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Suicides by the farmers' is increasing in India. From 2005 to 2020, 319,598 famers committed suicide and in states of AP and Telangana this number was 319,598 which is 28% of the total. It implies that more than one quarter of the total number of farmers' who committed suicide in the ountry were from Telangana and AP. Worldwide farming is considered as a high risk occupation for mental diseases. May be because of the nature of farming and the risk of natural calamities. The study aims to identify the factors that contribute to farmer suicides in Telangana andAndhra Pradesh (AP) and to propose preventive solutions for the problem. In this research in-depth interviews were done with the close relatives ofthe person who committed suicide and qualitative methodology is used. We find that the main causes of farmers suicides are economic and not themental health of the farmers. [ABSTRACT FROM AUTHOR]

Nutrition deficiency is commonly observed in lactating mothers and is a rising trend in India due to improper dietary patterns, physiological factors, socio-economic and demographic factors. The aim was to study the nutritional status and its related factors among lactating mothers in the urban areas of Delhi region, India. A structured, pre-tested and validated questionnaire was used to capture the socio-demographic information, including economical and medical conditions, of 150 lactating women in Delhi, India. Pearson correlation coefficient and association of various factors were determined. 72.5 per cent of women were in the age bracket of 20–25 years and in low-income group (70 per cent). The prevalence of underweight was 21.33 per cent, and the mean and SD of body mass index (BMI) of mothers were 19.17 ± 2.1 and 20.70 ± 2.3 for sedentary and moderate workers, respectively. There were significant correlations found between BMI, energy, carbohydrates, fat and protein intake (p <.05). Multivariate regression model was used to associate the nutrition of participants' income group, education, type of work, age of mothers and frequency of meals. Based on the results, intervention programmes for dietary correction and the effect of nutrition on the body have to be emphasised to lactating mothers for better health and nutritional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Mission Balam Sukham's Nutrition Rehabilitation Centre (NRC) combats malnutrition through prevention, treatment, and community engagement, ensuring children receive adequate nutrition for healthy growth. Objective: To document IYCF practices and risk factors of severe acute malnutrition (SAM) among NRC beneficiaries Methodology: A prospective cohort study was conducted comprising of 63 children aged 6 months to 5 years having SAM alongwith complications admitted at NRC of South Gujarat over the duration of 10 months. Observations: 90.5% poverty, 57.1% migrants, 7.9% single parent. 69.8% initiated breastmilk within 1hr, 15.9% weren't fed with colostrum, 6.3% were given pre-lacteals. 93.7% were exclusively breastfed, 6.3% initiated breastmilk at the time of 6 months. 16%, 60% and 9.8% met the criteria of MDD, MMF and MAD respectively. Boys show significant association on admission and discharge both (t = 2.43, p= 0.026 on admission and t= 2.66, p= 0.015 on discharge). In 13-24 months, MDD group (t = 2.34, p=0.02), children not suffering from anaemia shows significant weight (t=-2.540, p=0.18). Conclusion & Recommendations: Children's weight improvement is linked to better IYCF practices, emphasizing its importance of caregiver attention and education, highlighting need to address cultural barriers and promote practices like exclusive breastfeeding and continuous breastfeeding, focusing on empowering mothers and caretakers. [ABSTRACT FROM AUTHOR]

The underweight status among older adults in India and its association with other health risks has received little attention. Using nationally representative data from the first wave of the Longitudinal Aging Study in India (LASI, 2017-18), this study examined the underweight status among the Indian older adults and investigated its relationship with various health outcomes. The effective sample size of this study was 28,050 older adults aged 60 years or above. Multivariable logistic and linear regression models were employed to meet the objectives of the study. Underweight status was found to be negatively associated functional health, cognitive function, and grip strength. However, no significant association was observed between underweight status and depressive symptoms. Moreover, socioeconomic, demographic, and geographic factors were identified as strong determinants of underweight status among Indian older adults. India has implemented a wide range of nutrition policies that primarily focus on children, mothers, and adolescents. While these policies are important, it is equally crucial to develop interventions specifically tailored for adults and older adults. [ABSTRACT FROM AUTHOR]

Background: Child labor is considered one of the main social problems that affect the community and has a physical and psychosocial impact on a child's health, growth, and development. The study aimed to describe the sociocultural discourses of children involved in child labor. A macroethnographic approach was used to collect the data from the selected community areas of Punjab, India. Materials and Methods: A community-based qualitative study using purposive sampling was carried out among children engaged in child labor (n = 8). The data were gathered through in-depth or semi-structured interviews and non-participant observation under four phases: community context assessment, egocentric network analysis, validation, and dissemination of study findings. The guide for consolidated criteria for reporting qualitative research (COREQ) was followed. Ongoing analysis was conducted using Spradley's analysis approach to identify the themes. Results: Thematic analysis resulted in the emergence of various themes related to child labor, namely, adaptability, money-centric attitude, sense of being underserved, social deprivation, work burden, reduced emotional expression, workaholism, abuse, family shoulder, family cohesion, and sense of industry. Apart from that, inhuman living and working conditions, as well as school deprivation among study subjects, were observed. Poverty emerged as the single most compelling factor for child labor in India. Conclusion: The study concluded that child labor had a negative impact on children's overall development. An effective intervention to stop child labor is if vulnerable children are identified through primary healthcare, and a relationship of trust is built that allows for the provision of health care, education, support, and referral to additional services outside the health sector. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate how a community psychiatry model, referred to as the Mental Health Action Trust (MHAT) in India, provides decentralized care and comprehensive services to people with severe mental illness living in poverty. Using the complex adaptive system (CAS) framework, the authors aim to understand the factors that contribute to the diverse outcomes of the MHAT community mental health programme as observed in four different locations. Design/methodology/approach: Four MHAT clinics were purposively chosen from two districts in Kerala. A comparative case study methodology was used to document each clinic's MHAT services and activities, as found during field visits and interviews with staff members and volunteers. Findings: The study shows that all four clinics met the basic aim of providing free, quality mental health care to the poorest populations, although not all aspects of the comprehensive model could be equally provided. Alignment with the MHAT vision, appropriate leadership, the relationship with partners and their level of community engagement determined the varied success between clinics. Originality/value: The current study evaluation stresses that community ownership is crucial. Careful attention must be paid to the characteristics of selected partners, including their leadership styles and ability to garner resources. [ABSTRACT FROM AUTHOR]

The youth of North-East India are in disadvantaged situations as compared to youth from the rest of the country in all respects. The objective of this article was to examine the views of the NCC Officers of North-East states about youth welfare in the region as they have first-hand experience in dealing with youth. Participants' views were obtained on-line, by using a Semi-structured Questionnaire in the form of Google Form. A group of 142 NCC Officers provided feedback. Data collected were subjected to thematic analysis. Findings disclosed that youth of North-East states experience a range of challenges including poverty, lack of internet facilities, inability to attend NCC camps due to ongoing classes, substance dependence, lack of guidance and support leading to dropout and lack of values. The NCC Officers opined that a good number of North-East youths require mental health support and career guidance, in addition to mental health awareness. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative research examines the varied reasons for relocation to old age homes (OAHs) in contemporary India. The purpose of this study investigates the acceptance of institutional living in Lucknow (a Tier II city of India) and whether migration to OAHs is a voluntary decision. This study also examines the lifeworld of the older adult in these OAHs in an attempt to find out whether OAHs are conducive to positive ageing. Derivatively, the authors study their engagement/time use pattern and social networking patterns in the OAHs. Finally, the research seeks to learn whether OAHs are slowly substituting older adult care given within the family by offering the best of the facilities and services. Design/methodology/approach: This qualitative research was conducted in two private OAHs in Lucknow, India. The findings of the study are based on 28 qualitative interviews conducted with the inmates, administrative staff and caretakers. The interviews were unstructured and open-ended and were supported by observations. The observation was not only made of the social setting but also the reaction of the participants. The idea was to develop an emic view of the subject by exploring valid narratives. Pseudonyms were used to report the finding so as to maintain the confidentiality of the research subjects. Findings: This research moves beyond the traditional wisdom that people move to OAH because of the push factors within the family. OAHs in India have evolved over the years and high-end OAHs are equipped with modern amenities to cater to the upper class in their twilight years. Residents were found to lead active lives in OAHs and their common habitus and bonding capital helped them to face the vagaries of old age more confidently. Their active life and membership in various civic organizations challenge the contention of the role theory that the aged are more prone to lose rather than gain roles. Originality/value: The originality of the research lies in the fact that the authors are extending the arguments made by the role theory of social ageing. The theory proposes that aged people are more likely to lose out roles rather than gain new ones. This study finds that the elderly tend to live a very active life in OAHs and engaged various civic organizations. Although they may lose/voluntarily give up the roles like the head of the household, spouse, etc., they acquire new roles in the context of OAHs. [ABSTRACT FROM AUTHOR]

Live‐in child domestic work is an often exploitative informal labour sector that involves child migration and long‐term separation of children from their family. While studies have documented the impact of family separation in cases of adult migration and young adult migration, little is known about the impact of child migration and related parent–child separation. This small‐scale, explorative qualitative study aimed to understand lived experiences of parent–child separation through in‐depth interviews with seven parents of children working at households in Karnataka, as live‐in domestic help. This study is the first of its kind to explore parental experiences of separation from their child/ren in the context of live‐in domestic work and explores notions on the existence of choice in decision‐making, and sheds light on how practices of separation are interlinked with socioeconomic factors, societal hierarchy and cultural practices of parenting that lead to understanding and coping with the ensuing separation. It concludes by identifying some policy implications that are relevant for organizations seeking to re‐unify and reintegrate children with their families after a period of separation. [ABSTRACT FROM AUTHOR]

Introduction: Mental health issues were neglected in India. However, coronavirus disease 2019 (COVID-19) had raised the importance of mental health. Hence, this study aimed to determine the prevalence of awareness and utilization of the mental health services provided by primary care centers during the COVID-19 pandemic. Methods: This community-based cross-sectional study was conducted among individuals aged 18 years and above in selected primary health center (PHC) service areas, Karnataka, South India. The sample size was 388. A semi-structured questionnaire was used to collect the information. Results: The mean (standard deviation [SD]) age of the participants was 42.7 (±15.37) years and 76% were female. The prevalence of awareness was 47% (95% confidence interval [CI] 41.8%–52.0%), and only 1% (95% CI 0.8%–2.6%) had utilized the mental health services through PHCs during COVID-19. About 82% (95% CI 78.0%–85.8%) were willing to avail the mental health services through PHCs. No formal education (adjusted prevalence ratios [APR] = 7.33, 95% CI 1.81–29.60, P = 0.005) and current psychological distress (APR = 2.99, 95% CI 2.08–4.30, P = 0.00) were significantly associated with unwillingness to avail care from PHCs. Conclusion: The awareness and utilization of mental health services through primary care centers were poor in the community. Strategic measures must be implemented through the mental health program to improve the utilization of the services. [ABSTRACT FROM AUTHOR]

Introducing complementary feeding at 6 months can reduce premature death. We examined timing and factors associated with complementary feeding using the Indian Human Development Survey II (n = 11,218 women). Only 21% of mothers initiated complementary feeding at 6 months, 42% at 7–9 months, 33% at ≥10 months. In adjusted results, we found mothers with low income, with no formal education, and who had never formally worked were less likely to introduce complementary feeding at 6 months (p > 0.05). Our results indicate women in less advantaged groups are less likely to initiate complementary feeding at recommended age than women in more advantaged groups. [ABSTRACT FROM AUTHOR]

The studies conducted a decade ago showed that the Ponseti method, suffers from many execution-related issues-particularly in low and middle-income countries including poverty, physical distance, lack of transportation etc. The society has undergone many changes, including improvements in literacy, connectivity (both transport and digital), etc., in the last decade. Therefore, this study is designed to identify the contemporary apprehensions, concerns, and challenges of parents seeking CTEV treatment for their child through the Ponseti Method in India. A descriptive cross-sectional study of 200 parents of the children undergoing treatment at a multi-specialty hospital is carried out using an interview guide. The semi-structured interviews were conducted telephonically and recorded. The statistical analysis shows that a male child is presented late than a female child. The physical distance is associated with child discomfort during the casting and bracing phase, with the travel method affecting the follow-up. The increase in travel time may result in increased casts due to a lack of regular follow-up. Parents' income level is also strongly associated with regularity of follow-up and child discomfort during treatment. The patients traveling long distances in public transport are the most vulnerable group regardless of gender. The children in such cases are more likely to experience discomfort during the casting and bracing phase with a lack of regular follow-up. Expert doctors and brace unavailability in the local area remain vital challenges for the parents. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, the Government of India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY), a part of the Ayushman Bharat scheme as a progressive step toward universal health coverage. The scheme was intended to provide health insurance for the socioeconomically deprived population. This study was undertaken to assess the coverage of the scheme and to assess the reduction in medical out-of-pocket expenditure (OOPE). Methods: This was a cross-sectional study conducted among the urban slum dwellers in Mysuru. A semi-structured questionnaire was used for the study. Oral consent was taken from the participants before administering the questionnaire. Data were collected by face-to-face interviews. Statistical tests such as percentages and mean were calculated using SPSS software (Version 26, Licensed by JSSAHER). Results: The study was conducted among 104 individuals, of which 73% were females. Only 38 (33%) of the participants had PM-JAY cards while 59 (56.73%) did not have any health insurance. Thirty percentage (78.95%) of the card holders had utilized the insurance in the past 1 year and incurred an OOPE of Rs. 25,873/-. For all the cardholders, this amount was spent from their savings. Conclusion: The coverage of the scheme and OOPE reduction toward health care is still lacking. Greater measures need to be taken by medical officers, medicosocial workers, and other field workers to identify eligible households and help them avail the benefits of this scheme. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) represents a major cause of disability in India. For implementation of best practice management, it is important to consider the views of people in India since they might deviate from those expressed in previous studies by people with OA in the Western world. The purpose of this study was to explore and describe approaches toward OA and its management among patients in a rural setting in Central Western India. Conventional content analysis was used to analyze semi-structured interviews with 24 patients diagnosed with OA from the target area of Pravara University Hospital and ten adjacent primary health care centers in Maharashtra, India. Four categories; lack of power, active ambivalence, taking control and a constant struggle were identified as patients' approaches to OA. The categories were further elaborated on in seven subcategories. Daily challenges and efforts, of which some may be unique to patients in a rural setting in India, underlie passive and active approaches to OA and its management. Understanding these may enhance Indian physiotherapists' implementation of evidence-based self-management programs adapted to Indian conditions and reduce the distress of their patients. [ABSTRACT FROM AUTHOR]

Using a qualitative approach, this study aimed to undertake an in-depth exploration of the experiences of COVID-19 patients and their significant others among the economically weaker sections in Kashmir. The study was conducted on 18 participants of different households solely from rural Kashmir while using the purposive sampling technique to recruit the participants and the principle of data saturation to determine the sample size. Data were collected using semi-structured in-depth interviews and analyzed through Braun and Clarke's thematic analysis framework. From the data analysis, six overarching themes of diagnosis, healthcare, treatment, survival thereof, social support and stigma were arrived at, which delineated the direct or indirect experiences of participants with COVID-19. The findings of the study revealed that the economically weaker sections of rural Kashmir are deprived of requisite healthcare facilities, which further intensifies their vulnerabilities to COVID-19 and associated health issues. They lie at the core of acute health disadvantage amid the COVID-19 crisis, and are hence drifted toward extreme marginality and socioeconomic adversity. [ABSTRACT FROM AUTHOR]

In this paper, we present the results of a qualitative study by a non-profit organisation implementing a community-based urban adolescent development programme. The study highlights the sexual and reproductive health and rights (SRHR) situation of marginalised young women in a developed state of India. Our findings, based on in-depth interviews with young women and frontline health providers, show that structural factors, such as economic and social stratifiers, gender norms and cultural beliefs, result in further marginalisation of young women. In turn, marginalisation adversely affects the realisation of SRHR through discriminatory practices around menstruation and lack of control in matters related to sexuality, contraception, pregnancy and safe abortion. Rights to the highest standards of sexual and reproductive health (SRH) care are compromised. Health system factors like providers' attitudes and knowledge, commodity supplies, and indifference to ensuring delivery of contraceptives and other services often result in unplanned pregnancies and affect the quality of young women's SRH care. Whatever information and support adolescents and young women get is from local community-based organisations. We conclude that structural determinants and violations of fundamental rights to education, equal opportunities and participation constitute a significant barrier to the enjoyment of SRHR by the marginalised young women in the study. Unless these are addressed, government policies and programmes to promote young people's SRHR will not benefit young women from disadvantaged communities. Partnership and complementarity between government programmes, adolescents and health rights civil society organisations are recommended to promote rights-based, equitable adolescent and youth-friendly services to this vulnerable population. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a research study in Thane District, Maharashtra, India, on access to sexual and reproductive health and rights (SRHR) for women and girls of Nomadic and Denotified Tribes (NT-DNT). NT-DNT communities face stigma and violence due to their historically criminalised status and nomadic lifestyle. Their precarious legal, social, and economic status has a negative impact on women's SRHR. Existing literature on this subject is sparse, and studies by researchers from within the community, which could bring about organic and community-led change, are almost non-existent. This study, carried out by a woman from a Nomadic Tribe, presents an insider's perspective on the experiences of and factors underlying the violation of the SRHR of girls and women of NT-DNT communities. The study used a human rights-based participatory methodology with qualitative methods including three focus group discussions with 21 women and 10 in-depth interviews with women and key informants from NT-DNT communities. The findings describe the gender, community, and health system barriers which hinder women's and girls' access to SRHR. Issues such as language barriers between the women and medical fraternity, criminalisation by the police, and extreme deprivation – more intense than faced by the general poor – are unique to women of these communities. The NT-DNT communities face extreme deprivation of basic resources such as identity documents, shelter, sanitation, education support, workplace safety, and transportation, which further deny women their sexual and reproductive rights. The paper aims to amplify these women's voices to advocate for better SRHR services for women and girls of NT-DNT communities. [ABSTRACT FROM AUTHOR]

Internally displaced women are underserved by health schemes and policies, even as they may face greater risk of violence and unplanned pregnancies, among other burdens. There are an estimated 450,000 internally displaced persons in India, but they are not formally recognised as a group. Displacement has been a common feature in India's northeast region. This paper examines reproductive and maternal health (RMH) care-seeking among Bru displaced women in India. The study employed qualitative methodology: four focus group discussions (FGDs) were held with 49 displaced Bru women aged 18–45 between June and July 2018; three follow-up interviews with FGD participants and five in-depth interviews with community health workers (Accredited Social Health Activists – ASHAs) in camps for Bru displaced people in the Indian state of Tripura. All interviewees gave written or verbal informed consent; discussions were conducted in the local dialect, recorded, and transcribed. Data were indexed deductively from a dataset coded using grounded approaches. Most women were unaware of many of the RMH services provided by health facilities; very few accessed such care. ASHAs had helped increase institutional deliveries over the years. Women were aware of temporary contraceptive methods as well as medical abortion, but lacked awareness of the full range of contraceptive options. Challenges in accessing RMH services included distance of facilities from camps, and multiple costs (for transport, medicines, and informal payments to facility staff). The study highlighted a need for comprehensive intervention to improve RMH knowledge, attitudes, and practices among displaced women and to reduce access barriers. [ABSTRACT FROM AUTHOR]

India launched the National Rural Health Mission (NRHM) in 2005 to improve maternal and child health by providing good quality health services to all, especially deprived sections of society, to reduce inequality in access to health services. With the backdrop of NRHM, we analysed the extent to which the utilisation of maternal health care services (MHCSs) in the three stages of the continuum of care—antenatal care (ANC), care during child delivery and postnatal care (PNC)—–has improved among the poor vis-à-vis the rich in India, and the corresponding narrowing down in inequality in the period 2006–2016. Data from the 3rd round of the National Family Health Survey (NFHS) in 2005–2006, capturing the pre-NRHM period and the 4th round of NFHS 2015–2016, capturing the post-NRHM era ten years after the implementation of the flagship programme, are used for the analysis. We estimated absolute as well as relative measures of inequality, absolute gap and coverage ratio between the poor and rich, slope index of inequality and concentration index. Our findings show that maternal health care coverage increased significantly among the poor for all components of MHCSs. Even so, the extent of utilisation of services remains significantly lower among the poor in 2015–2016 compared to the coverage among the rich in 2005–2006. Although inequality declined at the national level over the decade, it still persists. High equity has been achieved in using skilled birth attendance during child delivery and institutional delivery during 2015–2016, however, inequality continues to be higher for ANC indicators including consumption of iron and folic acid supplements for at least 100 days, receipt of four or more antenatal check-ups and comprehensive health check-ups at least once during antenatal visits and receipt of first check-up in the first trimester. [ABSTRACT FROM AUTHOR]

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women's perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression "tension" to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women's distress and the need for scholarship on women's mental health in low-income settings to be more attuned to gendered forms of marginalization. [ABSTRACT FROM AUTHOR]

In India, many people living with HIV (PLHIV) do not successfully initiate antiretroviral therapy (ART) after diagnosis. We conducted a clinic-based qualitative study at the Y.R. Gaitonde Centre for AIDS Research in Chennai, Tamil Nadu to explore factors that influence ART non-initiation. We interviewed 22 men and 15 women; median age was 42 (IQR, 36-48) and median CD4+ was 395 (IQR, 227-601). Participants were distrustful of HIV care freely available at nearby government facilities. Faced with the perceived need to access the private sector and therefore pay for medications and transportation costs, non-initiators with high CD4+ counts often decided to postpone ART until they experienced symptoms whereas non-initiators with low CD4+ counts often started ART but defaulted quickly after experiencing financial stressors or side effects. Improving perceptions of quality of care in the public sector, encouraging safe serostatus disclosure to facilitate stronger social support, and alleviating economic hardship may be important in encouraging ART initiation in India. [ABSTRACT FROM AUTHOR]

Antenatal morbidities and associated malpractices are quite prevalent in slums of Delhi. This paper aims to highlight the relationship between calories intake, seasonality and gravida. It also draws attention towards inter-related aspects of antenatal practices and morbidity among women. Survey of 400 women conducted in the slums of Delhi indicated high occurrence of antenatal and post-natal malpractices. The findings indicated that discrepancies in the advice given by the medical practitioners and traditional birth attendants (TBAs). This was seen to adversely impact a majority of expectant mothers. The finding support a strong direct relationship between calories intake, seasonality morbidity and mortality patterns among women as well as their children. Although ample research has been done on homebirths and their challenges, the perspectives of TBAs (who assist in the majority of homebirths) remain unexamined. The present study sought to add to this knowledge base by uncovering various practices prevalent in low income households of a cosmopolitan city like Delhi. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the correlation between substance use and non-communicable diseases according to socioeconomic status in India. Methodology: We analyzed nationally representative data from the fourth round of National Family and Health Survey (NFHS-4), which was conducted in 2015–16, and estimated the prevalence of tobacco and alcohol consumption among 112,122 men aged 15–54 years. A logistic regression analysis was performed to estimate the effect of substance use on non-communicable diseases. Results: It was found that 45% of men in the sample used tobacco in any form and 30% consumed alcohol. Men aged 50–54 years, divorced, separated or deserted, uneducated, belonging to the scheduled tribes and in the poorest wealth quintile consumed significantly higher quantities of substances. The results show that men who consume tobacco and alcohol significantly more likely to have diabetes or heart disease. Correlation of substance use and non-communicable diseases shows that men in the age group of 50 to 54 years, who are married, with higher educational attainments and belonging to the Christian religion are significantly more likely to have diabetes or heart disease. Conclusion: This study concludes that men of low socioeconomic status, who are substance users are at higher risk of developing non-communicable diseases. The study also highlights that men who consume tobacco and alcohol are significantly more likely to develop non-communicable diseases. [ABSTRACT FROM AUTHOR]

With increase in lifestyle diseases such as diabetes, hypertension and heart disease in emerging economies, it is important to understand the impact of acquiring these health issues on household income and consumption. Using a panel data of Indian households, we show that acquiring diabetes, hypertension or heart disease results in increased medical and non-medical expenses for high-income households. However, affected low-income households, to meet their increased medical expenses, had to divert resources from non-medical expenses. Our findings add to the extant marketing literature on impact of crises on consumption behaviour and the marketing implications of such changes in consumption behaviour. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 crisis in India negatively impacted mental health due to both the disease and the harsh lockdown, yet there are almost no qualitative studies describing mental health impacts or the strategies of resilience used, and in particular, no reports from the most vulnerable groups. This study aimed to examine the acute mental health impacts of the COVID-19 crisis as well as coping strategies employed by disadvantaged community members in North India. Methods: We used an intersectional lens for this qualitative study set in rural Tehri Garwhal and urban Dehradun districts of Uttarakhand, India. In-depth interviews were conducted in May 2020 during lockdown, by phone and in person using purposive selection, with people with disabilities, people living in slums with psychosocial disabilities and widows (total n = 24). We used the framework method for analysis following steps of transcription and translation, familiarisation, coding, developing and then applying a framework, charting and then interpreting data. Findings: The participants with compounded disadvantage had almost no access to mobile phones, health messaging or health care and experienced extreme mental distress and despair, alongside hunger and loss of income. Under the realms of intrapersonal, interpersonal and social, six themes related to mental distress emerged: feeling overwhelmed and bewildered, feeling distressed and despairing, feeling socially isolated, increased events of othering and discrimination, and experiencing intersectional disadvantage. The six themes summarising coping strategies in the COVID-19 crisis were: finding sense and meaning, connecting with others, looking for positive ways forward, innovating with new practices, supporting others individually and collectively, and engaging with the natural world. Conclusions: People intersectionally disadvantaged by their social identity experienced high levels of mental distress during the COVID-19 crisis, yet did not collapse, and instead described diverse and innovative strategies which enabled them to cope through the COVID-19 lockdown. This study illustrates that research using an intersectional lens is valuable to design equitable policy such as the need for access to digital resources, and that disaggregated data is needed to address social inequities at the intersection of poverty, disability, caste, religious discrimination and gender inherent in the COVID-19 pandemic in India. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a critical public health issue that has reached epidemic proportions. Research investigating IPV among young women in India using large-scale population data is lacking. This study examined the prevalence and factors associated with IPV among women aged 15 to 24 years in India through a social-ecological approach. This cross-sectional study analyzed data from the National Family Health Survey, a population-based survey conducted in India from 2005 to 2006. The past-year prevalence of emotional, physical, and sexual forms of IPV, among ever-married women aged 15 to 24 years were computed. Multivariate logistic regression was conducted to evaluate the association of factors at various levels of the social-ecological framework with the past-year experience of emotional, physical, sexual, and any form of IPV. The past-year prevalence of IPV among women aged 15 to 24 years (n = 16,285) was 29%. Physical IPV was the most common, affecting 23% in the past year. The past-year prevalence of sexual IPV among women aged 15 to 24 years at 9.5% was higher than older women. Individual factors significantly associated with the past-year experience of all forms of IPV were the young age at first marriage, parental IPV, and ever had a terminated pregnancy. At the relationship level, husband's controlling behaviors, his consumption of alcohol, and experience of violence from other family members were positively associated with all forms of IPV in the past year. Poverty and acceptance of IPV increased the women's odds of experiencing IPV. IPV was associated with multiple factors occurring at all levels of the social-ecological framework. Actions to prevent and eliminate IPV in India demand multidisciplinary and collaborative efforts that are tailored specifically for adolescents and young women. It is imperative to protect the girls and young women from IPV; it protects the future of India. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is a consequence of food insecurity. Food insecurity in India became a public health problem due to explosive population growth and widening gap between rich and poor. It also has a detrimental effect on factors related to health and social well-being of the family. Objectives: The study was conducted to determine the prevalence of food insecurity at household level in rural population and factors associated with it. Subjects and Methods: A community-based cross-sectional study was conducted among the households of rural Puducherry. The adult females in the households were interviewed with a pretested semi-structured questionnaire in which, along with sociodemographic factors, food insecurity was assessed using the Household Food Insecurity Access Scale. Univariate and multivariate logistic regression analysis was done to identify the factors associated with food insecurity. Results: Out of 299 households that were assessed for food insecurity, 31.7% (95% confidence interval [CI]: 26.6-37.4) had food insecurity. Out of 95 households with food insecurity, 51 (17%), 37 (13%), and 7 (2%) had severe, moderate, and mild food insecurity, respectively. In univariate analysis, the presence of children in the family, using below poverty line ration card, and socioeconomic status were significantly associated with food insecurity. In multivariate analysis, socioeconomic status was significantly associated with food insecurity (rate ratio: 3.59; P < 0.001 [95% CI: 1.68-7.67]). Conclusions: One in three families experienced the food insecurity, and it was more among households with children. It has to be addressed to prevent nutrition-related disorders in community, particularly in children. [ABSTRACT FROM AUTHOR]

Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI. [ABSTRACT FROM AUTHOR]

Objectives mHealth interventions for MNCH have been shown to improve uptake of antenatal and neonatal services in low- and middle-income countries (LMICs). However, little systematic analysis is available about their impact on infant health outcomes, such as reducing low birth weight or malnutrition among children under the age of five. The objective of this study is to determine if an age- and stage-based mobile phone voice messaging initiative for women, during pregnancy and up to 1 year after delivery, can reduce low birth weight and child malnutrition and improve women's infant care knowledge and practices. Methods We conducted a pseudo-randomized controlled trial among pregnant women from urban slums and low-income areas in Mumbai, India. Pregnant women, 18 years and older, speaking Hindi or Marathi were enrolled and assigned to receive mMitra messages (intervention group N = 1516) or not (Control group N = 500). Women in the intervention group received mMitra voice messages two times per week throughout their pregnancy and until their infant turned 1 year of age. Infant's birth weight, anthropometric data at 1 year of age, and status of immunization were obtained from Maternal Child Health (MCH) cards to assess impact on primary infant health outcomes. Women's infant health care practices and knowledge were assessed through interviews administered immediately after women enrolled in the study (Time 1), after they delivered their babies (Time 2), and after their babies turned 1 year old (Time 3). 15 infant care practices self-reported by women (Time 3) and knowledge on ten infant care topics (Time 2) were also compared between intervention and control arms. Results We observed a trend for increased odds of a baby being born at or above the ideal birth weight of 2.5 kg in the intervention group compared to controls (odds ratio (OR) 1.334, 95% confidence interval (CI) 0.983–1.839, p = 0.064). The intervention group performed significantly better on two infant care practice indicators: giving the infant supplementary feeding at 6 months of age (OR 1.4, 95% CI 1.08–1.82, p = 0.009) and fully immunizing the infant as prescribed under the Government of India's child immunization program (OR 1.531, 95% CI 1.141–2.055, p = 0.005). Women in the intervention group had increased odds of knowing that the baby should be given solid food by 6 months (OR 1.89, 95% CI 1.371–2.605, p < 0.01), that the baby needs to be given vaccines (OR 1.567, 95% CI 1.047–2.345, p = 0.028), and that the ideal birth weight is > 2.5 kg (OR 2.279, 95% CI 1.617–3.213, p < 0.01). Conclusions for Practice This study provides robust evidence that tailored mobile voice messages can significantly improve infant care practices and maternal knowledge that can positively impact infant child health. Furthermore, this is the first prospective study of a voice-based mHealth intervention to demonstrate a positive impact on infant birth weight, a health outcome of public health importance in many LMICs. [ABSTRACT FROM AUTHOR]

Background: India ranks among the bottom five countries in public health spending. Out of pocket spending of households on healthcare is almost 70% of income and reimbursement in any form availed by households whose members are employed in the formal sector is negligible. Objectives: To determine the usual source of medical care opted for by the study population. To find out the illness pattern and its age/sex distribution in the study population. To find out the expenditure incurred on illness and its source of procurement by the study population. Methodology: 52.42% urban Aligarh resides in slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further forced into poverty and indebtedness on account of expenditure on illness. Conclusions: National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending. [ABSTRACT FROM AUTHOR]

Child labour is a multi-faceted problem. When we hear about child labour, generally we think of market work, i.e. children employed in mines and factories. Yet only small portion of child labour are engaged in market work particularly in developing countries like ours. Those children who are working in household industries are often excluded by researchers and policy planners. Thus leaving us with a limited knowledge about the possible causes of child labour in the home based industries like carpet weaving in Jammu and Kashmir state. To fill this gap, an attempt is made in the present study to analyse various determinants of child labour in the carpet weaving industry of Kashmir, so that necessary measures can be suggested for its reduction. Data has been collected from a sample of 960 sampled households with the help of interview schedules from four selected districts of Kashmir Valley. Our results shows that low socio-economic status i.e. low income of the family, illiteracy of household head and large size of the family force the children to enter into the labour market at their tender age. Further, we found because of growing educated unemployment problem in the state, parents prefer to employ their children in the labour market instead of schooling. The study suggests that child labour can be reduced if parents are compensated equal to the earnings of their children and their educational cost. [ABSTRACT FROM AUTHOR]

BackgroundStigma related to mental health is a major barrier to help-seeking resulting in a large treatment gap in low- and middle-income countries (LMIC). This study assessed changes in knowledge, attitude and behaviour, and stigma related to help-seeking among participants exposed to an anti-stigma campaign.MethodThe campaign, using multi-media interventions, was part of the SMART Mental Health Project, conducted for 3 months, across 42 villages in rural Andhra Pradesh, in South India. Mixed-methods evaluation was conducted in two villages using a pre-post design.ResultsA total of 1576 and 2100 participants were interviewed, at pre- and post-intervention phases of the campaign. Knowledge was not increased. Attitudes and behaviours improved significantly (p < 0.01). Stigma related to help-seeking reduced significantly (p < 0.05). Social contact and drama were the most beneficial interventions identified during qualitative interviews.ConclusionThe results showed that the campaign was beneficial and led to improvement of attitude and behaviours related to mental health and reduction in stigma related to help-seeking. Social contact was the most effective intervention. The study had implications for future research in LMIC. [ABSTRACT FROM AUTHOR]

This study aimed to understand access to maternal health care and the factors shaping it amongst poor migrants in Mumbai, India. A cross-sectional mixed methods approach was used. It included multistage cluster sampling and face-to-face interviews, through structured interview schedules, of 234 migrant women who had delivered in the two years previous to the date they were interviewed. Qualitative in-depth interviews of migrant women, health care providers and health officials were also conducted to understand community and provider perspectives. The results showed that access to antenatal care was poor among migrants with less than a third of them receiving basic antenatal care and a quarter delivering at home. Multivariate analysis highlighted that amongst migrant women those who stayed in Mumbai during pregnancy and delivery had better access to maternal health care than those who went back to their home towns. Poor maternal health care was also due to weaker demand for health care as a result of the lack of felt-need among migrants due to socio-cultural factors and lack of social support for, and knowledge of, health facilities in the city. Supply-side factors such as inadequate health infrastructure at primary and secondary levels, lack of specific strategies to improve access to health care for migrants and cumbersome administrative procedures that exclude migrants from certain government programmes all need to be addressed. Migrants should be integral to the urban development process and policies should aim at preventing their exclusion from basic amenities and their entitlements as citizens. [ABSTRACT FROM PUBLISHER]

The World Health Organisation has called for global action to reduce child stunting by 40% by 2025. One third of the world's stunted children live in India, and children belonging to rural indigenous communities are the worst affected. We sought to identify the strongest determinants of stunting among indigenous children in rural Jharkhand and Odisha, India, to highlight key areas for intervention. We analysed data from 1227 children aged 6–23.99 months and their mothers, collected in 2010 from 18 clusters of villages with a high proportion of people from indigenous groups in three districts. We measured height and weight of mothers and children, and captured data on various basic, underlying and immediate determinants of undernutrition. We used Generalised Estimating Equations to identify individual determinants associated with children's height‐for‐age z‐score (HAZ; p < 0.10); we included these in a multivariable model to identify the strongest HAZ determinants using backwards stepwise methods. In the adjusted model, the strongest protective factors for linear growth included cooking outdoors rather than indoors (HAZ +0.66), birth spacing ≥24 months (HAZ +0.40), and handwashing with a cleansing agent (HAZ +0.32). The strongest risk factors were later birth order (HAZ −0.38) and repeated diarrhoeal infection (HAZ −0.23). Our results suggest multiple risk factors for linear growth faltering in indigenous communities in Jharkhand and Odisha. Interventions that could improve children's growth include reducing exposure to indoor air pollution, increasing access to family planning, reducing diarrhoeal infections, improving handwashing practices, increasing access to income and strengthening health and sanitation infrastructure. [ABSTRACT FROM AUTHOR]

A lack of financial capability--financial opportunities and abilities--and poverty are highly interlinked. Over 65 percent of people in India are excluded from any financial services. This article explores income-poor Indians' experiences with financial capability through a qualitative study. Purposive sampling was used to collect data from 658 individuals, through focus groups (n = 566) and face-to-face interviews (n = 92). Findings show that 97 percent of respondents had the opportunity to earn an income, and 55 percent earned through financial inclusion programs, but 87 percent of respondents earned less than U.S. $2 a day. Although almost all saved and needed to borrow, 46 percent were eligible for formal savings and only 23 percent for formal loans. Financial abilities or knowledge and skills related to income, savings, and loans were higher among the few who had a stable income or had medium and high income in relation to those who had unstable and low income. Respondents experienced many challenges with their financial capabilities, including borrowing to save, fearing formal loans, and lacking clarity about loan and interest rate; banks miscalculating interest rates; and political parties influencing access to loans. Implications for social policy and social work practice are discussed. [ABSTRACT FROM AUTHOR]

Surgical sterilization is the primary method of contraception among low-income women in India. This article, using qualitative analysis of key informant, in-depth interviews, and quantitative analyses, examines the antecedents, process, and outcomes of sterilization for women in a low-income area in Mumbai, India. Family planning policies, socioeconomic factors, and gender roles constrain women’s reproductive choices. Procedures for sterilization rarely follow protocol, particularly during pre-procedure counseling and consent. Women who choose sterilization often marry early, begin conceiving soon after marriage, and reach or exceed ideal family size early due to problems in accessing reversible contraceptives. Despite these constraints, this study indicates that from the perspective of women, the decision to undergo sterilization is empowering, as they have fulfilled their reproductive duties and can effectively exercise control over their fertility and sexuality. This empowerment results in little post-sterilization regret, improved emotional health, and improved sexual relationships following sterilization. [ABSTRACT FROM AUTHOR]

Health information systems are an important planning and monitoring tool for public health services, but may lack information from the private health sector. In this fourth article in a series on district decision-making for health, we assessed the extent of maternal, newborn and child health (MNCH)-related data sharing between the private and public sectors in two districts of Uttar Pradesh, India; analysed barriers to data sharing; and identified key inputs required for data sharing. Between March 2013 and August 2014, we conducted 74 key informant interviews at national, state and district levels. Respondents were stakeholders from national, state and district health departments, professional associations, non-governmental programmes and private commercial health facilities with 3-200 beds. Qualitative data were analysed using a framework based on a priori and emerging themes. Private facilities registered for ultrasounds and abortions submitted standardized records on these services, which is compulsory under Indian laws. Data sharing for other services was weak, but most facilities maintained basic records related to institutional deliveries and newborns. Public health facilities in blocks collected these data from a few private facilities using different methods. The major barriers to data sharing included the public sector's non-standardized data collection and utilization systems for MNCH and lack of communication and follow up with private facilities. Private facilities feared information disclosure and the additional burden of reporting, but were willing to share data if asked officially, provided the process was simple and they were assured of confidentiality. Unregistered facilities, managed by providers without a biomedical qualification, also conducted institutional deliveries, but were outside any reporting loops. Our findings suggest that even without legislation, the public sector could set up an effective MNCH data sharing strategy with private registered facilities by developing a standardized and simple system with consistent communication and follow up. [ABSTRACT FROM AUTHOR]

The research study titled "An exploratory study to determine the quality of life (QoL) and factors leading to imprisonment among women prisoners in a selected women prison" was based on the objectives; to determine the quality of life of women prisoners, to explore the factors leading to imprisonment, to find the association between the QoL of women prisoners and selected socio demographic and clinical variables, to find the association between the QoL and domains of quality of life of women prisoners and to find the association between the QoL of women prisoners and factors leading to imprisonment. Survey approach with an exploratory design was adopted and was conducted in a selected women prison. The conceptual framework was based on the Quality of Life model at the Centre for Health Promotion, University of Toronto. The study had primary outcome variables as quality of life and factors leading to imprisonment among women prisoners. Seventy samples were selected by purposive sampling technique. The tools used for the study were validated, pretested and the reliability also was established. The major findings of the study revealed that 43 (61.4%) participants have good quality of life. Among seventy participants 21 (30%) of them had poor QoL in psychological domain. Thirty seven (52.9%) of the participants had good QoL score in physical domain and 36 (51.4%) of them had medium QoL score in psychological domain. Majority 51 (72.9%) of the samples had good QoL score in social domain and 46 (65.7%) of them had good QoL score in environmental domain. Majority i.e. 61 (87.1%) of them had good QoL score in spiritual domain. Among the 70 participants, 10 (14.3%) of the participants had poverty as the leading reason for committing crime, followed by 8 (11.4%) having physical abuse and another 8 (11.4%) having family breakdown as the factor leading to imprisonment. Among the socio demographic variables; age of women prisoners has statistically significant association with the QoL of women prisoners (p<0.05). Among the clinical variables; Blood pressure and Lipid profile (Total serum cholesterol) have statistically significant association with quality of life (p=0.048). Physical, psychological and social domains have statistically significant association with the QoL of women prisoners (p<0.05). Factors leading to imprisonment has statistically significant association with the QoL of women prisoners (p <0.05). [ABSTRACT FROM AUTHOR]

Gender inequality is exceptionally high in India. It shows up through various explicit measures, but implicit disparities embedded in patriarchal norms are harder to measure. This article explores whether disparate freedoms between genders influence paid-work capabilities—abilities, skills, resources, and opportunities at personal, interpersonal, and structural levels. Using a mixed-methods design, purposive sampling, and face-to-face interviews, this article reports paid-work capabilities of 67 women and 25 men. The study finds statistically significant gender differences in some work capabilities; however, combined capabilities for work impact type of work and income more for women than for men. Implications are discussed. [ABSTRACT FROM AUTHOR]

Background: There is growing global interest into the attitudes and clinical management of persons who have attempted suicide. Aims: The principal purpose was to determine senior nursing staff attitudes towards patients who had attempted suicide from a professional and cultural perspective, which might influence care following hospital admission. The focus concerned nursing staff interactions at a psychological level that compete with physical tasks on general hospital wards. Methods: A qualitative methodology was employed with audio-taped interviews utilising four level data coding. This article reports on a group of 15 nursing staff from a large general hospital in Mysore, Southern India. Results: Findings suggested that patient care and treatment is directly influenced by the nurse's religious beliefs within a general hospital setting with physical duties prioritised over psychological support, which was underdeveloped throughout the participant group. Conclusion: The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and cross-cultural comparison studies. In addition, interventions must focus on current resources and context to move the evidence-based suicide prevention forward. [ABSTRACT FROM AUTHOR]

Objectives: Women's participation in microfinance-based self-help groups (SHGs) and the resultant social capital may provide a basis to address the gap in health attainment for poor women and their children. We investigated the effect of combining a health program designed to improve health behaviours and outcomes with a microfinance-based SHG program. Design: A mixed method study was conducted among 34 villages selected from three blocks or district subdivisions of India; one in Gujarat, two in Karnataka. Methods: A set of 17 villages representing new health program areas were pair-matched with 17 comparison villages. Two rounds of surveys were conducted with a total of 472 respondents, followed by 17 key informant interviews and 17 focus group discussions. Results: Compared to a matched comparison group, women in SHGs that received the health program had higher odds of delivering their babies in an institution (OR: 5.08, 95% Cl 1.21 --21.35), feeding colostrum to their newborn (OR: 2.83,95% Cl 1.02--5.57), and having a toilet at home (OR: 1.53,95% Cl 0.76--3.09). However, while the change was in the expected direction, there was no statistically significant reduction in diarrhoea among children in the intervention community (OR: 0.86,95% Cl 0.42-1.76), and the hypothesis that the health program would result in decreased out-pocket expenditures on treatment was not supported. Conclusion: Our study found evidence that health programs implemented with microfinancebased SHGs is associated with improved health behaviours. With broad population coverage of SHGs and the social capital produced by their activities, microfinance-based SHGs may provide an avenue for addressing the health needs of poor women. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance In order to explore the traditional medicine practised by the ethnic communities residing in the topographically and climatically challenged Purulia, an underprivileged district of West Bengal, India, a quantitative ethnobiological approach was adopted to document the folkloric use of ethnomedicinals against different sexual, gynaecological and related ailments. Materials and methods Ethnobiological surveys were conducted during 2012–2015 by interviewing 82 informants or traditional healers with the help of a semi-structured questionnaire. The survey included questions on botanical and non-botanical ingredients and additives mixed with monoherbal and polyherbal formulations, vernacular names of the plants and animals, methods of preparation and administration and restrictions during medications. Additional quantitative indices such as use value, informant׳s consensus factor and fidelity level were used for data analysis. Results Twenty eight sexual and gynaecological disorders were found to be treated with 18 monoherbal and 31 polyherbal formulations consisting of a total number of 96 plant species from 86 genera and 47 families and four animal species. A variety of additives, either botanicals or non-botanicals were used with the formulations for higher efficacy and taste enhancement. Fabaceae (16 species) was found to be the most common family of medicinal plants whereas herbs (42.7%) and roots (32%) were the most common habit type and plant part used respectively. Use value, informant׳s consensus factor and fidelity level indicate frequency and coherence of citations. Conclusion Age old belief on traditional medicine prevails in the studied area due to its efficacy, inexpensive price and the remoteness of tribal villages from conventional medical centres. Traditional healers had detailed knowledge of preparations, doses, methods of administration, restrictions during medications, safety and efficacy of using folkloric therapeutics against sexual and gynaecological disorders. Possible synergistic interactions among phytochemicals and additives were indicated to explain enhanced therapeutic efficacy of mixed herbal formulations. [ABSTRACT FROM AUTHOR]

Introduction: Socio-economic rehabilitation is an important outcome parameter in successful renal transplant recipients, particularly in developing countries with low income patients who often depend on extraneous sources to fund their surgery costs. We studied the socioeconomic rehabilitation and changes in socioeconomic status (SES) of successful renal allograft recipients among Indian patients and its correlation with their source of funding for the surgery. Materials and Method: A cross-sectional, questionnaire-based study was conducted on 183 patients between January 2010 to January 2013. Patients with follow up of at least 1 year after successful renal transplant were included. During interview, two questionnaires were administered, one related to the SES including source of funding before transplantation and another one relating to the same at time of interview. Changes in SES were categorized as improvement, stable and deterioration if post-transplant SES score increased >5%, increased or decreased by <5% and decreased >5% of pretransplant value, respectively. Results: In this cohort, 97 (52.7%), 67 (36.4%) and 19 (10.3%) patients were non-funded (self-funded), one-time funded and continuous funded, respectively. Fifty-six (30.4%) recipients had improvement in SES, whereas 89 (48.4%) and 38 (20.7%) recipients had deterioration and stable SES. Improvement in SES was seen in 68% patients with continuous funding support whereas, in only 36% and 12% patients with non-funded and onetime funding support (P = 0.001) respectively. Significant correlation was found (R = 0.715) between baseline socioeconomic strata and changes in SES after transplant. 70% of the patients with upper and upper middle class status had improving SES. Patients with middle class, lower middle and lower class had deterioration of SES after transplant in 47.4%, 79.6% and 66.7% patients, respectively. Conclusions: Most of the recipients from middle and lower social strata, which included more than 65% of our patient's population, had deteriorating SES even after a successful transplant. One-time funding source for transplant had significant negative impact on SES and rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Globally women confront manifold violations of human rights and women with poverty and mental illness are doubly disadvantaged. Aim: The aim was to examine the influence of poverty in meeting human rights needs among recovered women with mental illness at family and community level. Materials and Methods: This was a descriptive study carried out among randomly selected (n = 100) recovered women with mental illness at a tertiary care center. Data were collected through face-to-face interview using structured needs assessment questionnaire. Results: Our findings revealed that below poverty line (BPL) participants were not satisfied in meeting their physical needs such as "access to safe drinking water" (χ² = 8.994, P < 0.02), "served in the same utensils" (χ² = 13.648, P < 0.00), had adequate food (χ² = 11.025, P < 0.02), and allowed to use toilet facilities (χ² = 13.565, P < 0.00). The human rights needs in emotional dimension, that is, afraid of family members (χ² = 8.233, P < 0.04) and hurt by bad words (χ² = 9.014, P < 0.02) were rated higher in above poverty line (APL) participants. Similarly, 88.9% of women from APL group expressed that they were discriminated and exploited by the community members (χ² = 17.490, P < 0.00). More than three-fourths of BPL participants (76.1%) believed that there were wondering homeless mentally ill in their community (χ² = 11.848, P < 0.01). Conclusion: There is an urgent need to implement social welfare programs to provide employment opportunities, disability allowance, housing and other social security for women with mental illness. Further, mental health professionals play an essential role in educating the family and public regarding human rights of people with mental illness. [ABSTRACT FROM AUTHOR]

In India, “non-notified” slums are not officially recognized by city governments; they suffer from insecure tenure and poorer access to basic services than “notified” (government-recognized) slums. We conducted a study in a non-notified slum of about 12,000 people in Mumbai to determine the prevalence of individuals at high risk for having a common mental disorder (i.e., depression and anxiety), to ascertain the impact of mental health on the burden of functional impairment, and to assess the influence of the slum environment on mental health. We gathered qualitative data (six focus group discussions and 40 individual interviews in July–November 2011), with purposively sampled participants, and quantitative data (521 structured surveys in February 2012), with respondents selected using community-level random sampling. For the surveys, we administered the General Health Questionnaire-12 (GHQ) to screen for common mental disorders (CMDs), the WHO Disability Assessment Schedule 2.0 (WHO DAS) to screen for functional impairment, and a slum adversity questionnaire, which we used to create a composite Slum Adversity Index (SAI) score. Twenty-three percent of individuals have a GHQ score ≥5, suggesting they are at high risk for having a CMD. Psychological distress is a major contributor to the slum's overall burden of functional impairment. In a multivariable logistic regression model, household income, poverty-related factors, and the SAI score all have strong independent associations with CMD risk. The qualitative findings suggest that non-notified status plays a central role in creating psychological distress—by creating and exacerbating deprivations that serve as sources of stress, by placing slum residents in an inherently antagonistic relationship with the government through the criminalization of basic needs, and by shaping a community identity built on a feeling of social exclusion from the rest of the city. [ABSTRACT FROM AUTHOR]

Transnational feminist discourse has critiqued the pursuit of women’s empowerment through international development programs. Empowerment, when reduced to the provision of financial resources and services, is unlikely to lead to wider changes in gender inequality unless programs strategically combine credit with other vital services. We interviewed women participating in a multifaceted empowerment program in Mumbai, India, to explore the potential of the “Credit-Plus” model to facilitate pathways of individual and collective empowerment. Emergent themes of empowerment were enhanced socioemotional well-being, increased economic assets, and improved household gender equity. Interview responses demonstrate changes in individual, household, and collective agency dynamics. [ABSTRACT FROM AUTHOR]

This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalised area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy-related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined. [ABSTRACT FROM AUTHOR]

Background: The old-age home industry is mostly unregulated and there is a need for putting in place certain minimum standards. Many times poor and destitute persons who may need institution-based care cannot afford them. Long-term care has a price, and there is also a need for debate on its policy and best practice. Objectives: 1) To find out the various factors for availing the residential services of old age homes. 2) To assess the facilities available in old age homes. 3) To study the quality of life of elderly people in old age homes. Methods: It was a descriptive cross-sectional study. Study population was elderly (age 60 years) enrolled in free and paid old age homes (OAHs) of Lucknow city. All the elderly living in OAHs for ≥ 6 months and had given the consent for interview were included in the study. Results: The most important reason for elderly people living in Free OAHs was no care giver (77.1%) followed by poverty (20.0%). In case of Paid OAHs it was no care giver (36.4%) followed by self-satisfaction (34.8%). Services were significantly better (p <0.05) in paid type of OAHs. Statistically significant differences in the mean score of quality of life were found in case of type of OAH and financial dependency status of elderly people. Conclusions: No care giver, self-satisfaction and loneliness were important reasons in Paid OAHs whereas in Free OAHs no care giver, poverty and support from children were the main reasons. With the exception of food all other facilities were significantly better in paid OAHs. Quality of life and facilities of Paid OAHs were significantly better than Free OAHs. Financial status of elderly people was responsible for this significant difference. [ABSTRACT FROM AUTHOR]

ABSTRACT Dissatisfaction with inflexible top-down development interventions has led to a demand for more community-led approaches and the proliferation of terms such as participation, empowerment, and community ownership. However, the practical implications of these terms remain unclear. This study examined how sociocultural factors influenced relationship building between NGO staff and community members, and how this mediated community participation in a child education and women's rights intervention in Kolkata. Twenty interviews and one focus group were conducted with NGO staff, pupils, and members of a women's group. A thematic analysis produced five global themes: Sociocultural Context, Staff-Community Divide, Power Dynamics, Building Relationships, and Unstable Progress. Differences in social status, lifestyle, and priorities marked clear divisions between staff and community members, leading to communication difficulties and resistance ranging from suspicious stares to open hostility. Establishing mutual respect was a slow and unpredictable process often fuelled by unanticipated events such as staff helping with medical emergencies. A campaign against domestic violence prompted some women to physically attack men and vandalise property, provoking violent retaliation and creating divides within the community. Overcoming these challenges required a responsive approach which often deviated from operational and funding plans. The more participatory and community-led an intervention, the less predictable it becomes. The flexibility needed to gain community acceptance and manage unanticipated events relies on trusting relationships between both communities and staff, and staff and donors. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]