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Abstract Glaucoma is defined as progressive optic neuropathy that damages the structural appearance of the optic nerve head and is characterized by permanent blindness. For mass fundus image-based glaucoma classification, an improved automated computer-aided diagnosis (CAD) model performing binary classification (glaucoma or healthy), allowing ophthalmologists to detect glaucoma disease correctly in less computational time. We proposed learning technique called fast discrete curvelet transform with wrapping (FDCT-WRP) to create feature set. This method is entitled extracting curve-like features and creating a feature set. The combined feature reduction techniques named as principal component analysis and linear discriminant analysis, have been applied to generate prominent features and decrease the feature vector dimension. Lastly, a newly improved learning algorithm encompasses a modified pelican optimization algorithm (MOD-POA) and an extreme learning machine (ELM) for classification tasks. In this MOD-POA+ELM algorithm, the modified pelican optimization algorithm (MOD-POA) has been utilized to optimize the parameters of ELM’s hidden neurons. The effectiveness has been evaluated using two standard datasets called G1020 and ORIGA with the $$10 \times 5$$ -fold stratified cross-validation technique to ensure reliable evaluation. Our employed scheme achieved the best results for both datasets obtaining accuracy of 93.25% (G1020 dataset) and 96.75% (ORIGA dataset), respectively. Furthermore, we have utilized seven Explainable AI methodologies: Vanilla Gradients (VG), Guided Backpropagation (GBP ), Integrated Gradients ( IG), Guided Integrated Gradients (GIG), SmoothGrad, Gradient-weighted Class Activation Mapping (GCAM), and Guided Grad-CAM (GGCAM) for interpretability examination, aiding in the advancement of dependable and credible automation of healthcare detection of glaucoma.

Abstract We hypothesized that consanguineous marriage will remain a risk factor for pregnancy outcome and offspring mortality, but the development in demographic, socioeconomic conditions and increased utilization of maternal and child health care services during postglobalization era would work as a buffer in the reduction of child mortality rates. Data fromNational Family Health Surveys 4(2015–2016) and 5(2019–2021) were pooled and used for the analysis. Binary logistic regression and Cox proportional hazard regression models were used to examine the effects of close (CC) and distant (DC) consanguinity on spontaneous abortion, stillbirth, neonatal mortality, post-neonatal, and child mortality respectively compared to non-consanguinity (NC). The final model showed that the risk of spontaneous abortion (both CC and DC, p

Recombinant technology-based vaccines have emerged as a highly effective way to prevent a wide range of illnesses. The technology improved vaccine manufacturing, rendering it more efficient and economical. These vaccines have multiple advantages compared to conventional vaccines. The pandemic has heightened awareness of the advantages of these vaccine technologies; trust and acceptance of these vaccines are steadily growing globally. This work offers an overview of the prospects and advantages associated with recombinant vaccines. Additionally, it discusses some of the challenges likely to arise in the future. Their ability to target diverse pathogen classes underscores their contributions to preventing previously untreatable diseases (especially vector-borne and emerging diseases) and hurdles faced throughout the vaccine development process, especially in enhancing the effectiveness of these vaccines. Moreover, their compatibility with emerging vaccination platforms of the future like virus-like particles and CRISPR/Cas9 for the production of next-generation vaccines may offer many prospects. This review also reviewed the hurdles faced throughout the vaccine development process, especially in enhancing the effectiveness of these vaccines against vector-borne diseases, emerging diseases, and untreatable diseases with high mortality rates like AIDS as well as cancer.

Abstract Background Despite a commendable rise in the number of women seeking delivery care at public health institutions in South India, it is unclear if the benefit accrues to wealthier or poorer socio-economic groups. The study’s aim was to investigate at how the public subsidy is distributed among Indian women who give birth in public hospitals in the southern regions. Methods Data from the Indian Demographic Health Survey’s fifth wave (NFHS-5, 2019–21) was used in this study. A total of 22, 403 were institutional deliveries across all the southern states of India were included. Out-of-pocket expenditure (OOPE) on childbirth in health institutions was the outcome variable. We used summary statistics, Benefits Incidence Analysis (BIA), concentration index (CI), and concentration curve (CC) were used. Results Most women in the lowest, poorest, and medium quintiles of wealth opted to give birth in public facilities. In contrast, about 69% of mothers belonging to highest quintile gave birth in private health institutions. The magnitude of CI and CC of institutional delivery indicates that public sector usage was concentrated among poorer quintiles [CIX: − 0.178; SE: 0.005; p

Abstract Background Publicly Funded Health Insurance Schemes (PFHIS) are intended to play a role in achieving Universal Health Coverage (UHC). In countries like India, PFHISs have low penetrance and provide limited coverage of services and of family members within households, which can mean that women lose out. Gender inequities in relation to financial risk protection are understudied. Given the emphasis being placed on achieving UHC for all in India, this paper examined intersecting gender inequalities and changes in PFHIS coverage in southern India, where its penetrance is greater and of longer duration. Data and methods This study used the fourth (NFHS-4, 2015–16) and fifth (NFHS-5, 2019–21) rounds of India’s National Family Health Survey for five southern states: namely, Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, and Telangana. The World Health Organization’s Health Equity Assessment Toolkit (HEAT) Plus and Stata were used to analyse PFHIS coverage disaggregated by seven dimensions of inequality. Ratios and differences for binary dimensions; Between Group Variance and Theil Index for unordered dimensions; Absolute and Relative Concentration Index (RCI) for ordered dimensions were computed separately for women and men. Results Overall, PFHIS coverage increased significantly (p

Abstract The National Sample Survey (NSS) collects reliable data on morbidity, health care, and health spending through its annual multi-subject and multi-round health surveys. Evidences from these surveys have been extensively used for research and policy. While these surveys collect comprehensive information on morbidity, hospitalisation, health expenditure, information on household consumption expenditure (which is used to explain the economic gradient in health outcomes) is collected through a single question. Literature suggests that having a single question on consumption expenditure results in measurement errors. In this paper, we examine the effect of measurement errors of household consumption expenditure on estimates of catastrophic health expenditure (CHE) in India using data from the 68th round of the consumption survey (2011–12) and the 71st round of the health survey (2014), carried out by the National Sample Survey (NSS). The consumption survey canvassed a detailed schedule on consumption and interviewed 101,651 households, whereas the health survey interviewed 65,932 households from across the country. Descriptive statistics, estimates of CHE, and logistic regression models were used in the analysis. We used both the budget share approach and the capacity-to-pay approach for estimating CHE. The NSS health survey was found to have underestimated monthly per capita consumption expenditure (MPCE) in India by 32%, with the level of underestimation being significant across the states. Using the budget share approach, the CHE of India in 2014–15 was estimated at 23.4% without adjusting for the underestimation of consumption and 21.1% after adjusting for it. Similarly, using the capacity-to-pay approach, CHE was estimated to be 13.4% without adjustment and 10.4% with adjustment. The estimates differed considerably across the states. In general, it was observed that the use of a single question on consumption overestimated CHE in India. The pattern was similar regarding the intensity of CHE. The predictors of CHE were similar using both the methods, but the unadjusted estimates of CHE showed significantly higher predicted probabilities of incurring CHE across household characteristics. It is recommended to include disaggregated questions on household consumption in the future rounds of the NSS-based health surveys. Researchers using NSS data need to be aware of the effect of measurement errors of consumption expenditure on estimates of catastrophic expenditure. Adjusting for the underestimation of MPCE may improve the estimation of CHE in India.

Abstract Background Increasing financial risk protection is a key feature of Universal Health Coverage and the path towards health for all. Publicly Funded Health Insurance Schemes (PFHIS) have been considered as one of the pathways to safeguard against financial shocks and potentially reduce Out-of-Pocket Expenditure (OOPE). The south Indian state of Kerala has roughly a decade-long experience in implementing PFHIS. To date, there have been very few assessments of the coverage of these schemes and their impact on expenditure. Aiming to fill this gap, we explored the extent of and inequalities in insurance coverage, as well as choice of providers, and median cost of hospitalization in Kerala among insured and uninsured individuals. Methods A cross-sectional household survey was conducted in four districts of Kerala as part of a larger health systems research study from July–October 2019. We employed multistage random sampling to collect data from 13,064 individuals covering 3234 households in the catchment area of eight primary health care facilities. We used descriptive statistics, bivariate and multivariate analysis. We evaluated socioeconomic disparities using an absolute measure of inequality—the Slope Index of Inequality (SII) and a relative measure—the Relative Concentration Index (RCI). Results A substantial proportion of our study respondents reported that they were covered by PFHIS (45.8%). Respondents belonging to lowest and middle wealth quintiles of household had significantly greater odds of being covered by insurance than respondents belonging to the richest wealth quintile. The negative magnitude of RCI [-16.8% (95%CI: -25.3, -8.4)] and SII [-21.5% (95%CI: -36.1, -7.0)] suggest a higher concentration of PFHIS coverage among the poor. Median OOPE for hospitalisation at private health facilities was INR 9000 (approx. USD 108.70) among those covered by PFHIS, whereas it was INR 10500 (approx. USD 126.82) at private health facilities among those not covered by insurance. Conclusion While PFHIS seems to be appropriately targeting poorer populations, among the insured, OOPE for hospitalization persists. Among the uninsured, population subgroups with advantage are spending the greatest amount, raising questions about whether those facing relative disadvantage are forgoing care altogether or seeking care using cheaper, public avenues. Further policy action to more effectively reduce financial burden among left behind eligible populations under PFHIS will be essential to UHC progress in the state.

Measles is the most infectious disease with a high basic reproduction number (R0). For measles, it is reported that R0 lies between 12 and 18 in an endemic situation. In this paper, a fractional order mathematical model for measles disease is proposed to identify the dynamics of disease transmission following a declining memory process. In the proposed model, a fractional order differential operator is used to justify the effect and success rate of vaccination. The total population of the model is subdivided into five sub-compartments: susceptible (S), exposed (E), infected (I), vaccinated (V), and recovered (R). Here, we consider the first dose of measles vaccination and convert the model to a controlled system. Finally, we transform the control-induced model to an optimal control model using control theory. Both models are analyzed to find the stability of the system, the basic reproduction number, the optimal control input, and the adjoint equations with the boundary conditions. Also, the numerical simulation of the model is presented along with using the analytical findings. We also verify the effective role of the fractional order parameter alpha on the model dynamics and changes in the dynamical behavior of the model with R0=1.

BackgroundAccredited Social Health Activists (ASHA) are Community Health Workers (CHWs) employed by the National Health Mission of the Government of India to link the population to health facilities and improve maternal and child health outcomes in the country. The government of Kerala launched primary health reform measures in 2016 whereby Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs). The COVID-19 pandemic in 2020 impacted essential health service delivery, including primary care services. The CHWs network of Kerala played a crucial role in implementing the primary care reforms and COVID-19 management efforts that followed. We carried out a study to understand the perspectives of the CHWs in Kerala about their role in the recent primary healthcare reforms and during the COVID-19 pandemic management efforts.MethodsWe conducted in-depth interviews (IDI) with 16 ASHAs from 8 primary care facilities in Kerala from July to October 2021. We further conducted Focus Group Discussions (FGDs) (N = 34) with population subgroups in these eight facility catchment areas and asked their opinion about the ASHAs working in their community. We obtained written informed consent from all the participants, and interview transcripts were thematically analysed by a team of four researchers using ATLAS.ti 9 software.ResultsOur study participants were women aged about 45 years with over 10 years of work experience as CHWs. Their job responsibilities as a frontline health worker helped them build trust in the community and local self-governments. CHWs were assigned roles of outpatient crowd management, and registration duties in FHCs. The COVID-19 pandemic increased their job roles manifold. Community members positively mentioned the home visits, delivery of medicines, and emotional support offered by the CHWs during the pandemic. The CHWs noted that the honorarium of INR 6,000 (US$73) was inconsistent and very low for the volume of work done.ConclusionThe CHWs in Kerala play a crucial role in primary care reforms and COVID-19 management. Despite their strong work ethic and close relationship with local self-governments, low and irregular wages remain the biggest challenge.

Diabetes is a common chronic illness or absence of sugar in the blood. The early detection of this disease decreases the serious risk factor. Nowadays, Machine Learning based cloud environment acts as a vital role in disease detection. The people who belong to the rural areas are not getting the proper health care treatments. So, this research work proposed an automated eHealth cloud system for detecting diabetes in the earlier stage to decrease the mortality rate and provides health treatment facilities to rural peoples. Extreme Learning Machine (ELM) is a type of Artificial Neural Network (ANN) that has a lot of potential for solving classification challenges. This research work is consisting of several activities like feature normalization, feature selection and classification. We have employed principal component analysis (PCA) for feature selection and extreme learning machine (ELM) for classification. Finally, a cloud computing-based environment with three numbers of virtual machines (vCPU-4, vCPU-8, and vCPU-16), is used for the detection of diabetes. The efficacy of the proposed model has been evaluated with the PIMA dataset in both standalone and cloud environments and achieved 90.57 % accuracy, 82.24 % sensitivity, 73.23 % specificity, and 75.03 % F-1 score with the virtual machine vCPU-16. The experimental results define the proposed model as superior to other state-of-art models with better classification accuracy and less number of features.

Abstract Background Non-Communicable Diseases (NCDs) constitute a significant danger to the nation’s public health system, both in terms of morbidity and mortality, as well as the financial burden they inflict. Kerala is undergoing an epidemiologic transition, which has significantly impacted the state’s morbidity and mortality figures. For decades, the state has been putting in place myriad programs to reduce the burden of NCDs across population groups. Socioeconomic inequalities in NCD testing have been documented in India, although they are understudied in Kerala. The study aimed to estimate and characterize districtwise socioeconomic inequality in Blood Pressure (BP) and Blood Glucose (BG) testing. Methods A cross-sectional household survey was conducted between July–October 2019 in Kasaragod, Alappuzha, Kollam and Thiruvananthapuram districts of Kerala, India. A total of 6383 participants aged 30 years and above were interviewed using multistage random sampling. Descriptive statistics were derived district-wise. We computed ratios, differences, equiplots, and Erreygers concentration indices for each district to measure socioeconomic inequality in BP and BG testing. Erreygers decomposition techniques were used to estimate the relative contribution of covariates to socioeconomic inequality. Results There was a significant concentration of BP and BG testing favouring wealthier quintiles in Alappuzha, Kollam, and Thiruvananthapuram districts. The inequality in BP and BG testing was highest in Thiruvananthapuram (0.087 and 0.110), followed by Kollam (0.077 and 0.090), Alappuzha (0.083 and 0.073) and Kasaragod (0.026 and 0.056). Decomposition analysis revealed that wealth quintile and education contributed substantially to socioeconomic inequality in BP and BG testing in all four districts. It was also found that family history of NCDs significantly contributed to observed socioeconomic inequality in BP testing (29, 11, 16, and 27% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram, respectively). Similarly, in BG testing, family history of NCDs substantially contributed to observed socioeconomic inequality, explaining 16–17% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram respectively of the total inequality. Conclusion While the magnitude of socioeconomic inequality in NCD risk factor testing did not appear to be very high in four Kerala districts, although levels were statistically significant in three of them. Greater exploration is needed on how education and caste contribute to these inequalities and their relationship to NCD risk factors such as family history. From such analyses, we may be able to identify entry points to mitigate inequalities in testing access, as well as burden.

Pathogen and human host interaction dynamics are often more complicated in the presence of co-pathogens. Co-infection can occur either as the presence of pre-existing pathogen which is accelerated by the new pathogen and more complications happened. In this study, we look at the burden of HIV/HCV viremia and the efficacy of treatment in reducing the severity of HIV/HCV co-infection patterns. Disease-free equilibrium and endemic equilibrium are two equilibrium states determined in the absence of drugs. The basic reproduction number is computed and the stability of the disease-free equilibrium of the model is analyzed using it. Here we have also incorporated the optimal drug therapy to control the co-infection disease progression. The efficacy of treatment has also been found to influence the natural progression of HCV in HIV/HCV co-infection. The numerical results suggest that the HIV viral load impacts the severity of the HCV infection impressively. This research is significant to develop antiviral therapy strategies to control HIV/HCV co-infection. The most effective way to control the co-infection with the minimum side effects is to take the combination of three medications with optimal dosing.

Abstract Background In India, there is currently a lack of data on socioeconomic inequalities in HIV testing on a national scale; thus, understanding socioeconomic inequalities in response to expanded HIV testing is critical for assessing and ensuring equity of HIV programmes in accordance with the Sustainable Development Goals. The specific objective of the study was to determine the factor associated with HIV testing during antenatal care and assess the socio-economic inequalities in HIV testing during antenatal care (ANC) among Indian women aged 15–49 years with a live birth in the two years preceding the survey. Methods The results drawn from the state module of women data file of fourth round of National Family Health Survey (NFHS-4, 2015–16), considering HIV testing during antenatal care among women aged 15–49 who gave live birth in the two years preceding the survey and received the result of HIV test as a matter of fact. Method, such as, descriptive statistics, binary ogistic regression, concentration index were used in the analysis. Results The findings of the study show that HIV testing during antenatal care was low (30%) among women in India. Our findings reveal that there were significant inequalities exist in HIV testing during ANC between richer and poorer quintile of women. Education, place of residence, comprehensive knowledge of HIV/AIDS, and regular exposure of mass media were substantially contributing to socioeconomic inequality in HIV testing during ANC among women in India. Conclusions The socioeconomic inequities in HIV testing during pregnancy should be monitored and addressed in order to ensure an equitable distribution of the benefits specially among children and accomplishments of HIV programs in India.

Abstract Background Nutrition has been a low-priority area in Pakistan, with low visibility from the political leadership. Despite various efforts, Pakistan has been reported to have one of the highest prevalences of child and women malnutrition compared to other developing counties. Therefore, this study intends to examine the prevalence and determinants of nutritional status of women and children in Pakistan. Methods The present study uses the Demographic Health Survey (DHS) data from Pakistan 2012–13 (PDHS-3). The nutritional status of women was examined through Body-Mass Index (Underweight, normal, overweight, & obese), and that of children was examined through stunting (severe and moderate), wasting (severe, moderate, overweight), and underweight (severe, moderate, overweight). Descriptive statistics and bivariate analysis have been used along with multinomial logistic regression. Results A higher proportion of children in rural areas were severely stunted (19.6% vs. 12.5%), severe wasted (2.4% vs. 2.2%), and severe underweight (9.4% vs. 6%) than their urban counterparts. A higher proportion of rural women (9.5% vs. 5.5%) were underweight than urban women, whereas a higher proportion of urban women were obese (24.3% vs. 19.0%) than rural women. The odds of severe stunting (OR = 0.24; C.I. = 0.15–0.37), severe underweight (OR = 0.11; C.I. = 0.05–0.22) were lower among children from the richest wealth quintile than their poorest counterparts. The Relative Risk Ratio (RRR) of being overweight (RRR = 3.7; C.I. = 2.47–5.54) and Obese (RRR = 4.35; C.I. = 2.67–7.07) than normal BMI were higher among women from richest wealth quintile than women belonged to poorest wealth quintile. Conclusion This study has highlighted determinants associated with maternal and child nutritional status, whereby the child’s nutritional status was measured by stunting, wasting, and underweight, and BMI measured the mother’s nutritional status. The main risk factors for a child’s poor nutritional status include low household wealth, urban residence, and mother’s educational status. Similarly, the main risk factors for women’s poor nutritional status include increasing the women’s age, educational status, rural residence, and household wealth. Poor households should be provided special attention to improve the nutritional status among women and children in poor households.

Objective This study assesses educational inequalities in measured as well as self-reported high blood pressure (BP) and high blood glucose (BG) in the southern Indian state of Kerala, which is known to have high chronic disease morbidity.Design The present findings are drawn from a large-scale, nationally representative cross-sectional study.Settings and participants India’s Demographic and Health Survey (conducted in 2019–2021) had data on 36 526 individuals aged 15 years and above in the state of Kerala, India.Primary and secondary outcomes measures Measured high BP and BG; self-reported high BP and BG; as well as self-reported BP and BG testing. Descriptive statistics, bivariate analysis, along with multivariate statistics, were used. Educational inequalities were assessed through absolute and relative complex measures of inequality, namely the Slope Index of Inequality (SII) and Relative Concentration Index (RCI), respectively, with 95% CIs.Results The largest margin of inequality in Kerala, between the least and the most educated groups, was observed for measured high BP (57.7% and 17.6%). Measured high BP (SII −45.4% (95% CI –47.3% to –43.4%); RCI −26.6% (95% CI –27.9% to –25.3%)), self-reported high BP (SII −34.5% (95% CI –36.3% to –32.7%); RCI −19.0% (95% CI –20.1% to –17.9%)). High BG levels were concentrated among those with lower educational attainment (SII −26.6% (95% CI –28.6% to –24.7%); RCI −15.7% (95% CI –16.9% to –14.5%)), represented by negative SII and RCI values.Conclusions The study findings suggest that research and programme efforts need to be redoubled to determine what is driving greater vulnerability to non-communicable diseases among population with lower educational attainment on the one hand and the possible role that improving education access can be on health outcomes, on the other hand. Further research should explore relevant intersections with low education.

Objective Older male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in NCD-MM among older adults is vital, as this issue is understudied in low-income and middle-income country (LMIC) contexts such as India, and has been growing in the past few decades.Design Large scale nationally representative cross-sectional study.Settings and participants Longitudinal Ageing Study in India (LASI 2017–2018) had data on 27 343 men and 31 730 women aged 45+, drawn from a sample of 59 073 individuals across India.Primary and secondary outcomes measures We operationalised NCD-MM based on prevalence of the presence of two or more long-term chronic NCD morbidities. Descriptive statistics and bivariate analysis along with multivariate statistics were used.Results Women aged 75+ had a higher prevalence of multimorbidity as compared with men (52.1% vs 45.17%). NCD-MM was more common among widows (48.5%) than widowers (44.8%). The female-to-male ratios of ORs (RORs) for NCD-MM associated with overweight/obesity and prior history of chewing tobacco were 1.10 (95% CI: 1.01 to 1.20) and 1.42 (95% CI: 1.12 to 1.80), respectively. The female-to-male RORs show that the odds of NCD-MM were greater in formerly working women (1.24 (95% CI: 1.06 to 1.44)) relative to formerly working men. The effect of increasing NCD-MM on limitations in activities of daily living and instrumental ADL was greater in men than women but reversed for the hospitalisation.Conclusions We found significant sex differences in NCD-MM prevalence among older Indian adults, with various associated risk factors. The patterns underlying these differences warrant greater study, given existing evidence on differential longevity, health burdens and health-seeking patterns all of which operate in a larger structural context of patriarchy. Health systems in turn must respond to NCD-MM mindful of these patterns and aim to redress some of the larger inequities they reflect.

Abstract Background Lumbar erector spinae plane block (L-ESPB) is being used in fractured hip patients for the postoperative pain relief and as a sole anesthetic technique. Various clinical and cadaveric studies have differences of opinion about its mechanism of action and pathways of local anesthetic spread; however, the role of lumbar plexus (LP) in the mechanism of action is still not considered. In our clinical experience, we observed that the action on LP could be a pathway for the analgesic action of local anesthetic along with paravertebral spread. Case presentation We report here three cases of the fractured hip who were given L-ESPB for postoperative pain management. The radiological examination was done after injection of non-ionic contrast to know the spread of local anesthetic. In two cases, the contrast spread was seen towards LP and in one case spread of contrast was observed towards the paravertebral area. Conclusions Effect of local anesthetic on the lumbar plexus is one of the plausible pathways in L-ESPB for its analgesic mechanism of action.

The wealth index based on household assets and amenities is been increasingly used to explain economic variations of health outcomes in the developing countries. While the variables used to compute the wealth index are easy to collect and time- and cost-effective, the wealth index tends to have an urban bias, uses arbitrary weighting, does not provide per capita measures and is a poor measure of inequality. We used micro data from two of the large-scale population-based surveys, the Longitudinal Ageing Study in India, 2017–18 and the India Human Development Survey, 2011–12 that covered over 42,000 households each and collected data on household consumption, assets and amenities in India. We examined the variations and inequality in health estimates by consumption per capita and asset-based measures in India. Descriptive statistics, logistic regression model, concentration index, and concentration curve were used in the analyses.We found a weak association between monthly per capita consumption expenditure (MPCE) and wealth index in both the surveys. Some of the health conditions such as hypertension, cataract, refractive error, and diabetes tended to be underestimated in the bottom 40% of the population when economic well-being was measured using the wealth index compared to consumption. Socio-economic inequality in health outcome, inpatient and outpatient health services were underestimated when measured using the wealth index than when measured using MPCE.We conclude that economic gradients of health by consumption and wealth index are inconsistent and that per capita consumption predicts health estimates better than the wealth index. It is recommended that public health research using population-based surveys that provide data on consumption and wealth index use per capita consumption to explain economic variations in health and health care utilization. We also suggest that the future rounds of the health surveys of National Sample Survey and the National Family and Health Surveys include an abridged version of the consumption schedule to predict better economic variations in health and health care utilization in India.

Objective: Biomarkers are increasingly integrated into population-based surveys to provide reliable estimates of the prevalence of specific diseases. The Demographic and Health Surveys have recently incorporated blood pressure measurements; however, little is known about the extent of agreement between measured and reported levels of hypertension in India. The objective of this study was to examine the extent of agreement between self-reported hypertension and the results of standard blood pressure measurements, as well as to explore the risk groups and factors associated with inconsistencies in self-reported and biomedically measured hypertension. Methods: Reliability measures such as sensitivity, specificity, and kappa statistics were used to examine inconsistencies in self-reported and biomedically measured hypertension in the National Family Health Survey-4 data. Multilevel logistic models were adopted to analyse the respondent characteristics related to both false-positive and false-negative responses in the survey. Results: Compared to biomedically measured hypertension, self-reported hypertension was inconsistent and disproportionate at disaggregated levels in India. While self-reports severely underestimated hypertension among men aged 15–54 years and women aged 35–49 years, it overestimated hypertension among women below the age of 35 years. The inconsistency in self-reported and biomedically examined hypertension had deviations from a sex standpoint. Women aged

This study aims to examine the effect of administration of shorter and longer versions of questionnaires on key indicators such as age displacement, birth displacement, age heaping, and skipping questions on antenatal care (ANC) visits and use of contraceptive methods in India using National Family Health Survey (NFHS)-4 data. At the individual level, the effect of the adoption of the shorter and longer versions of the questionnaires on the age displacement of women and children and skipping of the key questions is insignificant. However, the results from the two-level logistic regression model reveal that at the primary sampling unit (PSU) level, work pressure, depending on the number of eligible women in a household, emerges as a confounder in skipping certain questions, namely ANC [1.18 (p

Background: In India, it was reported previously about varying prevalence of asthma and chronic bronchitis among leather tannery workers with moderate to high exposures at the workplace to be significantly associated with asthma. This study intended to estimate the prevalence of asthma, tuberculosis, and chronic bronchitis among leather tannery workers and to identify the risk factors associated with it. Data and Methods: The data used in this study were collected through a cross-sectional household survey of 284 male tannery workers in the Jajmau area of Kanpur city in the state of Uttar Pradesh, during January–June 2015. A binary logistic regression analysis was performed to identify the factors associated with respiratory symptoms. Results: The prevalence Asthma and Chronic Bronchitis among Tannery workers was 12.3% and 11.6% which is higher as compared to non-tannery workers. The findings revealed that the prevalence of symptoms suggestive of asthma, tuberculosis, and chronic bronchitis among the tannery workers was higher compared to non-tannery workers. The study revealed that long time tannery working harms health, as tannery workers are more likely to be suffering from asthma and chronic bronchitis who worked above 11 years in the tannery (p

Abstract Background Unacceptably high rate of childhood stunting for decades remained a puzzle in the eastern Indian state of Bihar. Despite various programmatic interventions, nearly half of the under-five children (numerically about 10 million) are still stunted in this resource-constrained state. Data and methods Using four successive rounds of National Family Health Survey (NFHS) data spread over more than two decades and by employing unconditional quantile regressions and counterfactual decomposition (QR-CD), the present study aims to assess effects of various endowments as well as returns to those endowments in disparities in childhood stunting over the period. Results The results show that although the child’s height-for-age Z-scores (HAZ) disparity largely accounted for differing levels of endowments during the earlier decades, in the later periods, inadequate access to the benefits from various development programmes was also found responsible for HAZ disparities. Moreover, effects of endowments and their returns varied across quantiles. We argue that apart from equalizing endowments, ensuring adequate access to different nutrition-centric programmes is essential to lessen the burden of childhood stunting. Conclusion The state must focus on intersectoral convergence of different schemes in the form of state nutrition mission, and, strengthen nutrition-centric policy processes and their political underpinnings to harness better dividend.

Abstract Background The sexual behaviour of adolescents is of importance due to the engagement in risky sexual activity at a too early age, which may be associated with the adverse outcomes. The study aims to understand the transitions in adolescent boys and young men’s high-risk sexual behaviour in India using two rounds of Indian demographic health survey, NFHS-3 (2005–06) and NFHS-4 (2015–16). Methods A total of 25,538 in NFHS-3 (2005–06) and 35,112 in NFHS-4 (2015–16) men were considered for the analysis. Men have been divided into two age groups as 15–19 years (adolescent) and 20–24 (young men) for comparison purposes. Descriptive and multivariate statistics have been used. Results Overall, high-risk sexual behaviour has increased among adolescent boys (64 to 70%) and young men (18 to 27%) from 2005–06 to 2015–16. The trend of live-in relationship has increased among adolescent boys of rural areas (0.6 to 6.0%) as well as in urban areas (3.1 to 10.9%) over the last 10 years. Adolescent boys having 10th and above years of schooling (AOR = 1.98; p

The effect of antiviral therapy during Hepatitis C Virus (HCV) infection is the focus of this study. HCV infection destroys healthy hepatocyte cells in the human liver, causing cirrhosis and hepatocellular carcinoma. We introduce a cell-population model representing the long-term dynamics of HCV infection in response to antiviral drug therapies. The proliferation of existing cells can create hepatocyte cells in the system. Such models are based on the dynamics of susceptible hepatocytes, infected hepatocytes and HCV with interactive dynamics, which can give a complete understanding of the host dynamics of the system in the presence of antiviral drug therapy. Infection-free equilibrium and endemic equilibrium are two equilibrium states in the absence of drugs. The existence and stability conditions for both systems are presented. We also construct an optimal control system to find the optimal control strategy. Numerical results show that the effects of the proliferation rate and infection rate are critical for the changes in the dynamics of the model. The impact of different weight factors on the optimal control problem is analysed through numerical simulation.

Purpose: This article focuses at the prevalence of hysterectomy, its major correlates, and the socioeconomic inequalities in the prevalence of hysterectomy among women in India. Methods: It used data from 527,865 ever-married women interviewed in 2015–2016 National Family Health Survey-4 from 601,000 households across 640 districts in the country. The economic inequalities in the prevalence of hysterectomy have been analyzed using poor–rich ratio and the concentration index (CI) in addition to the adjusted effects of major correlates through multiple logistic regression. Results: Unadjusted (9.3%) and adjusted prevalence of hysterectomy (odds ratio [OR] =7.3; P < 0.001) are significantly higher among women aged 40 and above. Women from rural areas (OR = 1.2; P < 0.001) and those who were formerly married (6%) were more likely to have undergone hysterectomy. Over two-thirds of hysterectomies were conducted in private health-care facilities, where 51% reported that excessive menstrual bleeding was the main reason for hysterectomy. The value of poor–rich ratio (0.79) and CI (0.121) clearly depicts that hysterectomy is more inclined to be concentrated among middle-to-richer class of women in India. Conclusions: Private health-care sector should have standard regulatory practices to deliver more efficient, accountable, and sustainable maternal health-care services.

Distributed generators (DGs) are connected near load centers and integrated to grid for optimum power system operations. The challenging task for integration of DGs is the proper size and location, due to random character of generation and energy consumption. The objective of the research is to provide the proper size and location of DGs to optimize the voltage profile and reduction in active and reactive power losses. Optimization of distributed generators is performed through fuzzy logic controllers at Ramchandrapura 33/11 kV, 69 bus radial distribution substation, Kota, India. Fuzzy logic controller provides possible solution on selection of distributed generators on the basis of voltage profile of the bus and the impedance of the branch connected DGs at consumer’s end. Forward or backward sweep methodology is used to optimize the load flow analysis for calculation of real and reactive power losses and voltage profile with and without implementation of distributed generators. Proposed approach provides a possible solution for efficient integration of DGs.

Background: Breaking the silence on menstruation is essential for women and girls to achieve and exercise their full potential. The study explores the linkages between women empowerment, utilization of hygienic methods during menstruation, and its effect on reproductive tract infections (RTI) among women aged 15–24 years in India. Methods: The study used the fourth round of Indian Demographic and Health Survey (NFHS-4), 2015–16. The information regarding the different dimensions of women empowerment has been collected from 122,351 women at the state level. Overall, 42,912 women aged 15–24 years surveyed in the state module were questioned regarding menstruation hygiene methods and different dimensions of women's empowerment. Bivariate and multivariate statistical techniques have been utilized to draw inferences from the data. Results: Findings reveal that about 60% of women aged 15–24 utilized hygienic methods during menstruation in India. Owning a bank account, using mobile phones, and household decision-making emerged as significant factors that lead to the adoption of hygienic practices. Lack of menstrual hygiene method was found to result in adverse outcomes like RTI symptoms (genital sore/ulcer and had genital discharge) Conclusions: The study concludes that the different dimensions of women empowerment are essential in accelerating the level of practicing hygienic menstruation methods and providing assistance against diverse malpractices and taboos attached to it. The existing approach for the use of menstrual hygiene methods should focus on women's right to decide on their own life and health.

Background and Aims: Breast cancer has become the most common cancer in women worldwide. Acute post-operative pain following mastectomy remains a challenge for the anaesthesiologist despite a range of treatment options available. The present study aimed to compare the post-operative analgesic efficacy of pectoral nerve (Pecs) block performed under ultrasound with our standard practice of opioids and non-steroidal anti-inflammatory drugs for mastectomy. Methods: This randomised controlled study was conducted at a tertiary care teaching hospital in India, after obtaining ethical clearance. Fifty adult female patients posted for elective unilateral modified radical mastectomy were divided into two groups as follows: Group I (general anaesthesia only) and Group II (general anaesthesia plus ultrasound-guided Pecs block), each comprising 25 patients. Post-randomisation, patients in Group I received general anaesthesia, while Group II patients received ultrasound-guided Pecs block followed by general anaesthesia after 20 min. The primary outcome was measured as patient-reported pain intensity using Visual Analogue Scale (VAS) at rest. Statistical analysis was performed using Student's t-test and Mann–Whitney U-test. Data were entered into MS Excel spreadsheet and analysis was performed using the Statistical Package for the Social Sciences version 23.0. Results: VAS score was significantly lower in Group II at rest and on abduction post-operatively at all time intervals (P < 0.001). The 24-h tramadol consumption was significantly less in Group II compared to Group I (114.4 ± 4.63 mg vs. 402.88 ± 74.22, P < 0.0001). Conclusion: Pecs block provided excellent post-operative analgesia in the first 24 h.

Overview: Nonunion scaphoid is a common complication of fracture scaphoid which always remains a difficult surgical problem. Most of the cases present late with persistent pain and disability, not responding to conservative treatment. Simple bone grafts are generally not enough in cases with evidence of decreased vascularity of proximal fragment, so pronator quadratus osteomuscular transposition flap to revascularize the nonunion scaphoid gained popularity. A series of 11 cases treated using vascularized osteomuscular graft. Materials and Methods: This study was done on eleven cases of nonunion scaphoid with pronator quadratus vascularized bone graft. Herbert and Alnot classification was used and postoperative evaluation done by scaphoid outcome score. Results: Postoperative scaphoid outcome score was excellent in 4 cases, good in 4 cases, fair in 2 cases, and poor in 1 case. One case developed scaphoid nonunion advanced collapse and wrist arthritis and revision surgery with proximal row carpectomy was done in it. The mean follow-up period was 22 months. Conclusion: Bone grafting is the mainstay treatment for non-union scaphoid. Vascularized bone grafts using pronator quadratus osteomuscular flaps have proved to be more biological and more successful treatment option.