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Background: Coronavirus was first officially reported in Wuhan city of China in December 2019. As this novel coronavirus spread rapidly throughout the world, health care workers faced many difficulties addressing the pandemic. In the present study, we explored the challenges faced by front-line health managers on human resource management, execution of the central policies, and training and in formulating innovative approaches during the coronavirus disease 2019 (COVID-19) pandemic in India. Methods: A qualitative study was conducted using framework analysis among front-line health managers concerning COVID-19 management at the district level. We conducted 120 in-depth interviews among eight states with the use of an interview guide. Results: The results are described under five sections: ‘challenges of front-line managers in policymaking and its execution’, ‘human resource management’, ‘gaps in local execution of central policies’, ‘challenges in training workforce and data management’, and ‘innovative approaches adopted during COVID 19’. Conclusions: We observed that a centre-down approach was not appreciated much. Many participants felt that there was a need to understand the local context and appropriate amendment. The private system is a part of the Indian health system and can never be ignored; thus, all guidelines should include the private system. more...

Background: The postgraduate curriculum needs to be given a definite shape so as to make health programs more intensive and integrative. In the present scenario, most of the information is unclear and infrequent. A structured public health competency-based education is an important aspect to consider for integrative health care. Evaluate the structured competency-based curriculum (SCBC) prepared on health program matters. Methods: Mixed method model involving postgraduate students, faculties in community medicine departments of selected medical colleges and stakeholders from district administration. The SCBC was piloted and validated for use. The evaluation was then done based on pre- and posttest performance analysis, satisfaction survey, and questionnaires for reaction and learning components. Results: For a complete understanding of the program, students had to invest 52 hours of stipulated time. CBC assessment mean scores for a) problems in PHC and programmatic evaluation (78.9%) and b) identification of success and failure of programs (78.2%) were more than 75% mean score; whereas, assessment scores for topics on a) resource allocation and b) evaluation of program as write-up was 65% and 52%, respectively. As compared to the conventional method, the SCBC showed a critical evaluation score of 70% with a 0.001 significance level. Discussion and Conclusion: Students’ narratives were that they could understand as well as integrate them better on the field. There was enhanced satisfaction and encouragement. Structured curriculum will also help in making learning more student-centric and go a long way in boosting their creativity. more...

Abstract Background The Life-Space Assessment (LSA) is an instrument that measures mobility in older adults as they reach different areas, defined as life-spaces extending from home to beyond towns or regions. The purpose of the study was to develop the Hindi version of the LSA (LSA- H) and to investigate the validity and reliability of the Hindi version as well as its cultural adaptation. Methods A cross-sectional study of two hundred forty-five older adults participated in the study from four different study practice areas. Following forward backwards translation, the LSA-H was developed, and the scores were correlated with those of the Activities-Specific Balance Confidence Scale Hindi (ABC- H), the Physical Health Subscale of the WHO-BREF Questionnaire and the Geriatric Depression Scale: Short Form Hindi (GDS-SFH) to test the criterion and concurrent validity. Results The mean score and standard deviation of the LSA-H questionnaire were 56.53 ± 35.99, those of the Physical Health Subscale of the WHO-BREF instrument were 18.54 ± 7.87, those of the GDS-SFH questionnaire were 6.95 ± 4.21 and those of the ABC- H questionnaire were 54.40 ± 28.96. The Pearson correlation coefficient (r) between the LSA-H score and ABC-H score was 0.707 (p value more...

Over the past few decades, hypertension (HTN) has affected both young and old people. The public health problem has an enormous economic impact on societies as well. The present review aimed to understand and compare the differences from the available literature on HTN treatment at the primary care level in various states and at the national level in India. We reviewed the latest international, national, and state guidelines/protocols available for the treatment of HTN. In addition, we also searched the PubMed database with relevant Medical Subject Headings terms and included the articles published in the last 5 years. A total of 204 articles were screened and finally, eligible 5 articles were included in the review. International guidelines preferred thiazide diuretics as a drug of choice. While the state protocols and national guidelines preferred calcium channel blockers, followed by angiotensin receptor blockers as the drug of choice. All these guidelines focused on low-dose monotherapy. These guidelines also summarized additional drugs required in case of comorbid conditions. However, the new Essential Medicine List published by the World Health Organization prefers low-dose fixed-drug combination (two-drug regimen) at the primary care level for treatment of HTN. There was not much cost difference between monotherapy and fixed-drug regimens based on the published studies. With due rise in HTN cases, the standardized protocol is ubiquitously needed for better application, comparison, and streamline of the program. Fixed-drug combination therapy can be considered for better control rates among hypertensives by improving adherence and efficacy. more...

Introduction: Many plans and policy changes about health outcomes have evolved, but none of them have ever given a definite shape to the postgraduate (PG) curriculum so as to make it more intensive and integrative, which needs to be so structured and tailored that it is more patient, community centric, and less knowledge based. Objectives: The objective of this study was to identify the gap in existing curriculum in learning of health policy and program among PGs of community medicine and recommend a structured model for the same. Materials and Methods: A qualitative study (grounded theory approach) with all PGs of community medicine in one teaching institute in South India (8 PG students) was taken up. Results: PGs felt that they never had any day-to-day update. They wanted to understand the working pattern and ground reality of policy and program which was unavailable to them. People who came to postgraduation after being medical officers felt that the monitoring and evaluation done by inexperienced MD Community Medicine students was never accepted by state public health because they did not understand the implementation problems and so could not rightly critically evaluate the programmatic challenges. Conclusion: With the shift in medical education patterns and expectations of residents, it becomes important to justify the need of developing a structured based curriculum, more so for policy and programs, which will make them capable enough by polishing their managerial and financial skill set. The evaluation technique should focus more on practical aspects on field instead of their theory examination. more...

BACKGROUND: Tobacco use remains a significant global health challenge, contributing to 8 million annual deaths and potentially reaching 1 billion deaths in the 21st century. Despite taking efforts like India’s National Tobacco Control Program, the country faces a persistent 39% tobacco use prevalence, particularly in low-income communities like those from Madanpur Khadar, Delhi. This study explores the effectiveness of behavior modification therapy in addressing this challenge. MATERIALS AND METHODS: In a community-based trial, 400 adult tobacco users from Madanpur Khadar were enrolled and randomization and allocation concealment were done (CTRI no.: CTRI/2021/06/034298). Participants were randomly assigned to intervention and control groups during the study period of 18 months. Data on sociodemographic characteristics, smoking behaviors, and motivation levels were collected. The intervention included behavior modification therapy, while the control group received brief advice. Motivation levels were assessed using the contemplation ladder, and carbon monoxide levels were measured with piCO + Smokerlyzer. The study adhered to ethical considerations and obtained approval from Jamia Hamdard’s Institutional Ethical Committee. RESULTS: Sociodemographic characteristics revealed a predominantly male (88%) population, aged above 30 years (68.5%), with lower middle class representation (51%). The intervention group exhibited a 7% smoking cessation rate, which is significantly higher than the control group (1%). piCO+ Smokerlyzer confirmed a 41.7% reduction in carbon monoxide levels among participants in the intervention group. High motivation levels correlated with successful quitting, with a 6.5 times higher odds ratio for highly motivated individuals compared to low or moderately motivated ones. CONCLUSIONS: The study highlights the cost-effective impact of behavior modification therapy in promoting tobacco cessation, particularly in resource-constrained settings. The significant association between motivation levels and quitting underscores the importance of tailored interventions in public health initiatives aimed at reducing tobacco use. more...

Background: Multimorbidity is being recognized as a crucial maternal health challenge in India. However, pregnancy remains an exclusion criterion in most multimorbidity estimation studies resulting in a deficient understanding of the problem in this population. The present study aims to estimate the prevalence of multimorbidity, identify its correlates, and assess healthcare utilization and expenditure outcomes among women availing of antenatal care clinics. Methods: An exploratory cross-sectional study was conducted among 127 pregnant women attending three antenatal clinics of Bhubaneswar, Odisha, from February to July 2016. Data were collected using a “multimorbidity assessment questionnaire for primary care,” contextualized for antenatal settings. The prevalence and correlates were determined using descriptive analysis, and the outcomes were measured by the number of healthcare visits, medications, and healthcare expenditure. About 15% of antenatal women were multimorbid. Result: Anemia (52.6%), hypertension (31.6%), acid-peptic diseases (26.3%), and thyroid (26.3%) were the leading chronic conditions. Statistically, significant association was found between multimorbidity and medical consultation, the medicines consumed, and functional limitation. The healthcare expenditure was significantly higher among the multimorbidity groups. Conclusion: Our findings suggest the inclusion of comprehensive multimorbidity assessment in routine antenatal screening. Preconception care should establish linkages between maternal and reproductive health with chronic disease prevention, and identify ways to reduce healthcare utilization and expenditure. Longitudinal studies to assess the trajectory and impact of multimorbidity on maternal and infant health are warranted. more...

Introduction: Type 2 diabetes mellitus is a serious, progressive condition presenting with chronic hyperglycemia. Its prevalence is gradually increasing at a global level. A diabetic has to make multiple choices daily about the management of their condition, such as appropriate dietary intake, physical activity and adherence to drugs. There is hardly any input from a healthcare professional for guidance on a daily basis. Objectives: The aims of this study were to assess the change in knowledge by using various methods of health education as intervention and to compare the effect of technology as a tool of health education as compared to conventional methods of health education. Materials and Methods: A community-based interventional study was done in the field practice area of our Institute in South India. Two groups of people were selected from 40 adopted houses. One from urban; for intervention with technology, that is, health education using videos and the second group from rural population; for intervention with conventional method of health education, that is, using charts. Results: The mean baseline knowledge score in urban and rural area was 3.76 and 9.97, respectively. There was statistically significant increase in knowledge among both the groups. By the use of technology in the urban population knowledge level increased from 3.76 to 10.15 and was found to be statistically significant. The difference in increase in knowledge was higher in the technology group as compared to conventional group. Conclusion: In the era of smartphone, technology-based health education can reduce the total health care manpower which is deficient. Technology is a boon to introduce lifestyle modification in chronic diseases like Diabetes Mellitus. more...

IntroductionHealthcare workers (HCW) are most vulnerable to contracting COVID-19 infection. Understanding the extent of human-to-human transmission of the COVID-19 infection among HCWs is critical in managing this infection and for policy making. We did this study to estimate new infection by seroconversion among HCWs in recent contact with COVID-19 and predict the risk factors for infection.MethodsA cohort study was conducted at a tertiary care COVID-19 hospital in New Delhi during the first and second waves of the COVID-19 pandemic. All HCWs working in the hospital during the study period who came in recent contact with the patients were our study population. The data was collected by a detailed face-to-face interview, serological assessment for anti- COVID-19 antibodies at baseline and end line, and daily symptoms. Potential risk factors for seroprevalence and seroconversion were analyzed by logistic regression keeping the significance at pResultsA total of 192 HCWs were recruited in this study, out of which 119 (62.0%) were seropositive. Almost all were wearing Personal protective equipment (PPE) and following Infection prevention and control (IPC) measures during their recent contact with a COVID-19 patient. Seroconversion was observed among 36.7% of HCWs, while 64.0% had a serial rise in the titer of antibodies during the follow-up period. Seropositivity was negatively associated with being a doctor (odds ratio [OR] 0.35, 95% Confidence Interval [CI] 0.18-0.71), having COVID-19 symptoms (OR 0.21, 95% CI 0.05-0.82), having comorbidities (OR 0.14, 95% CI 0.03-0.67), and received IPC training (OR 0.25, 95% CI 0.07-0.86), while positively associated with partial (OR 3.30, 95% CI 1.26-8.69), as well as complete vaccination for COVID-19 (OR 2.43, 95% CI 1.12-5.27). Seroconversion was positively associated with doctor as a profession (OR 13.04, 95% CI 3.39-50.25) and with partially (OR 4.35, 95% CI 1.07-17.65), as well as fully vaccinated for COVID-19 (OR 6.08, 95% CI 1.73-21.4). No significant association was observed between adherence to any IPC measures and PPE adopted by the HCW during the recent contact with COVID-19 patients and seroconversion.ConclusionAlmost all the HCW practiced IPC measures in these settings. High seropositivity and seroconversion are most likely due to concurrent vaccination against COVID-19 rather than recent exposure to COVID-19 patients. Further studies using anti-N antibodies serology may help us find the reason for the seropositivity and seroconversion among HCWs. more...

Introduction: The burden of frailty and aging will have a profound impact on the economy along with the deteriorating clinical condition of the olds. Aim: This study aim was to assess frailty of an ethnogeriatric cohort and associate it with domains of quality of life in Delhi along with a follow-up outcome assessment. Method: Edmonton frail scale on an ethnogeriatric cohort of 200 individuals in periurban slums of Delhi was used and associated with quality of life, calculated by the WHO-BREF –QOL questionnaire. An interventional strategy for healthy aging was adopted, and a follow-up outcome assessment was done to look out for mortality or morbidity. Result: There were 37% frail with a mean score of 60 and 25% prefrails beyond 60 years with a significant increase in frailty with age. Females, single, working, and illiterate elderly were frailer as compared to their counterparts. Social domain followed by psychological domain of the QOL had least scores in the frail elderly. Olds, away from their place of origin were 25 times more likely to be frail and had lesser family integration, assessed by regression analysis. Nearly 6% died, with 21% of hospital readmissions after a 6-month follow-up. Discussion: An earlier start of assessment would give us more time to react and respond and be pro-active for healthy aging besides taking into consideration the diverse ethnography in our country. Conclusion: Cross-cultural variations need the physicians to address the health care disparities and language barriers so as to make interventions more convenient. more...

Background: Multimorbidity, the co-occurrence of two or more long-term conditions (LTC) in individuals, is associated with greater healthcare utilization, expenditure, and premature mortality, thus positing a challenge for patients and healthcare providers. Given its sparsely available epidemiological evidence, we aimed to describe the profile of multimorbidity in a representative sample of public healthcare outpatients in India. Methods: A facility-based cross-sectional study was conducted from 1st July to 31st December 2015 in Odisha, India. Fifteen public healthcare facilities were selected by stratified random sampling. Data was collected from 1,870 adult outpatients attending these settings using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool. Result: Nearly 3/4th of both women and men outpatients were either obese or overweight. >1/2 had multimorbidity (≥2 LTC) while 1/3rd had ≥3 LTC. Most prevalent condition was hypertension (63%), followed by chronic backache and arthritis. Cancer and psychiatric illness were least reported. Multimorbidity increased with age group, socioeconomic status, and education level. Females across all age groups had higher reported multimorbidity than males. Diabetes--hypertension was frequently occurring dyad. Both physical and mental component of quality of life was reduced in multimorbidity. Conclusion: Multimorbidity is becoming a norm in healthcare practice with high prevalence in females and older adults. Health services for non-communicable diseases need to include commonly occurring dyads along with health promotion. Higher prevalence in females reinforces the need to incorporate gender differences while studying multimorbidity. Analysis of multimorbidity epidemiology through an equity lens could illuminate the underpinning complexities and heterogeneities of this phenomenon. more...

Background: Understanding the perception and concerns of people about COVID-19 vaccine in developing and populous country like India will help in understanding demand for the vaccine and further tailoring out public health information and education activities. The study was carried out to assess the present state of knowledge people have about the probable vaccine for COVID-19, to know the preferences of respondents about this vaccine and to learn the expectations and apprehensions of people about features of this prospective COVID-19 vaccine residing in the capital city of India. Methods: This cross-sectional study was conducted amongst the residents of Delhi, India from July to October 2020. Both offline and online interview method was used to collect date from 513 participants representing various occupational strata. Data were collected on sociodemographic variable, vaccine acceptance and concerns regarding COVID-19 vaccine. Results: Among the study population, 79.5% said they will take the vaccine while 8.8% said they were not going to take the vaccine and remaining 11.7% had not yet decided about it. More than 50% were willing to pay for the vaccine and 72% felt vaccine should first be given to health workers and high-risk group. Conclusion: The following study has helped to understand the percentage of people who are hesitant to take the vaccine and also the concerns regarding the vaccine. Also since half of the population is willing to pay for the vaccine, a strategic approach considering the various economical classes of people could be applied in a developing country like India. more...

This study aimed to do a situation analysis of Telangana and systematically map the research done in the area of fluorosis and its health risks. Identify existing gaps in the available literature and unsheathe the challenges and threats in the progress so far among the people living in fluorine-contaminated zones in India. After weighing our research question, we adopted an iterative process for our search strategy by including electronic databases. A quality check was performed and guided as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses–scoping review (SCR) for SCRs which included details of the study type, setting, bias, funding, etc. It was found that out of the 15 studies summed up, most of them (>95%) had been conducted in South India. Nearly 27% of the studies were trials or experimental studies, 20% were studies involving groundwater sample testing, and few were in vitro studies. Nearly 26% were conducted on animals to see for interventions. With a total of 12,382 habitat affections, we found that Rajasthan had the highest fluoride habitation. There was a need to focus more on the seemingly less important. Many programs in India focus on risk assessment and healthy behavior. Although population affection as depicted by the Indian data statistics from the department of drinking water and sanitation show values as low as 0.01% affection for a few endemic states, they scale up to include and paralyze the lives of a lot many people in the 1.3 billion nations. At a cost, where these lives can be saved from living in suffering, what we need is mere pro-activeness, being responsible, integrating methods to tackle, using local methods to prevent, adequate nutrition, and rehabilitation. more...

Background: New Delhi is located in seismic zone IV, and the occurrence of earthquake is fairly common. Previous disasters have shown that only sustained and timely action to reduce risk can prevent or mitigate the impact of a disaster. Objectives: The objective was to assess the knowledge and preparedness regarding earthquake among the residents of South Delhi and to impart the awareness and assess the effectiveness of the awareness imparted. Methodology: One group pretest–posttest quasi-experimental research was done among 300 respondents on earthquake preparedness. Results: As per the study, 89% of participants felt that earthquake is a concern for Delhi. It was observed that majority of the population are not prepared to handle large scale disaster. Significant association was found between pretest and posttest knowledge assessment scores of the study population. Conclusion: Disasters due to their unpredictable occurrence are difficult to tackle, but awareness and preparedness to face the calamity will help to reduce the burden of disaster. more...

The United Nations Population Fund suggests that the number of elderly persons is expected to grow to 173 million by 2026. The aging phase is further made adverse by conditions such as failty, multimorbidity and polypharmacy. Aim: To assess the status and associates of frailty among elderly (>60 years) residing in a peri-urban slum area in Delhi by using the EDMONSTON Frail scale and evaluate the interplay of multimorbidity (MM) and polypharmacy (PP) on the frail pre-frail spectrum of the community-dwelling elderly cohort. Method: A community study from Dec 2018 till July 2019 with a sample size of 300 participants who were willing and consented to the study. Frailty was assessed and the STOP criteria was used for PP assessment. Result: There were 76 frail, 51 pre-frail, and 173 non-frail elderly. A higher prevalence (51%) of multimorbidity among the pre-frails and a higher probability (74%) of polypharmacy among the frails were found. Of the total in the frail-prefrail spectrum (127), 29.1% had multimorbidity (MM) and 39.4% had polypharmacy (PP). MM and PP were significantly higher among the old. Factors such as sex, marriage, loneliness, social circle, and education also had a positive bearing on the frailty-prefrailty spectrum. The working group had an increased (86%) probability of PP with statistical significance. Regression analysis depicted significant increased odds of MM and PP among female, illiterate, very old, lone, and single subjects. Discussion and Conclusion: Thus, we recommend earlier and timely intervention for the frail-prefrail which can revert their adversities. more...

Context: Tuberculosis (TB) is among the top ten causes of mortality, and to control this growing burden of disease, it is imperative that all TB patients receive the same quality of care, based on the best evidence available. The best practices for TB as enshrined in the International Standards of TB Care (ISTC) if adhered to can expedite the efforts to control TB. Aims: The aim of the study was to evaluate the current practices for diagnosis and treatment of TB among the private medical practitioners against benchmark practices in ISTC and to assess the factors associated with adherence to ISTC. Subjects and Methods: A cross-sectional study was conducted among fifty private practitioners (PPs) of Delhi over a period of 3 months. Data collection was done using a structured pro forma, and interviews were conducted privately in the PPs' office. The key outcome variable was the proportion of practitioners adhering to the ISTC standards of diagnosis (standards: 1–6) and treatment (standards: 7–13). Results: Among fifty practitioners, 42% were found to be adherent, while 58% were found to be non-adherent. Significant association was found between gender and any form of training/sensitization received in the Revised National Tuberculosis Control Program (RNTCP) (P < 0.05). Conclusion: As the adherence to the ISTC care among the PPs was poor, there is a need to train and give incentives to participating PPs in timely and regulated way. PPs play a key role in diagnosing and treating TB patients, and hence, timely training and orientation in RNTCP and standard treatment for TB care are essential and should be key priority areas. more...

Background: Girls' health and education form the cornerstone of development and the gateway to full participation as women in political, economic, and cultural life of a country. Poor menstrual hygiene management has been shown to result in a sense of shame, anxiety, and embarrassment that contributes to absenteeism and poor performance at school. The objectives of this study were to determine the percentage of girls absent from school during menstruation, to evaluate the various factors associated with school absenteeism during menstruation, and to assess the practices regarding menstrual hygiene. Materials and Methods: A mixed method research of combined cross-sectional study and qualitative research was conducted in six government schools of Delhi by means of a questionnaire survey and focus group discussions. The sample size was 600 adolescent girls. Results: Out of 600, 245 (40%) girls remained absent from school during their menstruation. School absenteeism was significantly associated with the type of absorbent used, lack of privacy at school, restrictions imposed on girls during menstruation, mother's education, and source of information on menstruation. Nearly 65% reported that it affected their daily activities at school and that they had to miss their class tests and classes as a result of pain, anxiety, shame, anxiety about leakage, and staining of their uniform. Conclusion: Since mothers are the primary source of information, they should be counseled to dispose of their taboos about discussing issues related to menstruation. They should be taught about the ill effects of adhering to taboos related to menstruation. The curriculum on general biology should have more detail on menstruation. more...

Background: Promoting family planning practices aid considerably in attaining Millennium Development Goals by various mechanisms. Despite concerted health system efforts, adoption of especially reversible contraceptive methods such as intrauterine devices (IUDs) has remained negatively skewed in India, which is the pioneer country to implement Family Planning programme way back in 1952. Although few studies in India have looked into the reasons for its nonacceptance, literature from Odisha was scant and hence the study was undertaken. Methodology: A cross-sectional study using qualitative methods was done in the Mahanga Tehsil of Cuttack district. In-depth interviews were conducted with women of reproductive age (WRA) and focused group discussions (FGDs) among health workers and health professionals were held separately. Data analysis was done using thematic framework approach supported by Atlas Ti software. Results: There were 31 in-depth interviews with WRA, two FGDs with health workers, and one FGD with health professionals. Availability of IUD services was low and wherever available, being located far away affected its physical accessibility. Most women were reluctant to ask health workers about services owing to their shyness while many women felt using IUDs breached their autonomy and privacy. The existence of fear and misconceptions regarding its use rooting from lack of knowledge and poor service quality also impeded its adoption by women. Conclusion: There is a pressing need to enhance the demand of IUDs by dispelling the myths among women through effective information, education, and communication and also to improve the availability of IUDs. more...

Today, health has transcended national boundaries and become more multifaceted. Global health has evolved as a new paradigm and is recently being identified as a thrust area now in India. Despite an existing need for a standardized global health curriculum, there is little information available on its education and curriculum in medical and health education space. In the Indian context, we are yet to have a fuller picture of the current status, including, content, structure, selection, teaching methods of global health, and how students are evaluated in India. The objective of this study was to map courses relating to studies on global health in India and analyze its mode of delivery. A detailed Internet search was carried out to identify global health courses and analyzed for: (i) whether global health is a part of the teaching curriculum, (ii) mode of teaching, (iii) broad contents, (iv) instructional formats, (v) assessment, and (vi) selection process. It was found that delivery of global health education in India was fragmented with limited focus at the undergraduate and postgraduate levels. Global health teaching was largely based on certificate courses or online courses, with hardly any institutions imparting a distinct global health education program. There is also no definite specification as to which institutes can impart teaching on global health education and what the specific eligibility requirements are. Our analysis suggests that efforts should be directed toward integrating global health education into broader public health curriculum. At the same time, the need for generation of global health leaders, creation of a common forum for addressing merits and demerits of global health issues, as well as creation of more opportunities for placements are recognized. more...

INTRODUCTION: India being a disaster-prone country necessitates us to be able to act proactively for any sort of preparedness and prevention. This necessitates a curriculum which can bring all the aspects related to disaster under one umbrella and thus impart training. AIM: The aim of the study was to assess the responses of students about the importance of disaster management (DM) in their MBBS course, take up suggestions about the important inclusions to be made in their curriculum, and get an insight of the higher education and research of DM domain in the Indian context. METHODOLOGY: A cross-sectional study with a batch of 100 MBBS students purposively sampled were part of the questionnaire. Besides, a thorough Internet search for institutes providing training on DM was done, and relevant details were noted down. Later on, the students were given guest lectures and demonstrations by certified trainers and experts along with a know-how of where to go for getting a hands-on training and whom to respond to. RESULTS: Seventy-two percent of the students felt the portion of DM being taught to them to be insufficient, and 95% never got any training or demonstration for DM although 22% felt that it is not so important for them as a doctor. Only 23% of them knew about any sort of DM courses or certifications in India, and almost 16% of the students were confident enough to tackle any incidence of public health emergency. CONCLUSION: Making an earlier start will impart seriousness and accountability in the mindset of budding physicians. more...

Objectives: The objective of this study was to find out practices related to delivery and antenatal care (ANC) among a group of females in a rural block of Haryana. Materials and Methods: We conducted a study in the block Lakhanmajra, which is a rural field practice area attached to Department of Community Medicine, Post Graduate Institute of Medical Sciences, Rohtak. A total of 210 study subjects were selected out of a cluster sampling and they were interviewed by a pre-tested, semi structured schedule. Results: It was found that only 72% of females received ANC. Tetanus coverage was 95.7% and 4.3% females did not receive even a single dose of tetanus toxoid. More than half of the subjects (55%) were not consuming adequate number of iron folic acid tablets. Almost 24.7% deliveries were conducted at home and nearly 50% of deliveries were in government facility. Still 4.7% deliveries were attended by untrained persons. Conclusion: Uptake of the services provided is far from universal even in settings where they are widely available. Utilization of ANC services and promotion of institutional deliveries should be increased by enhancing awareness among females, ensuring availability of health staff, improving the quality of services in government setups and training of the entire untrained traditional birth attendant. ANC plays a critical role in preparing a woman and her family for child birth by establishing confidence between the woman and her health care provider. more...