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Poonam Trivedi,1 Sandul Yasobant,1– 3 Deepak Saxena,1– 3 Salla Atkins4,5 1Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India; 2Centre for One Health Education, Research & Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India; 3School of Epidemiology & Public Health, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, Maharashtra, India; 4WHO Collaborating Centre on Health in All Policies and the Social Determinants of Health, Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland; 5Department of Global Public Health, Karolinska Institute, Solna, Stockholm, SwedenCorrespondence: Deepak Saxena, Indian Institute of Public Health Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, 382042, Gujarat, India, Email ddeepak72@iiphg.orgAbstract: The COVID-19 pandemic has hugely affected the world and human lives, the economy, and lifestyles. The pandemic control measures, such as lockdowns, forced many people to migrate from their destination to their source in various states, leading to increased vulnerability of migrants. The present review aimed to explore the different health, economic, and social impacts on internal migrants of India during the pandemic. The publications on internal migration and COVID-19 from India were retrieved from PubMed and Google Scholar using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 159 articles were extracted, of which 28 were reviewed. The articles published after March 1, 2020, were included in the review, irrespective of the design. Out of 28 articles, only half were original studies; the rest were either perspective, opinion, and review studies or editorial and commentary papers. Depression, anxiety, and stress due to job loss and lockdown were the major health issues documented. There was livelihood disturbance due to loss of income, such as inability to pay rent, loans, borrowing from relatives, and fear of its consequences. The migrants also faced stigma and discrimination from the villagers. The review also highlighted that although the government implemented various schemes to help the migrants, the majority were left out due to the non-availability of identity proof and ration cards. The safeguarding measures for these unregistered migrants must be facilitated to access health, economic, and social protection. Although various publications have focused on the mental health of the migrants, the socio-ecological aspects have been least explored, which calls for further studies. The literature on the impact of COVID-19 on other vulnerable populations like women and children and access to healthcare services is also scant, which needs to be explored further.Keywords: migrants, COVID-19, pandemic, health consequences

Sandul Yasobant,1– 3 K Shruti Lekha,1 Deepak Saxena1,2 1Centre for One Health Education, Research & Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India; 2School of Epidemiology & Public Health, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, MH, India; 3Global Health, Institute for Hygiene & Public Health, University Hospital Bonn, Bonn, GermanyCorrespondence: Sandul Yasobant, Centre for One Health Education, Research & Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India, Tel +91-9861357331, Email yasobant@iiphg.orgBackground: 61% of the infections around the world that have emerged to date are zoonotic. Evidence warns that the threat posed by zoonoses is on the rise, and the risk of a new pandemic is higher now than ever. Early identification of risk, populations at risk, and risk of transmission are essential steps towards a prevention, preparation and response to outbreaks. This review aims to look at the tools available for identifying and estimating risks and threats from one health perspective and finally propose a list of indicators which could assess the risk of transmission of disease at the humans, animals and the environment intersection.Methods: The databases like PubMed, google scholar, Embase and Scopus were used to extract the relevant articles. A search was carried out using a keyword. A total of 1311 articles were listed initially after the search and reviewed. Out of 1311, only 26 tools which assessed the risk of diseases mainly infectious or were relevant to risk of transmission of any infectious diseases were included in the review.Results: The tools included in this review involve risk assessment at the environmental, animal and human dimensions. The tools are used to evaluate the contamination of the environment due to chemicals or toxins or the risk of transmission of infection due to environmental factors like air contamination, to identify the animal diseases like bovine respiratory disease and foot and mouth disease and to estimate the human health risk at the community or individual levels.Conclusion: Risk assessment tools are an essential part of the prevention of pandemics. These tools are helpful in assessing the risk of transmission of infections either from human to human, between human and animals, between animals and animals and so on. Thus this review gives us an insight into the existing risk assessment tools and the need for a One Health risk assessment tools to prevent outbreaks in future. It also provides a list of factors that can be included in a one health risk assessment tool. Keywords: one health, risk assessment, one health risk assessment

Poonam Trivedi,1 Priya Bhavsar,2 Pachillu Kalpana,2,3 Krupali Patel,4 Tanmoy Das,5 Sandul Yasobant,1,2,6 Deepak Saxena1,2,6 1Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India; 2Centre for One Health Education, Research & Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India; 3Centre for Development Research (ZEF), University of Bonn, Bonn, Germany; 4Parul Institute of Public Health, Parul University, Waghodia, Gujarat, India; 5Terre des hommes Foundation, Kolkata, West Bengal, India; 6School of Epidemiology & Public Health, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, Maharashtra, IndiaCorrespondence: Deepak Saxena, Indian Institute of Public Health Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India, Email ddeepak72@iiphg.orgAbstract: Providing adequate Water Sanitation and Hygiene (WASH) in Health Care Facilities (HCFs) has many benefits, including achieving Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). However, there is a significant shortage of statistics on the status of WASH in Healthcare Facilities (WinHCF), resulting in roadblocks in developing improvement strategies. Further, there is a lack of detailed comparison of WASH components covered in available tools against the standards. The present study aims to dissect the national and international tools for WASH assessment in HCFs to suggest comprehensive WASH indicators. The databases like PubMed, Scopus, ScopeMed, Cochrane and Google Scholar were used to extract the available tools. The assessment process, methodology, and components of national and various international tools were compared and synthesized. A total of seven tools, namely WASH FIT 2, Facet, SARA, SPA, TOOL BOX-II, CDC and Kayakalp, were compared on eight components: water, sanitation, hand hygiene, healthcare waste, environmental cleaning and hygiene, infrastructure, workforce management, policy and protocols. Although most tools have covered the same indicators, the methodology and definitions differ. Few of the tools fail to capture the basic indicators defined by Joint Monitoring Programme (JMP). The critical indicators of policy and protocols are only covered in WASH FIT 2, Kayakalp, and TOOL BOX-II. Likewise, most tools fail to capture the indicator of cleaning, IPC practices and climate resilience. The present review also highlighted the limitations of selected tools regarding definitions, methodology and implementation. Hence, based on the review findings, a comprehensive short tool has been developed to monitor WASH in HCF of India. It comprises all the essential fundamental indicators identified from various tools, and recommended by the JMP service ladder with proper definitions. This tool can be helpful for hospital staff and managers for the routine monitoring of WASH in HCFs and improve the quality of care and IPC practices in HCFs.Keywords: WASH, IPC, SDGs, universal health coverage, assesment

Deepak Saxena,1,2,* Poonam Trivedi,1,* Priya Bhavsar,1,* Farjana Memon,1 Abhi Thaker,1 Chintan Chaudhary,1 Sandul Yasobant,1,2,* Deepika Singhal,3 Sanjay Zodpey4 1Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India; 2School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, India; 3Department of Ophthalmology, Gujarat Medical Education & Research Society, Ahmedabad, India; 4Public Health Foundation of India (PHFI), Gurgaon, India*These authors contributed equally to this workCorrespondence: Deepak Saxena, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India, Email ddeepak72@iiphg.orgPurpose: Despite the global efforts to improve organ donation, there is a demand-supply gap for organs in India. The only solution to meet this disparity is to improve deceased donor transplants in the country through victims of road accidents. The government has instituted several initiatives to achieve this goal. However, challenges and barriers continue to affect the organ donation process. The present study aims to document the motivating factors and obstacles in the decision of families to donate organs in Ahmedabad, Gujarat and their suggestions to improve the processes involved in organ donation.Patients and Methods: A qualitative exploratory study (in-depth interview) of ten relatives of deceased organ donors was conducted from Oct 2021 to Feb 2022. Interviews were audio recorded, and detailed notes were taken during the interview. Thematic analysis was done using ATLAS.ti version 8 software.Results: The significant motivators identified were family members’ belief or conviction that it would help save the lives of others; a sense of moral obligation to do so as bodies of brain-dead persons can contribute to this noble goal, no use of the body after death, an extension of life, and being a role model for others. The challenges were mistrusting the organ donation process, fear of being responsible for any mishappening, and feeling of shock. The suggestions to improve organ donation included awareness creation, simplifying the legal process for accidental deaths, providing benefits to the donor family, and a system for identifying potential donors and their counselling.Conclusion: The present study reflects the need for a more comprehensive awareness campaign to generate awareness and remove the misconception about organ donation in India. The findings of the study can be helpful for policymakers to amend the current organ donation process in India and improve the disequilibrium of demand and supply of deceased donations in India.Keywords: organ donation, factors, motivators, barriers

Deepak Saxena,1,2 Sandul Yasobant,1,2 Poonam Trivedi,1 Priya Bhavsar1 1Department of Public Health Science, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, 382042, India; 2School of Epidemiology and Public Health, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, Maharashtra, 442004, IndiaCorrespondence: Deepak Saxena, Indian Institute of Public Health Gandhinagar (IIPHG), Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, Gujarat, 382042, India, Email ddeepak72@iiphg.orgBackground: The disequilibrium in the demand-supply nexus of organ donation prevails an urgent need for understanding the process and cascade of the donation. There is a lack of evidence in organ donation literature within India that focuses on factors influencing familial consent, the decision-making process, and psychosocial factors that can predict successful organ donation. Such evidence can assist in designing interventions and policy dialogue focusing on the discussion on enhancing donation decisions with relatives. Thus, the present study is an effort to document the decision-making complexity systematically among successful cadaveric organ donation cases.Methods: A qualitative exploratory, including the network assessment was implemented between October 2021 and February 2022 in one of the western states of India, Gujarat. A semi-structured interview guide that was comprised of thematic, open-ended questions focused on understanding the network for the decision-making process was prepared, and trained interviewers conducted the interview at the suitable place of the donor’s relative.Results: The 10 interviews among the closest relatives of the deceased were conducted and the decision-making process indicated the involvement of multiple actors. The social network analysis reveals a minimum node of 2 to 7, with the highest ties of 22. The maximal degree was 3.6, and the density of 1 of these networks. Out of 10, in most cases, the ties were more than 2, with a maximum of 22 ties, which shows that more people communicated to each other before the final decision-making.Conclusion: The analysis indicates that the decision-making for deceased organ donation is a complex process as in most cases, multiple family members were involved and interaction happened before the final decision-making. The study explains the decision-making during the cadaveric organ donation process by exploring families’ experiences. Further research is recommended to generate evidence on the factors and the family dynamics, including the complexity of successful organ donation.Keywords: organ donation, decision-making, social network, India

Haseena Sait, Somya Srivastava, Deepti Saxena Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, IndiaCorrespondence: Deepti Saxena, Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Email saxenadrdeepti@gmail.comAbstract: Epidermolysis bullosa (EB) is a group of rare genodermatoses that is characterized by skin fragility resulting from minor trauma. There are four major subtypes, namely, EB simplex, junctional EB, dystrophic EB and Kindler EB, depending upon the localization of defective protein and resulting plane of blister formation. The phenotype is heterogeneous in terms of severity and majority of them present at birth or neonatal period. Currently, the treatment is mainly supportive and requires multidisciplinary care. The complex molecular pathology creates difficulty in discovering a unified curative treatment approach. But with arduous efforts, significant progress has been made in the development of treatment strategies in the last decade. The management strategies range from targeting the underlying causative factor to symptom-relieving approaches, and include gene, mRNA, protein, cell and combination therapies. In this review, we enumerate the promising approaches that are currently under various stages of investigation to provide effective treatment for patients with EB.Keywords: epidermolysis bullosa, blistering skin disorder, gene replacement, gene editing, antisense oligonucleotides, siRNA therapeutics, spliceosome-mediated RNA trans-splicing, revertant mosaicism, readthrough therapies, squamous cell carcinoma

Somen Saha,1 Apurvakumar Pandya,2 Yogini Kandre,1 Devang Raval,1 Deepak Saxena1 1Department of Public Health, Indian Institute of Public Health, Gandhinagar, Gujarat, India; 2Parul Institute of Public Health, Parul University, Vadodara, Gujarat, IndiaCorrespondence: Somen SahaDepartment of Public Health, Indian Institute of Public Health, Opp. Air Force Headquarter, Gandhinagar-Chiloda Highway, Near Lekawada Bus Stop, Gandhinagar, Gujarat, IndiaTel +91-968-7207549Email ssaha@iiphg.orgPurpose: Malnutrition status of adolescent girls remains a major public health problem in India. The present study assessed nutritional status, associated factors contributing to malnutrition and their access to health-care services in Dev Bhumi Dwarka district of Gujarat situated in western part of India.Materials and Methods: The study was carried out using descriptive cross-sectional design. A total of 1252 adolescent girls from all four blocks of Dev Bhumi Dwarka district were interviewed by field investigators. The data were collected on socio-demographic characteristics, physical activities, diet, and anthropometry. The WHO classification for body mass index (BMI) was used to assess underweight, overweight, and obesity among adolescent girls. Chi-square analyses were performed to identify significant determinants of under-nutrition.Results: Mean age of the study population was 13.82± 2.31. Of the total, around 34% of the adolescent girls were out-of-school. The prevalence of underweight (

Sandul Yasobant,1,2 Priya Bhavsar,1 Pachillu Kalpana,1 Farjana Memon,1 Poonam Trivedi,1 Deepak Saxena1– 3 1Department of Epidemiology, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, 382042, India; 2Center for One Health Education, Research, and Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, 382042, India; 3Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, 442004, IndiaCorrespondence: Deepak SaxenaIndian Institute of Public Health Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada, Gandhinagar, 382042, Gujarat, IndiaTel +91-9327396717Email ddeepak72@iiphg.orgAbstract: Tuberculosis (TB) care cascade is a recently evolved care model for patient retention across the sequential stages of care for a successful treatment outcome. The care cascade is multi-folded and complex in setting where the health system is reforming for its resilience. India, one of the countries with the highest burden of tuberculosis mortality and morbidity, is not an exception to this complexity. With the diverse challenges in the Indian health system and societal diversity, it is essential to understand the factors contributing to this TB care cascade. Thus, this study aims to map all the contributing factors to the TB care cascade in India. Further, it also captures the different patterns of factors explored so far in different countries’ regions. This systematic literature review was conducted between October 2020 and February 2021 in India using PubMed databases, Web of Science, and Google Scholar. Two reviewers extracted the data from eligible studies to summarize and tabulate important findings. Data were extracted and tabulated for study design, location of the study, type of TB patients, methodological approach, system side challenges, and demand-side challenges in the study’s findings. Out of 692 initial hits from the literature search, 28 studies were finally included to synthesize evidence in this review as per the inclusion and exclusion criteria. This review provides an insight into different factors such as the system-side (health workforce, institutional) and the demand-side (individual, societal) contributing towards the care cascade. The prime factors reflected in most of the studies were socio-economic condition, disease awareness, myths/beliefs, addictions among the demand-side factors and accessibility, the attitude of the healthcare staff, delay in referral for diagnosis among the system-side factors. The accountability for addressing these diverse factors is recommended to close the gaps in the TB care cascade.Keywords: care-seeking, care cascade, factors, tuberculosis, India

Siddhartha Dutta,1 Rimplejeet Kaur,2 Mainul Haque,3 Pankaj Bhardwaj,4 Deepak Saxena,5 Nor Azlina A Rahman,6 Halyna Lugova,7 Dilshad Jahan,8 Salequl Islam,9 Tajkera Sultana Chowdhury,10 Jaykaran Charan1 1Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India; 2Department of Pharmacology, Dr. S.N Medical College, Jodhpur, Rajasthan, India; 3The Unit of Pharmacology, Faculty of Medicine and Defence Health Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia; 4Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India; 5Indian Institute of Public Health (IIPH) Gandhinagar, Gujarat, India; 6Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia; 7The Unit of Community Medicine, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia; 8Department of Hematology, Gandaria Beside Dhupkhola, Asgar Ali Hospital Ltd, Dhaka, 1204, Bangladesh; 9Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; 10Department of Urology, Shaheed Suhrawardy Medical College Hospital, Dhaka 1207, BangladeshCorrespondence: Mainul HaqueThe Unit of Pharmacology, Faculty of Medicine and Defence Health Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, MalaysiaTel +60 109265543Email runurono@gmail.comBackground: Clinical Trial Registry - India (CTRI) is a valuable tool to access information regarding clinical trials conducted in India. To serve this purpose, the information provided on it must be complete and accurate. The present study was designed to assess the reasons for premature termination of clinical trials on the CTRI database and determine the average timings related to updating information on CTRI.Methods: The data were extracted from the website of Clinical Trial Registry - India; all the terminated trials from 20 July 2007 to 18 December 2019 were included. The reasons given for termination were categorized as scientific reasons, nonscientific reasons, and unspecified reasons.Results: Of 16,579 interventional clinical trials, 243 trials were terminated. Out of these 243 trials, reasons were given in 50 (20.58%). In reasoning with scientific data, the most common reason was safety issues (14%), and among nonscientific data, a significant delay in recruitment was a principal reason (16%). The median time from date of registration to date of modification was 1034 days (0– 3912), and the median time from the date of last revision to the date of our analysis was 1329 days (2– 3138).Conclusion: The reasons for termination are not mentioned adequately for the terminated clinical trials in the Clinical Trial Registry of India. Efforts need to be done to motivate investigators to report the reasons for termination. Proper planning of trial before initiation may prevent premature termination of clinical trials and ensure fair use of resources.Keywords: Clinical Trial Registry of India, terminated trials, reasons for premature termination

Patricia Maria Wiziack Zago,1 Ilza Maria Oliveira Sousa,2 Leila Servat-Medina,2 Michelle Pedroza Jorge,2 Lidio Gonçalves Lima Neto,3 Viviane Hass,4 Xin Li,5 Ana Lucia Tasca Gois Ruiz,2 Deepak Saxena,5 Mary Ann Foglio2 1Sao Leopoldo Mandic Medical School, Araras, São Paulo, Brazil; 2Faculty of Pharmaceutical Sciences at University of Campinas, Campinas, São Paulo, Brazil; 3Postgraduate Program in Parasitic Biology, CEUMA University, São Luis, Maranhão, Brazil; 4School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA; 5College of Dentistry, New York University, New York, NY, USACorrespondence: Mary Ann FoglioFaculty of Pharmaceutical Sciences at University of Campinas, Rua Candido Portinari 200, CEP: 13083-871, Campinas, São Paulo, BrazilTel +55 19 3521-8132Email maryann.foglio@fcf.unicamp.brIntroduction: Osteonecrosis of the jaw is a condition associated with intraoral ulceration and bone necrosis induced by antiresorptive medications, such as zoledronic acid, a bisphosphonate. Previous data on Arrabidaea chica (H&B.) Verlot wound healing activity prompted the study reported herein on A. chica standardized hydro alcoholic extract in vitro cytoprotective activity data on epithelial and osteoblastic cells exposed to zoledronic acid (ZA).Methods: Primary human gingival fibroblasts and murine pre-osteoblasts were treated with ZA 10 μM together with 5 or 10 μg.mL− 1 A. chica extract for 24h and 48 h. At both times, cells were submitted to viability assay and caspase 3/7 activation evaluation. Statistical analysis used one-way ANOVA and p=0.05.Results: In cell viability assay, a drastic damage effect of ZA appeared after 48 h in both epithelial (55.8%) and pre-osteoblastic cells (39.7%). When treated with ZA in combination with A. chica extract, cells showed higher viability values: 74.1%– 82.3% for fibroblasts and 66% for pre-osteoblasts. Furthermore, the combined treatment presented lower caspase 3/7 activation in fibroblasts and pre-osteoblasts.Conclusion: At low concentrations, A. chica extract showed promising cytoprotective effects against ZA-induced damage actions; however, further in vitro and in vivo studies are required to establish the mechanism of action.Keywords: Arrabidaea chica, zoledronic acid, epithelial cells, osteoblasts, fibroblasts

Millets are small‐seeded annual crops grown as cereal grains. They are known for their nutritional benefits and their role in preventing health problems. These grains are classified into major and minor millets. Kodo millet (Paspalum scrobiculatum), one of the minor millets, originated from Africa as a drought‐resistant crop and was domesticated in India in 3000 BC. It is grown in various states of India and is widely distributed in tropical and subtropical regions of the world. The Kodo seed is rich in phytochemical compounds and dietary fibers with remarkable storage properties. It can be stored for extended periods under normal storage conditions and is found as a famine crop, which means it can be used as an alternative to major cereals. Kodo millet is a rich source of phenolic compounds known for their antioxidant properties. It also contains antinutritional factors that can limit its use, but these can be reduced by proper processing methods to enhance its food applications. Different traditional methods, such as milling, decortication, roasting, germination, and fermentation, along with novel techniques such as microwave, cold plasma and ultrasound treatment significantly impact the value addition of Kodo millet and the development of various food products. Therefore, this review provides valuable information on the nutritional profile, processing methods, and food applications of Kodo millet. [ABSTRACT FROM AUTHOR]