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Background: Proper management of Biomedical waste (BMW) generated in a healthcare facility is one of the most important functions of a healthcare worker (HCW) as its improper management not only poses risk to human beings and environment, but may also invite legal action against HCW as well as hospital administration. This study was carried out to evaluate quality of BMW management in 1100-bedded hospital attached to a tertiary care public institute in North India. Methods: A checklist, including 29 parameters related to various functions to be carried out at source of generation by a HCW for BMW management was prepared by researcher and used after validation to record observations in all the 70 areas of hospital. A total of 6 visits were made to each area and mean percentage score was calculated for each area and each category of waste management. Results: It was found that summated mean percentage score of 'Treatment Room of Wards', which were used exclusively by resident doctors, was significantly lower than Operation Theatres (p value: 0.033) and 'Central Waste Collection Points of Wards' (p value: 0.018) for the function of 'mutilation of recyclable waste' and it was significantly lower than all other areas (p value: 0.006 to 0.017) for the function of 'disinfection of waste'. Conclusion: It is concluded that more emphasis needs to be laid on 'mutilation of recyclable waste' and disinfection of waste' by HCWs especially resident doctors. [ABSTRACT FROM AUTHOR]

Purpose: Profile of maternal deaths in selected districts of four Indian states was studied to examine the regional differences in non-biological causal factors (socioeconomic and sociocultural) in maternal mortality and to examine the method and completeness of implementation of Maternal and Perinatal Death Inquiry and Response (MAPEDIR) process. Methods: An integrated qualitative and quantitative method was used to study the MAPEDIR process in selected districts of four states in India, through the use of standardized questionnaire for key informant interviews, participant observation checklist, analysis of verbal autopsy questionnaire, and maternal death reports. Results: A comparison of Profile's maternal deaths investigated showed that women died between 25 and 27 years of age. Half of the women died at home because of inability to afford transport (Delay II) and treatment costs. One third of the deaths had occurred in a health facility (Delay III) because of lack of specialists, equipments or blood. Two thirds of the delays (Delay I) were in seeking medical care. Review of the implementation process of MAPEDIR highlighted that the social audit review model is a unique field based collaborative initiative comprising of stakeholders from various sector in order to improve maternal health programming by reducing maternal mortality. Conclusions: MAPEDIR has been able to identify socio-cultural, economic and health care systems related determinants of maternal deaths. Standardization the mechanism for information data sharing at district, sub-district and village level can maximize the use of available evidence for advocacy and policy shifts by developing policies and interventions suited to local needs. [ABSTRACT FROM AUTHOR]

Human resource insufficiency in the resource constraint countries like India insists that the existing human resources are optimally utilized. Supportive supervision is one such strategy to ensure retention of knowledge and skills of existing service providers for optimal implementation of any national health programme. The present study ascertained and documented various models of supportive supervision for implementation of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) strategy, to reduce under 5 mortality, in terms of its feasibility, sustainability, effectiveness, success and limitation in selected districts of Rajasthan, Orissa and Bihar states in India. The comparison of IMNCI indicators one year after the initiation of supportive supervision had shown that three post natal visits by health workers within 10 days of birth increased by 11.3 %, 20.2% and 37.6% in the districts - Tonk in Rajasthan, Mayurbhanj in Orissa and Vaishali in Bihar, respectively. There was a marked increase in the referral rates for both young infants and sick children in these states. More focused and regular supervisory visits kept health workers motivated and led to better IMNCI indicators in Bihar as compared to Rajasthan and Orissa. Model of supportive supervision involving both internal and external agency was found to be more feasible, sustainable and successful. [ABSTRACT FROM AUTHOR]

Purpose – Outpatient departments (OPDs) need to monitor the quality of care and patient satisfaction for continuous quality improvement. Additionally, there is a need for an increase in focused literature on patient satisfaction and quality of health care at a tertiary care level. The purpose of this paper is to attempt to fulfil this need. Design/methodology/approach – A cross-sectional hospital-based study among OPD patients was undertaken, where investigators conducted interviews with 120 patients at entry (registration), 120 patients at the OPD clinic (60 doctor-patient interactions and 60 exit interviews), and a further 120 patients at investigation facilities. Patient satisfaction, client convenience facilities, prescription quality, doctor-patient interaction and other quality elements as described in the study were given score of 0 or 1. Findings – At exit, 52 (86.6 percent) patients were satisfied with the OPD care. The mean total quality score was 80.9 percent of the total scores. It was above 90 percent of the total score for patient convenience facilities and for doctor-patient interaction, 76 percent for the prescription quality of the doctors and 43.3 percent for signage display. The mean score for patient-doctor interaction was found to be significantly lower (3.6/5) among dissatisfied patients compared to the satisfied patients (4.7/5). Satisfied patients reported a significantly higher consultation time (12.4 minutes) with a doctor compared to dissatisfied patients (8.5 minutes) (p=0.04). Research limitations/implications – Not using a Likert scale to measure patient satisfaction could be considered a limitation. However, the authors also arrived at similar conclusions with their tools as with the use of Likert scales in other studies. Furthermore, findings are limited to medicine and surgery general OPDs in a tertiary care setting. Any interpretation beyond this frame may be done with caution. Practical implications – Hospitals should encourage good patient-doctor interaction as it has emerged as the key factor associated with patient satisfaction. Social implications – Quality improvements in public sector health institutes can lead to better utilization of health care by the poor and compromised sections of society and can lead to a reduction in the inequity associated with health care. Originality/value – This paper fulfils the need to evaluate quality of hospital care in public sector hospitals at the tertiary care level. The methods and tools used are simple and extensive enough to capture information at multiple service points. [ABSTRACT FROM AUTHOR]

Background & objectives: User charges have been advocated on efficiency grounds despite the widespread criticism about their adverse effect on equity. We assessed the effect of user charges on inpatient hospitalizations rate and equity in Haryana State. Methods: The inpatient department (IPD) statistics of the public sector facilities in Yamuna Nagar district where user charges had been introduced were analysed and compared with Rohtak district which did not have user charge between 2000 and 2006. National Sample Survey data of Haryana for the 2004- 2005 period were analyzed to compare utilization of public sector facilities for hospitalization, cost of hospitalization, and prevalence of catastrophic out-of-pocket (OOP) expenditure by income quintiles in three districts which had user charges and 17 districts of Haryana which did not levy user charges. Results: During 2000 and 2006, hospital admissions declined by 23.8 per cent in Yamuna Nagar district where user charges had been introduced compared to an almost static hospitalization rate in Rohtak district which did not have user charges (P<0.01). Public sector hospital utilization for inpatient services had a pro-rich (concentration index 0.144) distribution in the three districts with user charges and pro- poor (concentration index -0.047) in the 17 districts without user charges. Significantly higher prevalence of catastrophic health expenditure was observed in public sector institutions with user charges (48%) compared to those without user charges (35.4%) (P<0.001). Interpretation & conclusions: The findings of our study showed that user charges had a negative influence on hospitalizations in Haryana especially among the poor. Public policies for revenue generation should avoid user charges. [ABSTRACT FROM AUTHOR]

Background Information on causes of death is vital for planning of health services. However, vital events registration systems are weak in developing countries. Therefore, verbal autopsy (VA) tools were incorporated in a community-based surveillance system to track causes of death. Method and Findings Trained fieldworker identified all deaths and interviewed a living relative of those who had died during 1992e2009, using VA, in eight villages of Haryana (11 864 populations). These field reports detailing events preceding death were reviewed by two trained physicians, who independently assigned an International Classification of Disease-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. Non-communicable conditions were the leading causes of death (47.6%) followed by communicable diseases including maternal, perinatal and nutritional conditions (34.0%), and injuries (11.4%). Cause of death could not be determined in 6.9% cases. Deaths due to cardiovascular diseases showed a significant rise, whereas deaths due to diarrhoeal diseases have declined (p<0.01). Majority (90.0%) of the deceased had contacted a healthcare provider during illness but only 11.5% were admitted in hospital before death. Conclusion Rising trend of cardiovascular diseases observed in a rural community of Haryana in India calls for reorientation of rural healthcare delivery system for prevention and control of chronic diseases. [ABSTRACT FROM AUTHOR]

National Rural Health Mission (NRHM) strategy of mainstreaming AYUSH health facilities, require evaluations for continual improvement. Objectives: To assess operationalisation and utilization of AYUSH clinics, to ascertain the level of patient satisfaction, to explore the perceptions of AYUSH practitioners regarding implementation of AYUSH scheme and to assess the factors influencing AYUSH scheme implementation. Material and Methods: Cross-sectional study design and mixed methodology was followed that included record review, and interviews with AYUSH service users and the service providers, of both Allopathic and AYUSH streams. Results: AYUSH system has been implemented successfully in Chandigarh and people are using these services. Females, prior users of allopathic medicine and suffering from chronic problems were the main users. Client satisfaction with service provision by AYUSH clinics was high. However, allopathic practitioners are not much enthusiastic about recognizing these systems as scientific therapies. More publicity about AYUSH in the region is required as the main goal of integration is not being fulfilled. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to determine the level of dental health care access and associated factors, at various public health facilities in the Union Territory (UT) of Chandigarh. Materials and Methods: A study was done using a multistage random sampling technique, to interview adult respondents at their homes and to interview the dentists in the public dental clinics and hospitals. Results: The mean composite access score was 59.2 (SD 18.9) in urban areas and 60.5 (SD 20.9) in rural areas (P=0.64) on a scale of 100. The mean score for the self-perceived condition of their oral health was 6.47 (95% CI 6.17 - 6.76). Thirty-four percent of the respondents did not contact a dentist despite having a problem in the last year, primarily because dental problems were not important for them (45%), they lacked time (22%), and took self-medication (16%). Overall 58% of the respondents suggested government clinics and 44% liked private dentists for treatment of dental cavities. The government setup was preferred because the facilities were cheaper and affordable. Conclusions: Dental health care access and only limited dental facilities were available in most of the dental clinics in Chandigarh. Self-reported dental problem was low, and people ignored their dental problems. [ABSTRACT FROM AUTHOR]

Objective To validate the verbal autopsy tool for stillbirths of the World Health Organization (WHO) by using hospital diagnosis of the underlying cause of stillbirth (the gold standard) and to compare the fraction of stillbirths attributed to various specific causes through hospital assessment versus verbal autopsy. Methods In a hospital in Chandigarh, we prospectively studied all stillbirths occurring from 15 April 2006 to 31 March 2008 whose cause was diagnosed within 2 days. All mothers had to be at least 24 weeks pregnant and live within 100 km of the hospital. For verbal autopsy, field workers visited mothers 4 to 6 weeks after the stillbirth. Autopsy results were reviewed by two independent obstetricians and disagreements were resolved by engaging a third expert. Causes of stillbirths as determined by hospital assessment and verbal autopsy were compared in frequency. Findings Hospital assessment and verbal autopsy yielded the same top five underlying causes of stillbirth: pregnancy-induced hypertension (30%), antepartum haemorrhage (16%), underlying maternal illness (12%), congenital malformations (12%) and obstetric complications (10%). Overall diagnostic accuracy of verbal autopsy diagnosis versus hospital-based diagnosis for all five top causes of stillbirth was 64%. The areas under the receiver operator characteristic curve (ROC) were, for congenital malformations, 0.91 (95% confidence interval, CI: 0.83-0.97); pre-gestational maternal illness, 0.75 (95% CI: 0.65-0.84); pregnancy-induced hypertension, 0.76 (95% CI: 0.69-0.81); antepartum haemorrhage, 0.76 (95% CI: 0.67-0.84) and obstetric complication, 0.82 (95% CI: 0.71-0.93). Conclusion The WHO verbal autopsy tool for stillbirth can provide reasonably good estimates of common underlying causes of stillbirth in resource-limited settings where a medically certified cause of stillbirth may not be available. [ABSTRACT FROM AUTHOR]

Background: Large poultry belt is located in the residential areas of rural Haryana in North India. Housefly problem has become a big nuisance in this area. Policy makers require evidence of the association of poultry farming with houseflies and its possible impact on the health of the population. Materials and Methods: A cross-sectional two-group comparison study was conducted. Six villages within 3 km and another six villages beyond 5 km from any poultry farms were selected as the study and the control villages, respectively. We measured indoor and outdoor housefly density and family morbidity in the last 1 month and observed the poultry hygiene and manure management practices. Findings: The mean fly density was 1737 (95% CI 697-2778) houseflies in study villages compared to 100 (95% CI 2-197) houseflies in the control area. The mean all-cause morbidity was also significantly higher in study village families compared to control village families. Poultry farm hygiene and use of insecticides and growth regulators were inadequate. Interpretation: Poultry farms are associated strongly with high fly density and high infectious morbidity in this area. Monitoring and regulation for poultry manure management practices and insecticide use practices need to be strengthened. [ABSTRACT FROM AUTHOR]

Objectives: (1) To assess the magnitude of the problem of low birth weight (LBW) in a rural area of Haryana (2) To study the association of caloric and protein intake in third trimester of pregnancy with birth weight. Study Design: Longitudinal study. Sample Size: One hundred and forty pregnant women. Study Area: Ten purposively selected villages in the rural area of Naraingarh block in Haryana. Study Tool and Data Collection: Pre-tested questionnaire was administered to record information regarding socioeconomic status, antenatal care, nature of physical activity and dietary intake in 24 h between September 2001 and August 2002. Data Analysis: For categorical variables, Chi-square test was used, and for numerical variables, t-test was used. Multivariate analysis was done for variables that were significant in bivariate analysis. Results: The prevalence of low birth weight (less than 2500 g) was 24.3% (95% CI 17.4-32.2%). The mean caloric intake during three dietary assessments was 1695 ± 182.8 kcal. The mean protein intake during three dietary assessments was 50.8 ± 9.27 g. The higher prevalence of LBW babies was observed in pregnant women with mean caloric intake of less than 1500 kcal and mean protein intake of less than 40 g (P < 0.001). In multivariate analysis, the association of caloric intake (P < 0.01) and weight of the mother (P = 0.02) was independently associated with LBW. Conclusions: Low caloric intake in the third trimester of pregnancy and maternal weight are significantly associated with the birth weight of babies. [ABSTRACT FROM AUTHOR]

Abstract: Nguyen TA, Page A, Aggarwal A, Henke P. Social determinants of discharge destination for patients after stroke with low admission FIM instrument scores. Objective: To investigate the effects of immigrant status (via country of birth), marital status, and area-based socioeconomic status (SES) on discharge destination after stroke for those with low admission scores on the FIM instrument. Design: Cross-sectional study. Setting: Inpatient rehabilitation ward at an urban community hospital in Australia. Participants: A total of 326 inpatients admitted for rehabilitation poststroke. Intervention: Multidisciplinary rehabilitation. Main Outcome Measure: Discharge home versus nursing home. Results: A total admission FIM score of 75 or lower was associated with a higher probability of nursing home discharge. Married patients with a total FIM admission score of 75 or lower were significantly more likely to be discharged home, after adjusting for immigrant status, type and side of stroke, sex, and age (odds ratio, 6.07; 95% confidence interval, 1.65−22.40; P<.01). This effect was also observed for low motor and cognition components of FIM admission score. The effect of immigrant status did not remain significant after adjusting for marital status. Area-based SES and stroke characteristics did not substantially attenuate the relationship between immigrant status, marital status, and discharge location. Conclusions: Marital status is a significant determinant of discharge destination. Immigrant status and area-based SES were not significant predictors of discharge disposition. [Copyright &y& Elsevier]

Objective: To measure the effectiveness of a reproductive health education package in improving the knowledge of adolescent girls aged 15-19 years in Chandigarh (India).Methods: A reproductive health education package, developed in consultation with parents, teachers and adolescents, was delivered to randomly sampled classes of two senior secondary schools and one school was selected as control. In one school, a nurse conducted 15 sessions for 94 students in three batches using conventional education approach. In another school she conducted sessions for a selected group of 20 adolescents who later disseminated the messages informally to their 84 classmates (peer education). Using a 70-item structured questionnaire the knowledge of 95 adolescents from conventional, 84 from peer, and 94 from control school were assessed before and one month after the last session. Change in the score in intervention and control groups was tested by ANOVA taking age and socio-economic status as covariates.Results: Teachers, parents and students overwhelmingly (88%, 95.5% and 93% respectively) favoured reproductive health education program. Five percent of the respondents reported that someone in their class is having sexual relations, and 13% of the girls approved of pre-marital sexual relations. Reproductive health knowledge scores improved significantly after intervention in conventional education (27.28) and peer education group (20.77) in comparison to the controls (3.64). Post-test scores were not significantly different between peer education group and conventional education group (43.65 and 40.52 respectively) though the time consumed in delivering the peer education intervention was almost one third of the time taken to implement conventional education.Conclusion: Peer education and conventional education strategies were effective in improving the reproductive health knowledge of adolescent girls but peer strategy was less time consuming. [ABSTRACT FROM AUTHOR]

The article inform in India, under the National Health Mission (NHM), Comprehensive Primary Health Care (CPHC) is delivered through a medical officer who manages a primary health centre catering to 20 000–30 000 population (50 000– 60 000 in an urban setting). Topic include baseline data for Electronic Health/Medical Records (EHRs/EMRs)are individual-level sociodemographic and clinical data collected and updated by the Auxiliary Nurse-Midwife (ANM) during the annual household survey.

Decline in knowledge and skills after Integrated Management of Neonatal and Childhood Illness (IMNCI) training substantiate the introduction of refresher training. The course structure of refresher training remains an area of discussion. The present study is an effort to construct and pilot test the refresher IMNCI training course for primary health care workers. Methodology: Based on the public health experts' opinion, one day refresher training was given to trained workers in standard IMNCI training of district Panchkula, Haryana. Results: As planned, one day refresher training was conducted from 9 AM to 5 PM for 76 participants in four batches. It included reading of treatment chart booklet followed by video demonstration and case study. Group discussion was conducted at the end of each session. One role play was performed by the participants. Conclusion: Authors observed that it is possible to construct and implement the refresher IMNCI training course primary health care workers. [ABSTRACT FROM AUTHOR]

Background and Objectives: Globally, a number of countries have developed guidelines that describe the design and conduct of economic evaluations as part of health technology assessment (HTA) or pharmacoeconomic analysis for decision making. The current scoping review was undertaken with an objective to summarize the recommendations made on methods of economic evaluation by the national healthcare economic evaluation (HEE) guidelines.A comprehensive search was undertaken in the website repositories of the International Society for Pharmacoeconomic and Outcomes Research (ISPOR) and Guide to Economic Analysis and Research (GEAR), and websites of national HTA agencies and ministries of health of individual countries. All guidelines in the English language were included in this review. Data were extracted with respect to general and methodological characteristics, and a descriptive analysis of recommendations made across the countries was undertaken.Overall, our review included 31 national HEE guidelines, published between 1997 and August 2020. Nearly half (45%) of the guidelines targeted the evaluation of pharmaceuticals. The nature of the guidelines was either mandatory (31%), recommendatory (42%), or voluntary (16%). There was a substantial consensus among the guidelines on several key principles, including type of economic evaluation (cost-utility analysis), time horizon of the analysis (long enough), health outcome measure (quality-adjusted life-years) and use of sensitivity analyses. The recommendations on study perspective, comparator, discount rate and type of costs to be included (particularly the inclusion of indirect costs) varied widely.Despite similarity in the overall processes, variation in several recommendations given by various national HEE guidelines was observed. This is perhaps unsurprising given the differences in the health systems and financing mechanisms, capacity of local researchers, and data availability. This review offers important lessons and a starting point for countries that are planning to develop their own HEE guidelines.Methodology: Globally, a number of countries have developed guidelines that describe the design and conduct of economic evaluations as part of health technology assessment (HTA) or pharmacoeconomic analysis for decision making. The current scoping review was undertaken with an objective to summarize the recommendations made on methods of economic evaluation by the national healthcare economic evaluation (HEE) guidelines.A comprehensive search was undertaken in the website repositories of the International Society for Pharmacoeconomic and Outcomes Research (ISPOR) and Guide to Economic Analysis and Research (GEAR), and websites of national HTA agencies and ministries of health of individual countries. All guidelines in the English language were included in this review. Data were extracted with respect to general and methodological characteristics, and a descriptive analysis of recommendations made across the countries was undertaken.Overall, our review included 31 national HEE guidelines, published between 1997 and August 2020. Nearly half (45%) of the guidelines targeted the evaluation of pharmaceuticals. The nature of the guidelines was either mandatory (31%), recommendatory (42%), or voluntary (16%). There was a substantial consensus among the guidelines on several key principles, including type of economic evaluation (cost-utility analysis), time horizon of the analysis (long enough), health outcome measure (quality-adjusted life-years) and use of sensitivity analyses. The recommendations on study perspective, comparator, discount rate and type of costs to be included (particularly the inclusion of indirect costs) varied widely.Despite similarity in the overall processes, variation in several recommendations given by various national HEE guidelines was observed. This is perhaps unsurprising given the differences in the health systems and financing mechanisms, capacity of local researchers, and data availability. This review offers important lessons and a starting point for countries that are planning to develop their own HEE guidelines.Results: Globally, a number of countries have developed guidelines that describe the design and conduct of economic evaluations as part of health technology assessment (HTA) or pharmacoeconomic analysis for decision making. The current scoping review was undertaken with an objective to summarize the recommendations made on methods of economic evaluation by the national healthcare economic evaluation (HEE) guidelines.A comprehensive search was undertaken in the website repositories of the International Society for Pharmacoeconomic and Outcomes Research (ISPOR) and Guide to Economic Analysis and Research (GEAR), and websites of national HTA agencies and ministries of health of individual countries. All guidelines in the English language were included in this review. Data were extracted with respect to general and methodological characteristics, and a descriptive analysis of recommendations made across the countries was undertaken.Overall, our review included 31 national HEE guidelines, published between 1997 and August 2020. Nearly half (45%) of the guidelines targeted the evaluation of pharmaceuticals. The nature of the guidelines was either mandatory (31%), recommendatory (42%), or voluntary (16%). There was a substantial consensus among the guidelines on several key principles, including type of economic evaluation (cost-utility analysis), time horizon of the analysis (long enough), health outcome measure (quality-adjusted life-years) and use of sensitivity analyses. The recommendations on study perspective, comparator, discount rate and type of costs to be included (particularly the inclusion of indirect costs) varied widely.Despite similarity in the overall processes, variation in several recommendations given by various national HEE guidelines was observed. This is perhaps unsurprising given the differences in the health systems and financing mechanisms, capacity of local researchers, and data availability. This review offers important lessons and a starting point for countries that are planning to develop their own HEE guidelines.Conclusion: Globally, a number of countries have developed guidelines that describe the design and conduct of economic evaluations as part of health technology assessment (HTA) or pharmacoeconomic analysis for decision making. The current scoping review was undertaken with an objective to summarize the recommendations made on methods of economic evaluation by the national healthcare economic evaluation (HEE) guidelines.A comprehensive search was undertaken in the website repositories of the International Society for Pharmacoeconomic and Outcomes Research (ISPOR) and Guide to Economic Analysis and Research (GEAR), and websites of national HTA agencies and ministries of health of individual countries. All guidelines in the English language were included in this review. Data were extracted with respect to general and methodological characteristics, and a descriptive analysis of recommendations made across the countries was undertaken.Overall, our review included 31 national HEE guidelines, published between 1997 and August 2020. Nearly half (45%) of the guidelines targeted the evaluation of pharmaceuticals. The nature of the guidelines was either mandatory (31%), recommendatory (42%), or voluntary (16%). There was a substantial consensus among the guidelines on several key principles, including type of economic evaluation (cost-utility analysis), time horizon of the analysis (long enough), health outcome measure (quality-adjusted life-years) and use of sensitivity analyses. The recommendations on study perspective, comparator, discount rate and type of costs to be included (particularly the inclusion of indirect costs) varied widely.Despite similarity in the overall processes, variation in several recommendations given by various national HEE guidelines was observed. This is perhaps unsurprising given the differences in the health systems and financing mechanisms, capacity of local researchers, and data availability. This review offers important lessons and a starting point for countries that are planning to develop their own HEE guidelines. [ABSTRACT FROM AUTHOR]

Background: Chronic non‐malignant pain is a disabling condition that results in a reduction in function and quality of life when inadequately managed. Sublingual ketamine has been shown to be efficacious for use in chronic pain. Despite its use for decades in chronic non‐malignant pain, there is no published long‐term data on safety, side‐effects or adverse drug reactions. Aim: The aim of this case‐series is to provide the initial evidence for safety and efficacy in this patient group. Methods: We present a retrospective review of 29 (n = 29) patients from a metropolitan tertiary pain service who have been receiving sublingual ketamine troches/lozenges between the period of 2012 and 2019. Patients were identified from the outpatient pain clinic, who had been admitted for inpatient subcutaneous ketamine infusions as part of opiate detoxification or management of central sensitisation due to a chronic neuropathic pain syndrome. An initial review was performed to check the patient started taking the ketamine troches. Each of these medical records was reviewed manually to extract information to a datasheet. Results: There was a wide range of dosages used from 25 to 600 mg in divided doses. The duration of treatment ranged 2−89 months. There was no association with either the dosage or duration of treatment and frequency of side‐effects. There was an overall reduction in the use of opioids, gabapentinoids or benzodiazepines in 59% of patients with 39% having a complete cessation of an analgesic agent. Side‐effects were reported in 24%, but only 7% discontinued the treatment due to the side‐effect (drowsiness). There were no reports of renal impairment, cystitis or hepatotoxicity. Discussion: This retrospective case‐series has demonstrated that sublingual ketamine is a safe and effective analgesic agent to use in chronic non‐malignant pain management. It is indicated in a variety of chronic pain conditions and has an excellent safety profile, with no association between the frequency in side‐effects and duration of therapy or total daily dosages. The study has also shown that the 'safe' dose may be higher than the previous consensus. [ABSTRACT FROM AUTHOR]

High energy storage performance of polymer-ceramic nanocomposites at elevated temperatures (room temperature to 100 °C) becomes unstable because of thermally unstable dielectric behavior (permittivity and loss tangent). Therefore, the present work describes the experimental and analytical investigation of the temperature-dependent dielectric behavior, AC conductivity, and impedance of flexible poly(vinylidene difluoride) (PVDF)-Ba 0.8 Sr 0.2 TiO 3 (BST) nanocomposite thick films. An increase in the dielectric constant and a decrease in the loss tangent is found with an increase in the loading of BST nanoparticles in the nanocomposite thick films. The highest dielectric constant, approximately 25, and the lowest loss tangent, approximately 0.03, are observed for 10 wt% BST–loaded PVDF-BST nanocomposite at 1 kHz; the dielectric constant and the loss tangent increase to approximately 93 and approximately 1.64, respectively, at 150 °C. The dielectric constant and the loss tangent of all the PVDF-BST nanocomposites are thermally stable up to 70 °C, and then increase with further increase of the temperature. A phenomenological model is proposed to explain the experimentally observed behavior, which might be attributed to the thermally induced translational motion in the polymeric chains of PVDF, the motion of ions, and the migration of space charge in the interfacial layer of the PVDF matrix and BST nanoparticles. [Display omitted] • Qualitative analysis of temperature-dependent dielectric, AC conductivity & impedance behavior of PVDF-BST nanocomposites. • Phenomenological model based on interfacial layer of PVDF/BST interface & polymeric chain's translational motion is proposed. • The increase in ε' and tanδ for temperatures >70 °C is due to the migration of ions & space charge in the interfacial layers. [ABSTRACT FROM AUTHOR]

Background & objectives: India aspires to achieve universal health coverage, which requires ensuring financial risk protection (FRP). This study was done to assess the extent of out-of-pocket (OOP) expenditure and FRP for hospitalization in Haryana State, India. Further, the determinants for FRP were also evaluated. Methods: Data collected as a part of a household level survey conducted in Haryana 'Concurrent Evaluation of National Rural Health Mission: Haryana Health Survey' were analyzed. Descriptive analysis was undertaken to assess socio-demographic characteristics, hospitalization rate, extent and determinants of OOP expenditure and FRP. Prevalence of catastrophic health expenditure (CHE) (more than 40% of non-food expenditure) and impoverishment (Int$ 1.25) were estimated. Multivariate logistic regression was used to assess determinants of FRP. Results: Hospitalization rate was found to be 3106 persons or 3307 episodes per 100,000 population. Median OOP expenditure on hospitalization was ₹ 8000 (USD 133), which was predominantly attributed to medicines (37%). Prevalence of CHE was 25.2 per cent with higher prevalence amongst males [odds ratio (OR)=1.30], those belonging to scheduled caste and scheduled tribes (OR=1.35), poorest 20 per cent households (OR=3.05), having injuries (OR=4.03) and non-communicable diseases (OR=3.13) admitted in a private hospital (OR=2.69) and those who were insured (OR=1.74). There was a 12 per cent relative increase in poverty head count due to OOP payments on healthcare. Interpretation & conclusions: Our findings showed that hospitalization resulted in significant OOP expenditure, leading to CHEs and impoverishment of households. Impact of OOP expenditures was inequitably more on the vulnerable groups. OOP expenditure may be curtailed through provision of free medicines and diagnostics and removal of any form of user charges. [ABSTRACT FROM AUTHOR]

Real-time RT-PCR is used as a gold standard method for the diagnosis of COVID-19. Since real-time RT PCR is nucleic acid-based, it is a highly sensitive and specific test. However, this test takes 4–8 h to generate results and, in emergency settings, this delay may prove fatal for certain patients. The frequent surge in COVID cases increases patient load in emergency settings. Thus, a nucleic acid-based rapid POC test is required that can generate results quickly as well as being comparable to real-time RT-PCR. In this study, comparison of real-time RT-PCR was carried out using the rapid nucleic acid-based LAMP method. Nasopharyngeal swabs were taken in duplicate from patients visiting the kiosk and were analyzed for the presence of the SARS-CoV-2 virus by both real-time RT-PCR and LAMP techniques ID NOW(bbott). Out of 14 positive and 31 negative samples tested by real-time RT-PCR, 13 samples were identified as positive and 31 were observed as negative with the LAMP-based test. Hence, the sensitivity and specificity of this method were found to be 92.9% and 93.5%, respectively. Therefore, LAMP-based point-of-care testing has the potential to be used in hospital emergency settings for quick diagnosis of critically ill patients, and the information generated here will further draw the attention of policymakers toward such nucleic acid-based rapid tests. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) are at the front line of the Coronavirus disease (COVID‑19) outbreak response. They have faced great risks to both physical and mental health. We aimed to assess the psychological effect of COVID‑19 among ancillary hospital staff. Methods: A cross‑sectional study was conducted among 267 on‑duty ancillary hospital staff using a semi‑structured questionnaire to assess their psychological status and risk perception. In addition, their knowledge, attitude, and practices (KAP) and risk perception were also assessed. The General Health Questionnaire (GHQ‑12) was used to screen for psychological distress. Results: Among 267 participants, the mean (±SD) age was 33.5 (7.6) years. The majority knew about the symptoms of COVID‑19 (88.4%), droplet spread (99.3%), and the importance of isolation (99.3%). About 35.2% were worried about infecting family members, while 26.2% were worried about colleagues at the frontline. Only 38.9% of them had a good knowledge score. Participants with high school and above education level had significantly good knowledge about COVID‑19 (OR = 1.99; 95% CI = 1.17‑ 3.39) than those with primary school or below. Being female (OR 1.99; 95% CI 1.17‑3.39) and working with COVID‑19 patients (OR 3.88, 95% CI 1.77‑8.47, P = 0.001) was associated with psychological distress. Conclusion: The ancillary hospital staff had insufficient knowledge regarding the risk factors of COVID‑19 but possessed positive attitudes and practices. Continued health education and appropriate psychological interventions may improve understanding and reduce psychological distress. [ABSTRACT FROM AUTHOR]

Background & objectives: Various models of referral transport services have been introduced in different States in India with an aim to reduce maternal and infant mortality. Most of the research on referral transport has focussed on coverage, quality and timeliness of the service with not much information on cost and efficiency. This study was undertaken to analyze the cost of a publicly financed and managed referral transport service model in three districts of Haryana State, and to assess its cost and technical efficiency. Methods: Data on all resources spent for delivering referral transport service, during 2010, were collected from three districts of Haryana State. Costs incurred at State level were apportioned using appropriate methods. Data Envelopment Analysis (DEA) technique was used to assess the technical efficiency of ambulances. To estimate the eficient scale of operation for ambulance service, the average cost was regressed on kilometres travelled for each ambulance station using a quadratic regression equation. Results: The cost of referral transport per year varied from ??? 5.2 million in Narnaul to ??? 9.8 million in Ambala. Salaries (36-50%) constituted the major cost. Referral transport was found to be operating at an average efficiency level of 76.8 per cent. Operating an ambulance with a patient load of 137 per month was found to reduce unit costs from an average ??? 15.5 per km to ??? 9.57 per km. Interpretation & conclusions: Our results showed that the publicly delivered referral transport services in Haryana were operating at an eficient level. Increasing the demand for referral transport services among the target population represents an opportunity for further improving the efficiency of the underutilized ambulances. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Nischay scheme (provision of pregnancy detection kit) in improving antenatal care. Methodology: A natural experiment design was conducted during September 2011 to April 2012 in a randomly selected district of Haryana state of India. Community Health Center (CHC), Primary Health Center (PHC), sub-center and villages were selected using random sampling technique. The retrospective record analysis of antenatal data pertaining to 6 months before (April to September 2008) and after (October 2008 till March 2009) the launch of Nischay scheme was compared in the study. Only those centers were included in the study which have timely and adequate supply of the kits so that pregnant women would not have been missed (to be diagnosed as pregnant). The training status of ANMs and ASHA of selected sub-centers along with their knowledge about usage of kits was assessed. Besides this, beneficiaries were interviewed from selected sub-centers about their awareness and utilization of Nischay scheme. Results: Before 6 months of a launch of Nischay scheme, the median of ANC registration per sub-center per month was in the range of 18-25.5, whereas after 6 months it was 16-22.5. The difference in key ANC parameters (ANC registration, ANC < 12 weeks and completed three ANC) before and after introduction of the scheme was not found to be statistically significant. Only 15.6 % of beneficiaries were aware about Nischay scheme. The primary source of the information is either ANM (60 %) or ASHA (40 %). Those who were aware of this scheme had utilized this kit from the nearby sub-center. All (100 %) ANMs and 93 % of ASHAs had been adequately trained about using Nischay kit and interpreting the result. Conclusions: There was no significant change in ANC registration in the period of 6 months after the launch of the scheme despite trainings to the frontline health workers. Further research is required to understand the bottlenecks so that corrective actions can be taken. [ABSTRACT FROM AUTHOR]

Background & objectives: Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a major global problem. Colonization rates of MRSA in the community have been reported to range from 0 to 9.2 per cent. The present study was conducted to detect S. aureus nasal colonization and prevalence of MRSA in children (5 to 15 yr) in an Indian community setting of rural, urban and semi-urban slums, as also evaluation of an in-house PCR to detect MRSA. Methods: Nasal swabs from children were cultured and S. aureus isolates were processed for antibiotic susceptibility, mecA gene was studied by polymerase chain reaction (PCR) on S. aureus isolates and directly from enrichment broth aliquots inoculated with nasal swabs, at sequential time intervals. Results: The overall prevalence of S. aureus nasal colonization was 52.3 per cent and that of MRSA 3.89 per cent. CA-MRSA nasal carriage was 3.16 per cent in children without prior exposure to health care settings. PCR detection directly on nasal swabs and enrichment broth had a poor sensitivity of 60.42 per cent. Interpretation & conclusions: There was a high rate of S. aureus nasal colonization in the 5-15 yr age group and an alarming rate (3.89%) of community acquired methicillin resistant S. aureus nasal colonization in the community. PCR as a method of direct detection of MRSA from nasal samples needs further fine tuning. [ABSTRACT FROM AUTHOR]

Dear Sirs, A 71-year-old right-handed woman presented with a severe global aphasia due to an acute left basal ganglia hemorrhage. CT brain showed a 20 × 40 × 50 mm hemorrhage in the left basal ganglia (Fig. 1 a Axial CT brain shows an acute left basal ganglia hemorrhage (20 mm × 40 mm × 50 mm; red arrowhead). b Axial MRI FLAIR confirms the basal ganglia hemorrhage and shows no ischemia or hemorrhage involving the overlying cortex (white arrowhead). c Axial MRI SWI shows blooming artifact in the left basal ganglia consistent with hemorrhage without extension to the cortex or additional areas of microhemorrhage (white arrow). [Extracted from the article]

• We have used a national level data set for non-invasive pre-diabetes screening. • The eight non-invasive features for pre-diabetes prediction in children and adolescents were used. • We have trained six hypertuned machine learning models for classification between normal and pre-diabetes. • We have deployed the most efficient machine learning model for real-time pre-diabetes screening. Pre-diabetes has been identified as an intermediate diagnosis and a sign of a relatively high chance of developing diabetes in the future. Diabetes has become one of the most frequent chronic disorders in children and adolescents around the world; therefore, predicting the onset of pre-diabetes allows a person at risk to make efforts to avoid or restrict disease progression. This research aims to create and implement a cross-validated machine learning model that can predict pre-diabetes using non-invasive methods. We have analysed the national representative dataset of children and adolescents (5–19 years) to develop a machine learning model for non-invasive pre-diabetes screening. Based on HbA1c levels the data (n = 26,567) was segregated into normal (n = 23,777) and pre-diabetes (n = 2790). We have considered eight features, six hyper-tuned machine learning models and different metrics for model evaluation. The final model was selected based on the area under the receiver operator curve (AUC), Cohen's kappa and cross-validation score. The selected model was integrated into the screening tool for automated pre-diabetes prediction. The XG boost classifier was the best model, including all eight features. The 10-fold cross-validation score was highest for the XG boost model (90.13%) and least for the support vector machine (61.17%). The AUC was highest for RF (0.970), followed by GB (0.968), XGB (0.959), ETC (0.918), DT (0.908), and SVM (0.574) models. The XGB model was used to develop the screening tool. We have developed and deployed a machine learning model for automated real-time pre-diabetes screening. The screening tool can be used over computers and can be transformed into software for easy usage. The detection of pre-diabetes in the pediatric age may help avoid its enhancement. Machine learning can also show great competence in determining important features in pre-diabetes. [ABSTRACT FROM AUTHOR]

Background & objectives: Creation of a strong referral transport network across the country is necessary for improving physical access to public sector health facilities. In this study we evaluated the referral transport services in Haryana, i.e. Haryana Swasthya Vaahan Sewa (HSVS), now known as National Ambulance Service (NAS), to assess the extent and pattern of utilization, and to ascertain its effect on public sector institutional deliveries. Methods: Secondary data on 116,562 patients transported during April to July 2011 in Haryana state were analysed to assess extent and pattern of NAS utilization. Exit interviews were conducted with 270 consecutively selected users and non- users of referral services respectively in Ambala (High NAS utilization), Hisar (medium utilization) and Narnaul (low utilization) districts. Month-wise data on institutional deliveries in public facilities during 2005-2012 were collected in these three districts, and analysed using interrupted time series analysis to assess the impact of NAS on institutional deliveries. Results: Female gender (OR = 77.7), rural place of residence (OR = 5.96) and poor socio-economic status (poorest wealth quintile OR = 2.64) were significantly associated with NAS ambulance service usage. Institutional deliveries in Haryana rose significantly after the introduction of NAS service in Ambala (OR=137.4, 95% CI=22.4-252.4) and Hisar (OR=215, 95% CI=88.5-341.3) districts. No significant increase was observed in Narnaul (OR=4.5, 95% CI= -137.4 to 146.4) district. Interpretation & conclusions: The findings of the present study showed a positive effect of referral transport service on increasing institutional deliveries. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at hospitals and health centres. [ABSTRACT FROM AUTHOR]

Background & objectives: Despite years of salt iodization, goitre continues to be a major public health problem worldwide. We examined the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of Chandigarh, north India. Methods: Two phase study; in the first phase, 2148 children of 6 to 16 yr were screened for goitre by two independent observers as per the WHO grading system. In the second phase, a case-control study, 191 children with goitre and 165 children without goitre were compared with respect to urinary iodine, iodine content of salt, serum levels of T3, T4, TSH, anti-TPO (thyroid peroxidase) antibody, haemoglobin, ferritin and selenium. Results: Prevalence of goitre in the studied subjects was 15.1 per cent (13.9% in 6 to 12 yr and 17.7% in 13 to 16 yr age group, P= 0.03). Median urinary iodine excretion in both the groups was sufficient and comparable (137 and 130 µg/l). 3.2 per cent children with goitre and 2.4 per cent without goitre had hypothyroidism (subclinical and clinical) and only one child with goitre had subclinical hyperthyroidism. Nine (4.9%) children in the goitre group and 3 (1.9%) in control group had anti-TPO antibody positivity. The median serum selenium levels were not different in both the groups (181.9 and 193.5 µg/l). Seventy one (37.4%) of the goitrous children had anaemia (haemoglobin <12 g/dl) as compared to 41 (24.8%) of the control group (P<0.01). More number of goitrous children (39, 20.6%) were depleted of tissue iron stores (serum ferritin <12 µg/l) as compared to controls (11, 6.4%; P<0.001). Serum ferritin level negatively correlated with the presence of goitre (r = -0.22, P=0.008) and had an OR of 2.8 (CI 1.20 - 6.37, P=0.017). Interpretation & conclusions: There was a high prevalence of goitre in young children despite iodine repletion and low thyroid autoimmunity. The concurrent iron deficiency correlated with the presence of goiter. However, the cause and effect relationship between iron deficiency state and goitre requires further elucidation. [ABSTRACT FROM AUTHOR]

Introduction: Primary healthcare is broadly acknowledged as the cornerstone of any strategy aimed at achieving Universal Health Coverage (UHC). This study aims to evaluate the costs, work patterns and efficiency of comprehensive primary healthcare (CPHC) in India., Methods and Analysis: We will use a top-down microcosting approach to estimate the economic cost of services delivered at the primary healthcare facilities in India. A multistage stratified random sampling approach will be applied to select the primary healthcare facilities -Ayushman Arogya Mandirs (AAMs), formerly Health and Wellness Centres (HWCs). First, states will be selected based on key supply-side and demand-side healthcare indicators. Second, two districts will be chosen in each state based on advanced functionality criteria of AAMs. Finally, AAM-subhealth centres (SHCs) and AAM-primary health centres (PHCs) will be randomly selected within each district, implying a total of 48 SHCs and 24 PHCs. Data on both quantity and prices of capital (such as space, building, equipment and furniture) and recurrent resources (including salaries, medicines, consumables, stationery and overheads) used for delivering primary healthcare services during the period from April 2022 to March 2023 will be collected. All costs will be reported in current India Rupees (₹) and US Dollar (USD) ($) at an exchange rate of $1 = ₹86. A time and motion study will be undertaken to collect data from a total of 48 Community Health Officers (CHOs) and 48 auxiliary nurse midwives (ANMs) over a period of 6 days. This will be complemented by interviews to ascertain time spent on various services and activities. The data will be analysed to derive the annual cost of delivering CPHC services at an AAM, unit cost of individual services as a part of the 12 CPHC packages, as well as time spent by the healthcare workers (CHO and ANM) on various activities and services. Finally, a data envelopment analysis will be used to assess the level of technical efficiency in delivering primary healthcare services. The evidence on cost generated through the study will be useful for decisions related to better planning of healthcare services by aligning the work pattern to desired goals, efficient resource allocation, as well as future research on cost-effectiveness and benefit incidence over health accounts of primary healthcare services., Ethics and Dissemination: The study has been approved by the Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research, Chandigarh, India vide IEC no: PGI/IEC/2023/EIC000588. The study results will be published in peer-reviewed journals and presented to the policymakers at the national level. Furthermore, the cost estimates generated by the study will be integrated into the National Health System Cost Database for India, providing information to policymakers and researchers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Serum insulin-like growth factor 1 (IGF-1) is an important biochemical tool to diagnose and monitor growth hormone (GH)-related disorders. However, ethnicity-specific Indian data, following consensus criteria for the establishment of normative data, are not available. Our objective was to generate chronological age (CA)-, bone age (BA)- and Tanner stage-specific normative data for IGF-1 in healthy Indian children and adolescents., Methods: A cross-sectional epidemiological study was conducted in schools and the community, which enrolled apparently healthy children and adolescents with robust exclusion criteria. The outcome measure was serum IGF-1 assessed using an electro-chemiluminescence immunoassay (ECLIA). The 2.5th, 5th, 10th, 25th, 50th (median), 75th, 90th, 95th, and 97.5th centiles for IGF-1 were estimated using generalized additive models., Results: We recruited 2226 apparently healthy participants and following exclusion, 1948 (1006 boys, 942 girls) were included in the final analysis. Girls had median IGF-1 peak at CA of 13 years (321.7 ng/mL), BA of 14 years (350.2 ng/mL) and Tanner stage IV (345 ng/mL), while boys had median IGF-1 peak at CA of 15 years (318.9 ng/mL) BA of 15 years (340.6 ng/mL) and Tanner stage III (304.8 ng/mL). Girls had earlier rise, earlier peak, and higher IGF-1 values. The reference interval (2.5th to 97.5th percentile) was broader during peripubertal ages, indicating a higher physiological variability., Conclusion: This study provides ethnicity-specific normative data on serum IGF-1 and will improve the diagnostic utility of IGF-1 in the evaluation and management of growth disorders in Indian children and adolescents., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)

Background: The design of health benefits package (HBP), and its associated payment and pricing system, is central to the performance of government-funded health insurance programmes. We evaluated the impact of revision in HBP within India's Pradhan Mantri Jan Arogya Yojana (PM-JAY) on provider behaviour, manifesting in terms of utilisation of services., Methods: We analysed the data on 1.35 million hospitalisation claims submitted by all the 886 (222 government and 664 private) empanelled hospitals in state of Punjab, from August 2019 to December 2022, to assess the change in utilisation from HBP 1.0 to HBP 2.0. The packages were stratified based on the nature of revision introduced in HBP 2.0, i.e., change in nomenclature, construct, price, or a combination of these. Data from National Health System Cost Database on cost of each of the packages was used to determine the cost-price differential for each package during HBP 1.0 and 2.0 respectively. A dose-response relationship was also evaluated, based on the multiplicity of revision type undertaken, or based on extent of price correction done. Change in the number of monthly claims, and the number of monthly claims per package was computed for each package category using an appropriate seasonal autoregressive integrated moving average (SARIMA) time series model., Findings: Overall, we found that the HBP revision led to a positive impact on utilisation of services. While changes in HBP nomenclature and construct had a positive effect, incorporating price corrections further accentuated the impact. The pricing reforms highly impacted those packages which were originally significantly under-priced. However, we did not find statistically significant dose-response relationship based on extent of price correction. Thirdly, the overall impact of HBP revision was similar in public and private hospitals., Interpretation: Our paper demonstrates the significant positive impact of PM-JAY HBP revisions on utilisation. HBP revisions need to be undertaken with the anticipation of its long-term intended effects., Funding: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)., Competing Interests: The present manuscript was written as part of a project funded by ‘The Deutsche Gesellschaft für Internationale Zusammenarbeit’, also known as GIZ. The project funding was made to the institution –Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. We would like to note that the lead author—Shankar Prinja, has formerly served as the Executive Director at the National Health Authority (NHA), while Basant Garg is currently the Additional CEO of the NHA. The authors declare no other conflicts of interest., (© 2024 The Authors.)

Objective: We aimed to assess risk of COVID-19 infection & seroprotection status in healthcare workers (HCWs) in both hospital and community settings following an intensive vaccination drive in India., Setting: Tertiary Care Hospital., Methods: We surveyed COVID-19 exposure risk, personal protective equipment (PPE) compliance, vaccination status, mental health & COVID-19 infection rate across different HCW cadres. Elecsys® test for COVID-19 spike (Anti-SARS-CoV-2S; ACOVs) and nucleocapsid (Anti-SARS-CoV-2; ACOV) responses following vaccination and/or COVID-19 infection were measured in a stratified sample of 386 HCW., Results: We enrolled 945 HCWs (60.6% male, age 35.9 ± 9.8 years, 352 nurses, 211 doctors, 248 paramedics & 134 support staff). Hospital PPE compliance was 90.8%. Vaccination coverage was 891/945 (94.3%). ACOVs neutralizing antibody was reactive in 381/386 (98.7%). ACOVs titer (U/ml) was higher in the post-COVID-19 infection group (N =269; 242.1 ± 35.7 U/ml) than in the post-vaccine or never infected subgroup (N = 115, 204.1 ± 81.3 U/ml). RT PCR + COVID-19 infections were documented in 224/945 (23.7%) and 6 HCWs had disease of moderate severity, with no deaths. However, 232/386 (60.1%) of HCWs tested positive for nucleocapsid ACOV antibody, suggesting undocumented or subclinical COVID-19 infection. On multivariate logistic regression, only female gender [aOR 1.79, 95% CI 1.07-3.0, P = .025] and COVID-19 family contact [aOR 5.1, 95% CI 3.84-9.5, P < .001] were predictors of risk of developing COVID-19 infection, independent of association with patient-related exposure., Conclusion: Our HCWs were PPE compliant and vaccine motivated, with immunization coverage of 94.3% and seroprotection rate of 98.7%. There was no relationship between HCW COVID-19 infection to exposure characteristics in the hospital. Vaccination reduced disease severity and prevented death in HCW., Competing Interests: None of the authors has any conflict of interest to declare., (© The Author(s) 2024.)