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Background: Professional development (PD) in a range of occupations has become increasingly digitised. Numerous digital courses are available, with evidence that social media, blogs and apps are increasingly being used for PD. Yet despite clear benefits, there is little robust evidence on the characteristics of digital PD that impact positively on learning and practice, particularly for physical education (PE) teachers and youth sport coaches. This paper provides new insights into the characteristics of effective PD in the context of a complex digital landscape. Purpose: While advocated as an innovative genre from which to optimise learners' proclivity for sharing, curiosity and discovery, little is known about how professional learners respond to massive open online courses (MOOCs) courses to inform their practice. The purpose of this study was to understand how participants responded to the learning design of two MOOCs (n = 13,104 from 155 countries) in the fields of physical education and youth sport coaching. Methods: Drawing from a mixed methodology, data were generated from semi-structured interviews (n = 27) and online survey methods (n = 66) with participants across both MOOCs. Findings: New data offer insights into the features of course design that practitioners found positive in promoting engagement. It was apparent in the data, for example, that four features were influential: establishing relevance, facilitating bridging, designing for personalisation, and building community. Constructed themes reflect how participants organised and negotiated MOOC experiences, and illuminate the ways in which they navigated and used course content. Evidence from this study provides insights into the ways in which digital genre for PD might be structured to facilitate engagement and presents broader challenges to the ways in which pedagogy is conceptualised and practiced online. Conclusions: The refined focus on digital genre as a form of social action in this study seeks to ensure that learners needs can be met in a complex and ever-changing PD digital landscape. In this regard, a more nuanced approach is required that helps explicate the cognitive tools that participants engage as they organise their learning experiences on digital platforms, and how this aligns with their expectations and needs of online PD.

The language learning strategy question has been debated on a number of levels, including definition, the strategy/success relationship and strategy coordination. In addition, awareness has been steadily growing of the importance of taking an holistic view of the strategy phenomenon and examining strategies not just in isolation but as part of an overall picture which includes learning situation, learning target and individual learner characteristics. This article will first of all review the literature and the previous research on these controversial issues, and suggest a workable definition. Then, in order to illustrate the importance of such an holistic view, the results of a small scale study which looks at the strategies used by 16 successful language learners who were all either teaching English or teaching in English at university level will be reported. The quantitative results indicated that these successful learners used many strategies, especially those that suited their goals and their situations; they also frequently used and carefully orchestrated strategy repertoires which suited their own individual needs. The responses of one highly successful respondent were also examined qualitatively. The implications of these findings and the importance of viewing learners holistically are discussed and suggestions are made for ongoing research.

Introduction: People affected by leprosy are at increased risk of impairments and deformities from peripheral nerve damage. This mostly occurs if diagnosis and treatment is delayed and contributes to continued transmission within the community. Champa district of Chhattisgarh state in India is an endemic area with the highest national annual case detection and disability rates for leprosy. The Replicability Model is a system strengthening intervention implemented by the Leprosy Mission Trust India in Champa that aims to promote early diagnosis and treatment of leprosy, improve on-going management of the effects of leprosy and improve welfare for the people affected by leprosy. This protocol presents a plan to describe the overall implementation of the Replicability Model and describe the barriers and facilitators encountered in the process. We will also quantify the effect of the program on one of its key aims- early leprosy diagnosis. Methods: The replicability model will be implemented over four years, and the work described in this protocol will be conducted in the same timeframe. We have two Work Packages (WPs). In WP1, we will conduct a process evaluation. This will include three methods i) observations of replicability model implementation teams' monthly meetings ii) key informant interviews (n = 10) and interviews with stakeholders (n = 30) iii) observations of key actors (n = 15). Our purpose is to describe the implementation process and identify barriers and facilitators to successful implementation. WP2 will be a quantitative study to track existing and new cases of leprosy using routinely collected data. If the intervention is successful, we expect to see an increase in cases (with a higher proportion detected at an early clinical stage) followed by a decrease in total cases. Conclusion: This study will enable us to improve and disseminate the Replicability Model by identifying factors that promote success. It will also identify its effectiveness in fulfilling one of its aims: reducing the incidence of leprosy by finding and tracking cases at an earlier stage in the disease. [ABSTRACT FROM AUTHOR]

In this paper we use Transformative Learning Theory as a lens for making sense of teachers' learning from study visits to the Global South. Transformative Learning theory is made up of two main elements: the form of transformations and the processes that support transformations. "Life changing" experiences as expressed by study visit participants have been interpreted as transformational, but questions about who and what are transformed, and whether this is at the expense of the "Other," are rarely addressed. Drawing on data from a project investigating study visits for UK teachers to Gambia and Southern India, we analyse the "form" that changes take and discuss whether these can be seen as transformational. We argue that without an explicit focus on relational forms of knowledge about culture and identity, self and other, the potential for transformations in how we relate to, and learn from, each other in postcolonial contexts is severely diminished.

This paper critically analyses the neo-liberal discourse informing global education policy and practice. We use postcolonial theory to deconstruct the contexts for global educational partnerships, highlighting how issues of power and representation are central to their development and the learning that takes place within them. Teacher development through North-South study visits is one way of challenging teachers' worldviews, but these are not always effective. We argue that study visit "courses," where learning is facilitated by differently knowledgeable others, have the potential to be more effective, but only if the courses are underpinned by postcolonial theory and informed by socio-cultural pedagogy. (Contains 5 notes and 1 figure.)

The Indian monsoon is a seasonal large-scale circulation system with complex dynamical and thermodynamic interactions. The physical processes are not fully understood. In particular, the mechanisms that control the propagation of the monsoon onset across the Indian continent, against the mid-level wind field, are debated. The Indian monsoon is poorly represented in weather and climate models, with persistent systematic errorsmaking it difficult to forecast the Indian monsoon accurately on subseasonal timescales. A two-layermodel based on moisture conservation with a parameterised flux representing convection is developed and used to investigate the competition between dry advection in the upper levels, the rate of moisture replenishment at low levels, and the rate of convection fromthe lower to the upper layers. In a fixed Eulerian frame, the system is initialised at an equilibrium representing pre-onset (May) conditions. Then, changes in the rates of moist inflow and upper-level advection are introduced, triggering a transition to a new equilibrium, which reflects the full monsoon state (July-September). The two-layer model reproduces the Indian monsoon onset and its progression to the northwest, against an imposed 5m⋅s-1 wind in the upper layer. Increasing the parameter representing moist inflow induces a monsoon onset, defined as a threshold of total column moisture, with clear progression from southeast toward northwest India. A lesser wind speed in the upper layer, signifying a weakening midtropospheric dry intrusion, allows more rapid progression of themonsoon onset. A greater upper-level wind speed, associated with a strengthening dry intrusion, causes the monsoon onset to retreat. We can quantify the nature of the monsoon onset by deriving an onset speed and the time taken for the system to adjust to a new equilibrium, using analytical theory. [ABSTRACT FROM AUTHOR]

A cluster randomized trial design was used to test the efficacy of a behaviour change communication intervention on the quality of the home environment and infant development at 15 months of age. Children (n = 600) in rural South India were followed from 3 through 15 months of age. The control group (C group) received the standard of care, the complementary feeding group (CF group) received recommendations on complementary foods and the responsive complementary feeding and play group (RCF&P group) received recommendations on complementary foods plus skills on responsive feeding and play. The intervention was delivered in biweekly home visits to caregivers using flip charts. At postintervention, infants (n = 521) were assessed for development (Bayley‐II scales) and their home environment was assessed (Home Observation for Measurement of the Environment [HOME] scale). Cluster adjusted analysis of variance showed no significant differences at baseline. The HOME score at 15 months differed by group, F(2, 38) = 6.41, P = 0.004; the CF and RCF&P groups had higher scores than the C group. Scores on subscales 'Opportunities for Variety in Daily Stimulation' and 'Caregiver Promotion of Child Development' (CPCD) were higher for the RCF&P group than for the C and CF groups. Mental development index (MDI) scores differed by group, F(2, 37) = 3.31, P = 0.04, with the RCF&P group showing higher scores than the C group (P < 0.04); no differences were noted in psychomotor development index (PDI) scores (P = 0.48). The subscales of HOME associated with MDI at 15 months were 'CPCD' and 'Cleanliness of Child' (R2 = 0.076). 'CPCD' was also associated with PDI (R2 = 0.039). A responsive complementary feeding and play intervention delivered through home visits benefitted children's mental development and caregiving environment at 15 months. [ABSTRACT FROM AUTHOR]

Online activities such as online gaming and social media use have become very popular and for most individuals, engagement in such activities is highly enjoyable. However, for a small minority of individuals, such behaviors can lead to problematic internet use. There are many screening instruments that assess problematic internet use including the nine-item Internet Disorder Scale-Short-Form (IDS9-SF). The present study translated the IDS9-SF into Bangla and investigated its psychometric properties. The sample comprised 534 adolescents aged 13 to 18 years (61.0% male; mean age 15.7 years (SD = 1.5) from selected schools (secondary and higher secondary) in Dhaka City. The study included confirmatory factor analysis, Cronbach's alpha, and item-total correlation. Results demonstrated that the Bangla IDS9-SF had very good internal validity (Cronbach's alpha =.82), and that IDS score was positively and significantly correlated with scores on depression and anxiety scales. A confirmatory factor analysis showed the model had an excellent fit to the data. Therefore, the Bangla IDS9-SF appears to be a valid and reliable instrument that may be employed in further research on problematic internet use in Bangladesh. [ABSTRACT FROM AUTHOR]

The live attenuated Japanese encephalitis (JE) vaccine SA14-14-2 has been used in Nepal for catch-up campaigns and is now included in the routine immunisation schedule. Previous studies have shown good vaccine efficacy after one dose in districts with a high incidence of JE. The first well-documented dengue outbreak occurred in Nepal in 2006 with ongoing cases now thought to be secondary to migration from India. Previous infection with dengue virus (DENV) partially protects against JE and might also influence serum neutralising antibody titres against JEV. This study aimed to determine whether serum anti-JEV neutralisation titres are: 1. maintained over time since vaccination, 2. vary with historic local JE incidence, and 3. are associated with DENV neutralising antibody levels. We conducted a cross-sectional study in three districts of Nepal: Banke, Rupandehi and Udayapur. Udayapur district had been vaccinated against JE most recently (2009), but had been the focus of only one campaign, compared with two in Banke and three in Rupandehi. Participants answered a short questionnaire and serum was assayed for anti-JEV and anti-DENV IgM and IgG (by ELISA) and 50% plaque reduction neutralisation titres (PRNT50) against JEV and DENV serotypes 1–4. A titre of ≥1:10 was considered seropositive to the respective virus. JEV neutralising antibody seroprevalence (PRNT50 ≥ 1:10) was 81% in Banke and Rupandehi, but only 41% in Udayapur, despite this district being vaccinated more recently. Sensitivity of ELISA for both anti-JEV and anti-DENV antibodies was low compared with PRNT50. DENV neutralising antibody correlated with the JEV PRNT50 ≥1:10, though the effect was modest. IgM (indicating recent infection) against both viruses was detected in a small number of participants. We also show that DENV IgM is present in Nepali subjects who have not travelled to India, suggesting that DENV may have become established in Nepal. We therefore propose that further JE vaccine campaigns should be considered in Udayapur district, and similar areas that have had fewer vaccination campaigns. [ABSTRACT FROM AUTHOR]

Children in slums are at high risk of acute malnutrition and death. Cost-effectiveness of community-based management of severe acute malnutrition programmes has been demonstrated previously, but there is limited evidence in the context of urban slums where programme cost structure is likely to vary tremendously. This study assessed the cost-utility of adding a community based prevention and treatment for acute malnutrition intervention to Government of India Integrated Child Development Services (ICDS) standard care for children in Mumbai slums. The intervention is delivered by community health workers in collaboration with ICDS Anganwadi community health workers. The analysis used a decision tree model to compare the costs and effects of the two options: standard ICDS services with the intervention and prevention versus standard ICDS services alone. The model used outcome and cost data from the Society for Nutrition, Education & Health Action’s Child Health and Nutrition programme in Mumbai slums, which delivered services to 12,362 children over one year from 2013 to 2014. An activity-based cost model was used, with calculated costs based on programme financial records and key informant interviews. Cost data were coupled with programme effectiveness data to estimate disability adjusted life years (DALYs) averted. The community based prevention and treatment programme averted 15,016 DALYs (95% Uncertainty Interval [UI]: 12,246–17,843) at an estimated cost of $23 per DALY averted (95%UI:19–28) and was thus highly cost-effective. This study shows that ICDS Anganwadi community health workers can work efficiently with community health workers to increase the prevention and treatment coverage in slums in India and can lead to policy recommendations at the state, and potentially the national level, to promote such programmes in Indian slums as a cost-effective approach to tackling moderate and severe acute malnutrition. [ABSTRACT FROM AUTHOR]

The most important stream of game developers' revenue is arguably via gamer's in-game purchases. Previous literature has identified a number of strong determinants of online purchase intention including values, consumer experience, lifestyle, security, perceived risk, information, and subjective norms and behavioural control. The present study examined the relationship between online mobile gaming addiction and loyalty towards purchase intention of online mobile game in-game apps. The present study comprised 430 students from two major Indian universities who completed a short 28-item survey focusing on three variables (i.e., addiction, loyalty towards online games, and purchase intention towards online mobile in-game features). The results demonstrated that (i) online mobile game addiction shared a significant positive relationship with online mobile game loyalty; (ii) online mobile game addiction had a positive relationship with the purchase of online mobile in-game apps, and (iii) online mobile game loyalty increased game users' intention to purchase online mobile in-game apps. The present study is the first to investigate loyalty and gaming addiction in relation to the purchase of in-game apps. Game developers will always want to facilitate loyalty among its clientele. However, if the engagement strategies used by gaming operators facilitate addiction as a way of increasing purchase intention of online mobile game in-game apps, this raises serious ethical questions which the gaming industry need to address as part of its corporate social responsibility strategy. [ABSTRACT FROM AUTHOR]

Objective: This paper is to identify key areas where healthy living may be improved in India, and the converse, through cultivating connections at government, community, and at individual levels. Methods and Materials: Key healthy living issues for India were selected and relevant evidence obtained from internet sources together with personal experience over decades of multi- and inter-disciplinary international research activities. Approach: Key activities of connectivity in the development of Indian healthcare arising from -Methods and Materials:were evaluated. These included, the UN Millennium Development Goals, government-private interaction for healthcare benefit, family planning, Modicare 2015, women in society, business and clinical strategies, infrastructure, building "families", fish stocks preservation, ecological epidemiology, NCDs, and transgenesis. Results: In a nutritional context, "education for all" leading to connectivity and a pragmatic inspirational approach to understanding complex issues of population dynamics is essential. Of importance are scientific endeavours in agriculture and aquaculture, water utilization, 132 AIMS Medical Science Volume 4, Issue 2, 131-150. food manufacture, complex issues of supply and demand at an economic eco-friendly and sustainable level, chemoprevention and treatment of diseases (where nutritionally applicable) such as with functional foods: all of which are so vital if one is to raise standards for healthy living in this century and beyond. Developing-India could be a test-bed for other countries to follow, having both the problems and professional understanding of issues raised. By 2025, the UK's Department for International Development programme in India aims to promote secondary school education for young girls, i.e., extending the age of marriage, and interventions that will lead to better health and nutrition, family planning, and developing skills for employment; and supporting India's -Right to Education Act". The outcome may result in smaller better-nourished higher-income families. Computer school networks at Nosegay Public School in Moradabad and the municipal authorities, there, aim to reduce the consumption of unhealthy foodstuff dictated by personal convenience, media influence, and urban retail outlets and promotions. The Tsim Tsoum Institute has advocated the adoption of the Mediterranean/Palaeolithic diet with its high omega-3: omega-6 fatty acid ratio aimed at an improvement in global health due to an expected reduction in the epidemic of pre-metabolic disease, type 2 diabetes and cardiovascular disease [1,2]. Tomorrow, low-cost computer apps are advocated as a driving force in the selection of healthy foods, grown/produced under environmentally safe conditions, within retail outlets for use by mothers with limited budgets that may lead to a revolution in retail management and policy. Chemo-preventive prospective strategies such as those involving polyphenols, lignans, (found in fruits, vegetables, and soya) and other natural phytochemical products, and functional foods, which balance benefit and risk of disease, need to be continually developed, especially to reduce breast and prostate cancer. Conclusion: There is an opportunity to make nutrition a central part of the post-2015 sustainable human and agricultural development agenda for the The Expert Panel for the UN 2030 programme to consider. Solutions for cultivating connections and inspiring solutions for healthy living in India have included all the above issues and this swathe of actions, some within the Nagoya protocol, has been presented for the purpose of contributing towards the health of India. [ABSTRACT FROM AUTHOR]

Background: In total, 3.1 million young children die every year from under-nutrition. Greater understanding of associations between socio-economic status (SES) and the biological factors that shape under-nutrition are required to target interventions. Aim: To establish whether SES inequalities in under-nutrition, proxied by infant size at 12 months, operate through maternal and early infant size measures. Subjects and methods: The sample comprised 347 Indian infants born in 60 villages in rural Andhra Pradesh 2005–2007. Structural equation path models were applied to decompose the total relationship between SES (standard of living index) and length and weight for ageZ-scores (LAZ/WAZ) at 12 months into direct and indirect (operating through maternal BMI and height, birthweightZ-score and LAZ/WAZ at 6 months) paths. Results: SES had a direct positive association with LAZ (Standardised coefficient = 0.08, 95% CI = 0.02–0.13) and WAZ at age 12 months (Standardised coefficient = 0.08, 95% CI = 0.02–0.15). It also had additional indirect positive associations through increased maternal height and subsequently increased birthweight and WAZ/LAZ at 6 months, accounting for 35% and 53% of the total effect for WAZ and LAZ, respectively. Conclusion: Findings support targeting evidence based growth interventions towards infants from the poorest families with the shortest mothers. Increasing SES can improve growth for two generations. [ABSTRACT FROM AUTHOR]

Nutrition research in India has previously focused on the serious problem of undernutrition related to nutrient deficit and high rates of infection. Recent data from the National Family Health Survey 1998/99 (NFHS 2), however, identified a significant proportion of Indian women as overweight, coexisting with high rates of malnutrition. This paper examines the emerging nutrition transition for women living in rural and urban communities of Andhra Pradesh, India. NFHS 2 provides nationally representative data on women's weight and height. In this paper, we examine representative data from the state of Andhra Pradesh (n = 4032 women). Logistic regression analyses are applied to the data to identify socioeconomic, regional and demographic determinants of overweight and thinness. The major nutrition problem facing women continues to be undernutrition, with 37% having a low body mass index [(BMI) < 18.5 kg/m(2)]; 8% of these women are severely malnourished (BMI < 16 kg/m(2)). However, 12% of the women can be classified as overweight (BMI > 25 kg/m(2)) and 2% are obese (BMI > 30 kg/m(2)). Furthermore, in the large cities of the state in which 4% of the sample live, 37% of women are overweight or obese, whereas in the rural areas in which 74% reside, 43% have a low BMI. Women from lower socioeconomic groups are also significantly more likely to have a low BMI. Findings from the logistic regression models reveal socioeconomic status to be a more important predictor of both over- and underweight than location of residence. [ABSTRACT FROM AUTHOR]

The highly masculine sex ratio in India has increased substantially in the twentieth century, in contrast to most other countries in the world. Competing arguments alternatively posit under-enumeration, highly masculine sex ratios at birth, or excess female mortality throughout the life course as the factors underlying the level of the overall sex ratio; these arguments have not been resolved. Based on population projections that simulate population dynamics, our findings show that small differences in mortality at young ages, persisting over a long period, as well as a sex ratio at birth of 106 males per 100 females, result in a highly masculine population sex ratio. [ABSTRACT FROM AUTHOR]

Background: The Avahan programme has provided HIV prevention activities, including condom promotion, to female sex workers (FSWs) in southern India since 2004. Evidence suggests Avahan averted 202,000 HIV infections over 4 years. For replicating this intervention elsewhere, it is essential to understand how the intervention’s impact could have been optimised for different budget levels. Methods: Behavioural data were used to determine how condom use varied for FSWs with different levels of intervention intensity. Cost data from 64 Avahan districts quantified how district-level costs related to intervention scale and intensity. A deterministic model for HIV transmission amongst FSWs and clients projected the impact and cost of intervention strategies for different scale and intensity, and identified the optimal strategies that maximise impact for different budget levels. Results: As budget levels increase, the optimal intervention strategy is to first increase intervention intensity which achieves little impact, then scale-up coverage to high levels for large increases in impact, and lastly increase intensity further for small additional gains. The cost-effectiveness of these optimal strategies generally improves with increasing resources, while straying from these strategies can triple costs for the same impact. Projections suggest Avahan was close to being optimal, and moderate budget reductions (≥20%) would have reduced impact considerably (>40%). Discussion: Our analysis suggests that tailoring the design of HIV prevention programmes for FSWs can improve impact, and that a certain level of resources are required to achieve demonstrable impact. These insights are critical for optimising the use of limited resources for preventing HIV. [ABSTRACT FROM AUTHOR]

Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster-randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home-visits would increase children's dietary intake, growth and development compared with home-visit-complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother-infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi-weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12-month intervention to the CFG and RCF&PG significantly ( P < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0-0.4] in the CFG (but not RCF&PG) and increased ( P < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8-5.3) in the RCF&PG (but not CFG) compared with CG. Community-based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food-secure rural Indian families. [ABSTRACT FROM AUTHOR]

Background: The WHO 2006 child growth standard is advocated in India, although the conformity of the growth of Indian infants to the WHO standard has only been assessed at cross-sectional points. Aim: To assess the implications of using the WHO standard in rural India and to investigate the factors responsible for any departure from optimal growth, as shown in the WHO standard. Subjects and methods: Mixed-effects models were applied to serial weight and length data from 384 rural south Indian infants. Unadjusted and adjusted (for, among other things, breastfeeding and maternal education) estimates were converted to Z-scores and the risks of underweight, wasting and stunting using the WHO standard compared to the NCHS 1977 child growth reference were calculated. Results: Weight growth was more similar to the WHO standard than the NCHS reference and in late infancy the WHO standard was less likely to classify underweight (RR at 15 months == 0.45; 95% CI == 0.31-0.65). Adjusting the serial data shifted the curves 0.25 Z-scores closer to the median of either chart; variations in household socioeconomic status and morbidity were largely responsible for this shift. Conclusion: In late infancy, the WHO standard will allow a more focused intervention effort and use of resources for targeting programmes at infants most at risk of malnutrition. [ABSTRACT FROM AUTHOR]

Abstract: The high prevalence of child under-nutrition remains a profound challenge in the developing world. Maternal autonomy was examined as a determinant of breast feeding and infant growth in children 3–5 months of age. Cross-sectional baseline data on 600 mother-infant pairs were collected in 60 villages in rural Andhra Pradesh, India. The mothers were enrolled in a longitudinal randomized behavioral intervention trial. In addition to anthropometric and demographic measures, an autonomy questionnaire was administered to measure different dimensions of autonomy (e.g. decision-making, freedom of movement, financial autonomy, and acceptance of domestic violence). We conducted confirmatory factor analysis on maternal autonomy items and regression analyses on infant breast feeding and growth after adjusting for socioeconomic and demographic variables, and accounting for infant birth weight, infant morbidity, and maternal nutritional status. Results indicated that mothers with higher financial autonomy were more likely to breastfeed 3–5 month old infants. Mothers with higher participation in decision-making in households had infants that were less underweight and less wasted. These results suggest that improving maternal financial and decision-making autonomy could have a positive impact on infant feeding and growth outcomes. [Copyright &y& Elsevier]

Abstract: Background: Disposable-syringe jet injectors (DSJIs) have the potential to deliver vaccines safely and affordably to millions of children around the world. We estimated the incremental costs of transitioning from needles and syringes to delivering childhood vaccines with DSJIs in Brazil, India, and South Africa. Methods: Two scenarios were assessed: (1) DSJI delivery of all vaccines at current dose and depth; (2) a change to intradermal (ID) delivery with DSJIs for hepatitis B and yellow fever vaccines, while the other vaccines are delivered by DSJIs at current dose and depth. The main advantage of ID delivery is that only a small fraction of the standard dose may be needed to obtain an immune response similar to that of subcutaneous or intramuscular injection. Cost categories included were vaccines, injection equipment, waste management, and vaccine transport. Some delivery cost items, such as training and personnel were excluded as were treatment cost savings caused by a reduction in diseases transmitted due to unsafe injections. Results: In the standard dose and depth scenario, the incremental costs of introducing DSJIs per fully vaccinated child amount to US$ 0.57 in Brazil, US$ 0.65 in India and US$ 1.24 in South Africa. In the ID scenario, there are cost savings of US$ 0.11 per child in Brazil, and added costs of US$ 0.45 and US$ 0.76 per child in India and South Africa, respectively. The most important incremental cost item is jet injector disposable syringes. Conclusion: The incremental costs should be evaluated against other vaccine delivery technologies that can deliver the same benefits to patients, health care workers, and the community. DSJIs deserve consideration by global and national decision-makers as a means to expand access to ID delivery and to enhance safety at marginal additional cost. [ABSTRACT FROM AUTHOR]

Public health education in China and India has a long history that has been both deeply responsive to the unique needs and medical traditions of each country, and sensitive to global influences. The history of public health education in China reaches back several centuries, with substantial input from American and European organizations during the Republican Era, 1911-1949. In India, centuries-old health care traditions were influenced during the colonial period by the British Empire prior to independence in 1947. Political upheaval in both countries during the 1940s further impacted the public health systems as well as public health education. The primary goal of this review is to outline public health education in India and Mainland China, with a focus on describing the historical systems and structures that have promoted the development of formalized public health education. We examine current challenges, and analyze opportunities for improvement. Health reforms in China and India need to consider new and modern models for public health education, perhaps in independent faculties of public health, to reinvigorate public health education and strengthen the position of public health in addressing the health challenges of the 21st century. [ABSTRACT FROM AUTHOR]

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

This study explores differences in body mass index (BMI), diet, and lifestyle between women of varying socio-economic status in Karnataka, India, using data from the National Family Health Survey 2 (n=4374), in-depth interviews (n=20) and six focus group discussions (n=40) completed in Bangalore. Predictors of overweight (BMI ≥25kg/m2) were modelled using logistic regression. A content analysis of the qualitative data was undertaken to understand behavioural factors affecting overweight. Prevalence of undernutrition was high for rural women (48%) and for overweight, prevalence was high in large urban areas (44%). In Bangalore knowledge of unhealthy foods was higher for richer women, although their diet and activity levels were less healthy than poorer women, who did not have the resources to purchase less healthy diets. Although some knowledge of the need for activity and healthy diets exists for wealthier Bangalore women, this does not translate into healthy behaviour, suggesting a need for obesity prevention programmes.European Journal of Clinical Nutrition (2005) 59, 1217–1220. doi:10.1038/sj.ejcn.1602228; published online 3 August 2005 [ABSTRACT FROM AUTHOR]

Journal of Applied Ecology (2004) 41, 224 –237 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: This research investigates the prevalence and determinants of anemia among women in Andhra Pradesh. We examined differences in anemia related to social class, urban/rural location and nutrition status body mass index (BMI). We hypothesized that rural women would have higher prevalence of anemia compared to urban women, particularly among the lower income groups, and that women with low body mass index (BMI; <18.5 kg/m2) would have a higher risk compared to normal or overweight women. DESIGN:: The National Family Health Survey 1998/99 (NFHS-2) provides nationally representative cross-sectional survey data on women's hemoglobin status, body weight, diet, social, demographic and other household and individual level factors. Ordered logit regression analyses were applied to identify socio-economic, regional and demographic determinants of anemia. SETTING:: Andhra Pradesh, a southern Indian state. SUBJECTS:: A total of 4032 ever-married women aged 15–49 from 3872 households. RESULTS:: Prevalence of anemia was high among all women. In all 32.4% of women had mild (100–109.99 g/l for pregnant women, 100–119.99 for non-pregnant women), 14.19% had moderate (70–99.99 g/l), and 2.2% had severe anemia (<70 g/l). Protective factors include Muslim religion, reported consumption of alcohol or pulses, and high socioeconomic status, particularly in urban areas. Poor urban women had the highest rates and odds of being anemic. Fifty-two percent of thin, 50% of normal BMI, and 41% of overweight women were anemic. CONCLUSIONS:: New program strategies are needed, particularly those that improve the overall nutrition status of women of reproductive ages. This will require tailored programs across socio-economic groups and within both rural and urban areas, but particularly among the urban and rural poor. SPONSORSHIP:: Partial support for Margaret Bentley was provided by the Ford Foundation/India and the Carolina Population Center.... [ABSTRACT FROM AUTHOR]

Examines gender, family and nutritional status of children in three culturally contrasting states in India. Measurement of the clustering of children to establish gender differences; Impact of the presence of a mother-in-law in the household on the nutritional status of children; Study of behavioral factors and resource allocation.

The authors talk about a study by J. Rose and colleagues on public health impact and cost effectiveness of mass vaccination with live attenuated human rotavirus vaccine. The study showed that the costs of introducing the virus vaccine in India are as much as 11.6 percent of the total budget of the Indian Ministry of Health and Family Welfare. Rotavirus vaccines that became available in 2006 are mentioned. The authors cite barriers to the introduction of rotavirus vaccine.

The editor cites his personal comment that appeared in the November 1992 issue and welcomes the current issue's contributors from India and China.

Maternal autonomy has been hypothesized as an important factor related to infant growth, care and survival, although little research has been undertaken to test this hypothesis within the Indian context, where female autonomy is relatively low. We examine the association between maternal autonomy and the introduction of complementary foods/liquids and growth of infants aged between 2 and 5 months in Andhra Pradesh, India. We examine baseline measures of 600 mother-infant dyads enrolled in a longitudinal randomized behavioral intervention trial. Using logistic and linear regression, we examine the association between measures of different dimensions of maternal autonomy and the introduction of foods/liquids as well as weight-for-height z-scores controlling for socio-economic and demographic variables. Our results indicate that mothers with lower autonomy [indicated by less mobility outside of the home (OR=1.877; 95% CI 1.324 2.66) and less control over household resources (OR=1.417; 95% CI 1.07 1.878)] are more likely to introduce foods/liquids to their 2-5 month old infants. Mothers with lower mobility scores (OR= 1.623; 95% CI 1.01 2.618) are more likely to have infants with poor growth. These results suggest that improvements in maternal autonomy in settings such as India will have an impact on infant care and growth outcomes. [ABSTRACT FROM AUTHOR]