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Introduction: Youths are the most vulnerable population to initiate tobacco use. It is the need of the hour to prevent tobacco addiction among young people to reduce the morbidity and mortality associated with it. Therefore, there is a need for necessary data to build an appropriate strategy to combat this epidemic. Aim: To determine the prevalence and trends of tobacco use and to assess the factors associated with tobacco use among youths (age 15-24 years) in India. Materials and Methods: This retrospective secondary data analysis study was conducted at Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, between January 2023 and June 2023, using data from the National Family Health Survey-5 (NFHS-5), 2019-2021, which was conducted across all states of India to estimate the prevalence of tobacco use among the 15-24 age group. Data were compared with NFHS 3 and 4 to observe the trends in tobacco use. The data were analysed using Statistical Packages for Social Sciences (SPSS) software (version 21.0). Multivariate logistic regression was used to identify the significant risk factors associated with tobacco use. A p-value less than 0.05 was considered statistically significant. Results: The prevalence of smoking and smokeless tobacco use was 2109/14525 (14.52%) and 2237/14525 (15.40%) respectively among male youths aged 20-24 years, and it was 374/119043 (31%) and 119/119043 (1.53%) in females of similar age. For males, the prevalence has decreased from 40.07% in NFHS-3 to 27.31% in NFHS-4 and to 22.51% in NFHS-5. For females, the prevalence has decreased from 4.55% in NFHS-3 to 2.38% in NFHS-4 and to 1.33% in NFHS-5. Males and females belonging to the scheduled caste/scheduled tribe, having a poor wealth index, and in the married category had a higher prevalence of tobacco use. Youths residing in rural areas were using more smokeless tobacco. Conclusion: There was a declining trend of tobacco use among youths over NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 (2019-2021). Male gender, higher age, rural area, the northeast region of India, poor wealth index, education upto primary level, being married, and other categories of marriage had higher adjusted odds of using both forms of tobacco. There is a need to implement and enforce evidence-based tobacco control strategies that can substantially improve the health of the young, hence securing India’s future.

Abstract Buildings in rural Central Asia have unique characteristics as they were built during the Soviet era (during 1950–1960) without any energy efficiency measures. The special and aged building stock pose a crucial challenge on energy security and energy supply. However, accurate scientific data on their energy usage is lacking, highlighting a research gap about robust and validated methodology to determine the energy use of rural Central Asian buildings. In response to this need, this research paper proposes a set of generalised residential building typologies for rural Central Asia, with a focus on Kyrgyzstan. The study combines quantitative and qualitative methods, including household surveys, energy demand modelling, EnergyPlus simulations, and result validation. It derives energy-based building typologies from construction year and building envelope characteristics. Through numerous validated simulations, it was identified that the heat demand for rural Kyrgyz houses is 3–5 times here compared to European houses (250–400 kWh/m2). The study revealed the estimated heat demand for homes in rural Kyrgyzstan, indicating a significant potential for improving building energy efficiency in the region. These results can inform specific approaches, such as building renovation plans, energy certification, and renovation strategies. Furthermore, the validated methodology introduced offers opportunities for researchers in the field of building energy efficiency and can be applied to similar regions in Central Asia with comparable building stocks and climates.

The escalating demand for water, energy, and food, coupled with the imperative for sustainable development, necessitates innovative solutions to address the complex interdependencies within the water–energy–food nexus. In this context, agriculture and photovoltaics (Agri-PV or Agri–voltaics) systems have emerged as a promising approach to promoting sustainable agricultural practices while enhancing energy efficiency and food production. However, limited research, especially on the technical aspects of Agri-PV, has resulted in a knowledge gap regarding how to model and determine the suitability of Agri-PV for different crops based on local conditions. This study presents a novel approach to modeling and simulating Agri-PV systems for various major crops in developing countries, using Uzbekistan as a case study. It provides a blueprint for selecting suitable Agri-PV systems. The research investigates the technical feasibility of Agri-PV technology tailored to Uzbekistan’s agricultural landscape, with broader implications for Central Asia. Employing a systematic methodology, the study begins by selecting appropriate sites and crops for Agri-PV system testing, ensuring the relevance and applicability of the research findings to the local context. Using advanced software tools such as PVSyst, the study accurately calculates photosynthetically active radiation (PAR) values specific to selected crops, bridging a significant knowledge gap and providing empirical data essential for informed decision making. The methodology further incorporates an in-depth analysis of economic and technical considerations in selecting PV modules and inverters, enhancing the scientific accuracy of the study. By strategically modeling Agri-PV systems based on parameters like row density, module distance, and tilt angle, this research aims to optimize the integration of photovoltaic technology with agricultural practices in Uzbekistan. Moreover, this study helps to understand the impact of Agri-PV systems on the water–energy–food nexus, providing valuable insights into the potential benefits and challenges specific to the region. The study identifies the positive impact of Agri-PV on major crops and provides a suitable design and modeling approach for sustainable farming practices.

Objective: Cardiovascular diseases (CVD) are one of the most addressed preventable diseases of public health importance. However, the risk estimates and use of these risk scores for CVD prevention are the least explored areas. So, in this study, we explored the different categories of Framingham heart study (FHS) 10-year-CVD risk score and their associated factors among the adult male population in Tamil Nadu, India. Methods: We used the risk factor level data for male adults aged 18 years and above from the National Family Health Survey (NFHS-5) of Tamil Nadu state, India. Sociodemographic variables, behavioral factors, and physiological/biochemical factors were considered as the risk factor and were estimated using the world health organization (WHO) STEPS categories. FHS 10-year-CVD risk score was calculated using a body-mass index-based published Cox regression equation. Results: Out of 2289 adult males, only 1.12% of the participants had a 10-year CVD risk score greater than 30% and ∼4% of the total participants require statin treatment (FRS-CVD risk score ≥20). Educational status (aOR:14.21, 95 CI: 4.36–46.22- no formal schooling when compared to 10th and above standard), weekly fruit intake (aOR:0.51, 95 CI: 0.27–0.97 when compared to daily fruit intake) and abdominal obesity (aOR:2.43, 95 CI: 1.58–3.74) were found to be associated with higher FRS scores when adjusted for all other factors not involved in FRS calculation. Conclusion: Widespread use of this score needs to be encouraged in clinical practices and patients with a higher risk of CVD events should be counselled for lifestyle modifications and compliance with treatment for decreasing the burden due to CVDs.

Kyrgyzstan's high-altitude rural housing sector consumes 3–5 times more energy than European buildings due to ageing infrastructure, lack of insulation, and reliance on non-sustainable resources. One potential solution is the implementation of thermal insulation. However, due to limited public awareness of energy efficiency, inadequate government policies, insufficient technology, and challenging geography, people in rural areas rely on non-sustainable resources such as coal, cow dung, and firewood for heating, which creates a negative impact on the local ecosystems. To close the energy efficiency gap, the paper proposes a sustainable and holistic approach that integrates thermal insulation with effective energy efficiency planning using a staged-renovation approach by utilising locally available insulation materials / resources. The feasibility study presented in the paper was conducted with a simulation-based parametric study to recognise the potential of novel and sustainable insulation structures on building heat demand. This innovative approach can potentially reduce heat demand in high-altitude houses by as much as 70 %, offering a transformative solution. Furthermore, its adaptability makes it transferable to similar high-altitude communities, thus advancing sustainable energy practices for climate change mitigation and contributing to broader sustainable development goals.

Objective. To determine the prevalence and antimicrobial resistance of Escherichia coli and Salmonella spp. in animal feed samples collected between 2018 and 2021 in Colombia. Methods. This was a laboratory-based cross-sectional study using routine data from the program for inspection, surveillance, and control of animal feed at the Colombian Agriculture Institute. Samples of animal feed for swine, poultry, canine, feline, leporine, piscine, and equine species were processed for detection of E. coli and Salmonella spp. using enrichment and selective culture methods. Isolates were tested for antimicrobial susceptibility using an automated microdilution method. Results. Of 1 748 animal feed samples analyzed, 83 (4.7%) were positive for E. coli and 66 (3.8%) for Salmonella spp. The presence of E. coli and Salmonella spp. was highest in feed for poultry (6.4% and 5.5%) and swine (6.1% and 4.3%). Antimicrobial resistance testing was performed in 27 (33%) E. coli isolates and 26 (39%) Salmonella isolates. Among E. coli, resistance was most frequently observed to ampicillin (44.5%) followed by cefazolin (33.3%), ciprofloxacin (29.6%), ampicillin/sulbactam (26%), and ceftriaxone (11.1%). The highest resistance levels in Salmonella spp. isolates were against cefazolin (7.7%) and piperacillin/tazobactam (7.7%). Conclusions. This is the first study from Colombia reporting on the prevalence and antimicrobial resistance of E. coli and Salmonella spp. in animal feed samples. Its results establish a baseline over a wide geographical distribution in Colombia. It highlights the need to integrate antimicrobial resistance surveillance in animal feed due to the emergence of resistant bacteria in this important stage of the supply chain.

Objectives. To determine the proportion of Salmonella enterica in fecal samples of live pigs with suspected salmonellosis analyzed at the diagnostic unit of the University of Antioquia, Colombia between 2019 and 2021, and examine the serotypes and antimicrobial resistance patterns. Methods. This was a laboratory-based cross-sectional study of routine data on fecal samples received from pig farms in all nine subregions of Antioquia state, Colombia. Salmonella spp. detection at the university is done using enrichment, selective culture, and polymerase chain reaction. Serotypes were identified using the Kauffmann–White scheme and isolates were tested for antimicrobial susceptibility using broth microdilution. Results. Of 653 samples tested, 149 (23%) were positive for S. enterica. Nine serotypes were identified. The most common were Salmonella Typhimurium (56%) and its monophasic variant (35%). Resistance to ampicillin (70%) was most frequently observed, followed by ciprofloxacin (55%), and sulfamethoxazole–trimethoprim (52%). No isolates were resistant to amikacin and gentamicin. Multidrug resistance (resistance to ≥ 3 classes of antibiotics) was observed in 61 (44%) isolates. Multidrug resistance was highest in S. Typhimurium (57%) compared with the other serotypes. Serotype was associated with multidrug resistance (p = 0.01), but age of the pig and sub-region were not. Conclusions. The proportion of Salmonella spp. and the associated high levels of multidrug resistance are of concern and may indicate irrational use of antimicrobials and poor management practices in pig production systems in the region. Strengthened surveillance is needed to monitor and improve farm management practices and the use of antimicrobials in farms in Colombia.

Energy is a pivotal element for overall development. Therefore, affordable and clean energy for all (Sustainable Development Goal 7) is one of the important elements. Despite a suitable approach, Kyrgyzstan lags behind to achieve its Sustainable Development Goals by 2030. Improving access to energy can significantly impact the progress of many other sustainable development targets. However, access to reliable, sustainable, and adequate energy is a crucial task in rural Kyrgyzstan. Taking into consideration the energy situation and the importance of the availability of energy services, the overarching aim of the presented article is to map the potential of improving rural energy services to foster overall sustainable development goals. The article presents the most relevant information about rural energy usage behaviour based on three primary pillars: energy demand, energy carrier, and energy sources. In addition, the presented research article synthesises the key driving factors which have a direct or indirect impact on the energy services in rural areas. The summarised data displays a deep insight into a variety of complex and dynamic household energy consumption patterns. The article provides a potential solution nexus to foster improved energy services in rural Kyrgyzstan and therefore to foster the overall sustainable development in Kyrgyzstan. The findings of the article help to formulate a strategy to design rural energy services for policy makers and stockholders.

In rural Kyrgyzstan, the energy need is usually derived from multiple natural energy resources such as firewood, charcoal, agricultural residues, animal dung, and wood branches, which are considered common and predominant practices. Because of the non-sustainable resources and heavy reliance on the environment, Kyrgyzstan is one of the most vulnerable countries to climate change in Central Asia. On the contrary, the great renewable energy potential in Kyrgyzstan is untapped, which could be the most promising solution to ensuring sustainable energy supply in the country. However, because of the lack of scientific knowledge, current energy policies, and the lack of infrastructure, renewable resources are mainly untapped. To exploit the country’s renewable energy potential, there is a need for a systematic diagnosis to develop a strategy to explore renewables in Kyrgyzstan, which is currently missing in the existing literature. In that regard, the presented study aims to assess the current status of renewable energy sources by considering the local energy context from a potential point of view. Further to this, it provides a comparative overview through a matrix of strengths, weaknesses, opportunities, and threats. Such novel analysis would be the fundamental base for formulating policy advice and a national plan to enhance the utilization of renewable energy in Kyrgyzstan. The presented analysis was carried out based on the extensive literature review, the country’s national plan, and the existing energy policies of Kyrgyzstan. The article found out that there is huge potential available for the renewable energy market. As compared to other renewable energy sources, solar energy has great potential and can be considered one of the pioneer sustainable sources for integration into the country’s power generation framework.

This paper introduces a comprehensive approach for sizing grid-connected hybrid renewable energy systems tailored for electric bus fleet operations. The study involves two main steps. First, a mathematical model that optimizes the configuration of such systems by considering daily electric bus consumption, solar irradiance, wind speed, and biomass potential is formulated. The model utilizes Pareto frontier multi-objective optimization to minimize the net present cost, the cost of energy, and greenhouse gas emissions. Second, the model is rigorously applied and tested in a real-world case study in Fez, Morocco, using HOMER Pro; the case study centers on the daily energy requirements of the buses, estimated at 2.5 megawatt hours per day, with a peak demand of 345 kilowatts. Two scenarios are explored, revealing a discernible trade-off dilemma between the full hybrid renewable energy scenario (Scenario 1) and the grid-connected hybrid renewable energy scenario (Scenario 2). In Scenario 2, the grid-connected hybrid renewable energy system demonstrates a notable 42.8% reduction in the net present cost, totaling USD 984,624. Similarly, the levelized cost of energy experiences a significant decrease, reaching approximately 0.08 USD/kWh, marking a 38.1% reduction. However, this apparent economic advantage is juxtaposed with a critical consideration—an increase in greenhouse gas emissions from null to 330,418 kg/year.

Tuberculosis preventive treatment (TPT) is an important intervention in preventing infection and reducing TB incidence among household contacts (HHCs). A mixed-methods study was conducted to assess the “Test and Treat” model of TPT care cascade among HHCs aged ≥5 years of pulmonary tuberculosis (PTB) patients (bacteriologically/clinically confirmed) being provided TPT care under Project Axshya Plus implemented in Maharashtra (India). A quantitative phase cohort study based on record review and qualitative interviews to understand the challenges and solutions in the TPT care cascade were used. Of the total 4181 index patients, 14,172 HHCs were screened, of whom 36 (0.3%) HHCs were diagnosed with tuberculosis. Among 14,133 eligible HHCs, 10,777 (76.3%) underwent an IGRA test. Of them, 2468 (22.9%) tested positive for IGRA and were suggested for chest X-ray. Of the eligible 2353 HHCs, 2159 (91.7%) were started on TPT, of whom 1958 (90.6%) completed the treatment. The median time between treatment initiation of index PTB patient and (a) HHC screening was 31 days; (b) TPT initiation was 64 days. The challenges in and suggested solutions for improving the TPT care cascade linked to subthemes were tuberculosis infection testing, chest X-ray, human resources, awareness and engagement, accessibility to healthcare facilities, TPT drugs, follow-up, and assessment. A systematic monitoring and time-based evaluation of TPT cascade care delivery followed by prompt corrective actions/interventions could be a crucial strategy for its effective implementation and for the prevention of tuberculosis.

The National TB Elimination Programme (NTEP) of India is implementing tuberculosis preventive treatment (TPT) for all household contacts (HHCs) of pulmonary tuberculosis patients (index patients) aged 5 years with TB infection (TBI). We conducted an explanatory mixed-methods study among index patients registered in the Kolar district, Karnataka during April-December 2022, to assess the TPT cascade and explore the early implementation challenges for TPT provision. Of the 301 index patients, contact tracing home visits were made in 247 (82.1%) instances; a major challenge was index patients’ resistance to home visits fearing stigma, especially among those receiving care from the private sector. Of the 838 HHCs, 765 (91.3%) were screened for TB; the challenges included a lack of clarity on HHC definition and the non-availability of HHCs during house visits. Only 400 (57.8%) of the 692 eligible HHCs underwent an IGRA test for TBI; the challenges included a shortage of IGRA testing logistics and the perceived low risk among HHCs. As HHCs were unaware of their IGRA results, a number of HHCs actually eligible for TPT could not be determined. Among the 83 HHCs advised of the TPT, 81 (98%) initiated treatment, of whom 63 (77%) completed treatment. Though TPT initiation and completion rates are appreciable, the NTEP needs to urgently address the challenges in contact identification and IGRA testing.

Background: Globally, hypertension (HTN) and obesity are two cardinal causes of morbidity and mortality. The Asian population shows comorbidities associated with obesity at a much lower body mass index (BMI) than the western population. Aim: The primary objective of the present study was to evaluate the association between BMI and HTN among the adult population. Material and Methods: We did a cross-sectional secondary data analysis of the NFHS-4 datasets, conducted during 2015–16. We included the adult population, that is, ≥19 years of age (93,040 men and 5,46,066 women), and excluded adolescents and pregnant women from our analysis. HTN was the primary dependent variable, while BMI was the primary predictor variable. Other covariates included age, education, place of residence, wealth index, use of alcohol and tobacco, and diabetes. Weighted analysis was done to depict our results. Results: Around 18.7% of men and 13.5% of women were hypertensive, of which 53.86% of males and 38.7% females were either overweight or obese. The odds of living with HTN among obese men and women increased with age, wealth, use of alcohol and tobacco, and comorbidities such as diabetes. The prevalence of HTN was higher even among the underweight adults living with diabetes and those consuming alcohol and tobacco. Conclusion: We reaffirm the significant association between BMI and HTN among adults. The use of the Asian classification of BMI for India and its neighboring countries to assess the burden of obesity would help in planning better interventions. A community-based targeted approach would help in controlling and reducing the prevalence of HTN.

The COVID-19 pandemic will subside only through the emergence and distribution of an efficacious vaccine. The two main aspects that should be maintained in equilibrium: the dire necessity for speedy vaccine research and the need for safeguarding the research subjects, which is of utmost concern in research ethics. This opens up a discussion of what norms to follow during the clinical trials while developing the vaccine. As of now, various companies like Moderna, Pfizer, University of Oxford, Astra-Zeneca and so on have moved beyond the safety, efficacy and immunogenic studies. This narrative review explores and discusses the key principles of ethics: a principle of autonomy, beneficence, non-maleficence, and justice along with its ten general expanded principles. Furthermore, it delves into the different types of vaccines, their mechanisms, side effects, limitations, and advantages.

BackgroundThe association of conventional (modifiable and non-modifiable) risk factors for hypertension has already been established in the literature. However, there are other putative risk factors specific to women (early menarche, age at first childbirth, women empowerment, number of children born, hysterectomy, etc.) in the development of hypertension. This study is the first study to highlight the potential association of gender-specific factors along with other conventional risk factors and hypertension, using a nationwide sample.MethodsThe study is a secondary analysis of the data collected from the National Family Health Survey-4 (NFHS-4), a nationally representative sample of 699,686 women of reproductive age in India. The interview schedule included data on general background characteristics, marriage, reproductive history, hysterectomy, knowledge, and utilization of family planning services, maternal and child care, women empowerment, non-communicable diseases, and domestic violence. The blood pressure was measured by direct observation by the study investigators using a digital blood pressure monitor. To account for disproportionate sampling and non-response, a weighted statistical analysis was performed. Logistic regression analysis was done to study the strength of the association between the risk factors and hypertension (computation of unadjusted and adjusted odds ratio).ResultsThe prevalence of hypertension was 11.8% among women. Among the conventional factors, older age, higher body mass index (BMI), tobacco use, and alcohol use had higher odds for hypertension, while higher education, higher socio-economic position, and living in urban areas had lower odds. Among the gender-specific factors, younger age at first childbirth, early menarche, oral contraceptive pill use [adjusted OR: 1.23; (1.18–1.28)], and hysterectomy [adjusted OR: 1.10; (1.05–1.69)] were found to be risk factors for hypertension. Domestic violence was significantly associated with hypertension [unadjusted OR: 1.11; (1.02–1.20)]. Empowered women had lower odds of hypertension [adjusted OR: 0.93; (0.95–1.03)].ConclusionSignificant association of these gender-specific factors among women necessitates the need for taking into account these factors while screening for hypertension among women and thus, designing a tailored model better suited to them for risk assessment.

More than half of the urban population of Sub-Saharan Africa lives in informal housing conditions. While urban areas are, in general, characterized by a high electrification rate, residents of informal settlements are still affected by energy poverty, the use of traditional energy sources and unreliable electricity supply. The aim of the study is to give an overview of different renewable-energy-based solutions which are able to improve local energy provision. These are Solar Home Systems, Mini-Grids, and Energy-Hubs. The technologies are compared to another option for improving energy supply, namely Grid Expansion. The analysis is based on 24 Key Performance Indicators, which can be classified into technical, economic, environmental, social, and political dimensions. The selection of indicators is based on the challenges prevalent in informal settlements that impede a comprehensive, sustainable energy supply. The literature-based indices are used to determine which of the four technologies is a suitable solution for minimizing the challenges prevailing in informal settlements. The resulting matrix provides a holistic comparison and serves as a decision aid in selecting the appropriate technology for future projects in informal settlements, depending on local conditions and the needs of the population. The results show that the Energy-Hub is a valid alternative for energy supply improvement in Informal Settlements.

The meaning of “vaccine diplomacy (VD)” is defined as “the use of vaccines to increase a country's diplomatic relations and influence over other nations.” The golden era of vaccine science diplomacy started during the time of Cold War between the United States (US) and the Union of Soviet Socialist Republics (USSR) with the development of a prototype of oral polio vaccine by the US Scientist Dr Albert Sabin working along with his Soviet counterparts. The foundation stone was already laid down by Edward Jenner when he shared his technique of the smallpox vaccine with other major countries to curb the spread of smallpox. Eventually, such a step led to the eradication of such a deadly disease. Only time has changed, not the tide. Even today, vaccines continue to remain as one of the important tools for achieving Millennium Developmental Goals (MDGs) and other targets in developing countries like India. During the wake of the Corona Virus Diseases-19 (COVID-19) pandemic, India's role in developing its vaccine science diplomacy has been a point of attraction. The phase-3 trial of Covaxin being developed by Bharat Biotech started in Lucknow and Gorakhpur in October 2020, and it is widely considered as the forerunner for the Indian vaccine market. As per the Union Health Ministry of India- “The Union Government is working on at least five distinct ways, ranging from free vaccines to guaranteed supply, in which it can help its immediate neighbours and countries in West Asia, Africa and even Latin America—officials familiar with the plan said on conditions of anonymity. The idea is to leverage the country's standing as the world's vaccine factory to merge diplomatic ties. Historically, it is observed that by the development and introduction of newer vaccines from time to time, many dismaying hurdles to vaccine science diplomacy (VSD) arise from ongoing wars and political instability. The current scenario is that both VSD and VD are at crossroads, and there is a possibility of getting a good direction if we make a piggyback policy approach of vaccine diplomacy along with the foreign policy. The lessons learned from the past must be followed now and, in the future, to make a better world for all. We acknowledge that the COVID-19 episode has again highlighted the dire need for VSD, and we assume that not only COVID-19 but in future, emerging and re-emerging diseases will occur so we have to prepare ourselves for combatting those future emerging and re-emerging diseases.

Problem considered: Incorrect breastfeeding technique is a common cause of breastfeeding problems and subsequent discontinuation. Representative community-based data on practice of correct breastfeeding technique is not easily available. This study assessed the breastfeeding techniques as practiced by mothers having child under 6 months of age residing in urban slum areas of a city in western India. Methods: This community-based cross-sectional study was conducted after ethics committee approval. We selected 210 mothers through population proportionate to size cluster sampling with 30 slum areas as clusters and 7 mothers from each cluster. Breastfeeding technique was observed by a trained female investigator through a checklist based on Integrated Management of Neonatal and Childhood Illness guidelines. Outcome variables were percentage of mothers with good position, good attachment and effective suckling. EpiData analysis and MedCalc were used for data analysis. Results: The proportion (95% confidence interval) of mothers having correct breastfeeding position was 45.2% (35.2–55.3%), good attachment 73.8% (67.2–80.4%) and effective suckling 73.3% (67.8–78.8%). 128 (61%) mothers reported having been taught the technique of breastfeeding by someone, the most common source being nurse at health facility. Nuclear family, low parity and previous training in breastfeeding technique were positively associated with correct breastfeeding technique. Conclusion: The proportion of mothers with correct breastfeeding technique was low in light of the robust presence of maternal and child health programs.

Abstract Background High rates of Adverse Events (AEs) during treatment is one of the leading causes of unsuccessful treatment outcomes among patients with drug resistant tuberculosis (DR-TB). However, information related to AEs is not systematically collected and managed under programmatic setting. The present study assessed the a) incidence and pattern of adverse events in first three months of DR-TB treatment initiation; b) treatment seeking behaviour for AE management; and c) explore the challenges in seeking treatment and reporting AEs. Methods This mixed methods study included all patients diagnosed and initiated on treatment under RNTCP during July–September 2018 at Ahmedabad DR-TB centre. The patients were interviewed telephonically and assessed for all AEs experienced by them. In-depth interviews and key-informant interviews were conducted among patients, DOTS supervisors and programme staff (treatment supervisors, medical officer and district program managers). Results Total 207 AEs were reported by the 74 DR-TB patients. All patients experienced at least one AE during initial treatment period. Incidence rate of AEs (experienced) was 3.11 (1st month-4.6, 2nd month-2.7, 3rd month-2.02) per 100 person days. Of the 207 AEs, gastro-intestinal (59, 28.3%), ophthalmic (32, 15.4%) and otolaryngology (25, 11.9%) system related AEs were commonly experienced. Treatment was not sought in two-fifths of the AEs. Themes and sub-themes related to challenges in treatment seeking or reporting of AEs were 1) Patient related-Misconceptions, accessibility and affordability of management, lack of counselling support, stigma and discrimination, and past treatment experience; 2) Health system related- lack of guidelines and training for AE management, 3) Poor coordination between hospital and tuberculosis centre. Conclusion The incidence of AEs was high among patients with DR-TB in the first three months of treatment and treatment seeking/reporting was low. Adequate health education and counselling of the patient and orientation of the health systems is the need of the hour. An efficient real-time reporting and management of AE should be developed and tested for effective DR-TB control.

This paper proposes a home energy management system able to achieve optimized load scheduling for the operation of appliances within a given household. The system, based on the genetic algorithm, provides recommendations for the user to improve the way the energy needs of the home are handled. These recommendations not only take into account the dynamic pricing of electricity, but also the optimization for solar energy usage as well as user comfort. Historical data regarding the times at which the appliances have been used is leveraged through a statistical method to integrate the user’s preference into the algorithm. Based on real life appliance consumption data collected from a household in Morocco, three scenarios are established to assess the performance of the proposed system with each scenario having different parameters. Running the scenarios on the developed MATLAB script shows a cost saving of up to 63.48% as compared to a base scenario for a specific day. These results demonstrate that significant cost saving can be achieved while maintaining user comfort. The addition of supplementary shiftable loads (i.e., an electric vehicle) to the household as well as the limitations of such home energy management systems are discussed. The main contribution of this paper is the real data and including the user comfort as a metric in in the home energy management scheme.

Building construction in rural Kyrgyzstan is heavily dominated by earthen buildings. Old and inappropriate residential building structures contribute significantly to high domestic space heating energy consumption. Therefore, it is necessary to understand the relevant building construction techniques. However, the scant information on Kyrgyz building techniques, especially for high-altitude rural settlements, was the prime motivation to perform the presented study. The key objective of the study is to investigate residential building construction techniques in high-altitude rural Kyrgyzstan, and this was to be achieved by house visits during field trips, literature review, and pilot interviews with local people. The analysis enabled the detailed identification of individual building envelopes as well as predominant building materials to be recorded. Based on the assessment, a housing profile was created that represents the typical characteristics of traditional rural Kyrgyz houses. Furthermore, the study demonstrates the potential for energy savings in rural Kyrgyz houses of 50–70%. However, local conditions prevent people from making improvements to all domestic energy efficiency parameters simultaneously. Therefore, the study developed a ‘sequential roadmap’ to reduce domestic space heating demand in different phases based on simulation studies. Existing low-income rural Kyrgyz habitations can use the presented roadmap to reduce domestic space heating demand sequentially to overcome financial barriers and, therefore, contribute to establishing sustainable buildings in Kyrgyzstan. These results may be partially replicated in other Central Asian rural communities depending on their location and building characteristics.

Introduction: Health indicators of rural and urban India show a wide variation. Rural areas have received large focus in child health services, but on the flip side, urban areas have been the last to receive such attention. Materials and Methods: A cross-sectional study was conducted to include one randomly selected outreach session from all the 19 urban primary health centers of Vadodara city from April 2013 to May 2014. Nineteen session sites were observed for the process evaluation of three components of child health care, namely, “planning of Health and Nutrition Day,” “availability of vaccines/logistics,” and “direct observation of actual immunization process” at the site using a structured checklist. Results: Most of the vaccines and logistics were present at all 19 sites visited, but adverse events following immunization kit were observed at ten sites (52%) only. Open vial policy, no-touch technique, and immediate cutting of syringe with hub cutter were implemented at all sites; however, completely filled Mamta Card was observed at 9 (47%) sites only. All four key messages were given at 5 (26%) sites only. Conclusion: Immunization services such as proper vaccine administration with no-touch technique and open vial policy were mainly focused; however, other services such as biomedical waste management, record keeping, and delivery of all four key messages need to be strengthened during Mamta Divas. Strengthening of other child health care services such as growth monitoring, Integrated Management of Neonatal and Childhood Illnesses, and referral services is required in urban areas.

Background: Inspite of rise in institutional deliveries, early initia- tion of breastfeeding and exclusive breastfeeding (EBF) remains an area of concern especially in urban slums. This study was done to assess the current feeding practices of mothers having children under 6 months of age residing in urban slums of study city and to identify the predictors of EBF. Methods: This cross-sectional study was conducted in urban slums of the study city, Gujarat from July 2016 to December 2016. A total of 210 mothers were selected using cluster sampling meth- od. Primary variables studied were initiation of breastfeeding, fre- quency of breastfeeding in 24 hrs, EBF and other food given. Mul- tiple logistic regression analysis was carried out to find the factors associated with EBF. Results: Forty five percent of the mothers initiated breastfeeding within one hour of birth. 76.7% mothers had given EBF. The pre- dictors for EBF found on multivariate analysis were male child (AOR: 2.2, 95% CI: 1.1-4.5) and prior information about breastfeed- ing received by the mothers (AOR: 2.7, 95% CI: 1.3-5.9). Conclusion: Although the prevalence of EBF was high, the fre- quency of feeding in 24 hours was low among many mothers. EBF was seen more in children whose mothers received prior infor- mation about breastfeeding.

Background: The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018. Objective: To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers’ perspective. Methods: We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted ‘presumptive TB’: any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes. Results: Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision. Conclusions: The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process.

The northern part of the globe is dominated by industrialisation and is well-developed. For many years, the southern part of the world (South Asia, Africa etc.) has been a target of research concentrating on access to energy (mainly electricity) in rural regions. However, the Central Asian region has not been a focus of energy research compared to South East Asia and Africa. Despite plentiful domestically available energy resources, the energy supply in Central Asia is very unevenly distributed between urban and rural areas. Almost half of the total population of Central Asia lives in rural areas and there is a lack of access to modern energy services to meet primary needs. To analyse the energy situation (i.e., electricity, heating, hot water consumption, cooking, etc.) in rural Central Asia, this paper reviews residential energy consumption trends in rural Central Asian regions as compared to urban areas. Furthermore, the paper illustrates the potential of renewable energies in Central Asia. To perform the study, a qualitative comparative analysis was conducted based on a literature review, data, and statistical information. In summary, the presented article discusses the rural energy situation analytically and provides in-depth insights of Central Asian energy infrastructure.

BACKGROUND: Covaxin is the first indigenous vaccine developed in India against COVID-19. The purpose of this study was to analyze the news stories on Covaxin published in the online media between two statements issued by Indian Council for Medical Research on 2nd and 4th July for their content, quality of information, and reporting standards. MATERIALS AND METHODS: A systematic search was performed on Google to identify the news stories related to Covaxin in the English language published between these two statements. The selected news stories were subjected to content analysis and reviewed using the screening points developed through a consultation by two independent experts using ten prevalidated criteria for health news review. The data were analyzed in MS Excel and StataMP14. RESULTS: The final analysis included 24 news stories. The mean and median score of the news stories is 10.71 and 12 (out of 20), respectively, with a score ranging from 2 to 17. The stories did not promote disease or vaccine mongering (100%), adequately mentioned the true novelty of the vaccine (95.8%), and source of the information (83.3%). However, they mostly failed to mention the information on costs, research data related to benefits, and harms and quality of the available evidence. CONCLUSION: There is a lack of reporting of detailed analysis about the methodology of development of the vaccine and limitations in its research design by health journalists. It is important to train journalists on proper reporting of health news to improve its quality in Indian media.

Background Tobacco use has been an important public health problem in India. Tobacco cessation is considered a cost effective intervention in controlling the tobacco epidemic in terms of preventable morbidity and mortality. Readiness to quit is one of the key steps in the process towards tobacco cessation. However, it is important to know the addiction pattern in the particular region so as to initiate de-addiction initiatives. So the current study was carried out with an objective to find the addiction habits and readiness to quit addiction among patients visiting GMERS Gotri General Hospital, a tertiary care hospital attached to Medical College in Gujarat, India. Methods All the patients at the registration desk of the hospital were randomly selected during May 2015. A total of 626 patients having any form of addiction were enrolled in this cross sectional study after taking written informed consent. They were interviewed in vernacular language using a validated semi-structured questionnaire. After counseling them for quitting tobacco use, their readiness to quit was enquired and those willing were referred to de-addiction clinic in Psychiatry department. Data was entered and analysed using Epi Info Software. Results Out of 626 addictive patients registered, 97% were males, 50.8% in the middle age group and 59.3% from rural areas. The most common form of addiction was tobacco chewing (66.4%) followed by smoking (32.7%) and alcohol (19.4%). Among them 428 (68.4%) showed readiness to quit. Out of those ready to quit 198 (46.2%) were actually registered at the de-addiction clinic. Conclusions Majority of patients were ready to quit addiction, so there is a need to have an ongoing program for awareness among patients about the de-addiction services already available within the hospital to improve quit rate. An awareness kiosk at the outpatient department can be explored in further studies.

Background: In 2016, the National AIDS Control Programme (NACP) in Gujarat, India implemented an innovative intervention called ‘M-TRACK’ (mobile phone reminders once every week for four weeks after diagnosis and electronic patient tracking tool) to reduce pre-treatment loss to follow-up (LFU) among people living with HIV (PLHIV) in Vadodara district while other districts received standard of care. Objectives: To assess the effectiveness of M-TRACK in reducing pre-treatment LFU (proportion of diagnosed PLHIV not registering for HIV care by four weeks after diagnosis) and to explore the implementation enablers and challenges from health care providers’ and PLHIV perspective. Methods: An explanatory mixed-methods study design was used wherein the quantitative phase (cohort study with two groups: Vadodara district exposed to M-TRACK and Rajkot district as unexposed) was followed by a qualitative phase (descriptive study involving group interview with 16 health care providers, personal interviews with two programme managers and telephonic interviews with 16 PLHIV). Data were collected during October 2016 to February 2017. Results: During the pre-M-TRACK period (July–September 2016), the LFU proportion was similar [13% (25/191) in Vadodara; 15% (21/141) in Rajkot (p = 0.8)]. During the M-TRACK period (October–December 2016), LFU decreased to 4% (9/209) in Vadodara (exposed), whereas it remained similar at 16% (18/113) in Rajkot (unexposed) district (p = 0.02). PLHIV exposed to M-TRACK had an 80% lower risk of LFU (aRR 0.2; 95% CI: 0.1–0.5) compared with standard care, after adjusting for socio-demographics, time and clustering at district level. During interviews, M-TRACK was welcomed by both PLHIV and the counsellors. The latter felt it saved time by obviating the need for home visits and helped in documentation. Inconvenience of using landline phone available at the health facility, lack of budgets for reimbursement of mobile call expenses and internet connectivity problems were the key implementation challenges. Conclusion: M-TRACK was highly effective in reducing the gap between diagnosis and treatment. It may be considered for scale-up after addressing the challenges noted.

Background: Domestic violence is a major contributor to physical and mental ill health of the victim, and it is evident to some degree, in every society of the world. Objectives: 1) To study perception about domestic violence in the study population. 2) To compare prevalence of domestic violence within the three subgroups of the study population (i.e. spouses of psychotic patients, spouses of non-psychiatric patients and hospital staff). Materials and Methods: A cross-sectional study was conducted among married men and women coming to Dhiraj General Hospital. Interviews were conducted using a semi-structured questionnaire. Inquiry was done about their perception regarding domestic violence, own experience any time in their life, and about the form of violence. Data was entered and analyzed using SPSS. Results: 42.7% of study participants had never heard the words domestic violence. The overall prevalence of any form of violence in the study population as a whole was 32.3%. There was no significant difference found in the proportion of domestic violence among the three groups. The prevalence of physical, emotional, sexual and economic domestic violence was 16.3%, 25.3%, 2% and 11.3% respectively. Younger age group and female sex were significantly associated with the occurrence of domestic violence. Conclusion: Apart from the high prevalence of domestic violence in the present era, it is evident from the study that the participants′ perception about domestic violence was low. Efforts should be made to raise public consciousness and reporting of domestic violence and its attendant consequences.

Background: Human immunodeficiency virus (HIV) disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure. Materials and Methods: To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively. Results: Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands′ HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing. Interpretation and Conclusion: The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India.