6 years of age and , non-hospitalized. Information gathered by questionnaire included; demographic information on individuals and families, as well as method of poisoning and the child's condition after hospitalization. Information was collected from interviews and medical records. Data were analyzed after collection using descriptive statistics (frequency distribution, means and standard deviation) and inferential statistics (chi-square tests, t-test). Results: The findings showed that most children (51.4 %) were between the ages of 1-3 years. Of the total sample 64.3 % were boys and 35.7 % were girls. In 80% of cases, poisoning was accidental and 97.1% were gastrointestinal in nature. In 51.4% cases, the cause was poisoning from medicine; 36.1% of cases were caused by methadone and in 17.1% of cases incidents had occurred in the kitchen. There was significant difference in both case and control groups in terms of father's level of education (P = 0.012) and mother's job (P = 0.025). Conclusion: Results showed that the most common cause of poisoning in children aged 1-3 was from pharmaceutical drugs; determined by the side effects of poisoning. A low rate of parental awareness was considered to have contributed to these cases of poisoning so parental awareness was determined as significantly important for improving childcare in the study region.

BACKGROUND The most common psychological problem that affects a woman during her perinatal period worldwide is depression. The risk of prenatal depression increases significantly as pregnancy progresses and clinically significant depressive symptoms are common in mid and late trimesters. Studies from various countries around the world have shown a prevalence rate ranging from as low as 4% to as high as 81%. The prevalence of depression in India is shown to vary from 9.18% in one study to 36.75 % reported in another. There is paucity of research on depression during the prenatal period, especially in India. Given this background, the present study aimed to assess the prevalence of prenatal depression and its associated risk factors among pregnant women in Bangalore, Southern India. METHODS: The study was nested within an on-going cohort study. The study participants comprised of pregnant women attending the antenatal clinic at Jaya Nagar General Hospital (Sanjay Gandhi Hospital) in Bangalore. The data was collected using standardised questionnaires. Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support Scale (MSPSS), Revised Dyadic Adjustment Scale, The Modified Conflict Tactics scale, Modified Kuppuswamy socio economic scale, Pregnancy related anxiety Scales were used. RESULTS: Of the 280 pregnant mothers, the proportion of them who screened positive for prenatal depression was 35.7%. Presence of domestic violence was found to impose a five times higher and highly significant risk of developing prenatal depression among the respondents. Pregnancy related anxiety was also found to be a positive predictor of prenatal depression. Presence of catastrophic events in the past one year was found to impose a two times higher and significant risk of developing prenatal depression among the respondents. CONCLUSION: The present study showed a higher prevalence of prenatal depression among the study participants which is suggestive of the public health importance in the study region. Health care plans therefore can include screening and diagnosis of prenatal depression in the antenatal care along with other health care facilities provided.

Emerging science will make an important contribution towards the development of improved contraceptives. While long-acting reversible contraceptives remain the most effective method, new user-controlled, mid-acting methods will avoid the need for procedures requiring trained providers. Contraceptives combined with other agents may bring additional health benefits, such as dual protection against both pregnancy and sexually transmitted infections. Emerging research areas in proteomics allowed the discovery of new reproductive targets that may lead to non-hormonal contraceptives for both men and women. Current research objectives include the improvement of existing contraceptive methods, as well as discovery of new materials able to deliver new molecules more specifically to their target without systemic actions.

Background: The increasing recognition of antenatal depression is an emerging area of concern in developing countres. We conducted a study to estimate the prevalence of antenatal mental distress and its relation with sociodemographic factors, obstetric factors, and physiological wellbeing in pregnant women attending public health facilities in Bengaluru, South India. Methods: Nested within a cohort study, we assessed the mental status in 823 pregnant women in two public referral hospitals. Kessler Psychological Distress Scale (K-10 scale) was used to assess maternal depression. We collected information related to social-demographic characteristics and recent medical complaints. Descriptive statistics and odds ratios were calculated using SPSS version 20. Results: Results show that 8.7% of the women exhibited symptoms of antenatal depression. Sociodemographic characteristics, such as respondent occupation, husband education, husband’s occupation, total family income showed significance. First time pregnancy, anemia, and high blood pressure were also associated with mental distress. Conclusion: Our study has demonstrated feasibility of screening for mental health problems in public hospitals. Early detection of mental distress during pregnancy is crucial as it has a direct impact on the fetus. The public health facilities in low- and middle-income countries such as India should consider piloting and scaling up screening services for mental health conditions for pregnant women.

Background The mental health status of a pregnant woman and its consequent impact on foetal well being is not given much importance compared to the risk imposed by obstetric complications and medical conditions. Maternal psychological distress is a major public health problem and needs timely detection and intervention to prevent any adverse pregnancy outcome. There is ample evidence from literature that justifies the association of prenatal maternal mental stress and elevated cortisol with delayed infant motor and cognitive development; evidence from India being rather limited. The study aim is to prospectively assess the association of maternal psychological distress and cortisol level with motor and cognitive development of the infant. Methods A sample of 2612 eligible pregnant women who have been registered for antenatal care at selected public sector hospitals in Bengaluru will be recruited after obtaining written informed consent. They will be assessed for the presence of maternal psychological distress in the form of depression and anxiety using appropriate scales and saliva samples will be collected for cortisol estimation during early, mid and late pregnancy. Follow up visits after delivery will be done on day 10, 3 months, 8 months and 12 months. The Bayley Scales of Infant and Toddler Development [BSID] (Third edition) will be used to measure both motor and mental milestones in terms of Psychomotor Development Index (PDI) and Mental Development Index (MDI). Logistic regression model will be used to determine the association between the exposure variables and outcomes which will be reported as Odd’s Ratio (OR) and 95% confidence intervals (CI). Discussion Our study findings could add to the growing evidence that maternal psychological distress during pregnancy adversely influences growth and development in the offspring and subsequent development of the child. While maternal anxiety and depression can be measured by using self reporting instruments, estimation of maternal endogenous cortisol levels could serve as a biomarker of prenatal psychological stress. Findings from this study could be used to focus upon the burden of mental health problems during pregnancy and to consider steps to scale up prenatal mental health services in health care settings.

Background: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal mortality and low birthweight. According to the National Family Health Survey-4 reports, maternal anemia continues to be a public health problem. Objective: To study the prevalence of anemia and its risk factors among pregnant women attending a public-sector hospital. Materials and Methods: This study was nested within an ongoing cohort study “ÇASCADE” which is exploring the effect of prenatal exposure to maternal cortisol and psychological distress on infant development in Bangalore. The respondents were enrolled from the antenatal clinic at Jayanagar General Hospital, which is a sub-district hospital. A total of 280 women who fulfilled the eligibility criteria were enrolled. Results: The prevalence of anemia was observed to be 33.9%; proportion of mild and moderate anemia was almost similar (48.4 and 49.5%). The mean hemoglobin level of all the participants was 11.33 ± 1.460 g/dl. The mean hemoglobin level concentration was high during early gestation with a slight decrease by 21–24 weeks. Prenatal depression but not anxiety appeared to be a strong predictor of anemia on bivariate as well as multivariate analysis. No association was observed with socio-demographic and obstetric variables. Conclusion: The burden of maternal anemia was considerably high in the study population. Although iron-folic acid supplementation is available under the national health program to address this issue, it is important to consider and address other risk factors when designing and implementing target interventions for anemia control in selected populations.

Steady progress in contraception research has been achieved over the past 50 years. Hormonal and non-hormonal modern contraceptives have improved women’s lives by reducing different health conditions that contributed to considerable morbidity. However the contraceptives available today are not suitable to all users and the need to expand contraceptive choices still exists. Novel products such as new implants, contraceptive vaginal rings, transdermal patches and newer combinations of oral contraceptives have recently been introduced in family planning programs and hormonal contraception is widely used for spacing and limiting births. Concerns over the adverse effects of hormonal contraceptives have led to research and development of new combinations with improved metabolic profile. Recent developments include use of natural compounds such as estradiol (E2) and estradiol valerate (E2V) with the hope to decrease thrombotic risk, in combination with newer progestins derived from the progesterone structure or from spirolactone, in order to avoid the androgenic effects. Progesterone antagonists and progesterone receptor modulators are highly effective in blocking ovulation and preventing follicular rupture and are undergoing investigations in the form of oral pills and in semi long-acting delivery systems. Future developments also include the combination of a contraceptive with an antiretroviral agent for dual contraception and protection against sexually transmitted diseases, to be used before intercourse or on demand, as well as for continuous use in dual-protection rings. Alhough clinical trials of male contraception have reflected promising results, limited involvement of industry in that area of research has decreased the likelihood of having a male method available in the current decade. Development of non-hormonal methods are still at an early stage of research, with the identification of specific targets within the reproductive system in ovaries and testes, as well as interactions between spermatozoa and ova. It is hoped that the introduction of new methods with additional health benefits would help women and couples with unmet needs to obtain access to a wider range of contraceptives with improved acceptability.

Background Pediatric HIV is poised to become a major public health problem in India with the rising trend of HIV infection in pregnant women (Department of AIDS Control, Ministry of Health and Family Welfare, http://www.naco.gov.in). There is lack of information on the epidemiology of pediatric HIV infection in India. Existing surveillance systems tend to underestimate the Pediatric burden. The overall aim of the present study is to estimate the disease burden of pediatric HIV among children in Belgaum district in the state of Karnataka in Southern India. An innovative multipronged epidemiological approach to comb the district is proposed. Methods The primary objectives of the study would be attained under three strategies. A prospective cohort design for objective (i) to determine the incidence rate of HIV by early case detection in infants and toddlers (0–18 months) born to HIV infected pregnant women; and cross sectional design for objectives (ii) to determine the prevalence of HIV infection in children (0–14 years) of HIV infected parents and (iii) to determine the prevalence of HIV in sick children (0–14 years) presenting with suspected signs and symptoms using age specific criteria for screening. Burden of pediatric HIV will be calculated as a product of cases detected in each strategy multiplied by a net inflation factor for each strategy. Study participants (i) (ii) (iii): HIV infected pregnant women and their live born children (ii) Any HIV-infected man/woman, of age 18–49 years, having a biological child of age 0–14 years (iii) Sick children of age 0–14 years presenting with suspected signs and symptoms and satisfying age-specific criteria for screening. Setting and conduct: Belgaum district which is a Category ‘A’ district (with more than 1 % antenatal prevalence in the district over the last 3 years before the study). Age-appropriate testing is used to detect HIV infection. Discussion There is a need to strengthen existing pediatric HIV estimation methods in India and other developing countries. We hope that the novel methodology emanating from this study would be applicable for estimating the burden of HIV in other settings and it would be adaptable for estimating the burden of other infectious/chronic diseases. Findings from this study will give future direction to the national program for prevention and control of HIV in India and other developing countries. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3132-8) contains supplementary material, which is available to authorized users.

The progesterone vaginal ring (PVR) has been shown to be effective as a contraceptive in breastfeeding women who need a better method of spacing pregnancies, and previous clinical trials of 1-year duration demonstrated its efficacy to be similar to that of the IUD during lactation. The duration of lactational amenorrhea is significantly prolonged in PVR users in comparison to IUD users with fewer median numbers of bleeding/spotting (B/S) episodes and B/S days. This long-acting delivery system designed for 3-month use needs to be renewed every 3 months as long as breastfeeding continues. The system designed as a matrix ring delivers 10 mg/day of the physiological hormone progesterone. Various factors such as comfort, ease of use, user control, rather than provider-dependent, and the fact that it contains a natural hormone have contributed to a high acceptability of the PVR method by breastfeeding women. The frequency of breastfeeding, breast milk volume and infant growth were not different in PVR users or IUD users, and the safety of this new method has been well documented. This article describes the available information and the results of the studies that led to approval of this method in several countries in Latin America so far. Further evaluation of the PVR acceptability in different populations where breastfeeding is popular and highly recommended for the infant's benefit is warranted.

The synthetic progestins used for contraception so far are structurally related either to testosterone (estranes and gonanes) or to progesterone (pregnanes and 19-norpregnanes). Several new progestins have been designed to minimize side-effects related to androgenic, estrogenic or glucocorticoid receptor (GR) interactions. Dienogest (DNG) and drospirenone (DRSP) exhibit a partial antiandrogenic action, and DRSP has predominant anti-mineralocorticoid properties. The 19-norpregnanes include Nestorone (NES), nomegestrol acetate (NOMAc) and trimegestone (TMG), and possess a high specificity for binding to the progesterone receptor (PR) with no or little interaction with other steroid receptors. DRSP has been developed as combination oral pills with ethinyl estradiol (EE); DNG has been combined both with EE and, more recently, with estradiol valerate (E2V). NOMAc has been used as a progestin-only method and more recently combined with estradiol (E2). Nestorone is not active orally but proved to be the most active antiovulatory progestin when used parenterally. It has been developed in various formulations such as implants, vaginal rings or transdermal gel or spray. Risks and benefits of the new progestins depend upon the type of molecular structure, the type of estrogen associated in a combination and the route of administration.

The rising number of unintended pregnancies worldwide could be attributed to contraceptive failure or an unmet need for contraceptives. Noncompliance and improper use constitute the most common causes of contraceptive failure. There is a need to explore and widen the availability of contraceptives, especially those that may be delivered via the non-oral route, and long-acting methods that may improve compliance. While several non-oral hormonal contraceptives have been approved or made available over the past few years, such as intrauterine systems, injectables and subdermal implants, other methods, such as contraceptive vaginal rings and transdermal patches, are relatively newer entrants in the contraceptive market. A number of non-oral contraceptive methods, such as vaginal gels, transdermal sprays and transdermal gel, as well as products containing different steroidal agents, are in various stages of clinical development. Current research is also focusing on the feasibility of new methods bringing addit...

People living with HIV/AIDS (PLHAs) continue to face stigma and discrimination in society. The felt needs of PLHAs can be met by means of a comprehensive, holistic, and integrated approach by the concerned sectors. This study included 100 PLHAs admitted at 3 care homes run by nongovernmental organizations in New Delhi. As many as 22% of the patients had been diagnosed with pulmonary Koch’s. Unemployment rates were found to increase after disease onset. Majority were satisfied with the medical treatment and overall care provided at these centers. About 25% expressed that they would like the government to provide them with suitable jobs. Less than one third (30%) of the PLHAs expressed satisfaction with their family life whereas the rest yearned for love and acceptance from society. Study findings highlight the important role of nongovernmental organizations and stresses on the need for a holistic approach toward the care of these people.

The main objective of this article is to provide a comprehensive overview of the situation regarding HIV/AIDS among youth in India, and explore the possible strategies that could be effective in combating the spread of this disease. India is in the grip of the HIV/AIDS epidemic, with an increasing number of infections being reported among youth, who comprise a quarter of the population but account for almost one-third of the HIV/AIDS burden. The prevalence in young women appears to be on the rise. Although the majority of youth are aware of the disease, a number of myths and misconceptions still prevail. Furthermore, or as a consequence, a higher percentage of young males report engaging in premarital sexual activity compared with females. Even though condom awareness is fairly high, condom usage is low. Of late, sex tourism and its implications for the HIV/AIDS epidemic present an increasing concern. Indian youth appear to hold negative attitudes towards HIV testing and people living with HIV/AIDS. Although a number of preventive and control programmes and policies exist, these need further strengthening and evaluation.

Compounds that can be described as selective estrogen receptor modulators (SERMs) have expanded dramatically over the past two decades. The ability of SERMs to act as estrogens in certain tissues while remaining inert or acting as an anti-estrogen in other tissues has opened up opportunities for treating specific estrogen-modulated diseases without accepting the risk of systemic estrogen activity. SERM development has resulted in significant therapeutic advances for breast cancer, osteoporosis and potentially other diseases associated with the menopause. After the publication of the Women's Health Initiative, interest in compound selectivity that reduces menopausal symptoms while protecting bone, breast, uterus and the heart has increased. Future SERMs may also have a therapeutic profile that can be tailored to specific patient populations, including men. This review paper summarizes the characteristics of different SERMs from various pharmacological categories and the feasibility and scope of their use for a large range of disease/health conditions.

Context: In India, the Janani Suraksha Yojana (JSY) scheme, translated as “safe motherhood scheme,” has been implemented to tackle this financial insecurity by giving cash incentives to women who give birth in public health facilities and accredited private health facilities. Although there is a reported increase in the number of institutional deliveries, there has not been much improvement in maternal or neonatal mortality rates. Objective: To explore the utilization of and barriers toward the use of JSY scheme by eligible rural pregnant women. Design: Qualitative research method in the form of in-depth interview was used for data collection and analysis. Methodology: The study was conducted in seven villages of Bellary district in Karnataka, South India. In depth interview was conducted for the study participants included twenty women who had delivered over the last 1 year and were selected by purposive sampling from antenatal registers which were available from the primary and community health centers in the district. Results: About 80% had delivered at public sector health facilities. To pay for the financial deficit to meet the pregnancy-related expenses, a large number of participants expressed to have raised money from loans, mortgage of land and house, and selling of jewelry and livestock. Many narrated their experiences with the poor quality of care at the public sector health centers. Several participants faced problems ranging from those related to opening a bank account to cumbersome procedures and logistical issues for money encashment. Conclusion: The incentive which is given under JSY does not seem adequate as, despite its availability, the family still needs to incur lofty medical expenditure. Furthermore, lack of quality care at public health facilities results in excessive out of pocket expenditure incurred at private health centers. The encashment procedure is also fraught with cumbersome procedures once again leads to loss of work time and additional economic losses.

To examine changes in behavioral outcomes among rural female sex workers (FSWs) involved in a community-based comprehensive HIV preventive intervention program in south India. A total of 14, 284 rural FSWs were reached by means of a community-based model for delivering outreach, medical, and referral services. Changes in behavior were assessed using 2 rounds of polling booth surveys conducted in 2008 and 2011. In all, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. There was a significant increase in condom use (from 60.4% to 72.4%, P = .001) and utilization of HIV counseling and testing services (from 63.9% to 92.4%; P = .000) between the 2 time periods. This model for a community-based rural outreach and HIV care was effective and could also be applied to many other health problems.

India continues to wage a battle against the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic. Despite an array of preventive and control efforts directed against the disease, it continues to finds its way from the high risk groups to the general population. Women are more vulnerable to HIV/AIDS because of biological as well as socio-cultural factors. Microbicides appear to provide an attractive option as a means of protection to be used by women. At present, microbicide trials are in study phases I and II in India. The development of an ideal microbicide candidate which would be effective and confirms to user satisfaction poses a major challenge to researchers.

Estrogen and progestins have been used by millions of women as effective combined oral contraceptives. Oral contraceptives (OCs) modify surrogate markers such as lipoproteins, insulin response to glucose, and coagulation factors, that have been associated with cardiovascular and venous risk. Ethinyl-Estradiol (EE) exerts a stronger effect that natural estradiol (E2) on hepatic metabolism. New progestins with high specificity have been designed to avoid interaction with other receptors and prevent androgenic, estrogenic or glucocorticoid related side-effects. The risks and benefits of new progestins used in contraception depend upon their molecular structure, the type and dose of associated estrogen, and the delivery route. The lower impact of E2-based combinations on metabolic surrogate markers may result in an improved safety profile, but only clinical outcomes are relevant to assess the risk. Large surveillance studies are warranted to confirm this hypothesis.

Progesterone receptor modulators (PRMs) delivered by contraceptive vaginal rings provide an opportunity for development of an estrogen-free contraceptive that does not require daily oral intake of steroids. The objective of this proof-of-concept study was to determine whether continuous delivery of 600-800 mcg of ulipristal acetate (UPA) from a contraceptive vaginal ring could achieve 80% to 90% inhibition of ovulation.This was a prospective, controlled, open-labeled, multicenter international trial to examine the effectiveness and safety of this prototype vaginal ring. Thirty-nine healthy women, 21-40 years old and not at risk of pregnancy, were enrolled at three clinic sites. Volunteers participated in a control cycle, a 12-week treatment period and a post-treatment cycle. Pharmacodynamic effects on follicular function and inhibition of ovulation, effects on endometrium, bleeding patterns and serum UPA levels were evaluated.Mean UPA levels during treatment were nearly constant, approximately 5.1 ng/mL throughout the study. Ovulation was documented in 32% of 111 "4-week treatment cycles." A correlation was observed between serum UPA and degree of inhibition of ovarian activity. There was no evidence of hyperplasia of endometrium, but PRM-associated endometrial changes were frequently observed (41%).In this study, the minimum effective contraceptive dose was not established. Further studies are required testing higher doses of UPA to attain ovulation suppression in a higher percentage of subjects.

Background Ulipristal (UPA; CDB-2914) is a progesterone receptor modulator with contraceptive potential. To test its effects when delivered by an intrauterine system (IUS), we prepared control and UPA-filled IUS and evaluated their effects in rhesus macaques. Study Design Short lengths of Silastic tubing either empty ( n =3) or containing UPA ( n =5) were inserted into the uteri of 8 ovariectomized macaques. Animals were cycled by sequential treatment with estradiol and progesterone. After 3.5 cycles, the uterus was removed. Results During treatment, animals with an empty IUS menstruated for a mean total of 11.66��0.88 days, while UPA-IUS treated animals bled for only 1��0.45 days. Indices of endometrial proliferation were significantly reduced by UPA-IUS treatment. The UPA exposed endometria were atrophied with some glandular cysts while the blank controls displayed a proliferative morphology without cysts. Androgen receptors were more intensely stained in the glands of the UPA-IUS treated endometria than in the blank-IUS treated controls. Conclusions In rhesus macaques, a UPA-IUS induced endometrial atrophy and amenorrhea. The work provides proof of principle that an IUS can deliver effective intrauterine concentrations of Ulipristal.

Following the publication of the Women's Health Initiative study, the controversy was raised regarding the role of progestins in hormonal replacement therapy (HRT). Some of the most prescribed molecules, with partial androgenic or glucocorticoid activity, have been shown to oppose partially the beneficial effect of estrogens on surrogate markers of cardiovascular disease risk. Unfortunately, this concern has been directed towards progestins as a class effect, although striking differences exist among the types of molecules used. The synthetic progestins used in HRT have varying pharmacologic properties depending on the molecules from which they are derived, either testosterone or progesterone. Very small structural changes in these molecules may induce considerable difference in their effects on various targets and especially on the surrogate markers of cardiovascular disease risk, where some molecules may reverse the beneficial effects of estrogen. Natural progesterone and some of its derivatives such as the 19-norprogesterone molecules or the new molecules drospirenone, a potent antimineralocorticoid agent with a beneficial effect on blood pressure, and dienogest do not exert any androgenic effect and have no negative effect on the lipids or on the endothelial cells. Although it is likely that the new progestins may be neutral on the coronary disease risk, when administered to the younger postmenopausal woman, this has not as yet been documented by large, randomized, controlled trials.

Tuberculosis control programs have recognized and addressed those system components in which knowledge and behavior of the patient and the general population are key issues because they have a profound influence on the treatment-seeking behavior and completion of course of treatment. As a part of the Revised National Tuberculosis Control Program, the ongoing information, education, and communication (IEC) efforts in Delhi were further intensified in the form of a multipronged media campaign. The objectives of this study are to evaluate ( a) the impact of the campaign on awareness generation among the target audiences, ( b) their opinion for making the campaign more effective and suited to their needs, and ( c) perceptions of health personnel regarding the campaign. The study follows a descriptive cross-sectional design. The following qualitative methods were used: ( a) focus group discussions of patients and the general population, ( b) 3 key informant interviews of the health care personnel and a defaulter patient, and ( c) in-depth interviews of 20 DOTS (directly observed treatment, short course) providers. The study observed that ( a) different sociocultural segments of the population varied in terms of their observations of IEC messages, ( b) stigma associated with tuberculosis is widely prevalent despite having a campaign, and ( c) television was voted as the most effective IEC medium. IEC strategies should be tailor-made and suited to the needs of a particular subpopulation.

New options for hormonal replacement therapy (HRT) include non-oral, low-dose sustained delivery of progestins in different formulations. Since the Women's Health Initiative (WHI) study, prescription trends were observed selecting progesterone over other progestins, or delivering the progestin parenterally, in order to reach low systemic levels of the steroid. Such modalities include progesterone vaginal rings or gels, and intra-uterine systems (IUSs). When given via the transdermal and intranasal routes, the hormones are delivered systemically although the first liver impact is by-passed. Of the progestins selected for delivery of low doses by means of an IUS, or transdermally, only very active molecules can be used. An IUS approved for HRT in several countries delivers very low doses of levonorgestrel (LNG) in the uterine cavity. Nestorone is well absorbed transdermally from a gel as well as from a metered dose transdermal system (MTDS) that sprays an invisible film on the skin. Transdermal patches combining oestradiol with either norethisterone acetate or LNG have been available for several years. Although parenteral administration of progesterone or low-dose progestins should in theory be associated with fewer side-effects than oral therapy, the long-term safety of the newer systems warrants further evaluation.

The preference for a son continues to be a prevalent norm in the traditional Indian household. This is evident from the declining sex ratio which has dropped to alarming levels, especially in the northern states according to Census 2001 reports. The proliferation and abuse of advanced technologies coupled with social factors contributing to the low status of women such as dowry, concerns with family name and looking up to the son as a breadwinner has made the evil practice of female feticide to become common in the middle and higher socioeconomic households, especially in the northern states. Despite the existence of the Prenatal Diagnostic Techniques Act, there is a dire need to strengthen this law since the number of convictions is despairingly low as compared to the burden posed by this crime. Moreover, it is necessary to gear efforts against the cultural, economic and religious roots of this social malady by woman empowerment and intensive Information, Education and Communication campaigns. The medical colleges and professional bodies have a vital role to play by sensitizing medical students who are the doctors of tomorrow.

Public provisioning of quality health care to make available affordable and reliable health services constitutes the focal point of national health programs and policies. Significant progress has been achieved over the decades during the various 5-year plan periods. The present paper discusses the changes achieved in the key areas of health over the XI 5-year plan period and further proposals for important areas under the XII 5-year plans.

Sir, According to a recent report by UNICEF, up to 50 million girls and women are missing from India's population as a result of systematic gender discrimination.(1) The 2001 Census reported an adverse child sex ratio of 927.(2) The proliferation and abuse of advanced technology coupled with the low status of women has made the evil practice of female feticide common in middle and higher socio-economic households, especially in the Northern states.(3,4) However, in contrast to these observations, another study reveals that the age-old son-preference has slightly declined at the end of the twentieth century, and a substantial selective male feticide is also being committed annually along with larger selective female feticide.(5) If the doctors are willing to fight against this emerging concern, the problem could easily be curbed. This study was conducted to assess the perspectives of tomorrow's doctors on this issue. Study participants included 62 interns and 39 MBBS students in their seventh semester who were posted to the Department of Community Medicine of Maulana Azad Medical College, New Delhi. They were asked to complete a pre-designed and pre-tested questionnaire that contained multiple choice questions pertaining to their knowledge and attitude toward female feticide. The data was entered using SPSS Version 13.0 software and analyzed by means of comparison of simple proportions. Out of 100 medical undergraduates, 57% were males and 43% were females. The mean age of students was 21.8 ± 0.6 years while the mean age of interns was 23.2 ± 0.8 years. Table 1 displays the participants' responses regarding the danger of female feticide and possible measures to curb this practice. It is important to note that less than a third of the participants were in favor of stricter punishment for the doctors involved in this practice. A significantly higher number of female participants were in favor of woman empowerment related strategies. Table 1 The dangers of female feticide and suggestions pertaining to steps to arrest the declining gender ratio The findings in our study underscore the need to sensitize tomorrow's doctors about the ethics related to the inappropriate and indiscriminate use of technology. This could be brought about by conducting regular workshops/Continuing Medical Education sessions (CMEs) and awareness campaigns in field practice areas of the department. Private practitioners should also be encouraged to participate in such programs. While the future doctors could join hands in efforts directed at improving the status of women in India, it is more urgent that they unite in curbing the threat posed by doctors involved in such practices and, most importantly, be sensitized enough so as to not get involved themselves.

Background To examine changes in behavioural outcomes among rural female sex workers (FSWs) involved in a community-based HIV preventive intervention in south India. Methods 14,284 rural FSWs from 1,253 villages that were selected through a process of rapid rural mapping were reached by community workers (called link workers) and FSW peer educators over a period of three years between 2009 and 2012. A community-based model for delivering outreach, medical and referral services was developed and employed. Socio-demographic profiles of the FSWs and programme outputs were captured using an individualised computerised management information system (CMIS). Changes in behaviour were assessed in an anonymised fashion using two rounds of polling booth surveys (PBS) conducted in 2009 and 2012. Results 91% of FSWs were above the age of 25, and 85% had been involved in sex work for two or more years. During the three-year period, 95% of the mapped FSWs were reached at least once, 80.3% received condoms as per need, and 71% received health services for sexually transmitted infections. In 2012, 45% reported having been tested for HIV infection, at least once in the previous six months. The two rounds of PBS showed significant differences in behavioural outcomes. Condom use increased from 60% to 72%, and condom breakage reduced from 30. 2% to 8.4%. Utilization of HIV counselling and testing services increased from 64% to 92.4%, and the proportion of FSWs testing HIV positive declined from 2.3% to 0.17%. Conclusions This community-based model for delivering HIV prevention programmes and services among widely dispersed female sex workers in rural areas was effective. Community-based health workers provided the vital link between marginalised communities in need of services and the formal health system. This model for rural outreach and HIV care could also be applied to many other health problems.

The global HIV/AIDS epidemic continues to take its toll of human lives. In 2007 there were 33 million people living with HIV/AIDS, with 2.7 million new HIV infections and two million HIV-related deaths.(1) With a total of 2.5 million people living with HIV/AIDS, India too is in the grip of the HIV/AIDS epidemic.(2) According to the HIV Sentinel Surveillance data 2004–2006, there are 156 Category A districts (where there is more than one per cent antenatal prevalence at any given time, in any of the sites, in the last three years).(3) Despite the recent progress in increasing access to treatment and prevention programs, the epidemic continues to outpace the global prevention efforts. In countries that are most heavily affected, the epidemic has led to a significant increase in household poverty and reduction in the life expectancy by more than 20 years.(4,5) The effects of gender inequality leave women and girls more at risk of exposure to HIV. In India, women are becoming increasingly vulnerable to HIV/AIDS and account for around one million cases.(6) Moreover, they have fewer and rather unfeasible options available to protect themselves such as abstinence and use of condom. The best hope of ending the epidemic lies in the development of a suitable vaccine.(7) Vaccines are one of the most effective public health interventions ever known. An HIV vaccine could either prevent disease onset or progression to AIDS. According to mathematical estimates by the International AIDS Vaccine Initiative (IAVI) - provided that other programs for treatment and prevention have been scaled up — an HIV vaccine with an efficacy as low as 30% and coverage as low as 20% could avert as many as 5.5 million new infections between the years 2015 and 2030.(8) The development of an effective vaccine has posed a wide range of challenges, as HIV has proven to be a uniquely complex virus.

India is in a phase of demographic transition. As per the 1991 census, the population of the elderly in India was 57 million as compared with 20 million in 1951. There has been a sharp increase in the number of elderly persons between 1991 and 2001 and it has been projected that by the year 2050, the number of elderly people would rise to about 324 million.(1) India has thus acquired the label of “an ageing nation” with 7.7% of its population being more than 60 years old. The demographic transition is attributed to the decreasing fertility and mortality rates due to the availability of better health care services. It has been observed that the reduction in mortality is higher as compared with fertility. There has been a sharp decline in the crude death rate from 28.5 during 1951–1961 to 8.4 in 1996; while the crude birth rate for the same time period fell from 47.3 to 22.8 in 1996.(2) Over the past decades, India's health program and policies have been focusing on issues like population stabilization, maternal and child health, and disease control. However, current statistics for the elderly in India gives a prelude to a new set of medical, social, and economic problems that could arise if a timely initiative in this direction is not taken by the program managers and policy makers. There is a need to highlight the medical and socio-economic problems that are being faced by the elderly people in India, and strategies for bringing about an improvement in their quality of life also need to be explored.

Health is a fundamental human right and it is the responsibility of the government to provide health care to all people in equal proportions. Ever since Indias independence in 1947 various national health schemes and programs have been launched with the view to improve the health status of people living in rural areas. It is not almost 2 years since the Government of India launched the National Rural Health Mission (NRHM on 12th of April 2005. The aim of the NRHM is to bring about dramatic improvement in the health system and the health status of the people especially those who live in rural areas of the country. The Mission seeks to provide universal access to equitable affordable and quality health care as well as to bring about an improvement in the health status of the underprivileged sections of the society especially women and children. Although the NRHM aims to cover all the states - namely Arunachal Pradesh Assam Bihar Chhattisgarh Himachal Pradesh Jharkhand Jammu and Kashmir Manipur Mizoram Meghalaya Madhya Pradesh Nagaland Orissa Rajasthan Sikkim Tripura Uttaranchal and Uttar Pradesh. The government has embarked an outlay of Rs. 8207 crores for 2006-2007 in comparison to Rs. 6553 crores in the previous year. The budget for 2007-2008 is likely to be increased to Rs. 10500 crores. The present article aims to explore the current status of implementation and progress of activities as envisaged under NRHM in the highly-focus states of the country that are under priority as well as non-priority states. Following actions have been taken under NRHM. (excerpt)

Background : India is at present facing an emergence of sexually transmitted infections (STIs) and human immunodeficiency virus. Community-based studies on the prevalence of STIs among males are scanty. Aim : (i) To study the prevalence of STIs and (ii) to assess the level of awareness about STIs among males belonging to the reproductive age group residing in an urban slum. Setting and Design : This is a cross-sectional study conducted in selected areas of Delhi, using a camp approach. Materials and Methods : One hundred ninety-six males in the reproductive age group were interviewed regarding their awareness about STIs, past history and present complaints of any symptoms suggestive of an STI. This was followed by a clinical examination. Required samples were also collected for microbiological tests. Statistical Tests : Simple proportions and Chi-square test. Results and Conclusions : As many as 70% of the study participants were unable to mention even one symptom of an STI. About 73.4% of the study participants stated that staying in a monogamous relationship could help prevent STI, while only 39.2% were aware that condoms could afford protection against an STI. As many as 8.7% complained of urethral discharge, while 5.6% complained of itching, 2.5% reported presence of genital ulcer and 1.0% complained of groin swelling. We found a seroprevalence rate of 1.5% for trichomoniasis and 3.6% for syphilis. Thus the overall awareness level about STIs and their prevention was rather low. Poor treatment-seeking behavior was also observed. The actual prevalence rate in the general population might be higher due to the likelihood of presence of an asymptomatic infection. The present study calls for a multipronged approach which also includes targeted interventions and strategies to be adopted in the reproductive health programs for males who have been neglected by the program managers so far.