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One of the major challenges of Reproductive and Child Health Programme in India is addressing the barriers in communication and improve dialogue between diverse stakeholders, particularly women in the community. Through a qualitative study conducted in one of the rural districts of India, it was attempted to understand the factors affecting women's decision-making process. It is observed that most of the factors are affected by strong intrinsic environment and hence it becomes important for programme managers to understand the environment first in order to design an acceptable and effective communication strategy. In this study, knowledge, tradition, stigma and accessibility of services are identified as the key primary factors affecting decision making of women in the community, particularly on their health related issues. These in turn are governed by various supporting factors. Finally, it is observed that communication strategies can achieve their desired objective only when the local intrinsic environment is taken into cognisance.

BackgroundDuring 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. ObjectiveIn this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care programs. MethodsA two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. ResultsOut of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. ConclusionsOverall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial RegistrationClinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27

Essential medicines or drugs are recognized as highly cost-effective components within contemporary healthcare, demonstrating significant potential for improving health outcomes. The provision of essential medicines directly impacts the functioning of healthcare facilities, resulting in financial hardship. This review aims to fill knowledge gaps by examining obstacles hindering access and utilization of essential medicines in India. This study conducted a comprehensive evidence synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to analyse articles on the availability and utilization of essential medicines in India. The search strategy included various databases and keywords. Published, peer-reviewed articles focusing on the National/ State List of Essential Medicines and meeting specific criteria were considered. Data items included essential medicines, drug availability, utilization, and challenges. Data was extracted, synthesized, and analysed using thematic framework analysis. Out of 1,129 articles, 11 were selected for review. Studies consistently highlighted the inadequate availability of essential medicines in different Indian states. Availability of essential medicines varies in the range of 17-51 percent across major states of India. Stock-outs of medicines vary from 4 to 14 weeks. Governance issues including differential procurement mechanisms across states of India, hinder seamless availability of essential medicines. Other challenges included distribution and purchasing system inefficiencies, governance-related issues, and facility/ user-level challenges impacting drug utilization. Disruptions in utilization were observed due to improper prescription practices and non-availability of affordable options. Accessibility and affordability also affected drug utilization. Issues with supply chain management and conflicting guidelines further contributed to the obstacles faced in ensuring availability and utilization of essential medicines in India. Ensuring the availability, accessibility, and affordability of essential medicines is of utmost importance. The public health system needs to strengthen its procurement and distribution management. Strengthening the logistics support for an efficient supply of essential medicines will reduce the time lag in receipt of drugs. Guidelines on essential drugs prepared by the National Health System Resource Centre need to be strictly adhered to and monitored in inventory management system. There is an urgent need to develop a sustainable model for achieving uniformity in the availability and utilization of essential medicines in India.

Background: Work-related musculoskeletal disorders (WMSDs) are the second most common cause of disability, accounting for 17% of all Years lived with a disability (YLDs) worldwide. Healthcare professionals, especially dentists, are known to be at a higher risk of WMSDs. Therefore, this study aims to determine the point and period prevalence of WMSDs among dentists and to assess the risk factors for WMSDs, including workstation analysis. Methods: This cross-sectional study was conducted among 120 dentists from three dental colleges in Gujarat (Ahmedabad and Gandhinagar), India. A structured questionnaire was used to collect sociodemographic and occupational history along with pre-validated standardized tools such as the Nordic Musculoskeletal Questionnaire (NMQ), Rapid Entire Body Assessment (REBA) score sheet and Quick Exposure Checklist (QEC). Data analysis was performed using SPSS version 20. Results: The period prevalence of MSDs and WMSDs were 85% and 75.8% respectively, and the point prevalence was 39.2% and 23.3% respectively. Prosthodontists reported the highest prevalence of WMSDs. The neck (64.7%) was the most commonly affected area. A statistically significant result was obtained between MSDs and BMI (P = 0.02), qualification (P = 0.01) and between WMSDs and duration of work in the sitting posture (P = 0.03). Conclusions: The prevalence of both MSDs and WMSDs was found to be high. Dentists with higher BMI, higher qualifications, lack of breaks, having poor workstations and higher REBA and QEC scores, whose job tasks involve continuous inspection, frequent bending of elbow joints, frequent repetitive motions, tasks that require them to reach distances greater than 20 inches and tasks that involve twisting of the waist are at a higher risk of developing MSDs. [ABSTRACT FROM AUTHOR]

Background: Gujarat has implemented an mHealth program, technology for community health operations-plus (TeCHO+) in 2019. TeCHO+ is a mobile and web-based application that essentially enables data entry by the frontline workers providing service at the time and place of service delivery to improve the coverage and data quality. It also facilitates early identification of morbid condition and timely treatment. This study assessed the cost-effectiveness of TeCHO+ program in Gujarat. Materials and Methods: The study compared key program outcome indicators before and after the launch of TeCHO+ program. As the program was launched across the State, eMamta, the previous version of mother and child tracking system was used for comparison. A decision tree was parameterized to estimate change in disability-adjusted life year (DALY) and cost as a result of implementing TeCHO+ from a health system perspective. Results: TeCHO+ incurred a cost of Rs. 2,624 per beneficiary against Rs. 1,075 per beneficiary under the previous eMamta program. TeCHO+ has resulted in significant DALY averted through early identification of high-risk cases both among pregnant women and children. Overall, cost-effectiveness analysis indicated that TeCHO+ incurred an incremental cost of Rs. 1802.84 per DALY averted, which is 1.19% of the GDP per capita of India (year 2020). Conclusion: This study concludes that TeCHO+ is cost-effective for mother and child care and can be considered for replicating. [ABSTRACT FROM AUTHOR]

Yoga is recognized and practiced for different levels of prevention since antiquity. The current scoping review aimed to identify and document the evidence reporting the effect of yoga interventions on immunity against COVID-19 infection. Three databases––PubMed, Cochrane, and Google Scholar, were searched to identify eligible studies. Articles published in English after 2010 and assessing the impact of any form of yoga (such as yogasanas, meditations, or pranayamas) on immunological markers were included in the review. The studies without information of the intervention on immunity markers, and experience sharing reviews were excluded. The search yielded 45 eligible articles with majority of the studies being published from the USA and India. Most of the studies were randomized controlled trials, enrolling the adult population with a specific focus on diseases like HIV, cancer, and heart failure. It was observed that a variety of yoga interventions along with meditation and pranayama, in different combinations were used by the authors. However, all these studies unanimously reported improvement in immunological profile (indicated by improved biochemical markers) of an individual (irrespective of disease state and type) with yoga. Moreover, the beneficial effects of these traditional Indian interventions were also found to have a positive impact on overall physical and physiological wellbeing and quality of life. Findings from the existing literature indicate that the practice of yoga has the potential to strengthen cell-mediated immunity and hence could be used as an effective preventive measure against COVID-19 where immunity plays a critical role. [ABSTRACT FROM AUTHOR]