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Background Food policies and environment (availability, accessibility, affordability, marketing) in and around educational institutes can influence food choices and behaviours of children and adolescents. Methods Cross-sectional, mixed-methods study was implemented in schools (n = 9; Private = 6, Public = 3) and colleges (n = 4) from Delhi and National Capital Region (India). The data was collected from students of schools (n = 253) and colleges (n = 57), parents of school students (n = 190), teachers (n = 12, schools = 9, colleges = 3) and canteen operators of Private schools and colleges (n = 10; schools = 6, and colleges = 4). The primary and secondary data was collected to: 1) identify the strengths and weaknesses of the existing guidelines and directives (desk review); 2) examine food environment, existing policies and its implementation (structured observations, in-depth interviews, surveys, focus group discussions), and; 3) assess food choices, behaviours of students (focus group discussions). The thematic analysis was used for qualitative data and descriptive analysis for quantitative data. Results The available food and beverage options, in and around the participating educational institutes were either high in fat, salt and sugar (HFSS), despite government and educational institute guidelines on restricting the availability and accessibility of HFSS foods. The healthy food and beverage options were expensive compared to HFSS foods both inside and outside educational institutes. In total, 37 vendors (Private = 27; Public:10) were observed outside schools at dispersal and twelve at lunchtime. Around colleges, vendors (n = 14) were seen throughout the day. Students from all Private schools (n = 6) and colleges (n = 2) were exposed to food and beverage advertisements either HFSS (Private schools = 1–3 and colleges = 0–2 advertisements), whereas no advertisements were observed around Public schools. Conclusion It is imperative to implement food policies to improve the food environment in and around educational institutes to ensure the availability of healthy foods to establish and sustain healthy eating behaviours among students. Thus, the study findings emphasise stringent implementation, regular monitoring and surveillance of recently introduced Food Safety and Standards (Safe food and balanced diets for children in school) Regulation 2020, ensuring its compliance through effective enforcement strategies.

BackgroundIndia’s tobacco-free film and TV rules were implemented from 2012. To assess the effect of the rules, we studied tobacco depictions in top-grossing Bollywood films released between 2006 and 2017 and rule compliance after 2012.MethodsTobacco incidents and brand appearances were coded in 240 top-grossing Bollywood films (2006–2017) using the Breathe California method. Trends in number of tobacco incidents per film per year were studied before and after implementation of the rules using Poisson regression analysis. Compliance with rules over the years was studied using Pearson product-moment correlations.ResultsForty-five films were U-rated (all ages), 162 were UA-rated (below age 12 years must be adult-accompanied), and 33 were A-rated (age 18+ years only). Before implementation of the rules, the number of tobacco incidents per film was increasing by a factor of 1.1/year (95% CI 1.0 to 1.2, p=0.002). However, beginning year 2013, the number of incidents per film started falling significantly by a factor of 0.7/year (95% CI 0.6 to 0.9; p=0.012) compared with the previous increasing trend. The percentage of youth-rated (U and UA) films with any tobacco incidents also declined from a peak of 76% in 2012 to 35% in 2017. The percentage of films complying with the rules (audio-visual disclaimers, health spots, static warnings) did not change significantly from 2012 to 2017.ConclusionIndia’s 2012 rules were followed by a reduction in tobacco depictions in Bollywood films. Enhanced monitoring of compliance is needed to ensure the continued effectiveness of the rules.

The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p

BackgroundBidi use remains an intractable public health problem for India. This is partly due to the informal nature of the bidi supply chain, including tax exemptions for small producers. The aim of this paper is to assess the impact of making all bidis subject to duty and Goods and Services Tax. Although this may require legislative changes and incur some extra administrative costs, the net benefits would include greater oversight of the supply chain as well as increased tax revenues and reduced consumption.MethodsWe use a form of gap analysis (the difference between duty paid and total bidi consumption) to estimate the number of tax-exempt bidis. We then use local evidence on the price elasticity of demand for bidis to assess the impact of eliminating these exemptions on the price and consumption of presently tax-exempt bidis.FindingsTotal bidi consumption is estimated at 400 billion sticks per annum, including 275 billion duty paid sticks and 125 billion duty exempt sticks. Removing the small producer exemptions would increase the price of currently exempt bidis by INR4.6/pack. Total bidi consumption would decrease by 6% and the number of smokers would decrease by 2.2 million adults. This would bring the rate of bidi smoking down from 7.7% to 7.5%, while generating INR14.8 billion in tax revenues.ConclusionsEliminating India’s tax exemptions for small bidis producers would make a significant contribution to tobacco control, both directly by reducing the number of smokers and indirectly by plugging a loophole in the supply chain.

In this paper, we develop a novel methodology for constructing price indices of India Made Foreign Liquor (IMFL), which account for incompatible state-level taxation structure and policies across seven states in India. We use this price index to compute price and tax elasticity of IMFL in the seven states. We find that a 1% increase in price leads to only a 0.057% decline in consumption while a 1% increase in tax reduces alcohol consumption by 0.14%. We extend our estimates to show that a 10% increase in taxes will lead to an 8.4% increase in tax revenue. Our results are the most updated estimates of alcohol consumption elasticities, which overcomes several challenges such as varying manufacturing costs across states and varying tax across types of products within states, which other papers do not.

Additional file 1. Study tools.

Background Increasing the price of tobacco through taxation is a very effective means of reducing tobacco use. However, the impact of price increases can be diluted if consumer incomes are growing strongly. The affordability of tobacco products has, therefore, become an important indicator for tobacco control. This study asks whether tobacco products in India became more or less affordable during 2007/2008 to 2017/2018. Methods Survey data on the retail price of chewing tobacco, bidis and cigarettes were used to measure affordability at state and national levels. We adapted the price relative to income measure by calculating the percentage of net state domestic product (NSDP) per capita needed to purchase 1000 g of tobacco in each form and then calculating the average annual percentage change (AAPC) in affordability. We used ordinary least squares regression analysis to test for any changes. Results In 2017/2018, it took 1.72% and 1.18% of NSDP/capita to purchase 1000 g of tobacco in the form of bidis and chewing tobacco respectively. The affordability of bidis remained unchanged, while chewing tobacco became more affordable (AAPC = −1.83%, 95% confidence interval −2.87 to −0.80, P = 0.003). For cigarettes, it took 7.56% of NSDP/capita to purchase 1000 g of tobacco in 2017/2018; although affordability decreased in many states, national average affordability was unchanged. Conclusion Tobacco products, especially indigenous forms such as bidis and chewing tobacco, have not become measurably less affordable over the past decade. India should raise taxes on all tobacco products to significantly reduce the affordability of these products and to promote public health.

Introduction About 28.6% of Indian adults use tobacco. This study estimates the economic burden of deaths and diseases attributable to smoking and smokeless tobacco (SLT) use for persons aged ≥35 years. Methods The National Sample Survey data on healthcare expenditures, the Global Adult Tobacco Survey data on tobacco use prevalence, and relative risks of all-cause mortality from tobacco use were used to estimate the economic burden of diseases and deaths attributable to tobacco use in India, using a prevalence-based attributable-risk approach. Costs are estimated under the following heads: (1) direct medical and nonmedical expenditures; (2) indirect morbidity costs; and (3) indirect mortality costs of premature deaths. Results Total economic costs attributable to tobacco use from all diseases and deaths in India in the year 2017–2018 for persons 35 years or older amount to INR 1773.4 billion (US $27.5 billion), of which 22% is direct and 78% is indirect cost. Men bear 91% of the total costs. Smoking contributed 74% and SLT use contributed 26% of the costs. Conclusions The economic costs of tobacco use amount to approximately 1.04% of India’s gross domestic product (GDP), while the excise tax revenue from tobacco in the previous year was only 12.2% of its economic costs. The direct medical costs alone amount to 5.3% of total health expenditure. The enormous costs imposed on the nation’s health care system due to tobacco use could potentially stress the public health care system and strain the economy and it warrants massive scaling up of tobacco control efforts in India. Implications The study finds that the economic burden from tobacco constitutes more than 1% of India’s GDP, and the direct health expenditures on treating tobacco-related diseases alone accounts for 5.3% of the total private and public health expenditures in India in a year. It shows that, for every INR 100 that is received as excise taxes from tobacco products, INR 816 of costs is imposed on society through its consumption. It establishes that tobacco consumption is a major resource drain on the national exchequer, and its effective regulation through comprehensive fiscal and non-fiscal policies is highly warranted.

To estimate the magnitude of illicit cigarette consumption in India using a tax-gap approach.In the tax-gap analysis, illicit cigarette consumption in India was defined as the difference between total and legal consumption. Data on total cigarette consumption came from two national Global Adult Tobacco Surveys carried out from 2009 to 2010 and from 2016 to 2017. Legal consumption was derived from Government of India data on domestic cigarette production and trade.Estimated total cigarette consumption was 104.8 billion sticks in 2009 to 2010 and 94.2 billion sticks in 2016 to 2017, a decrease of 10.6 billion sticks, or of 10%, over the time period. Legal cigarette consumption fell from 99.4 to 88.5 billion sticks over the same period, a drop of 11%. Estimated illicit cigarette consumption was, therefore, 5.4 billion sticks in 2009 to 2010 and 5.6 billion sticks in 2016 to 2017, and accounted for 5.1% and 6.0% of the market in these periods, respectively. Consequently, only about 1 in 20 cigarettes consumed in India was illicit. Between 2016 and 2017, the estimated equivalent retail sales value of illicit cigarettes was 49 billion Indian rupees (753 million United States dollars, US$) and the estimated tax revenue foregone was 25 billion Indian rupees (US$ 390 million).Illicit cigarette consumption is relatively modest in India by global standards. Nonetheless, India should strengthen its capacity to control the illicit tobacco market as part of a comprehensive tobacco control strategy, while also continuing to implement traditional demand reduction measures, such as tobacco taxation.Estimer l'ampleur de la consommation illicite de cigarettes en Inde grâce à une approche basée sur l'écart fiscal.Pour procéder à l'analyse de l'écart fiscal, la consommation illicite de cigarettes en Inde a été définie en calculant la différence entre la consommation totale et la consommation légale. Les données relatives à la consommation totale de cigarettes proviennent des résultats nationaux de deux Enquêtes mondiales sur le tabagisme chez l'adulte (GATS), menées de 2009 à 2010 et de 2016 à 2017. Celles sur la consommation légale ont été extraites des données du gouvernement indien concernant la production et le commerce de cigarettes dans le pays.La consommation totale s'élevait à 104,8 milliards de cigarettes de 2009 à 2010, et à 94,2 milliards de cigarettes de 2016 à 2017. Ce qui représente une baisse de 10,6 milliards de cigarettes, donc de 10%, au cours de cette période. La consommation légale a chuté, passant de 99,4 à 88,5 milliards de cigarettes sur la même période, une diminution de 11%. Par conséquent, la consommation illicite est estimée à 5,4 milliards de cigarettes de 2009 à 2010, et à 5,6 milliards de cigarettes de 2016 à 2017. L'équivalent de 5,1% et 6,0% du marché, respectivement. Ainsi, sur l'ensemble des cigarettes consommées en Inde, seule une cigarette sur vingt environ était illicite. Entre 2016 et 2017, on considère que le commerce illicite de cigarettes a rapporté l'équivalent de 49 milliards de roupies indiennes (753 millions de dollars américains) de ventes au détail, tandis que le manque à gagner fiscal s'est élevé à 25 milliards de roupies indiennes (390 millions de dollars américains).La consommation illicite de cigarettes est relativement modeste en Inde par rapport aux standards internationaux. Néanmoins, le pays devrait renforcer ses capacités de contrôle du commerce illicite du tabac dans le cadre d'une stratégie complète de lutte contre le tabagisme, tout en continuant à mettre en œuvre les mesures traditionnelles visant à réduire la demande, comme la taxation du tabac.Estimar la magnitud del consumo ilícito de cigarrillos en la India mediante la aplicación de un enfoque de diferencias impositivas.El consumo ilícito de cigarrillos en la India se definió en el análisis de la diferencia impositiva como la diferencia entre el consumo total y el consumo legal. Los datos sobre el consumo total de cigarrillos procedían de dos Encuestas mundiales sobre el tabaquismo en adultos de alcance nacional que se realizaron entre 2009 y 2010 y entre 2016 y 2017. El consumo legal se obtuvo a partir de los datos del Gobierno de la India sobre la producción y el comercio nacional de cigarrillos.Se estima que el consumo total de cigarrillos fue de 104 800 millones de cigarrillos entre 2009 y 2010 y 94 200 millones de cigarrillos entre 2016 y 2017, lo que supone una reducción de 10 600 millones de cigarrillos, o del 10 %, durante ese periodo. El consumo legal de cigarrillos se redujo de 99 400 a 88 500 millones de cigarrillos en el mismo periodo, un descenso del 11 %. Por lo tanto, el consumo ilícito de cigarrillos estimado fue de 5400 millones de cigarrillos entre 2009 y 2010 y de 5600 millones de cigarrillos entre 2016 y 2017, lo que representó el 5,1 % y el 6,0 % del mercado en estos periodos, respectivamente. Por consiguiente, solo 1 de cada 20 cigarrillos que se consumen en la India es ilícito. Entre 2016 y 2017, el valor equivalente estimado de las ventas al por menor de cigarrillos ilícitos fue de 49 000 millones de rupias indias (753 millones de dólares estadounidenses, USD) y el estimado de los ingresos fiscales no percibidos fue de 25 000 millones de rupias indias (390 millones de USD).El consumo ilícito de cigarrillos es relativamente moderado en la India según las normas mundiales. No obstante, la India debería fortalecer su capacidad para controlar el mercado ilícito de tabaco como parte de una estrategia integral de control del tabaco, al tiempo que continúa aplicando medidas tradicionales para reducir la demanda, como los impuestos sobre el tabaco.الغرض تقدير حجم الاستهلاك غير المشروع للسجائر في الهند باستخدام نهج الفجوة الضريبية. الطريقة في تحليل للفجوة الضريبية، تم تعريف الاستهلاك غير المشروع للسجائر في الهند على أنه الفرق بين الاستهلاك الإجمالي والاستهلاك القانوني. جاءت البيانات المتعلقة بالاستهلاك الإجمالي للسجائر من مسحين وطنيين عالميين عن التبغ للبالغين، تم إجراؤهما في الفترة من 2009 إلى 2010، ومن 2016 إلى 2017. وتم اشتقاق الاستهلاك القانوني من بيانات الحكومة الهندية حول إنتاج وتجارة السجائر المحلية على الصعيد المحلي. النتائج بلغ تقدير إجمالي استهلاك السجائر 104.8 مليار سيجارة في الفترة من 2009 إلى 2010، و94.2 مليار سيجارة في الفترة من 2016 إلى 2017، بانخفاض قدره 10.6 مليار سيجارة، أو ما يعادل نسبة 10٪، خلال الفترة الزمنية. انخفض الاستهلاك القانوني للسجائر من 99.4 إلى 88.5 مليار سيجارة خلال نفس الفترة، بانخفاض قدره 11٪. وبالتالي بلغ تقدير الاستهلاك غير المشروع للسجائر 5.4 مليار سيجارة في الفترة من 2009 إلى 2010، و5.6 مليار سيجارة في الفترة من 2016 إلى 2017، بانخفاض قدره 5.1%، و6.0%، من السوق خلال هاتين الفترتين على التوالي. وبالتالي ، فإن 1 من كل 20 سيجارة يتم تدخينها في الهند كانت غير مشروعة. بين عامي 2016 و2017، كانت القيمة التقديرية لمبيعات التجزئة المعادلة للسجائر غير المشروعة 49 مليار روبية هندية (753 مليون دولارًا أمريكيًا)، وبلغت الإيرادات الضريبية التقديرية السابقة 25 مليار روبية هندية (390 مليون دولارًا أمريكيًا). الاستنتاج يعتبر الاستهلاك غير المشروع للسجائر متواضع نسبيًا في الهند بالمعايير العالمية. وبالرغم من ذلك، يجب على الهند تعزيز قدرتها على التحكم في سوق التبغ غير المشروع كجزء من استراتيجية شاملة لمكافحة التبغ، مع الاستمرار كذلك في تنفيذ تدابير تقليص الطلب التقليدية، مثل فرض الضرائب على التبغ.使用税收缺口法估算印度的非法卷烟消费量规模。.在税收缺口法中，印度的非法卷烟消费量是指总消费量与合法消费量之间的差额。卷烟总消费量的数据来自于 2009-2010 年和 2016-2017 年在全国范围内进行的两次“全球成人烟草调查”。合法消费量来源于印度政府关于国内卷烟生产和贸易的数据。.据估计，2009-2010 年卷烟总消费量为 1048 亿支，2016-2017 年为 942 亿支，同比减少 106 亿支，降幅为 10%。同期合法卷烟消费量从 994 下降至 885 亿支，下降了 11％。因此，据估计，2009-2010 年非法卷烟消费量为 54 亿支，2016-2017 年为 56 亿支，分别占同期市场份额的 5.1% 和 6.0%。因此，在印度消费的卷烟中，只有大约二十分之一是非法的。2016 年至 2017 年，非法卷烟的等值零售价值估计为 490 亿印度卢比（7.53 亿美元），税收损失估计为 250 亿印度卢比（3.9 亿美元）。.按全球标准衡量，印度的非法卷烟消费量相对适中。尽管如此，作为全面烟草控制战略的一部分，印度应加强其控制非法烟草市场的能力，同时还应继续执行烟草税等传统的减少需求措施。.Оценка масштабов незаконного потребления сигарет в Индии с использованием подхода налогового разрыва.В анализе налоговых разрывов незаконное потребление сигарет в Индии было определено как разница между общим и законным потреблением. Данные об общем потреблении сигарет были получены из двух национальных глобальных опросов потребления табачных изделий среди взрослого населения, проведенных с 2009 по 2010 г. и с 2016 по 2017 г. Данные о законном потреблении были получены из данных правительства Индии по внутреннему производству сигарет и торговле ими.Предполагаемое общее потребление сигарет составило 104,8 млрд штук за период 2009–2010 гг. и 94,2 млрд штук за период 2016–2017 гг., что на 10,6 млрд штук, или на 10%, меньше за указанный период. За тот же период законное потребление сигарет упало с 99,4 до 88,5 млрд штук, т. е. на 11%. Таким образом, предполагаемое незаконное потребление сигарет составило 5,4 млрд штук за период 2009–2010 гг. и 5,6 млрд штук за период 2016–2017 гг.; на эти периоды приходились доли 5,1% и 6,0% рынка соответственно. Следовательно, только одна из двадцати сигарет, которые потреблялись в Индии, была незаконной. В период с 2016 по 2017 г. оценочный эквивалентный стоимостный объем розничных продаж незаконных сигарет составил 49 млрд индийских рупий (753 млн долларов США), а предполагаемые упущенные налоговые поступления в бюджет составили 25 млрд индийских рупий (390 млн долларов США).Уровень незаконного потребления сигарет в Индии относительно низкий по мировым стандартам. Тем не менее Индии следует усилить свой потенциал по контролю над незаконным табачным рынком в рамках всеобъемлющей стратегии борьбы против табака, а также продолжить реализацию традиционных мер по сокращению спроса, таких как налогообложение табачных изделий.

BackgroundData on the use of mobile technology in public health are sparse. Text messaging is cost-effective in disseminating information to large communities. The Ministry of Health and Family Welfare, Government of India, initiated and executed this mDiabetes programme.ObjectivesThe main objective of this commissioned study was to test the feasibility of using mobile technology to reach a large number of people to improve their lifestyle and health-seeking behaviour. Participants’ interest, acceptability and scope for improvement were assessed.MethodsThis mDiabetes observational study was done in India between 2016 and 2017. Text messages inviting registrations were sent to 130 million people in the country, mostly to the working class. Respondents (n=107 548) were registered by dialling a given phone number (missed phone call) or through a website. Based on the response, participants were grouped into six categories: persons with diabetes, pregnant/lactating women, high-risk individuals, healthcare professionals, elderly and normal population. They received 90 messages on healthy living during the 6 months. The impact of intervention was assessed at the third and sixth months by feedback messages. Telephonic interviews were conducted at 1 year in a subpopulation (n=855).ResultsThe registered respondents, 31 725, were grouped into six categories. 21.4% had diabetes and 5.3% had multiple risk factors. 15.6% responded to feedback messages. Among them, 57.2% followed a healthy diet, 72.3% practised advice on physical activity, 51.9% screened for diabetes and 67.3% checked their glycaemic status. The telephonic interviews showed that the programme was feasible and acceptable. The participants suggested use of interactive voice response system for registration and motivation.Discussion and conclusionThe study demonstrated the feasibility and acceptability of mHealth in a large population to disseminate knowledge regarding diabetes and healthy lifestyle, and to improve health-seeking behaviour. It helped to identify the limitations and scope for future improvements.

BackgroundIndia implemented tobacco-free film and TV rules (Rules) to protect adolescents and young adults from tobacco exposure.ObjectiveTo assess tobacco imagery in online series popular among adolescents and young adults.MethodsTen popular online series on streaming platforms were identified after discussions with participants (aged 15–24 years) in New Delhi, and content-coded for tobacco imagery following the Breathe California protocol. Incidents of tobacco use and brand appearances in each series episode were counted, and compliance with Indian Rules was recorded.Results188 episodes across 10 series on Netflix and Amazon Prime Video were coded. Seven series were rated age 16+, two were 18+ and one was 13+. The median number of tobacco incidents per episode in foreign productions was as follows: Amazon’s ‘The Marvellous Mrs Maisel’ (87.5, IQR 62.0–116.0) and Netflix’s ‘The Crown’ (29.0, 18.0–36.0) were higher than Indian productions: Netflix’s ‘Sacred Games’ (9.0, 0.5–14.5) and Amazon’s ‘Mirzapur’ (7.0, 4.0–11.0) (p=0.84). Tobacco incidents per hour ranged from 0 (Bodyguard, Riverdale, 13 Reasons Why) to 106.1 (The Marvellous Mrs Maisel). Seven of 10 series had tobacco imagery and none were compliant with the Rules.ConclusionContrary to Section 5 of India’s Cigarettes and Other Tobacco Products Act, its Rules are not being complied with by the streaming platforms. US-produced streaming media contains more tobacco incidents than Indian-produced media. There is an urgent need for better enforcement of existing Rules on streaming platforms in India, and modernisation of the WHO Framework Convention on Tobacco Control, Article 13 guidelines to account for new streaming platforms to protect youth from tobacco imagery globally.

The India Hypertension Control Initiative (IHCI) was launched in Telangana, India, with the vision of maintaining the continuum of care for hypertensive patients and improving treatment outcomes through provision of free hypertension medication. Decentralization of the IHCI towards more patient-centred services was undertaken to bring free medication and follow-up services closer to the community in the hopes of improving follow-up and control rates for hypertensive patients. To determine if decentralization of hypertension follow-up services and free medication to peripheral health centres improved continuity of care and treatment outcomes in hypertensive patients and helped to mitigate disruption during the coronavirus disease 2019 (COVID-19) pandemic, hypertension outcomes were reviewed before and during the COVID-19 pandemic, for patients registered in health centres that decentralized free medication and follow-up services to subcentres – the intervention group – and in health centres that did not decentralize these services – the non-intervention group. Hypertensive patients had higher rates of monthly follow-up and controlled blood pressure in the decentralized facilities than in the non-decentralized facilities, where these services were limited to primary and secondary health centres. Comparing follow-up rates and blood pressure control rates before and during the COVID-19 pandemic, these were maintained for patients in the decentralized facilities whereas they were significantly lower for patients in the non-decentralized facilities. The IHCI decentralized model appears to have contributed to continuity of care for people with hypertension and to have maintained this continuity against system shocks such as that of the COVID-19 pandemic. Decentralization of free medicines and follow-up services to the first and most peripheral point of contact in the primary health care system brings these essential services closer to home, which can encourage patients to seek services from the public sector – capturing a strong case for a primary health care foundation to the strengthening of systems for universal health coverage.

Background Tobacco consumption is a critical concern in populous low-income countries, like India. The social acceptability of tobacco perpetuates its use: the positive portrayal of tobacco in the media has been associated with increased consumption of tobacco. Hence, to counter the pro-tobacco imagery in the visual media, the Government of India modified its tobacco control law in 2011/2012, called as "Film Rule", requiring film theaters and television channels to screen pre-approved anti-tobacco public service announcements and a disclaimer at the beginning and during the middle of programs when tobacco consumption is depicted; and, health warning scrolls on screen while tobacco is in use onscreen. Methods Four studies were undertaken to monitor the genesis, implementation and effectiveness of the Rule. First, a news media analysis in the lead up the implementation of the Film Rule identified industry arguments against the Rule. Two observational studies, including exit interviews of cinema-goers, monitored the implementation and effectiveness of the Rule. Finally, legal research identified legal loopholes and opportunities. Results Findings from this comprehensive set of studies identified standard arguments against the Rule - such as impingement of creative freedom, arguments that health warnings are ineffective - and provide guidance for addressing these attacks preemptively. The observational studies identified over 80% compliance with the Film Rule in film theaters but less than 10% compliance by television channels. Exit interviews among film-goers also found positive impact among those exposed to anti-tobacco messaging. Legal research identified strengths in the current law, enabling implementation, and opportunities for its advancement within existing media laws and procedures. Conclusions The Film Rule is a novel health financing mechanism for sustained mass media campaigns at low (or no) cost to governments. Our studies show positive impact of the Rule and offer valuable lessons for strengthening the law within India and for other countries considering similar approaches.

Background and challenges to implementation The Indian tobacco control law (COTPA) prohibits tobacco advertising, promotion and sponsorship. However, emerging products like e-cigarettes and e-hookahs (ENDS) remain unregulated and traditional hookahs are regulated inadequately. Rampant promotional propaganda for these products has created a general mis-perception that they are safe/less harmful than regular tobacco products, resulting in increasing popularity among adolescents and youth. Intervention or response A youth-led monitoring exercise was conducted to build their capacity for identifying mis-leading and false ENDS and hookah advertisements and promotional campaigns, at multiple Points of Sale (PoS), at New Delhi, India. Sensitisation sessions were conducted for 104 school and college students, (13-23 years) from 6 schools and 5 colleges, on the hazards of ENDS and hookah usage; deceptive strategies of the tobacco industry to take advantage of policy loopholes. These empowered youth monitored 79 PoS (64 physical and 15 e-commerce sites), using standardised monitoring protocols/tools. Results and lessons learnt Approximately 31% of physical sites were within 100 yards of an educational institution (prohibited under COTPA). Warning boards against sale to minors were missing in more than half of the PoS. ENDS were commonly being promoted as: safe, herbal, as cessation devices and also as 'trendy' tobacco products. At 47% of PoS, hookah flavours were arranged as power walls. A range of e-commerce sites were selling ENDS and hookahs, without asking for any age proof or only self-declaration of age, which can be mis-reported. These websites offered attractive discounts and 'free home delivery' to boost sale. [Youth led monitoring_Key Findings] Conclusions and key recommendations Youth-targeted promotion and sale of ENDS and hookah is rampant. E-commerce sites are particularly lucrative PoS. The youth had many false notions about ENDS and hookah. There is an urgent need to regulate these products through national and global policy measures, in order to prevent the tobacco industry from exploiting this grey area in tobacco control policy.

Background In 2014, the Government of India's Ministry of Health & Family Welfare constituted an expert group for development of pictorial health warnings for tobacco products. Accordingly, six prototypes were developed with warnings displayed on the front and back occupying 85 percent of the space. The packs visually showed the adverse impact of tobacco consumption. The prototypes were pretested. The objective of the pretest was to assess the effectiveness of the health warnings and messages on different target groups in terms of noticeability, comprehension, informativeness, credibility, legibility, clarity of color & design, and intention to change behavior. The main task of the study was to exhibit six types of pack warnings developed separately for cigarette, bidi, and smokeless tobacco users and non-users and rank them based on their reactions to each of the attributes listed above. Methods The pre-testing was undertaken in one district each of the three states of India. In all, the study area covered 28 locations. The total number of respondents was 300 comprising of tobacco users and non-users. The sample included adult women and men. The study used qualitative methodology for pre-testing the pack warnings on cigarette, bidi and smokeless tobacco packs. It conducted: 28 focus group discussions and 20 in depth interviews. Results The study concluded that the image on cigarette, bidi or smokeless tobacco packs is the main source of information. Pack warnings which showed damage on the face or a disease were more impactful and understood. Cigarette/ Bidi are often bought loose, especially by those who are in the age group 18-25 years. Hence, the likelihood of noticing the pack warning is much lower by this age group. Conclusions The study recommended that the image and the written warning on the pack must match and must be in English and an Indian language.

Background Bidi is the most popular tobacco smoking product in India and commands an overwhelming market share of 85%. Perceptions of potential economic loss is a major impediment against any bidi control measure. Previous research has focussed on unregistered bidi sector and at a single time point. We estimated the economic contribution made by the entire bidi industry at three time points. Methods We conducted secondary analyses from data of nationally representative cross-sectional surveys conducted in 2000-01; 2005-06; 2010-11 : 1) Annual Survey of Industries 2) National Sample Survey (NSS) and 3) NSS Employment and Unemployment Survey. The total gross value added (GVA) has been adjusted for inflation by Wholesale Price Index using 2004-2005 base price. Results We found that there was a decline in overall bidi industry GVA in 2005-2006 from 2000-2001 by ₹ 13.7 billion but it has grown back to 2000-2001 levels of ₹ 48.2 billion in 2010-2011(0.65% of the GVA contributed by the manufacturing sector). Ratio of GVA contributed by unregistered to registered bidi firms has decreased by half in between 2005-2006 and 2010-11, although the proportion of employment provided by the unregistered firm remained constant at 89-81% during this period. There has been a gradually shift to smaller-size units in between 2000-2001 and 2010-2011. Conclusions The bidi industry does not make any significant economic contribution to the Indian economy. Employees in unregistered sector receive no welfare benefits. The shift towards smaller-size units might be reflective of contractualisation to enjoy excise tax exemption which was prevalent during the pre-Goods and Services Tax (GST) era. Better regulation of the sector by mandatory registration of bidi firms together with high GST taxes without exemption will lead to improved revenue, improvement of work conditions and act as a tobacco control measure too as consumption is price elastic in nature.

Background Majority of bidi manufacturing in India is in the unorganised sector which makes its regulation and taxation difficult. Bidi industry is highly labour-intensive and there is high home-based employment of women and children as bidi workers. Bidi workers are known to get inadequate social security and welfare benefits, and are paid low wages. This study highlights gender inequalities in employment and wages earned in the bidi industry, not previously studied. Methods Three data sources were used: 1) Annual Survey of Industries - for organized sector 2) National Sample Survey (NSS) Unorganized Manufacturing Enterprises Survey (2000-01; 2005-06; 2010-11) and 3) NSS Employment and Unemployment Survey (2011-12). Share of wages, nature and type of employment in organised and unorganised sectors were studied. Results In the organised as well as unorganised sector, the number of female workers was higher than that of male workers. Female workers made up 82.8% of the total unorganised sector bidi manufacturing employment in 2010-11. In 2000-01, average per capita wage of a bidi worker in organised sector was only 25% that of average per capita wage observed in the entire manufacturing sector. This figure declined to 20% in 2005-06 and 17% in 2010-11. In 2000-01, female workers earned INR 7,737.7 less per year than males, on average; in 2005-06, the wage disparity between male and female workers was lower at INR 6,327.8. In 2010-11 however, the wage disparity increased with male workers earning INR 6,610.7 more on average. Contractual workers were paid least wages and managerial workers were paid higher vs. those directly employed. Conclusions Although more females are employed in organised as well as unorganised bidi manufacturing sectors vs. males, the average annual wages of female workers are much lower than those of male workers, increasing inequalities. The system of crontractualisation further exacerbates inequity.

Background Tobacco tax is proved to be the most important cost effective instrument of tobacco control. There are ample evidences suggesting the role of tax in reducing tobacco consumption. However, there are limited evidences regarding the effectiveness of tobacco tax in tobacco control in India. This study has been undertaken to address the current knowledge gap. The objectives are to: · examine tax structure, tax rates and price trends across tobacco products · estimate affordability of tobacco products due to rise in income · examine excise and total tax burden across tobacco products Methods This study used secondary data from Government publications: Annual Survey of Industry (ASI), Ministry of Finance, Labour bureau, during 2005-06 to 2015-16. It compared wholesale and retail price indices of tobacco products with the general price indices to estimate the relative price increase of tobacco products. Affordability was measured comparing rise in per capita income and inflation rate of tobacco products. For tax burden, the share of excise tax in the retail price was calculated. Results The relative Whole Sale price Index (WPI) of tobacco products showed increasing trend between 2005-05 and 2015-16. Across products, the relative WPI was lowest for bidi. Affordability of cigarette increased during 2005-06 to 2012-13 and declined during 2013-14 to 2015016. For bidi and chewing tobacco, affordability increased over the years. The excise tax burden was 40% for cigarette and was only 4% for bidi in 2015-16. Total tax burden on bidi and cigarette was 20% and was 59% respectively. Conclusions This study suggests to increase prices of all tobacco products to raise the excise burden comparable to the international standard to make it more effective from a tobacco control perspective. More importantly, the tax rate on bidi has to be substantially increased for which affordability is declining.

Summary: EPI coverage survey was conducted in Adami-Tullu Woreda during February 1995. A total of 210 children aged 12-23 months, and the same number of mothers who have infants aged 011 months were studied using the EPI cluster survey questionnaire. Thirty-seven percent of the children were fully immunized, while 35.7% were not immunized at all. The coverage was significantly higher in urban areas (55.8%) compared to rural areas (26.3%), OR=3.54, 95% CI (1.88,6.70). The dropout rate was 39.0%, and the missed-opportunity rate was estimated to be 37.3%. Lack of information was an improtant reason for failure of immunization, reported more by rural residents 54 (40.6%), OR= 8.09, 95% CI (3.08,22.51). The coverage was much lower in rural areas partly due to lack of information, and accordingly more emphasis should be given to the expansion of health education and out-reach immunization services. The dropout rate and missedopportunity rate were remarkably high indicating the huge potential of raising the EPI coverage by minimizing these two rates. Health workers have always to be aware of the magnitude of these rates and try to reduce them. [Ethiop. J. Health Dev. 1997;11(2):109-113]

Background Baseline physical activity data are needed to effectively plan programs and policies to prevent noncommunicable diseases, but for many African countries these data are lacking. Purpose To describe and compare levels and patterns of physical activity among adults across 22 African countries. Methods Data from 57,038 individuals from 22 countries (11 national and 11 subnational samples) that participated in the STEPwise approach to chronic disease risk factor surveillance (2003–2009) were analyzed in 2010. The validated Global Physical Activity Questionnaire (GPAQ) was used to assess days and duration of physical activity at work, for transport, and during leisure time in a typical week. Results Overall, 83.8% of men and 75.7% of women met WHO physical activity recommendations (at least 150 minutes of moderate activity per week or equivalent). Country prevalence ranged from 46.8% (Mali) to 96.0% (Mozambique). Physical activity, both at work and for transport, including walking, had large contributions to overall physical activity, while physical activity during leisure time was rare in the analyzed countries. Conclusions Physical activity levels varied greatly across African countries and population subgroups. Leisure time activity was consistently low. These data will be useful to inform policymakers and to guide interventions to promote physical activity.

Objectives: To examine the impact of antenatal psychosocial stressors, including maternal common mental disorders (CMD), upon low birth weight, stillbirth and neonatal mortality, and other perinatal outcomes in rural Ethiopia. Methods: A population-based sample of 1065 pregnant women was assessed for symptoms of antenatal CMD (Self-Reporting Questionnaire-20: SRQ-20), stressful life events during pregnancy (List of Threatening Experiences: LTE) and worry about the forthcoming delivery. In a sub-sample of 654 women from six rural sub-districts, neonatal birth weight was measured on 521 (79.7%) singleton babies within 48 h of delivery. Information about other perinatal outcomes was obtained shortly after birth from the mother's verbal report and via the Demographic Surveillance System. Results: After adjusting for potential confounders, none of the psychosocial stressors were associated with lower mean birth weight, stillbirth or neonatal mortality. Increasing levels of antenatal CMD symptoms were associated both with prolonged labour (> 24 h) (SRQ 1-5: RR 1.4; 95% CI 1.0-1.9, SRQ >= 6: RR 1.6; 95% CI 1.0-2.6) and delaying initiation of breast-feeding more than eight hours (SRQ 1-5: RR 1.4; 95% CI 0.8 to 2.4, SRQ >= 6: RR 2.8; 95% CI 1.3-6.1). Worry about delivery was also associated with labour longer than 24 h (RR 1.5; 95% CI 1.0-2.1). Conclusions: This study provides preliminary evidence of important public health consequences of poor maternal mental health in low-income countries but does not replicate the strong association with low birth weight found in South Asia.

Reliable cancer burden estimates are rarely available from most developing countries where cancer registration is lacking. This study provided estimates on the current and future number of lung cancer deaths in Indonesia, Vietnam and Ethiopia, and Sub-Saharan Africa at large.The number of lung cancer deaths was estimated from detailed smoking prevalence data (obtained from surveys among 8,726 rural individuals aged 25-74 years in Indonesia, Vietnam, and Ethiopia in 2005-2006) and on lung cancer rate estimates among non-smokers.Our estimate for lung cancer deaths in Sub-Saharan Africa is 44,076 in 2005, which is 2.6 times the most recent WHO estimate in 2003 (17,000 deaths). A similar ratio is found for the country-specific estimate in Ethiopia. Our estimates are only slightly higher than the WHO's in Indonesia, and Vietnam. The attributable risk of smoking for lung cancer death among men was 39% in Ethiopia, 80% in Indonesia and 85% in Vietnam. We expect the annual number of lung cancer deaths to double by 2025, even if the smoking prevalence is assumed not to increase further.WHO estimates on lung cancer deaths in Asia appear to be slightly lower than our study results; however, in Africa, the burden appears to be largely underestimated.

ObjectiveTo estimate and compare dietary energy intake (DEI) and total energy expenditure (TEE) among adults, using questionnaires.DesignComparative, cross-sectional study.SettingCommunity-based, at the demographic surveillance site (DSS) in Butajira District of Ethiopia.SubjectsA total of 619 adults, 18–64 years of age, were randomly selected from among the urban and rural population of Butajira using the DSS sampling frame. Habitual dietary intake and physical activity were assessed using questionnaires. BMR was estimated using a regression equation, and TEE was calculated from BMR and the metabolic energy equivalent task (MET) and duration of reported activities. Physical activity level (PAL) was calculated as TEE/BMR, while food intake level (FIL) was calculated as DEI/BMR. The mean DEI:TEE ratio was used to evaluate reported DEI at the population level, while individual misreporters were identified by applying the Goldberg cut-off points at three levels of PAL.ResultsBased on the Goldberg method, 57 % of the study participants were identified as acceptable reporters of DEI, among whom mean TEE was 8·21 (95 % CI 8·01, 8·42) MJ (1963 (95 % CI 1914, 2012) kcal), mean DEI was 8·13 (95 % CI 7·93, 8·34) MJ (1944 (95 % CI 1895, 1993) kcal) and mean DEI:TEE was 1·01 (95 % CI 0·99, 1·04).ConclusionThe dietary history and physical activity questionnaires provide comparable estimates of mean energy intake and expenditure at a population level. Acceptable reporters have to be identified in order to obtain better estimates. Questionnaire-based estimates of energy intake should not be interpreted without an inherent system of comparison or validation.

Aims: To describe the epidemiological development of a rural Ethiopian population from 1987 to 2004 in terms of mortality and associated sociodemographic factors. Methods: A rural population comprising 10 communities was defined in 1987 and has since been followed by means of regular household visits. After an initial census, births, deaths and migration events were recorded, together with key background factors, on an open cohort basis. Over 97,000 individuals were observed during a total of over 700,000 person years. Results: The initial population of 28,614 increased by an average of 3.64% annually to 54,426 from 1987 to 2004, and also grew older on average. Birth and mortality rates fell, but were still subject to short-term variation due to external factors. Overall mortality was 13.5 per 1000 person years. Increasing mortality in some adult age groups was consistent with increasing AIDS-related deaths, but a new local hospital in 2002 may have contributed to later falls in overall mortality. Sex, age group, time period, literacy, water source, house ownership and distance to town were all significantly associated with mortality differentials. Conclusions: This population has undergone a complex epidemiological transition during a generation. Detailed long-term surveillance of this kind is essential for describing such processes. Many factors that significantly affect mortality cannot be directly controlled by the health sector and will only improve with general development.

Despite a growing burden of obesity and hypertension in developing countries, there is limited information on the contribution of body mass index (BMI) to blood pressure (BP) in these populations. This study examines the association between BMI and BP in three populations across Africa and Asia. Data on BMI, BP and other background characteristics of study participants were generated using the World Health Organization STEPwise approach to surveillance (STEPS), at three demographic surveillance sites in Ethiopia, Vietnam and Indonesia. BMI and BP increased along the socioeconomic gradient across the three countries. Mean (s.d.) BMI in men varied between 19.41 (2.28) in Ethiopia to 21.17 (2.86) in Indonesia. A high prevalence of overweight/obesity was noted among Indonesian women (25%) and men (10%), whereas low BMI was widely prevalent in Ethiopia and Vietnam, ranging from 33 to 43%. Mean (s.d.) systolic BP (SBP) among men varied between 117.15 (15.35) in Ethiopia to 127.33 (17.80) in Indonesia. The prevalence of hypertension was highest among women (25%) and men (24%) in Indonesia. Mean BP levels increased with increasing BMI. The risk of hypertension was higher among population groups with overweight and obesity (BMI>/=25 kg/m(2)); odds ratio (95% confidence interval); 2.47 (1.42, 4.29) in Ethiopia, 2.67 (1.75, 4.08) in Vietnam and 7.64 (3.88, 15.0) in Indonesia. BMI was significantly and positively correlated with both SBP and DBP in all the three populations, correlation coefficient (r) ranging between 0.23 and 0.27, P

Aims: Demographic surveillance systems (DSSs) create platforms to monitor population dynamics. This paper discusses the potential of combining the WHO STEPwise approach to Surveillance (STEPS) within ongoing DSSs, to assess changes in non-communicable disease (NCD) risk factors. Methods: Three DSSs in Ethiopia, Vietnam, and Indonesia have collected NCD risk factors using WHO STEPS, focusing on self-reported lifestyle risk factors (Step 1) and measurement of blood pressure and anthropometric parameters (Step 2). Results: DSSs provide sampling frames for NCD risk factor surveillance, which reveals the distribution of risk factors and their dynamics at the population level. The WHO STEPS approach with its add-on modules is feasible and adaptable in DSS settings. Available mortality data in the DSSs enable mortality assessment by cause of death using verbal autopsy, which is relevant in estimating the impact of NCDs. DSSs as well as risk factor surveillance data may potentially be a lever for hypothesis-driven research to address specific a priori hypotheses or research questions. Conclusion: Combining DSSs with the WHO STEPS approach can potentially address basic epidemiological questions on NCDs, which can be used as a powerful advocacy tool in public health decision-making for NCD prevention.

Objectives: (1) To investigate the impact of perinatal common mental disorders (CMD) in Ethiopia on the risk of key illnesses of early infancy: diarrhoea, fever and acute respiratory illnesses (ARI) and (2) to explore the potential mediating role of maternal health behaviours.Design: Population-based cohort study.Setting: Demographic surveillance site in a predominantly rural area of Ethiopia.Participants: 1065 women (86.3% of eligible) in the third trimester of pregnancy were recruited and 954 (98.6%) of surviving, singleton mother–infant pairs were followed up until 2 months after birth.Main exposure measure: High levels of CMD symptoms, as measured by the locally validated Self-Reporting Questionnaire (SRQ-20 ≥6), in pregnancy only, postnatally only and at both time-points (‘persistent’).Main outcome measures: Maternal report of infant illness episodes in first 2 months of life.Results: The percentages of infants reported to have experienced diarrhoea, ARI and fever were 26.0%, 25.0% and 35.1%, respectively. Persistent perinatal CMD symptoms were associated with 2.15 times (95% CI 1.39 to 3.34) increased risk of infant diarrhoea in a fully adjusted model. The strength of association was not affected by including potential mediators: breast feeding practices, hygiene, the infant's vaccination status or impaired maternal functioning. Persistent perinatal CMD was not associated with infant ARI or fever after adjusting for confounders.Conclusions: Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies.

Baseline physical activity data are needed to effectively plan programs and policies to prevent noncommunicable diseases, but for many African countries these data are lacking.To describe and compare levels and patterns of physical activity among adults across 22 African countries.Data from 57,038 individuals from 22 countries (11 national and 11 subnational samples) that participated in the STEPwise approach to chronic disease risk factor surveillance (2003-2009) were analyzed in 2010. The validated Global Physical Activity Questionnaire (GPAQ) was used to assess days and duration of physical activity at work, for transport, and during leisure time in a typical week.Overall, 83.8% of men and 75.7% of women met WHO physical activity recommendations (at least 150 minutes of moderate activity per week or equivalent). Country prevalence ranged from 46.8% (Mali) to 96.0% (Mozambique). Physical activity, both at work and for transport, including walking, had large contributions to overall physical activity, while physical activity during leisure time was rare in the analyzed countries.Physical activity levels varied greatly across African countries and population subgroups. Leisure time activity was consistently low. These data will be useful to inform policymakers and to guide interventions to promote physical activity.

Reliable data on lung cancer burden is not available from most developing countries as cancer registration is lacking. In a previously proposed model to estimate lung cancer deaths in those countries using smoking prevalence data, we estimated the current yearly number of lung cancer deaths in Ethiopia as 3356, a figure far above the WHO estimate of 1343 and the GLOBOCAN of 748. Our aim was to further develop and validate our estimation procedure. We included additional data on risk estimates for lung cancer mortality of ex-smokers and an approximation of duration of smoking into our model and reanalysed study results on non-smoker mortality, thus building two improved models. For validation the number of lung cancer deaths in Germany (2006), the UK (2006), Canada (2004), and Utah, USA (2000) were estimated based on all three models and compared to the observed number of deaths in these countries. We found that the refined model with a modified estimate of lung cancer mortality rates in non-smokers and a more detailed incorporation of smoking dose categories estimates rather well the observed lung cancer deaths in the above countries. With this model, the updated estimate of yearly lung cancer deaths in Ethiopia is 2946 deaths, close to the previous reported estimate. If Ethiopian lung cancer mortality rates in never-smokers and smoking relative risks are the same as in industrialised countries, our models suggests that WHO lung cancer deaths may be underestimated in Ethiopia.

Low-income volunteers constitute a major part of AIDS care workforces in sub-Saharan Africa, yet little research has been conducted to determine how poverty and insecurity among volunteers impact their wellbeing and the sustainability of the AIDS treatment programmes they support. This paper presents longitudinal ethnographic and epidemiological research documenting how the 2008 food crisis in Addis Ababa affected AIDS care volunteers’ care relationships and motivations. Ethnographic results highlight the distress and demotivation that rising food costs created for caregivers by contributing to their own and their care recipients’ experiences of food insecurity and HIV-related stigmatization. Epidemiological results underscore a high prevalence of food insecurity (approximately 80%) even prior to the peak of food prices. Rising food prices over the 3 years prior to 2008, underemployment and household per capita incomes averaging less than US$1/day, likely contributed to the very high prevalence of food insecurity reported by caregivers in our sample. We also show that new volunteers recruited in early 2008 by one of the non-governmental organizations (NGOs) involved in this study were more likely to be dependants within their households, and that these participants reported lower rates of food insecurity and higher household income. While this shift in volunteer recruitment may help sustain volunteer care programmes in the face of widespread poverty and underemployment, food insecurity was still highly prevalent (58–71%) among this sub-group. Given the inability of the local NGOs that organize volunteers to address the challenge of food insecurity for programme sustainability, our results raise important policy questions regarding compensation for volunteers’ valuable labour and poverty reduction through public health sector job creation.

Background Child undernutrition is a major public health problem in low income countries. Prospective studies of predictors of infant growth in rural low-income country settings are relatively scarce but vital to guide intervention efforts. Methods A population-based sample of 1065 women in the third trimester of pregnancy was recruited from the demographic surveillance site (DSS) in Butajira, south-central Ethiopia, and followed up until the infants were one year of age. After standardising infant weight and length using the 2006 WHO child growth standard, a cut-off of two standard deviations below the mean defined the prevalence of stunting (length-for-age Results The prevalence of infant undernutrition was high at 6 months (21.7% underweight, 26.7% stunted and 16.7% wasted) and at 12 months of age (21.2% underweight, 48.1% stunted, and 8.4% wasted). Significant and consistent predictors of infant undernutrition in both logistic and linear multiple regression models were male gender, low birth weight, poor maternal nutritional status, poor household sanitary facilities and living in a rural residence. Compared to girls, boys had twice the odds of being underweight (OR = 2.00; 95%CI: 1.39, 2.86) at 6 months, and being stunted at 6 months (OR = 2.38, 95%CI: 1.69, 3.33) and at 12 months of age (OR = 2.08, 95%CI: 1.59, 2.89). Infant undernutrition at 6 and 12 months of age was not associated with infant feeding practices in the first two months of life. Conclusion There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.