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Introduction: Anaemia is a global public health concern affecting individuals of all ages, particularly adolescents who are in a stage of rapid growth and development, making them more susceptible to iron deficiency anaemia. In India, the prevalence of anaemia among adolescents is high, with significant variations across regions. Literature regarding knowledge about anaemia and related dietary practices is scarce in Pune district, especially in Mulshi taluka. Aim: To study knowledge related to anaemia and assess the dietary practices in terms of consumption of iron-rich foods among adolescents aged between 14 to 17 years enrolled in public schools of Mulshi Taluka, Pune District. Materials and Methods: This cross-sectional study was conducted among school-going adolescents aged 14 to 17 years in Mulshi taluka, Pune district, Maharashtra, India, from June 2023 to August 2023. Data were collected from public schools using a pretested structured questionnaire administered through one-on-one interviews. A total of 285 responses were obtained. Descriptive statistics and the Chi-square test were applied to analyse the collected data using Microsoft (MS) Excel and Statistical Package for the Social Sciences (SPSS). Results: The study revealed that more than half of the adolescents were familiar with anaemia (59.6%). However, a lower percentage considered it a health problem (45.6%). Only a few adolescents had taken Iron-folic Acid (IFA) tablets within the past year (13%), while a higher percentage had consumed deworming tablets in the past six months (70.2%). Adolescents consumed roti or rice daily (90.2%), pulses (54.7%), and Dark Green Leafy Vegetables (DGLV) (73.7%) weekly. Fruits were consumed mainly weekly (46%) and occasionally (39.6%), whereas fried food and aerated drinks were regularly consumed. The findings revealed poor implementation of the National Iron Plus Initiative (NIPI) program. Conclusion: The study highlighted a lack of anaemia-related knowledge and observed inadequate dietary practices among adolescents. Thus, comprehensive efforts are required to bridge the knowledge gaps, improve dietary practices, and strengthen program implementation to ensure the comprehensive health and well-being of adolescents in Mulshi Taluka. [ABSTRACT FROM AUTHOR]

Introduction: Female Healthcare Workers (FHCWs) played a crucial role during the Coronavirus Diseases-2019 (COVID-19) pandemic, diligently donning Personal Protective Equipment (PPE) to deliver essential care to patients. While PPE effectively shielded FHCWs from infections, it simultaneously imposed limitations on their ability to perform fundamental human activities, including using restrooms and managing menstruation. During menstruation, the restricted access to sanitary pads, combined with the challenges of working in PPE, heightened vulnerability among FHCWs, resulting in discomfort, distress, and a decline in work efficiency. Aim: To assess the perceptions, experiences, and challenges of FHCWs regarding PPE usage while providing healthcare services during the COVID-19 pandemic. Additionally, it aimed to explore the challenges experienced in managing Menstrual Health and Hygiene (MHH) during the COVID-19. Materials and Methods: A cross-sectional study was conducted in the western region of India at a tertiary care hospital of the medical college of Symbiosis International (Deemed to be University) in Pune, Maharashtra, India from September 2020 to November 2020. A total of 300 FHCWs who were assigned COVID-19 duties and utilised PPE were included. Data was collected through a semistructured proforma, covering topics on PPE usage, challenges encountered, personal experiences, and the management of menstruation. The collected data underwent analysis using Statistical Package for Social Sciences (SPSS) software version 21.0, with a primary emphasis on descriptive statistics. Results: A total of 194 (64.7%) perceived that PPE imparted protection, and 267 (89.1%) believed that work efficiency was compromised. Challenges reported by FHCWs while working in PPE included sweating, difficulty in making eye contact, triggers of headaches, nausea, and earaches. A total of 161 (53.9%) reported experiencing a menstrual cycle while on duty with COVID-19 patients, out of which 40 (24.8%) experienced irregular periods, 23 (14.2%) experienced premenstrual stress, and 98 (60.8%) suffered from dysmenorrhoea during menstruation. Additionally, 155 (96.4%) were unable to change sanitary pads, 18 (11%) had stained PPE suits, and 146 (99.9%) experienced challenges in the disposal of sanitary napkins. Conclusion: Many FHCWs felt that PPE offered protection but also compromised work efficiency. Sweating, discomfort, and managing menstrual hygiene within PPE were common challenges encountered. Providing training on PPE usage, adjusting shift durations, implementing policies for the supply of sanitary pads, permitting breaks for changing, ensuring proper disposal arrangements, providing necessary medications and additional PPE if required, leaves, or creating alternative duty arrangements would be beneficial for FHCWs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Anemia poses a significant challenge among Indian adolescent girls due to their heightened vulnerability, resulting from increased micronutrient requirements, rapid physical growth, menstrual blood loss, inadequate nutrition, and socioeconomic disparities. This study sought to evaluate the prevalence of anemia, along with socioeconomic and nutritional statuses among adolescent girls attending rural public schools in Pune, India. METHODS: A sample of 400 girls was selected from 22 villages through Symbiosis International University. Hemoglobin levels were assessed using the HemoCue 201 system, while standardized protocols were employed for height, weight, and BMI-for-age measurements. Socioeconomic status was determined using the Kuppuswamy scale. RESULTS: The findings revealed an overall anemia prevalence of (42.75%), comprising severe (2.5%), moderate (21%) and mild (20.25%) cases. Additionally, a substantial proportion (74.6%) of girls were classified as underweight. Socioeconomic analysis disclosed that 64.25% of families belonged to the lower middle class, and 27% in the upper lower class. Anemia was more prevalent in young adolescent girls (10-14 years) and in the families of adolescents who had low income, were illiterate, unemployed, and belonged to the lower-middle class and upperlower-class socio-economic status (SES) and did not have a bank account. CONCLUSION: Anemia was prevalent in adolescent girls and associated with low SES. This study underscores the limitations of relying solely on the distribution of iron and folic acid tablets to combat anemia. A holistic strategy is imperative, encompassing improvements in SES of families (literacy, employment and income), as well as initiatives aimed at enhancing the nutritional status of adolescent girls. [ABSTRACT FROM AUTHOR]

Cancer care poses a significant economic burden in India, where noncommunicable diseases contribute to a large number of deaths and disability-adjusted life-years. Despite economic growth, equitable wealth distribution remains a challenge, leading to inequalities in healthcare access. India's healthcare system is primarily privatized, financed through out-of-pocket expenditure (OOPE), and lacks coverage for a majority of the population. As a result, individuals without financial means face catastrophic health consequences when seeking necessary healthcare. OOPE in India's healthcare system is a major concern, with medicines accounting for a significant portion of expenses, followed by diagnostic tests and consultation fees. Nonmedical expenses also contribute to the financial burden. Cancer care specifically faces substantial financial challenges, with high treatment costs, reduced workforce participation, and the need for distress financing. Cancer-related OOPE is predominantly borne by patients and their families, leading to significant financial strain. The lack of comprehensive health insurance coverage and limited access to publicly funded healthcare services exacerbate the problem. Catastrophic health expenditure (CHE) in cancer care is prevalent, pushing households into financial distress and potentially impoverishment. Efforts have been made to address this issue, such as increasing public spending on healthcare and implementing health insurance schemes. However, challenges remain in ensuring their effectiveness and reach. The role of family care physicians is crucial in supporting patients and their families during catastrophic health expenditures related to cancer-related palliative care. They coordinate care, provide advocacy, emotional support, symptom management, and facilitate end-of-life discussions. Comprehensive measures are needed to strengthen healthcare infrastructure, improve access to affordable cancer care, enhance health insurance coverage, and implement supportive measures for cancer patients. Additionally, promoting preventive measures and early detection can help reduce the need for expensive treatments and decrease the risk of catastrophic health expenditures. [ABSTRACT FROM AUTHOR]

Conducting research on healthcare systems, policy implementation and the impact of health programmes can systematically identify the gaps and challenges in public health service delivery in India. Anthropology is particularly useful for so doing, but the role of anthropologists in health policy and planning needs recognition in India, as they can evaluate the effectiveness of interventions through a cultural lens, informing the development of evidence-based policies. The USA and Europe are more advanced in the use of anthropology in public health, due to their established academic programmes, robust research funding and infrastructure, and effective integration into public health institutions. Anthropological analysis and intervention has the capacity to improve Indian public health practice, particularly in terms of inclusivity and diversity issues. [ABSTRACT FROM AUTHOR]

Background: Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. Methods: We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. Results: At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Conclusions: Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management. [ABSTRACT FROM AUTHOR]

Financial necessity and desperation is the primary reason for females to enter into sex work. The health and well-being of female sex workers (FSWs) depend on the balance between their earnings and the cost of living in their local environment. Therefore it would be of value to examine the comparative cost of living adjusted earnings of FSWs in different countries to gauge equity or its absence in their financial state. Data about per client per encounter earnings for FSWs in Pune, India was taken from primary research conducted by the first author. Equivalent secondary data was acquired for the US and Thailand from an online literature review. Earnings after converting to US dollar values were adjusted against the cost of living in the respective environments of the FSWs and then compared. An FSW in India, (Pune) earned on the average US $4.40 after adjusting for the cost of living locally, while in Thailand (Bangkok) the equivalent earning was US $18.77 and in the US (Washington DC region) it was $101.79. These results suggest that an FSW in the US earns 23 times more, and a Thai FSW earns 4 times more than an FSW in India. There are numerous variables that affect the earnings of an FSW and the limited defined scope of this paper based on available data does not permit detailed analyses of causal or intermediate influencing factors. Nonetheless, it can be said with reasonable confidence that much needs to be done and can be done to mitigate the earning disparity, particularly in an emerging economy like India as shown in this small study, and that can perhaps be done best under the umbrella domain of a "harm reduction approach." [ABSTRACT FROM AUTHOR]

The focus of the present study is to compare and assess the socio‐economic implications of the 1918 influenza pandemic and the COVID‐19 pandemic in India. Both pandemics are similar in the nature of their disease and spread, and have had a far‐reaching impact on society and economies worldwide. To achieve their objective, the researchers adopted the method of systematic literature review (SLR). The findings of the review have been categorised in four subsections: comparison of 1918 influenza and COVID‐19 pandemics in a global context; economic consequences of a pandemic in India; social consequences of a pandemic in India; and the pandemic mitigation measures adopted by India. The findings suggest there are similarities in the socio‐economic implications of the two pandemics and also indicate that developing countries face more severe implications of such pandemics as compared to developed countries. The research findings from the review of literature are followed by the recommendations made by the researchers. [ABSTRACT FROM AUTHOR]

Purpose: Girls with cerebral palsy can have limited capacity to cope with pubertal issues. It results in their parents being burdened with additional caregiving during this period. A qualitative study was undertaken among parents of girls with cerebral palsy to understand the caregivers' challenges and concerns. Method: Twenty-one interviews were conducted among purposively selected parents and caregivers of young adolescent girls with cerebral palsy in a tertiary care referral hospital in South India. The interview questions were related to menstrual hygiene, behavioural changes around puberty, fear of sexual abuse, and perceptions about contraception. Transcripts were coded and, after data anonymisation, manual thematic analysis was done using an inductive approach. Results: A total of 6 themes emerged, related to identification of problems, treatment-seeking patterns of the caregivers, social support and perspectives on contraception, pubertal challenges and concerns of parents for the future of their girls. Caregivers reported that puberty in girls with cerebral palsy places an additional burden on the caregivers. They were also worried about the safety of their girl children. Contraception and menstrual suppression were not considered as options. Caregivers wanted education and financial independence for their children. Conclusion: Awareness of methods of managing pubertal issues, shared caregiving responsibility by the family, and customised approach for healthcare interventions are of paramount importance in helping caregivers deal with the transition to puberty by girls with cerebral palsy. Family counselling and therapy can help to allay the parents' fears, worries and tensions [ABSTRACT FROM AUTHOR]

The Pradhan Mantri Ujjwala Yojana (PMUY), launched in India in 2016, is the world's largest program to provide cleaner cooking fuel to poor households. The PMUY may yield large health benefits because of increased LPG use, and more importantly, reduced chulha use, and thus may significantly reduce household air pollution exposures. This research, conducted in a tribal, difficult-to-reach area of Pune District, leveraged PMUY to study the uptake, adoption, usage, and health benefits of LPG. This work highlighted barriers to and facilitators of adoption and sustained LPG usage. Our findings have program implications and need to be addressed to ensure that poor households continue to use LPG as their primary cooking fuel. Our study indicates that most households expressed a desire to own an LPG gas stove but are not aware about the methods to avail the scheme and rely on the local governments to obtain the LPG. The perceived benefits of using LPG differ among people, depending on their own experiences. The most common perceived benefits include ease of use and less time spent on cooking. However, most people are unaware of the severe health effects of HAP, which, if known, might influence their decision to own and use LPG for cooking. The challenges in availing the scheme include varying registration amount, lesser awareness of the document requirements and multiple trips to the distributors' office to fulfil the documentary requirements. Further, the sustained use is hampered by the non-subsidized refills and unavailability of transport facilities for the refill replacement. Further, the beneficiaries are unaware that the subsidy goes towards the repayment of the loan and more clarity is expected from the distributor when availing the scheme. In conclusion, the population in tribal regions is willing to use the LPG regularly if the refill costs are subsidized. Further increasing logistical and financial support to rural distributors will help in better uptake. • Policymakers must increase awareness activities to inform the population about health benefits of using LPG • Process of obtaining new LPG connection through PMUY especially documentation should be made easy for marginalized groups • Further subsidizing LPG refills, as the cost is a major factor affecting refills will increase uptake. • One important aspect that is often neglected but picked up by our study is increasing logistical and financial support to rural distributors. [ABSTRACT FROM AUTHOR]

The rising prevalence of non-communicable diseases (NCDs) in young Indians underscores a compelling need to instil healthy lifestyles in adolescents and young adults. The present study aimed to assess the health-promoting lifestyles of freshmen admitted to institutes under seven different faculties of an international university in India. The study was conducted across five Indian cities and recruited 4253 participants pursuing both undergraduate and postgraduate programmes. Information on socio-demographic factors and health-promoting lifestyle behaviours using a modified Health-Promoting Lifestyle Profile (HPLP) scale was collected. The total HPLP and sub-scale scores for six domains were estimated. Univariate and age and gender-adjusted multivariate analyses were conducted to identify the determinants of health-promoting lifestyle scores. Gender-wise distribution of total HPLP and subscale scores indicated significant differences between female and male university students except for spiritual growth (P = 0.300). Overall, female students secured significantly higher total HPLP scores than male students (139.8 vs 137.6, P=0.000). Multivariate models showed that students from the faculties of Management and Law 3.15 (CI: 1.61, 4.68) and Humanities and Social sciences 4.90 (CI: 3.24, 6.58) had lower total HPLP scores compared to students of Science, Technology, Engineering and Mathematics (STEM) faculty. The faculty, zone, and residential status predicted nutrition sub-scale scores. Interestingly, students from North zone campuses (b − 0.62 (CI: −0.92, −0.32)) than west zone, and international students (b − 1.18 (CI: −2.11, −0.24)) compared to domestic students had lower nutrition sub-scale scores. Gender and faculty-specific targeted interventions could promote the healthy lifestyles of young Indian University students. [ABSTRACT FROM AUTHOR]

Background: Globally, community health workers (CHWs) are integral contributors to many health systems. In India, Accredited Social Health Activists (ASHAs) have been deployed since 2005. Engaged in multiple health care activities, they are a key link between the health system and population. ASHAs are expected to participate in new health programmes prompting interest in their current workload from the perspective of the health system, community and their family.Methods: This mixed-methods design study was conducted in rural and tribal Primary Health Centers (PHCs), in Pune district, Western Maharashtra, India. All ASHAs affiliated with these PHCs were invited to participate in the quantitative study, those agreeing to contribute in-depth interviews (IDI) were enrolled in an additional qualitative study. Key informants' interviews were conducted with the Auxiliary Nurse Midwife (ANM), Block Facilitators (BFF) and Medical Officers (MO) of the same PHCs. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically.Results: We recruited 67 ASHAs from the two PHCs. ASHAs worked up to 20 h/week in their village of residence, serving populations of approximately 800-1200, embracing an increasing range of activities, despite a workload that contributed to feelings of being rushed and tiredness. They juggled household work, other paid jobs and their ASHA activities. Practical problems with travel added to time involved, especially in tribal areas where transport is lacking. Their sense of benefiting the community coupled with respect and recognition gained in village brought happiness and job satisfaction. They were willing to take on new tasks. ASHAs perceived themselves as 'voluntary community health workers' rather than as 'health activists".Conclusions: ASHAs were struggling to balance their significant ASHA work and domestic tasks. They were proud of their role as CHWs and willing to take on new activities. Strategies to recruit, train, skills enhancement, incentivise, and retain ASHAs, need to be prioritised. Evolving attitudes to the advantages/disadvantages of current voluntary status and role of ASHAs need to be understood and addressed if ASHAs are to be remain a key component in achieving universal health coverage in India. [ABSTRACT FROM AUTHOR]

Objectives: Health is not mere absence of disease; it is a sense of well-being. Important to understand health problems of rural residents as they have limited access to health care facilities. The objective was to identify pattern of diseases in order to plan and build correct health interventions. Novelty/Originality: The research would contribute in building health interventions. Method: Explorative qualitative design, in depth interviews with 10 private medical doctors practicing in a village. Results & Discussions: Hypertensions, diabetes, anaemia, malaria, dengue, malnutrition, worm infestations among children. The study revealed possible reasons of high risk behaviour and lifestyle, water and sanitation issues, lack of knowledge and awareness for the disease pattern in the community. Application: The findings could be helpful to do surveys the findings of which could be generalized to larger rural community. Conclusion: Comprehensive health education sessions for different age groups, target oriented interventions collaboration with government health facilities would improve the health status. [ABSTRACT FROM AUTHOR]

Background: Community health workers (CHW) contribute to achieving health targets of the Sustainable Development Goals (SDG) and Universal Health Care (UHC) in low- and middle-income countries (LMICs). In India, accredited social health activists (ASHAs) function as health facilitators, service providers, and programme supporters for rural and tribal communities and are at the frontline during the COVID-19 pandemic. We aimed to describe the ASHAs' work roles both before and during the COVID-19 pandemic, explore the tasks ASHAs performed throughout the pandemic, and understand its effects on the evolving role of ASHAs., Methods: We used qualitative data from a pre-COVID-19 study conducted in 2018-2019 including face-to-face interviews with purposively sampled ASHAs and their health care supervisors (n = 18) from rural Maharashtra state (India), and a follow-up study during the COVID-19 pandemic using telephonic interviews with a subset of participants from the pre-COVID-study (n = 8). Data were analysed thematically using MAXQDA v11.00., Results: The primary theme in the pre-COVID-19 study was ASHAs' role as described above, except as social health activists, linking beneficiaries to the local maternal and child health care services, distributing medicines for common illnesses, access to government schemes, and engaging in multiple health surveys. During the pandemic, raising awareness, screening of at-risk populations, arranging referrals, providing treatment and follow-up to COVID-19 patients, and supporting their family members. These activities increased the workload and health risks to ASHAs and their family, causing stress and tension among them. However, they had effectively carried out the new duties. ASHAs have improved their status, earning praise from families, society, and the government. They were honoured with the Global Health Leaders Award at the 75th World Health Assembly., Conclusion: ASHAs' contribution to the health system improved the indicators related to maternal and child health during the pre-COVID-19 pandemic. Additionally, they maintained frontline health care during the COVID-19 pandemic, demonstrating resilience despite the challenges of increased workload and stress. However, the COVID-19 pandemic highlights the need to respond to and understand the implications of ASHAs' evolving roles., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)