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Background: Global diabetes prevalence has doubled since 1980; India has the second-largest diabetic population. Nearly half of type 2 diabetes mellitus (T2DM) cases go undiagnosed. This study assesses glycated hemoglobin A1c (HbA1c) for diagnosing T2DM and prediabetes in at-risk individuals. Materials and Methods: We conducted a community-based cross-sectional study in a rural area. We assessed glucose intolerance risk factors among 1353 individuals (age >20 years), categorizing participants into low and moderate– high risk using the Indian Diabetes Risk Score (IDRS). For 363 participants with moderate- or high-T2DM risk, we evaluated fasting plasma glucose, hemoglobin, and HbA1c. Receiver Operating Characteristics (ROC) were constructed for HbA1c against gold standard fasting plasma glucose and 2-h-postload glucose to determine diagnostic accuracy and cut-point values for prediabetes and T2DM. We used decision curve analysis (DCA) to assess the utility of the new HbA1c cut point for T2DM diagnosis. Results: The prevalence of newly diagnosed T2DM and prediabetes was 44.63% (95% CI: 39.44–49.91) and 48.48% (95% CI: 43.24–53.76), respectively in people with moderate to high risk of T2DM on IDRS. On ROC, the area under the curve was 90.36% and 79.18%, respectively, reflecting high diagnostic accuracy. The optimum cut point of HbA1c for diagnosis of T2DM was 6.34%, with sensitivity and specificity of 74% and 94%, respectively. The HbA1c cut point for prediabetes was 5.65%, with a sensitivity and specificity of 80% and 75%, respectively. The new cut point of 6.34% on DCA gives substantial net benefit at a 40% probability risk, identifying 31 additional cases per 100 individuals at risk of T2DM and reducing the false positive by 47%. Conclusion: Our findings offer potential for developing a diagnostic protocol for T2DM and prediabetes (impaired fasting glucose) using HbA1c cut-point in people with moderate- to high-T2DM risk in rural settings. [ABSTRACT FROM AUTHOR]

Training of medical students in the domain of clinical skills is an indispensable component of medical education delivery. Moulage in medical training deals with producing genuine simulations of wounds, injuries, and other medical conditions, so that students can relate to lifelike scenarios. Medical students through moulage are exposed to the complexities of real-world clinical practice to bring about an improvement in their confidence and competence levels as healthcare professionals. Integrating moulage into medical training essentially requires systematic planning and implementation to ensure that simulations are effective. The success of moulage, in terms of attainment of the learning objectives, can be enhanced by beginning with a few modules and then based on the experience, success, and acceptance, gradually expanding the process. In conclusion, the introduction of moulage into the existing medical curriculum can prove to be an effective tool to enrich the learning experience and aid in the process of acquisition of clinical skills. However, the success of the same in terms of attainment of the learning outcomes essentially depends on the planning and collaboration between different departments and stakeholders. [ABSTRACT FROM AUTHOR]

Context: Soil-transmitted helminths (STH) infections are among the most common and widespread infections in developing countries where sanitation facilities are inadequate. Aims: This study aimed to estimate the prevalence of STH infections in prenatal mothers in two states in India. Settings and Design: A cross-sectional survey was conducted in Maharashtra and Rajasthan state of India. We randomly selected one municipal corporation and one rural block from a selected district in each state. Methods and Material: Out of 2400 contacted, 2206 pregnant women gave stool samples for microscopy for parasitological study. The response rate was 89.91%. Stool specimens were transported to an accredited lab and examined microscopically within 24 hrs. Results: Prevalence of STH was 8.34 (95%CI 7.22–9.57). The prevalence in rural and urban areas was 10.01% (95%CI 8.51–11.74) and 5.76% (95%CI 4.39–7.52), respectively. Ascaris lumbricoides (34.7%) were the most common, followed by Entamoeba histolytica (30.43%), and 20.1% were mixed infections. Higher age, walking barefoot, weight gain during pregnancy were significantly associated with STH (p < 0.05). The mean hemoglobin value in women with STH was significantly less (8.75 gm%; SD 4.04) compared to those without STH (10.23 gm%; SD 1.23) (p < 0.05), and average weight gain during pregnancy was significantly less among women with STH (3.80 kg; 4.11) compared to women without STH (8.45 kg; 2.83); (p = 0.000). Conclusion: The study provides valuable insights into the burden and intensity of STH in pregnant women that may support the policy recommendation for deworming during pregnancy. [ABSTRACT FROM AUTHOR]

Background: In India, different types of Frontline Community Health Workers are recruited under different departments and health programmes. These include Anganwadi Workers (AWW) under ICDS, ASHA and ANMs under NRHM and health services. Training and recruitment of this staff cadre is an ongoing process. Most of the trainings are aimed at improving the knowledge and skills. A set of test is needed to assess the post training knowledge of trainees which should be feasible, acceptable and easy to administer. Team of Health Experts from DMIMSU, Wardha has developed such specific Computer based online certification tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted to assess the feasibility and acceptability of these tests. Aims and Objectives: 1] To assess the feasibility and acceptability of Computer based online certification tests for frontline workers. 2] To assess the scope for generalization of these tests to entire frontline health cadre of the district. Materials and Methods: Data was collected from 30 randomly selected Frontline Health Workers who were engaged in Community Outreach Activities/Projects of DMIMS and had undergone trainings and Online Certification tests. Questionnaire with Likert type scoring scale was administered. Data was compiled in MS Excel and Weighted Means and proportions of responses towards agreement and disagreement were calculated. Results: Average Weighted Mean was 4.07 showing Strong Agreement towards the feasibility and acceptability. Only 10.3% participants showed disagreement towards the feasibility and acceptability of this test whereas 89.7% participants showed agreement and among them, 47.67% showed strong agreement towards the feasibility and acceptability of this test. Conclusion: These tests were found quite feasible and well accepted by Frontline Health Workers. Similar tests should be made compulsory for all Frontline Health Workers Cadre and their performance in tests should be linked to provisions of incentives and seniority benefits. [ABSTRACT FROM AUTHOR]

Responsive parenting constitutes an essential part of the context in which children live and has shown a positive effect on child development in the early years of life. This study aimed to assess the effectiveness of family parenting programs for enhancing competencies of responsive parenting among caregivers. Cluster-RCT in 50 Anganwadi center areas. Twenty-five intervention clusters received responsive parenting intervention. Anganwadi workers delivered sessions after support and training. We enrolled 530 mother-child dyads; 264 (49.9 %) from the intervention arm and 266 (50.1 %) from the control arm. We assessed caregivers' knowledge and skills about child development using a parenting quiz. We evaluated the effect of an intervention on the home environment, mother-child interaction, and development outcomes at the endpoint. We conducted 200 parenting sessions in 25 intervention clusters. Caregivers attended, on average, five sessions out of the nine scheduled. Caregivers with improved knowledge and skills about nutrition, shelter & care, play & stimulation for responsive parenting were significantly more in the intervention than in the control arm (p < 0.05). Mean difference in scores of home environment (1.24; SE-0.75 & ICC-0.088) and mother to child interaction (2.36; SE-0.87 & ICC-0.023) motor development (1.71; SE-0.61 & ICC-0.002), language development (2.97; SE-0.85 & ICC-0.002) and socioemotional development (1.45; SE-0.56 & ICC-0.066) between intervention and control arm was statistically significant (p < 0.05). A locally adapted, family parenting curriculum was a practical approach for enhancing parents' competencies and confidence to promote early child development. [ABSTRACT FROM AUTHOR]

Background: To promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children., Methods: Study participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program's effectiveness. The outcomes of children were assessed at 12 and 24 months., Findings: At recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate-mild impact on ECD - cognitive (0.31, 95%CI: 0.13-0.48), language (0.2, 95%CI: 0.01-0.39), and socioemotional-development (0.19, 95%CI: 0.01-0.37), moderate effect on home-environment and mother-child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%., Interpretations: The study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers' knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program., Funding: The trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gaidhane, Khatib, Telrandhe, Patil, Kogade, Gaidhane, Choudhari, Holding, Saxena and Syed.)

Background: Effective and real-time data analytics plays an essential role in understanding gaps and improving the quality and coverage of complex public health interventions. Studies of public health information systems identify problems with data quality, such as incomplete records and untimely reporting. Effective data collection and real-time analysis systems for rapid-cycle learning are necessary to monitor public health programs and take timely evidence-based decisions. Early childhood development (ECD) programs are very diverse. Rapid-cycle evaluation and learning (REAL) guides the implementation process of such complex interventions in real time. Stepping stones was one such early childhood development program implemented in Central India., Objective: The objective was to improve the delivery of complex, integrated public health interventions for early childhood development in remote areas of rural India., Methodology: The program was developed according to the principles of inclusion and community-centeredness, which can be tested quickly and iteratively. To enhance the decision-making process and improve delivery and coverage, the core team implemented an information system for rapid-cycle learning. We developed performance indicators and a performance measurement matrix after defining the specific needs. Following that, we trained staff to collect complete data using electronic data collection tools and transfer it the same day to the server for quality review and further analysis. A variety of data/information was triangulated to address the gaps in intervention delivery, and those decisions were subsequently implemented., Results: We observed that the quality of data collection improved, and errors were reduced by 50% in the third quarter. The quality of the narrative was also enhanced; it became more elaborate and reflective. Sharing their field output in meetings and improving the quality of the narrative enhanced the self-reflection skills of field staff and consequently improved the quality of the intervention delivery. Refresher training and mentoring by supervisors helped to improve the data quality over time., Conclusion: Rapid-cycle evaluation and learning (REAL) can be implemented in resource-limited settings to improve the quality and coverage of integrated intervention in early childhood. It nurtures a reinforcing ecosystem that integrates providers, community, and family perspectives and guides interactions among stakeholders by integrating data from all available sources., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gaidhane, Telrandhe, Patil, Holding, Khatib, Gaidhane, Quazi Syed, Choudhari, Umate and Pathade.)

Background: Capturing real-life practices through photographs provides an opportunity to create awareness and focus discussions on relevant issues in community. Photographs and narratives also engage decision makers, inspiring changes in policy and practice. Objective: Paper describes development and adaptation of an integrated photostory approach documenting actions and stimulating positive change in Early Child Development (ECD). Methodology: The Photostory method was built through a cyclical process to describe and explore early-childhood practices in central-India through photographs and stories. A systematic format to capture, archive and evaluate photographic material was developed. A standardized rating system was established to monitor levels of, and change in, community practices. We integrated Photostory process into routine visits undertaken during implementation of Stepping-Stones, an ECD intervention program. This paper utilized collected data to explore utility of rating framework to describe and measure behavior and to track change. We explored role of Photostory approach in engaging community in process of stimulating positive ECD experiences. Results: We developed a systematic framework to support data capture, analysis, and data utilization using multistep iterative mixed method process. A total of 161 Photostories were collected (72 at baseline and 89 at endpoint). Using a rating system which measured both the structure of the tasks, and the emotional engagement of the child and parent, many activities and practices observed were evaluated as providing at least an adequate learning space. In exploring change over the implementation process, at endpoint children were more likely to be observed as more engaged in their play activities ( p < 0.05). Parental engagement levels remained stable, toward being less actively engaged. At endpoint we observed a trend toward activities being provided for children at a level of difficulty higher than child's level of developmental. The data provided the intervention team with local examples through which to engage parents in discussions on activities that stimulate effective child exploration and learning. We were also able to demonstrate the added value of photographs in stimulating detailed discussion amongst community members on early child development. Conclusion: Photostories can provide a systematic and rigorous methodology to stimulate engagement, monitor and measure change in community-based parenting interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Gaidhane, Holding, Shah, Patil, Telrandhe, Jadhav, Kogade, Chaudhari and Zahiruddin.)