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Background: Verbal autopsy (VA) has been a crucial tool in ascertaining population-level cause of death (COD) estimates, specifically in countries where medical certification of COD is relatively limited. The World Health Organization has released an updated instrument (Verbal Autopsy Instrument 2022) that supports electronic data collection methods along with analytical software for assigning COD. This questionnaire encompasses the primary signs and symptoms associated with prevalent diseases across all age groups. Traditional methods have primarily involved paper-based questionnaires and physician-coded approaches for COD assignment, which is time-consuming and resource-intensive. Although computer-coded algorithms have advanced the COD assignment process, data collection in densely populated countries like India remains a logistical challenge., Objective: This study aimed to develop an Android-based mobile app specifically tailored for streamlining VA data collection by leveraging the existing Indian public health workforce. The app has been designed to integrate real-time data collection by frontline health workers and seamless data transmission and digital reporting of COD by physicians. This process aimed to enhance the efficiency and accuracy of COD assignment through VA., Methods: The app was developed using Android Studio, the primary integrated development environment for developing Android apps using Java. The front-end interface was developed using XML, while SQLite and MySQL were employed to streamline complete data storage on the local and server databases, respectively. The communication between the app and the server was facilitated through a PHP application programming interface to synchronize data from the local to the server database. The complete prototype was specifically built to reduce manual intervention and automate VA data collection., Results: The app was developed to align with the current Indian public health system for district-level COD estimation. By leveraging this mobile app, the average duration required for VA data collection to ascertainment of COD, which typically ranges from 6 to 8 months, is expected to decrease by approximately 80%, reducing it to about 1-2 months. Based on annual caseload projections, the smallest administrative public health unit, health and wellness centers, is anticipated to handle 35-40 VA cases annually, while medical officers at primary health centers are projected to manage 150-200 physician-certified VAs each year. The app's data collection and transmission efficiency were further improved based on feedback from user and subject area experts., Conclusions: The development of a unified mobile app could streamline the VA process, enabling the generation of accurate national and subnational COD estimates. This mobile app can be further piloted and scaled to different regions to integrate the automated VA model into the existing public health system for generating comprehensive mortality statistics in India., (©Harleen Kaur, Stuti Tripathi, Manjeet Singh Chalga, Sudhir K Benara, Amit Dhiman, Shefali Gupta, Saritha Nair, Geetha Menon, B K Gulati, Sandeep Sharma, Saurabh Sharma. Originally published in JMIR Formative Research (https://formative.jmir.org).)

Background: Cause-of-death (CoD) information is crucial for health policy formulation, planning, and program implementation. Verbal Autopsy (VA) is an approach employed for the collection and analysis of CoD estimates at the population level where medical certification of cause of death is low and, secondly, for integrating it with the existing public health system by utilizing the grassroots level workforce., Objective: The study aims to understand the field perspectives on implementing the 2022 WHO VA instrument in rural India through the existing public health system., Methods: This article is derived from a qualitative arm of study that was conducted in one of the blocks of Kanpur district, Uttar Pradesh. Frontline health workers (FHWs), as well as Medical Officers (MOs) serving in the Community Health Centre (CHC) area, were selected as study participants. A 5-day training and orientation workshop was conducted to train the FHWs to conduct computer-assisted personal interview VA using the 2022 WHO VA instrument. MOs have been trained to assign the CoD via Physician-Certified VA (PCVA). In-depth interviews (IDIs) were conducted with FHWs involved in conducting VA and physicians involved in conducting PCVA within the field practice area., Results: A total of 13 IDIs were conducted, consisting of 10 FHWs and 3 MOs, within the selected CHC area of Ghatampur. Based on the responses received, five major themes were identified. Although VA is being used to collect CoD information from the community in India through a Sample Registration Survey (SRS), the key findings suggest that this activity could be scaled up by utilizing the existing public health system. However, additional manpower may be required for constant monitoring and evaluation of the program. Incentivization of FHWs would aid in the timely completion of VAs and coordination with local and higher health authorities., Conclusion: The perception of healthcare workers about the feasibility and acceptability of VA in this study highlighted some of the challenges and possible solutions that could aid in developing a comprehensive model to improve CoD information at the population level through the existing public health system., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Background: Physician-coded verbal autopsy (PCVA) is the most widely used method to determine causes of death (COD) in countries where medical certification of death is low. Computer-coded verbal autopsy (CCVA), an alternative method to PCVA for assigning the COD is considered to be efficient and cost-effective. However, the performance of CCVA as compared to PCVA is yet to be established in the Indian context., Methods: We evaluated the performance of PCVA and three CCVA methods i.e., InterVA 5, InSilico, and Tariff 2.0 on verbal autopsies done using the WHO 2016 VA tool on 2,120 reference standard cases developed from five tertiary care hospitals of Delhi. PCVA methodology involved dual independent review with adjudication, where required. Metrics to assess performance were Cause Specific Mortality Fraction (CSMF), sensitivity, positive predictive value (PPV), CSMF Accuracy, and Kappa statistic., Results: In terms of the measures of the overall performance of COD assignment methods, for CSMF Accuracy, the PCVA method achieved the highest score of 0.79, followed by 0.67 for Tariff_2.0, 0.66 for Inter-VA and 0.62 for InSilicoVA. The PCVA method also achieved the highest agreement (57%) and Kappa scores (0.54). The PCVA method showed the highest sensitivity for 15 out of 20 causes of death., Conclusion: Our study found that the PCVA method had the best performance out of all the four COD assignment methods that were tested in our study sample. In order to improve the performance of CCVA methods, multicentric studies with larger sample sizes need to be conducted using the WHO VA tool., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Benara, Sharma, Juneja, Nair, Gulati, Singh, Singh, Yadav, Rao and Rao.)

Introduction: Individual and community characteristics predictive of knowledge, perception, and attitude on COVID-19, specifically on gender, have not been adequately explored., Objective: To examine the gender differences in COVID-19 knowledge, self-risk perception and public stigma among the general community and to understand other socio-demographic factors which were predictive of them., Method: A nationally representative cross-sectional multi-centric survey was conducted among adult individuals(≥18 yrs) from the community member (N = 1978) from six states and one union territory of India between August 2020 to February 2021. The participants were selected using systematic random sampling. The data were collected telephonically using pilot-tested structured questionnaires and were analyzed using STATA. Gender-segregated multivariable analysis was conducted to identify statistically significant predictors (p < 0.05) of COVID-19-related knowledge, risk perception, and public stigma in the community., Results: Study identified significant differences between males and females in their self-risk perception (22.0% & 18.2% respectively) and stigmatizing attitude (55.3% & 47.1% respectively). Highly educated males and females had higher odds of having COVID-19 knowledge (aOR: 16.83: p < 0.05) than illiterates. Highly educated women had higher odds of having self-risk perception (aOR: 2.6; p < 0.05) but lower public stigma [aOR: 0.57; p < 0.05]. Male rural residents had lower odds of having self-risk perception and knowledge [aOR: 0.55; p < 0.05 & aOR: 0.72; p < 0.05] and female rural residents had higher odds of having public stigma [aOR: 1.36; p < 0.05]., Conclusion: Our study findings suggest the importance of considering thegender differentials and their background, education status and residential status in designing effective interventions to improve knowledge and reduce risk perception and stigma in the community about COVID-19., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Ltd.)

Objective: To assess factors associated with COVID-19 stigmatizing attitudes in the community and stigma experiences of COVID-19 recovered individuals during first wave of COVID-19 pandemic in India., Methods: A cross-sectional study was conducted in 18 districts located in 7 States in India during September 2020 to January 2021 among adults > 18 years of age selected through systematic random sampling. Data on socio demographic and COVID-19 knowledge were collected from 303 COVID-19 recovered and 1,976 non-COVID-19 infected individuals from community using a survey questionnaire. Stigma was assessed using COVID-19 Stigma Scale and Community COVID-19 Stigma Scale developed for the study. Informed consent was sought from the participants. Univariate and multivariate binary logistic regression analysis were conducted., Results: Half of the participants (51.3%) from the community reported prevalence of severe stigmatizing attitudes toward COVID-19 infected while 38.6% of COVID-19 recovered participants reported experiencing severe stigma. Participants from the community were more likely to report stigmatizing attitudes toward COVID-19 infected if they were residents of high prevalent COVID-19 zone (AOR: 1.5; CI: 1.2-1.9), staying in rural areas (AOR: 1.5; CI:1.1-1.9), belonged to the age group of 18-30 years (AOR: 1.6; CI 1.2-2.0), were male (AOR: 1.6; CI: 1.3-1.9), illiterate (AOR: 2.7; CI: 1.8-4.2), or living in Maharashtra (AOR: 7.4; CI: 4.8-11.3). COVID-19 recovered participants had higher odds of experiencing stigma if they had poor knowledge about COVID-19 transmission (AOR: 2.8; CI: 1.3-6.3), were staying for 6-15 years (AOR: 3.24; CI: 1.1-9.4) in the current place of residence or belonged to Delhi (AOR: 5.3; CI: 1.04-26.7)., Conclusion: Findings indicated presence of stigmatizing attitudes in the community as well as experienced stigma among COVID-19 recovered across selected study sites in India during the first wave of COVID-19 pandemic. Study recommends timely dissemination of factual information to populations vulnerable to misinformation and psychosocial interventions for individuals affected by stigma., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Adhikari, Aggarwal, Nair, Joshi, Diwan, Stephen, Devi, Kumar Mishra, Yadav, Bangar, Sahu, Yadav, Ovung, Gulati, Sharma, Singh, Duggal, Sharma, Ujagare, Padmakar Chinchore, Rebecca, Rani, Selvaraj, Xavier, Peter, Watson, Kannan, Asmathulla, Bhattacharya, Turuk, Palo, Kanungo, Kumar Behera, Pandey, Zaman, Misra, Kumar, Behera, Singh, Narain, Kant, Sahay, Tiwari, Thomas and Rao.)

Good quality health, nutrition and demographic survey data are vital for evidence-based decision-making. Existing literature indicates system specific, data collection and reporting gaps that affect quality of health, nutrition and demographic survey data, thereby affecting its usability and relevance. To mitigate these, the National Data Quality Forum (NDQF), under the Indian Council of Medical Research (ICMR) - National Institute of Medical Statistics (NIMS) developed the National Guidelines for Data Quality in Surveys delineating assurance mechanisms to generate standard quality data in surveys. The present article highlights the principles from the guidelines for informing survey researchers/organizations in generating good quality survey data. It describes the process of development of the national guidelines, principles for each of the survey phases listed in the document and applicability of them to data user for ensuring data quality. The guidelines may be useful to a broad-spectrum of audience such as data producers from government and non-government organizations, policy makers, research institutions, as well as individual researchers, thereby playing a vital role in improving quality of health, nutrition and demographic data ecosystem.

Background & Objectives: COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community., Methods: COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants' interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test-retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach's alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test-retest reliability., Results: Items in the scales were relevant and comprehensible. Both the scales had Cronbach's α above 0.6 indicating moderate-to-good internal consistency. Test-retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement., Interpretation & Conclusions: Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.

Background: Infectious diseases are important causes of morbidity and mortality globally. At least 25% of about 60 million deaths that occur worldwide each year are estimated to be due to infectious diseases. In India, the burden of infectious diseases is enormous; although it has decreased as a result of overall socioeconomic progress and use of vaccines and antimicrobials, it is still a major health-care burden. Studying a disease trend over a certain time period is important in a country's public health system as it guides agencies to prioritize funds and other measures for its control., Objectives: The present study tries to understand its transition in an urban population of India., Materials and Methods: "Medical Certification of Cause of Death" data for the period from 1989 to 2015 have been used. Deaths under the head "age not stated" have been distributed in all age groups in proportion to total deaths at those age groups for all the years, and the percentage of the cause of death to total deaths has been calculated. Three years' moving average of these percentages have been calculated., Results: The overall age group analysis showed a downward trend in both males and females. However, age-segregated analysis showed that mortality is declining among children and youth population, specifically showing a steep decline among infants and under-five population., Conclusion: Infectious diseases are still a major public health problem in India., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Community Medicine.)

Background & Objectives: The level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among Scheduled Tribes in rural areas., Methods: Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992-2006., Results: Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1.1-1.7) as compared with births to the mother's aged 20-29 yr. Hazard of under-five mortality was 42 per cent (95% CI=1.3-1.6) higher among four or more birth order compared with the first birth order. The risk of infant dying was higher among male children (HR = 1.2, 95% CI=1.1-1.4) than among female children while male children were at 30 per cent (HR=0.7, 95% CI=0.6-0.7) less hazard of child mortality than female children. Literate women were at 40 per cent (HR=0.6, 95% CI=0.50-0.76) less hazard of child death than illiterate women., Interpretation & Conclusions: Mortality differentials by socio-demographic and economic factors were observed over the time period (1992-2006) among Scheduled Tribes (STs) in rural India. Findings support the need to focus on age at first birth and spacing between two births.

Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wall of vagina connecting to bladder or to rectum due to prolonged obstructed labour without timely medical assistance. A few research studies carried out in India and recently conducted DLHS-3 survey (2007-08) has information on obstetric fistula that gives scope for further research. This paper examines prevalence of obstetric fistula and its correlates using DLHS-3 data for selected states in India. Ever experience of obstetric fistula among women in these states ranges from 0.3 percent to 3.4 percent, being highest in Uttarakhand. Women living in rural areas have higher chance of obstetric fistula. Age and physical maturity is important factor in the occurrence of fistula and it is found that those women who were below 18 years at the time of their first birth have higher risk of fistula in comparison to those who had child at 18 or above years. In addition to this, those having problems at the time of delivery are around two times more likely to have fistula. Auxulary Nurse Midwife can be key players in the early detection and referral of cephalo-pelvic disproportion, malpresentation and prolonged, obstructed labour cases.