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Introduction: The burden of non-communicable diseases (NCDs) is a major challenge for countries, regardless of their level of development. Social branding is an emerging approach to health promotion for NCD prevention. In this paper, the process of social branding is documented as a case study to help researchers develop similar kinds of interventions in the settings in which they work. Methods: The process of developing a social brand is documented through conversations with the project team, observations in the field, interaction with community local members, and information gathered through photographs, videos and newspaper clippings. Results: The social brand focused upon in this study was named the Aarogyachi Vaari (Health Pilgrimage) inspired by the Pandrapur Wari, a religious pilgrimage undertaken in the state of Maharashtra, India. Various stakeholders from self-help groups, panchayat raj institutions and schools from the local village collaborated successfully to implement the health event in a manner similar to the way in which diverse religious groups come together for the Pandrapur Wari religious pilgrimage. The Aarogyachi Vaari took the form of a strategically planned health event consisting of various health promotion stalls, many developed by local villagers themselves. The organisation of the event was aided by resource mobilisation within the local community. Discussion: Social branding can be an effective tool for health promotion in community settings. Studying people's cultural preferences and what makes them feel connected and excited can lay the foundations for the creation of a social brand that reflects their choices and helps them take up healthy behaviours on their own. It is possible to mobilise a community for health through social branding that is culturally relevant and connected to the interests and priorities of local people. [ABSTRACT FROM AUTHOR]

Psychological morbidities are one of the emerging global health problems. It affects a considerable number of ante-natal women leading to consequences during the postnatal period as well. We conducted this research to study the magnitude and determinants of psychological morbidities during pregnancy. In this study, we included 650 pregnant women from an established cohort of 2500 pregnant women and assessed the psychological morbidities among them using the GMHAT/PC tool. The overall prevalence of psychological morbidities during pregnancy was 14.6%, with anxiety and depression being the leading ones. Low education levels, lower socio-economic status, unintended pregnancy, complicated previous pregnancy, lack of family and social support, and domestic violence increased the odds of psychological morbidity. On Multivariate logistic regression, Low education levels increased the odds to more than twice [illiterate/primary schooling OR: 4.00, p = 0.026; secondary schooling OR: 2.64, p = 0.034; high school OR: 2.60, p = 0.033] unintended pregnancy [OR: 1.91, p = 0.043] and lack of family support [OR: 7.19, p < 0.001] increased the odds of psychological morbidity among pregnant women. Bringing these issues to the mainstream and addressing them by developing interventions to address them during the lifecycle of a female will help to prevent episodes of psychological stress and morbidity among pregnant females. [ABSTRACT FROM AUTHOR]

Japanese encephalitis (JE) disease among children continues in central India despite vaccination implemented in the routine immunization program. Therefore, we planned to estimate the JE vaccination effectiveness among children by undertaking a 1:2 individually‐matched population‐based case‐control study from August 2018 to October 2020. The laboratory‐confirmed JE cases aged 1–15 years were enrolled along with neighborhood controls without fever and encephalitis matched on the residence area, age and sex. The JE vaccination history was enquired from parents and verified independently from the vaccination cards available at home and records at health facilities. We enrolled 35 JE cases and 70 matched controls. The vaccination effectiveness of 86.7% (95% confidence interval [CI]: 30.8–94.7) was estimated on the per‐protocol analysis of 31 case‐control sets. The screening method provided an effectiveness of 89.5% (CI: 78.9–94.7) on using the population vaccination coverage of 90% reported earlier in the same area. In conclusion, JE vaccination offered a moderate level of protection among children in JE medium‐endemic central India, similar to reports from high‐endemic areas in India. The operational aspects of vaccination program implementation need to be evaluated to assess the impact of vaccination on the disease burden of JE in medium‐endemic regions of India. [ABSTRACT FROM AUTHOR]

We aimed to estimate the coverage of Japanese encephalitis (JE) vaccination in central India to help explain the continued occurrence of JE disease despite routine vaccination. We implemented a 30‐cluster survey for estimating the coverage of JE vaccination in the medium‐endemic areas implemented with JE vaccination in central India. The parents were enquired about the uptake of the JE vaccine by their children aged 2−6 years, followed by verification of the immunization cards at home along with reasons for non‐vaccination. Vaccination coverage was reported as a percentage with 95% confidence intervals (CI). We estimated high coverage of live‐attenuated SA 14‐14‐2 JE vaccination in Maharashtra (94.8%, 95% CI: 92.7−96.3) and Telangana (92.8%, 95% CI: 90.0−94.9). The vaccination card retention was 90.3% in Maharashtra and 70.4% in Telangana state. There were no gender differences in coverage in both states. A similar level of JE vaccination coverage was observed during the year 2013−2021 in both states. In Maharashtra, the maximum age‐wise coverage was 96.6% in the >60 months age category, whereas in Telangana it was in the <24 months age category (97.2%). The timeliness of JE vaccination was appropriate and similar in both states. We found a very good agreement between JE and measles‐rubella vaccinations administered simultaneously. The reasons for non‐vaccination were the shortage of vaccines and the parental migration for work. The coverage of JE vaccination was high in medium‐endemic regions in central India. Vaccination effectiveness studies may help further explain the continued incidence of JE. [ABSTRACT FROM AUTHOR]

The existing level of the early age pregnancy necessitates in-depth discussions and study. The objective of this study is to explore the perception of rural population regarding adolescent pregnancy with reference to the perceived burden, causes and consequences. A cross-sectional study through cultural domain analysis using free listing and participatory learning and action (PLA) tool of ten seed analysis was used for exploring the perceptions of the community. Cognitive salience was estimated using the Sutrop (Su) index. The perceived burden of adolescent pregnancy was around 18%. Early marriage (Su index = 0.274), love/relationship (Su index = 0.246), pre-marital sex (Su index = 0.215), rape/incest (Su index = 0.162), and poor educational status (Su index = 0.152) were the salient causes of adolescent pregnancy. The salient consequences identified were weak baby (Su index = 0.170), social stigma (Su index = 0.124), excessive bleeding during delivery (Su index = 0.114), mother may die (Su index = 0.112) and abortion (Su index = 0.109). Teenage pregnancy is perceived as a problem by the community. The causes of teenage pregnancy in this setting are multi-dimensional and are deeply embedded in the system of local values, beliefs and practices. [ABSTRACT FROM AUTHOR]

Background: Progress has been made in the reduction of under-five mortality in India; however, neonatal mortality is reducing at a slower rate. Efforts are required to bring down neonatal mortality in order to attain the Sustainable Development Goal-3. Prevention of sepsis among the high-risk, vulnerable low birth weight neonates by a newer intervention with probiotic supplementation is promising.Methods: A phase III, multicenter, randomized, double-blind, placebo-controlled study is being conducted at six sites in India. A total of 6144 healthy low birth weight (LBW) infants fulfilling the eligibility criteria would be enrolled within the first week of life, after obtaining written informed consent from the parents of the infant. Randomization in 1:1 ratio, stratified by site, sex, and birth weight, would be done through an interactive web response system (IWRS) using a standard web browser and email service. Vivomixx®, a probiotic containing a mix of 8 strains of bacteria, in a suspension form standardized to deliver 10 billion CFU/ml, or an organoleptically similar placebo would be fed to enrolled infants in a 1-ml/day dose for 30 days. The follow-up of enrolled infants for 60 days would take place as per a pre-specified schedule for recording morbidities and outcome assessments at the six participating sites. Screening for morbidities would be conducted by trained field workers in the community, and sick infants would be referred to designated clinics/hospitals. A physician would examine the referred infants presenting with complaints and clinical signs, and blood samples would be collected from sick infants for diagnosis of neonatal sepsis by performing sepsis screen and blood culture. Appropriate treatment would be provided as per hospital protocol. The study would be implemented as per the MRC guideline for the management of Global Health Trials in accordance with ICH-GCP and Indian Regulatory guidelines. A contract research organization would be engaged for comprehensive monitoring and quality assurance. The final analysis would be conducted in a blinded manner as per the statistical analysis plan (SAP) to estimate the primary outcomes of sepsis, possible serious bacterial infection (PSBI), and secondary outcomes. The codes will be broken after DMC permission. The protocol has been reviewed by the Research Ethics Committee of the Liverpool School of Tropical Medicine (REC-LSTM), from Research Ethics Committees of the six subject recruitment participating sites.Discussion: This adequately powered and well-designed trial would conclusively answer the question whether probiotics can prevent neonatal sepsis in the high-risk group of low birth weight infants as indicated by a pilot study in 1340 LBW infants, evidence from systematic reviews of hospital-based studies, and a primary study on healthy newborns in Orissa. Results of the study would be generalizable to India and other low-middle-income countries.Trial Registration: Clinical Trial Registry of India (CTRI) CTRI/2019/05/019197 . Registered on 16 May 2019. [ABSTRACT FROM AUTHOR]

Background: Community participation is one of the core principles of primary healthcare. The village health nutrition and sanitation committee (VHNSC), one of the elements in implementation of the National Health Mission (NHM), is an example of community participation. There are not many studies conducted to assess the actual participation of VHNSC in health-care delivery at the village level. Objective: The objective of the study is to develop a VHNSC Maturity Index (VMI) and pilot it to assess the institutional maturity of VHNSC. Materials and Methods: This community-based, cross-sectional study was conducted in 83 villages under four Primary Health Centres (PHCs) of the Wardha Community Development block. VMI was developed, Through several discussion sessions with VHNSC members and staff of the DCM; observations of VHND; attending VHNSC monthly meetings; the VMI was finalized after piloting it in all the four PHC areas. Results: All the 83 VHNSCs were constituted as per norms led down under NHM. Forty-eight (57.8%) VHNSCs had developed an annual Village Health Action Plan, 72 (86.7%) VHNSCs had ≥4 meetings held in the past 6 months, and ≥70% attendance in the past 6 months was observed in 40 (48.2%) VHNSCs. A majority of 82 (98.8%) VHNSCs helped in organizing the village health and nutrition day, 59 (71.1%) VHNSCs monitored the implementation of national health programs. The entire untied fund received in the previous year was utilized by 68 (81.9%) VHNSCs. Conclusion: The study shows that VMI can be used for continuous monitoring and assessment tool for VHNSC to evaluate and plan different health activities. [ABSTRACT FROM AUTHOR]

Background: Depression is the most common psychiatric disorder among elderly population in India, yet, it is commonly misdiagnosed and undertreated. The exact burden of depression among the elderly population in rural India was not known. Objectives: To study the magnitude of depression among the elderly masses in rural Maharashtra and to find its correlates. Material and Methods: This is a cross sectional study, carried out among the elderly (≥60 years) population of both sexes residing in the field practice area of the department of community medicine. Geriatric depression scale was used for screening depression among the study population. Data collection was completed within 2 months using convenience sampling. Ethical approval was taken before beginning the study. Magnitude was expressed in percentage along with its 95% confidence interval (CI). Univariate and multivariate logistic regression was carried out to study associated correlates. Odds ratio and 95% CI was used to express association. Results: The magnitude of depression among the elderly population was found to be 41.7% (95% CI 36.1-47.4). We got the significant positive association of female sex, living without spouse, lacking in decision making capability, a victim of abuse or neglect, or suffering from chronic illnesses with depression among elderly population in univariate analysis that did not hold good in the multivariate logistic regression. Our study showed the prevalence of mild depression among elderly to be 26.72% and that of severe depression to be 15.17%. Conclusion: To deal with this huge social problem of depression among the elderly population, more enthusiastic steps should be undertaken. [ABSTRACT FROM AUTHOR]

Objective We report the epidemiology of Japanese encephalitis (JE) disease after the implementation of routine immunization in medium-endemic districts in the states of Maharashtra and Telangana in Central India. Methods We investigated acute encephalitis syndrome (AES) patients hospitalized from October 2018 to September 2020. Field visits were also made to the residences of 262 AES cases, including 54 JE cases. Results The overall case fatality ratio was 31%. Maharashtra state contributed 72% of JE and 67% of AES cases. The rural localities had a significantly higher number of JE cases than the urban areas. The occurrence of JE was reported year round, with most JE cases reported during the rainy season. Both AES and JE cases were reported mostly among children, with JE in 66% and non-JE AES in 70% of children. Conclusion The JE disease continues to affect the population after routine immunization. Surveillance, prevention, and control need to be enhanced to achieve accelerated control. [ABSTRACT FROM AUTHOR]

Background & objectives: In India, health expenditure accounts for less than 5 per cent of the Gross Domestic Product and the level of out-of-pocket (OOP) spending is 69.5 per cent of total health expenditures. OOP expenditure exacerbates poverty and has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. This study was conducted to estimate the OOP expenditure on health and catastrophic health expenditure and their socio-demographic determinants in a rural area of Maharashtra, India. Methods: This was a prospective observational study involving monthly follow up visits, done in 180 households of three villages under a primary health centre in Wardha district, India. Results: Of the 180 families, 18.9 per cent had catastrophic health expenditure over a period of one year. The median total out-of-pocket health expenditure was ₹ 1105.00 with median medical expenditure being ₹ 863.85 and median non-medical health expenditure being ₹ 100.00. A total of 151 (83.9%) had enough money, 27 (15%) borrowed money and two (1.1%) of them sold assets. The significant correlates for the ratio of out-of-pocket health expenditure to total annual income of the family were the occupation of head of family, caste category and type of village. The significant correlate for catastrophic health expenditure was type of village. Interpretation & conclusions: Around one-fifth of the households had catastrophic health expenditure. People with no healthcare facility located in their village had higher odds of having catastrophic health expenditure. Private providers were preferred for the treatment of acute illnesses and medical college hospitals for hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: To compare the difference between the growth and developmental status of the children who were residing in the area where Inclusive Early Childhood Development (IECD) project was being implemented and who had received interventions through trained Anganwadi workers (Frontline workers) under Integrated Child Development Services (ICDS) scheme with the children who had not received the Inclusive ECD project interventions., Methods: It was a mixed method cohort study, nested in an ongoing project in a medical college in which Inclusive ECD was used as an intervention through International Guide for Monitoring Child Development (GMCD) which is a tool for both monitoring and assessment with the help of existing government structures and personnel such as Anganwadi workers, Anganwadi supervisors and their contact points with communities. A sample of 200 children was selected; 100 each from intervention group (IECD cohort) and comparison group (Usual care cohort) and were followed till the child became 2 y of age., Results: IECD intervention showed statistically significant effect on weight (p = 0.04) and height (p = 0.03) of the IECD cohort. Overall developmental assessment showed that the identified developmental issues (Concerns + Delays) were approximately half in IECD cohort (9.67% + 5.37% = 15.04%) as compared to usual care cohort (17.20% + 11.82% = 29.02%). The results from binomial logistic regression performed for developmental outcomes were statistically significant (p = 0.04) suggesting that children with IECD intervention have lower odds of developing developmental issues., Conclusions: The study indicates that it is possible to implement IECD interventions through frontline workers, which significantly improves the growth and development of the children., (© 2024. The Author(s), under exclusive licence to Dr. K C Chaudhuri Foundation.)