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A survey was conducted in eight secondary schools located in two watersheds in Gujarat and Rajasthan (semi-arid region of India) to assess students' perceptions about groundwater scarcity issues and the impact of the scarcity on their educational opportunities. Survey responses to a detailed questionnaire by a cohort of students in both watersheds; school attendance records of year 8 class students (13-14 years old) and responses gathered via a socio-economic survey involving 500 families in the study area were used in the study. In both watersheds, >90% students identified groundwater scarcity as a major issue. Required to work at home or farm, about 65% students in Gujarat and 60% in Rajasthan missed school for up to 2 days/month; and a smaller proportion (~ 30%) missed schools for 4 or more days/month. School absenteeism was found to be linked with gender; female students missed schools more frequently than their male counterpart. The school attendance records in Rajasthan showed that the frequency of female students missing schools for 5 or more days/month was on an average 2-10 times greater than that for males. The gender difference in absenteeism in all schools was statistically significant (P < 0.018**). The study highlighted that groundwater scarcity in the study area, and consequent demand on their time for household work including fetching drinking water are contributing factors towards limiting their educational and economic opportunities. Groundwater scarcity can be one of the key factors that can limit inclusiveness and empowerment of women and need to be considered in policy-making.

The top 20 highest burdened countries (in disability-adjusted life years) account for more than 75% of the global burden of viral hepatitis. An effective response in these 20 countries is crucial if global elimination targets are to be achieved. In this update of the Lancet Gastroenterology & Hepatology Commission on accelerating the elimination of viral hepatitis, we convene national experts from each of the top 20 highest burdened countries to provide an update on progress. Although the global burden of diseases is falling, progress towards elimination varies greatly by country. By use of a hepatitis elimination policy index conceived as part of the 2019 Commission, we measure countries' progress towards elimination. Progress in elimination policy has been made in 14 of 20 countries with the highest burden since 2018, with the most substantial gains observed in Bangladesh, India, Indonesia, Japan, and Russia. Most improvements are attributable to the publication of formalised national action plans for the elimination of viral hepatitis, provision of publicly funded screening programmes, and government subsidisation of antiviral treatments. Key themes that emerged from discussion between national commissioners from the highest burdened countries build on the original recommendations to accelerate the global elimination of viral hepatitis. These themes include the need for simplified models of care, improved access to appropriate diagnostics, financing initiatives, and rapid implementation of lessons from the COVID-19 pandemic., Competing Interests: Declaration of interests GSC is supported in part by the Biomedical Research Centre of Imperial College NHS Trust. In the last 36 months, IW has received grant funding from AbbVie, Arena, AstraZeneca, Novartis, and Pharco. JG has received funding from AbbVie, bioLytical, Camurus, Cepheid, Gilead, Hologic, and Indivior. YT has received funding from Fujirebio, Sysmex, AbbVie, GlaxoSmithKline, and Gilead Sciences. JVL acknowledges grants and speaker fees from AbbVie, Gilead Sciences, Merck Sharp and Dohme, and Roche Diagnostics to his institution; speaker fees from Echosens, Janssen, Novo Nordisk, and ViiV; consulting fees from GSK and Novavax; and support to ISGlobal (grant CEX2018-000806-S) funded by MCIN/AEI/10.13039/501100011033, and the Generalitat de Catalunya through the CERCA programme, outside of the submitted work. DLT has provided expert testimony for Merck; has worked on diagnostics with Abbott. Through the Taskforce for Global Health, LH and JWW have received support for the Coalition for Global Hepatitis Elimination from governmental, philanthropic, individual, and industry partners (Abbott Laboratories, AbbVie, Cepheid, Gilead Sciences, Merck, Pharco, Roche Diagnostics, Siemens, VBI Vaccines, and Zydus-Cadila). DA-P has received payment from Viatris and Inogen Pharmaceutical for delivering presentations at conferences. ADM received AU$300 in 2021 to review a grant for the National Medical Research Council, Singapore. HC received lecture fees from Gilead Sciences. A portion of MAD's compensation comes from the Bill & Melinda Gates Foundation Global Public Goods Grant through its funding of work done for the Global Burden of Diseases, Injuries & Risk Factors study. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)