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Background: Multimorbidity is rising in low-and middle-income countries such as Nepal, yet the research has not gained pace in this field. We aimed to systematically review the existing multimorbidity literature in Nepal and estimate the prevalence and map its risk factors and consequences. Methods: We reviewed data collated from PubMed, Embase and CINAHL by including original studies that reported prevalence of multimorbidity in Nepal. The quality of included studies was assessed using the Appraisal Tool for Cross-sectional Studies. The summary of the review is presented both qualitatively as well as through meta-analysis to give pooled prevalence. We prospectively registered in PROSPERO (CRD42024499598). Results: We identified 423 studies out of which seven were included in this review. All studies were conducted in a community setting except one which was hospital based. The prevalence reported across various studies ranged from 13.96% to 70.1%. The pooled prevalence of multimorbidity was observed to be 25.05% (95% CI: 16.99 to 34.09). The number of conditions used to assess multimorbidity ranged from four to nine. The major risk factors identified were increasing age, urban residence, and lower literacy rates. Conclusion: A wide variance in the prevalence of multimorbidity was observed. Moreover, multimorbidity assessment tool/conditions considered for assessing multimorbidity were heterogeneous. [ABSTRACT FROM AUTHOR]

The constantly changing nature of cyber threats presents unprecedented difficulties for people, institutions, and governments across the globe. Cyber threats are a major concern in today's digital world like hacking, phishing, malware, and data breaches. These can compromise anyone's personal information and harm the organizations. An intrusion detection system plays a vital responsibility to identifying abnormal network traffic and alerts the system in real time if any malicious activity is detected. In our present research work Artificial Neural Networks (ANN) layers are optimized with the execution of Spider Monkey Optimization (SMO) to detect attacks or intrusions in the system. The developed model SMO-ANN is examined using publicly available dataset Luflow, CIC-IDS 2017, UNR-IDD and NSL -KDD to classify the network traffic as benign or attack type. In the binary Luflow dataset and the multiclass NSL-KDD dataset, the proposed model SMO-ANN has the maximum accuracy, at 100% and 99%, respectively. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis (LF) is a significant public health issue in India. Despite 10–15 rounds of mass drug administration (MDA) in India, the global LF elimination target of 2030 appears challenging. To strengthen the program, community and provider perspectives on ways to bridge a gap in MDA are needed. Through the motivation–opportunity–ability–behaviour (MOAB) lens, we systematically reviewed the facilitators and barriers encountered in LF elimination in India. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched PubMed, Embase, ProQuest and Google Scholar databases to explore factors related to MDA program implementation in India through 30 June 2021. We analysed the data using a thematic framework. We identified 576 studies; of these, 20 studies were included. This review revealed that the public health system for distributing MDA drugs in India created a better enabling environment, including zero out-of-pocket expenditure, door-step distribution of medicines and ample capacity-building training and follow-up. However, community members were unaware of the rationale for drug consumption, leading to a gap in drug distribution and consumption. Motivation is required among community members, which suggests capacity-building training for service providers to counsel the community. [ABSTRACT FROM AUTHOR]

Objectives: This is the first systematic review and meta-analysis of the prevalence of multimorbidity, its risk factors including socioeconomic factors, and the consequences of multimorbidity on health systems and broader society in India. Methods: A systematic review of both published and grey literature from five databases (Medline, Embase, EBSCO, Scopus, and ProQuest) was conducted including original studies documenting prevalence or patient outcomes associated with multimorbidity among adults in India. We excluded studies that did not explicitly mention multimorbidity. Three independent reviewers did primary screening based on titles and abstracts followed by full-text review for potential eligibility. The risk of bias was independently assessed by two reviewers following the Appraisal Tool for Cross-Sectional Studies. We presented both qualitative and quantitative (through meta-analysis) summaries of the evidence. The protocol for this study was prospectively registered with PROSPERO (CRD42021257281). Results: The review identified 5442 articles out of which 35 articles were finally included in this study. Twenty-three studies were based on the primary data while 12 used secondary data. Eleven studies were conducted in hospital/primary care setting while 24 were community-based. The pooled prevalence of multimorbidity based on (n=19) studies included for meta-analysis was 20% (95% CI: 19% to 20%). The most frequent outcomes were increased healthcare utilization, reduced health-related quality of life, physical and mental functioning. Conclusion: We identified a wide variance in the magnitude of multimorbidity across age groups and regions with most of the studies from eastern India. Nation-wide studies, studies on vulnerable populations and interventions are warranted. [ABSTRACT FROM AUTHOR]

In order to replace conventional diesel, biodiesel from various feedstocks is being researched for diesel engines. This study explores novel biodiesel blends produced from unconventional resources such as mentha piperita (peppermint), pontederia crassipes (water hyacinth), tamarindus indica (tamarind), and trichosanthes cucumerina (snake gourd) to assess the outcomes of a diesel engine. The fuel samples are designated as MP20, PC20, TC20, and TI20, which consist of 80% biodiesel and 20% diesel. The assessment is carried out on a four-stroke, one-cylinder diesel engine that is water-cooled and set to operate at 1500 rpm with a 17.5 compression ratio under various engine loading scenarios with quarter-incremental loading from one-fourth to full loading conditions. The fuel samples are injected with 220 bar injection pressure into the combustion chamber 23° before TDC. An extensive analysis of engine parameters is performed using engine configuration, fuel characteristics, and applied boundary conditions. This comprises brake-specific energy consumption (BSEC), fuel consumption (BSFC), thermal efficiency (BTE), cylinder pressure (CP), heat release rate (HRR), particulate matter (PM), nitrogen oxide (NOx), and carbon dioxide (CO2) emissions. At 100% load, the biodiesel blends show an increase in BSFC (2.8–12.6%) and BSEC (1.1–7.1%) but a minor decrease in CP (0.9–6.9%), HRR (0.8–16.2%), and BTE (1.2–2.9%). For biodiesel blends at full engine load, the emissions of PM (8.9–21.4%), NOx (1.4–16.2%) and CO2 (2.4–7.9%) are all significantly reduced. The results emphasize the distinct benefits of biodiesel blends, demonstrating enhanced engine performance and substantial decreases in emissions, which supports the aim of providing sustainable energy solutions. [ABSTRACT FROM AUTHOR]

Malaria elimination mandates early and accurate diagnosis of infection. Although malaria diagnosis is programmatically dependent on microscopy/RDTs, molecular diagnosis has much better diagnostic accuracy. Higher cost of molecular diagnoses is a recognized challenge for use at the point of care. Because funding is always a recognized constraint, we performed financial cost-analyses of available molecular platforms for better utilization of available budget. Two strategies were applied to deduce the cost per sample. Strategy 1 included recurring components (RC) in minimum pack size, and biologist's time whereas strategy 2 included only RC and non-recurring components and costs are calculated for sample sizes (1–1,000,000) to infer the sample size effect. Spin column-based manual DNA extraction (US$ 3.93 per sample) is the lowest-cost method, followed by magnetic bead-based automated, semi-automated, and PCI-based manual method. Further, DNA extraction cost per sample via spin column-based manual method and semi-automated method decreases with an increase in sample size up to 10,000. Real-time PCRs are ~ 2-fold more economical than conventional PCR, regardless of sample size. This study is the first for malaria to estimate systematic molecular diagnosis financial costs. Kit-based and automated methods may replace conventional DNA extraction and amplification methods for a frugal high-throughput diagnosis. [ABSTRACT FROM AUTHOR]

Physicians' hold pivotal roles in improving non-communicable diseases (NCDs). Studies conducted in India revealed that physicians' feel unprepared to address NCDs risk reduction and provide counseling. We conducted a gap analysis using desk reviews to identify inclusion of NCD risk reduction in medical curricula, and a scoping review to assess knowledge, attitude, perception, and practice related to NCD risk reduction among the undergraduate medical students in India. We also conducted key-informant interviews to understand perceptions among medical students and physicians. We found a lack of knowledge about NCDs and strong interest and perceived need for NCD risk reduction training among both medical students and their teachers. Our findings suggest promoting NCD prevention by physicians and allied health workers in clinical settings can enable the learning environment for medical students to adopt these practices. [ABSTRACT FROM AUTHOR]

Malaria has inflicted serious morbidity and mortality across the globe. The major brunt of the disease has been on African, South-East Asian and South American countries. Proportionally, malaria has attracted global research priorities and this is evident from the number of publications related to malaria from across the globe, irrespective of its endemicity. However, formal and exhaustive analyses of these 'malaria publications' are rarely reported. The systematic review and secondary data analyses were done to retrieve information on what has been published on malaria, where is it published, and which countries are major contributors to malaria research. The study presents malaria publications from 1945 to 2020 retrieved using three databases: Web of Science™, Embase® and Scopus®. Exported data were examined to determine the number of publications over time, their subject areas, contributions from various countries/organizations, and top publishing journals. The total number of published records on malaria ranged from 90,282 to 112,698 (due to three different databases). Based on the number of publications, USA, UK, France, and India were identified as the top four countries. Malaria Journal, American Journal of Tropical Medicine & Hygiene, and PLoS One were the most preferred journals, whereas the University of London (Institutions other than LSHTM), the National Institute of Health, the London School of Hygiene and Tropical Medicine, and the University of Oxford appeared to be the top contributing organization. A disproportional contribution to malaria research was observed with non-malaria endemic countries making the largest contribution. Databases differed in their output format and needed standardization to make the outputs comparable across databases. [ABSTRACT FROM AUTHOR]

The recent article by Harit et al. in Human Genomics reported a novel association of the C allele of rs479200 in the human EGLN1 gene with severe COVID-19 in Indian patients. The gene in context is an oxygen-sensor gene whose T allele has been reported to contribute to the inability to cope with hypoxia due to increased expression of the EGLN1 gene and therefore persons with TT genotype of EGLN1 rs479200 are more susceptible to severe manifestations of hypoxia. In contrast to this dogma, Harit et al. showed that the C allele is associated with the worsening of COVID-19 hypoxia without suggesting or even discussing the scientific plausibility of the association. The article also suffers from certain epidemiological, statistical, and mathematical issues that need to be critically elaborated and discussed. In this context, the findings of Harit et al. may be re-evaluated. [ABSTRACT FROM AUTHOR]

Introduction: Cataracts are the leading cause of blindness among older people, but they can be treated with corrective surgery. India boasts the oldest blindness control programme in the world. We aimed to assess the prevalence of cataract surgery, and we compared the determinants of undergoing cataract surgery and identified the unmet needs for cataract surgery among older adults in India. Methods: We included 52,380 individuals aged =50 years from the Longitudinal Ageing Study in India, wave-1. The primary outcome measures of our study were the prevalence of cataract surgery and the unmet need for cataract surgery. Multivariate analysis was executed to investigate the association between socio-demographic variables and outcomes, expressing the results as adjusted odds ratios with 95% confidence intervals (CIs). Results: The overall prevalence of cataracts was 14.85%. The coverage of cataract surgery was 76.95%, with 23% having unmet needs for cataract surgery. Notably, cataract surgery coverage was higher at 78.30% (95% CI: 76.88-79.48) among participants aged 66-80 years, while the percentage of those who did not undergo cataract surgery was higher at 24.62% (95% CI: 23.09-26.20) among participants aged 50-60 years. The most deprived group had a higher odds ratio [adjusted odds ratio: 1.20 (95% CI: 1.00-1.44)] (p < 0.05) of having unmet needs for cataract surgery. Conclusions: There is a considerable burden of age-related cataracts in India. While the coverage of cataract surgery is high, the unmet need for cataract surgery cannot be overlooked. The existing blindness control programme has contributed significantly to increasing the coverage of cataract surgery, but it still needs to be strengthened, especially to reach the most deprived sections of society. [ABSTRACT FROM AUTHOR]

Background: Sulfadoxine-pyrimethamine (SP), as a partner to artesunate as ACT is the treatment of choice for uncomplicated P. falciparum infections in the majority of India and SP-resistance has a potential to lead to ACT failure. In the lack of robust surveillance of therapeutic efficacy of SP, validate molecular markers of SP-resistance offer a hint of failing SP. However, studies reporting these validated markers often suffer from certain pitfalls that warrant a careful interpretation. Main body : Critical analyses of the results and their reported interpretations from a recent study and other studies conducted on the WHO-validated molecular markers of SP-resistance in India were analysed and the main problems with studying and reporting of these markers are presented here. It was noted that almost all studies analysed flawed either on the usage, estimation and/or interpretation of the standardized classification of the studies SP mutations. These flaws not only impart spatiotemporal incomparability of the published data but also have the potential of being misunderstood and wrongly translated. Conclusion: Based on this universal problem in studying, reporting and interpreting the data from the studies on molecular markers of SP-resistance, it is stressed that the future studies should be conducted with utmost caution so that robust evidence may be generated and correctly translated to policy. [ABSTRACT FROM AUTHOR]

Background: Lymphatic filariasis (LF) persists as a public health problem in India. Despite more than ten rounds of mass drug administration (MDA), LF continues to be endemic in the Dhenkanal district of Odisha. Hence, we assessed the coverage and compliance of the MDA program and explored the factors affecting it in the Dhenkanal district. Methods: An explanatory mixed-method study was conducted, wherein for the quantitative survey, 552 participants aged 2 years and above were recruited following a multistage cluster random sampling during February 2022. Indepth interviews were conducted among purposively selected key stakeholders and program implementers. Descriptive statistics were used to report coverage and compliance, along with a 95% confidence interval. Qualitative data were analyzed using a thematic approach. Results: We observed coverage of 99.28% and compliance of 85.87% for MDA drugs. Supervised drug administration proved to be a major pillar in increasing compliance. There was difficulty in administering drugs in urban areas due to gated societies, the absence of individuals during the day, and the perspective toward healthcare providers. Participants reported a lack of confidence in drug distributors and a fear of side effects as major causes for non-compliance. Conclusion: There is a need to strengthen MDA, especially in urban areas. An urban-specific strategy, along with surveillance, behavioral change communication, and the involvement of multi-disciplinary teams, is required. [ABSTRACT FROM AUTHOR]

Introduction: India has a multifaceted healthcare system and recognizes complementary and alternative systems of medicine (AYUSH) that cater to the healthcare needs of people. Multimorbidity requires frequent visits to physicians and long-term use of medications, due to which people tend to prefer AYUSH systems as they provide holistic patient-centered treatment. Hence, we aimed to estimate the prevalence of multimorbidity and assess its correlates among patients attending AYUSH primary care clinics in Delhi. Methods: A cross-sectional study was conducted among 943 patients aged ≥ 18 years attending various AYUSH primary care clinics in Delhi from September 2021 to February 2022, employing a stratified random sampling technique. Descriptive statistics such as frequency and proportion were used to report the prevalence of multimorbidity (two or more chronic conditions in an individual out of the 33 conditions listed as per the Multimorbidity Assessment Questionnaire for Primary Care). A multivariable logistic regression assessed the association between various socio-demographic characteristics and multimorbidity, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results: The prevalence of diabetes (14.7%) was found to be the highest (out of all included chronic conditions) among the patients attending various AYUSH primary care settings. The overall prevalence of multimorbidity was observed to be around 39.4%. We observed a higher likelihood of having multimorbidity among participants aged ≥ 70 years [AOR: 9.19 (95% CI: 3.75–22.54)], females [AOR: 1.57 (95% CI: 1.04–2.37)], and middle class [AOR: 2.23 (95% CI: 1.45–3.43)]. Conclusion: Multimorbidity was evidently prevalent across AYUSH primary care settings, which cannot be overlooked. The results suggest behavioral change communication may be aimed at older individuals, females, and the middle class. [ABSTRACT FROM AUTHOR]

Increase in the prevalence of hysterectomy among low-and middle-income countries (LMICs) such as India has become a significant concern. Reports based on either a particular group or region show an increasing trend in hysterectomy, but there is a dearth of national-level data in this domain. Hence, there seems to be an urgent need to garner evidence on the prevalence and determinants of hysterectomy, which could pave the way for future programs and policies. We aimed to estimate the prevalence of hysterectomy and assess its determinants using a nationally representative sample. An observational analysis was conducted using data from Longitudinal Aging Study in India (LASI), 2017–2018. 38,154 women aged > 18 years were included. A multivariable logistic regression, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI), was used to predict the association between various socio-demographic characteristics and hysterectomy. A separate multivariable logistic regression model was executed to determine the association between selected non-communicable diseases (NCDs) and hysterectomy. Survey weights compensated the complex study design. The overall prevalence of hysterectomy was around 11.35%. Excessive menstrual bleeding followed by fibroids emerged as the leading causes of hysterectomy. The various determinants of hysterectomy were urban residents [AOR: 1.54 (1.21–1.96)], other backward class [AOR: 2.19 (1.72–2.78], working women [AOR: 1.19(1–1.42)] and the most affluent (rich) group [AOR: 2.06 (1.62–2.63)]. Hysterectomy was associated with cancer [AOR: 4.83 (2.51–9.29)], diabetes [AOR: 1.79 (1.25–2.57)], hypertension [AOR: 1.48 (1.27–1.71)] and joint diseases [AOR: 1.43 (1.09–1.88)]. Hysterectomy is considerably prevalent in India, which cannot be overlooked. Health promotion regarding hysterectomy and its implications is needed especially among urban residents, affluent groups and those with a higher body mass index. Health programmes aimed at women should follow a life course approach by prioritizing health and overall well-being even after reproductive years. [ABSTRACT FROM AUTHOR]

With the decline in HIV mortality, a concomitant increase in morbidity and death not directly related to HIV has been witnessed. Consequently, many countries especially low- and middle-income countries (LMICs) are now facing the dual burden of HIV and non-communicable diseases (NCDs). 2.3 million people living with HIV in India are at a higher risk of developing NCDs due to ageing, which can be attributed to the additional impact of long-standing HIV infection and the side-effects of antiretroviral therapy. This has led to a rise in demand for a combined health system response for managing HIV infection and co-existing NCDs, especially in LMICs such as India. The health and wellness centres (HWCs) envisioned to provide an expanded range of preventive and curative services including that for chronic conditions may act as a window of opportunity for providing egalitarian and accessible primary care services to these individuals. The reasons for integrating HIV and NCD care are epidemiological overlap between these conditions and the similar strategies required for provision of healthcare services. [ABSTRACT FROM AUTHOR]

Purpose: With the current COVID-19 outbreak, the majority of the higher educational institutes (HEI) are conducting online examinations to assess their students, where both teachers and students are facing various constraints. Under these circumstances, it is very important to understand the perspectives of teachers and students towards online examinations in higher education institutions and the factors affecting their perspectives. Design/methodology/approach: This study has been conducted with the mentioned objective through online survey responses and rigorous statistical analysis of the data. The data analysis has been performed and presented using self-explanatory bar graphs, partial least squares structural equation modeling (PLS-SEM) and sentiment analysis. Findings: While the students responded diversely for items in one of the constructs: scope for malpractice, the teachers agreed with the items, indicating that the online exams are not sufficiently effective in dealing with cheating and malpractice. Few more issues related to Internet connections, short time duration for uploading answer scripts are identified as problems and need attention while framing the rules to conduct the online examinations in future. Originality/value: A new questionnaire was drafted to measure the effect of different constructs. An attempt is made to understand the perspectives of both the teachers and the students towards online examinations with respect to each of these considered constructs with a rigorous statistical analysis. [ABSTRACT FROM AUTHOR]

Increase in the prevalence of hysterectomy among low-and middle-income countries (LMICs) such as India has become a significant concern. Reports based on either a particular group or region show an increasing trend in hysterectomy, but there is a dearth of national-level data in this domain. Hence, there seems to be an urgent need to garner evidence on the prevalence and determinants of hysterectomy, which could pave the way for future programs and policies. We aimed to estimate the prevalence of hysterectomy and assess its determinants using a nationally representative sample. An observational analysis was conducted using data from Longitudinal Aging Study in India (LASI), 2017–2018. 38,154 women aged > 18 years were included. A multivariable logistic regression, presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI), was used to predict the association between various socio-demographic characteristics and hysterectomy. A separate multivariable logistic regression model was executed to determine the association between selected non-communicable diseases (NCDs) and hysterectomy. Survey weights compensated the complex study design. The overall prevalence of hysterectomy was around 11.35%. Excessive menstrual bleeding followed by fibroids emerged as the leading causes of hysterectomy. The various determinants of hysterectomy were urban residents [AOR: 1.54 (1.21–1.96)], other backward class [AOR: 2.19 (1.72–2.78], working women [AOR: 1.19(1–1.42)] and the most affluent (rich) group [AOR: 2.06 (1.62–2.63)]. Hysterectomy was associated with cancer [AOR: 4.83 (2.51–9.29)], diabetes [AOR: 1.79 (1.25–2.57)], hypertension [AOR: 1.48 (1.27–1.71)] and joint diseases [AOR: 1.43 (1.09–1.88)]. Hysterectomy is considerably prevalent in India, which cannot be overlooked. Health promotion regarding hysterectomy and its implications is needed especially among urban residents, affluent groups and those with a higher body mass index. Health programmes aimed at women should follow a life course approach by prioritizing health and overall well-being even after reproductive years. [ABSTRACT FROM AUTHOR]

The long term in vitro culture of Plasmodium falciparum was successfully established by Trager and Jensen in 1976; however it largely remains unachieved for P. vivax. The major obstacle associated with Plasmodium vivax in vitro culture is its predilection for invading younger reticulocytes and the complex remodelling of invaded reticulocytes. There are many factors under exploration for this predilection and host--parasite interactions between merozoites and invaded reticulocytes. These include various factors related to parasite, host and environment such as compromised reticulocyte osmotic stability after invasion, abundance of iron in the reticulocytes which makes them favourable for P. vivax growth and propagation and role of a hypoxic environment in P. vivax in vitro growth. P. vivax blood stage transfection represents another major hurdle towards understanding this parasite's complex biology. Efforts in making this parasite amenable for molecular investigation by genetic modification are limited. Newer approaches in sustaining a longer in vitro culture and thereby help advancing transfection technologies in P. vivax are urgently needed that can be explored to understand the unique biology of this parasite. [ABSTRACT FROM AUTHOR]

Background: Evidence on tobacco use among indigenous communities is scarce with available literature based either on a specific region or a particular tribe. Considering the large tribal population in India, it is pertinent to generate evidence on tobacco use among this community. Using nationally representative data, we aimed to estimate the prevalence of tobacco use and assess its determinants and regional variations among older tribal adults in India. Methods: We analysed data from Longitudinal Ageing Study in India (LASI), wave-1 conducted in 2017–18. A sample of 11,365 tribal individuals aged ≥ 45 years was included in this study. Descriptive statistics was used to assess the prevalence of smokeless tobacco (SLT), smoking, and any form of tobacco use. Separate multivariable regression models were executed to assess the association of various socio-demographic variables with different forms of tobacco use, reported as adjusted odds ratio (AOR) with 95% confidence interval. Results: The overall prevalence of tobacco use was around 46%, with 19% of smokers and nearly 32% smokeless tobacco (SLT) users. Participants from the lowest MPCE quintile group had a significantly higher risk of consuming (SLT) [AOR: 1.41 (95% CI: 1.04–1.92)]. Alcohol was found to be associated with both smoking [AOR: 2.09 (95% CI: 1.69–2.58)] and (SLT) [AOR: 3.05 (95% CI: 2.54–3.66)]. Relatively higher odds of consuming (SLT) were associated with the eastern region [AOR: 6.21 (95% CI: 3.91–9.88)]. Conclusion: This study highlights the high burden of tobacco use and its social determinants among the tribal population in India, which can help tailor anti-tobacco messages for this vulnerable population to make tobacco control programs more effective. [ABSTRACT FROM AUTHOR]

COV-2 SARs has disproportionately affected low- and middle-income countries such as Ghana, where the healthcare system was not prepared enough to provide care, drugs, and equipment. This study was carried out to assess predictors of COVID-19 vaccine acceptance among health professionals in the Bono region of Ghana. A facility-based cross-sectional study was conducted among 424 health professionals recruited through simple random sampling. Univariate and multivariate logistic regression models were utilized to identify the predictors of COVID-19 vaccine acceptance presented as an odds ratio (OR) with a 95% confidence interval (CI). All respondents had heard about the COVID-19 vaccine. The most common source of information was the media (45.8%). The proportion of health professionals who accepted the COVID-19 vaccine was 73.6%. Among those who did not take the vaccine, 64.3% were willing to take it in the future. The key predictors of taking the COVID-19 vaccine included: age 25 to 45 years (AOR = 1.96, 95% CI: 1.14–3.35), age older than 45 years (AOR = 5.30, 95% CI: 2.59–10.87), males (AOR = 4.09, 95% CI: 2.34–7.15), Christians (AOR = 3.10, 95% CI: 1.44–7.72), and at least three years of experience (AOR = 1.74, 95% CI: 1.033–2.93). Reasons for not taking vaccines included: vaccines were rapidly developed and approved (41.0%), immediate side effects (39.2%), and unforeseen future effects (37.5%). This study showed that most participants had received their first dose of COVID-19 vaccination, and most of those hesitant about the vaccine were willing to receive it in the future. This is a positive finding for policy makers since it reflects that fewer resources will be needed for behavioural change initiatives. In addition, it would present a chance to focus on minority individuals who are unwilling to take the vaccine and offer targeted community mobilisation. [ABSTRACT FROM AUTHOR]

Background Telelactation, a virtual lactation support platform, is a convenient and effective way of providing virtual breastfeeding support services and communicating proper breastfeeding techniques to new mothers to address any breastfeeding challenges and boost overall maternal breastfeeding confidence all from the comfort of their homes. This Ontario Health Insurance Plan (OHIP) covered service benefits more mothers in the remote areas where in-person LC service is not easily accessible. Objective The objective of this cross-sectional survey study is to explore the feasibility, potential benefits, and challenges, and level of patient satisfaction in virtual lactation consultation services along with virtual paediatrician consultation available in Ontario, Canada. Method Patient satisfaction was assessed using a structured online survey as a part of a cross-sectional observational study that asked questions relevant to several independent demographic variables as well as specific Likert type scale questions to gauge patient satisfaction with virtual lactation consultation. Results Data were analyzed from 177 survey responses (n=177), of which study revealed that 86.44% (153/177) were satisfied with the virtual lactation services they received. Patient satisfaction was found to be higher in the first-time mothers with high school or undergraduate education between the age group of 26 to 35 years living in the Greater Toronto Area (GTA). In terms of connectivity, participants from the GTA had a better experience overall compared those living outside the GTA. Conclusion OHIP covered telelactation with a paediatrician consultation is an innovative and feasible health care delivery platform for providing remote professional breastfeeding support to mothers of all socio-economic strata with great potential to further improve both patient experience and efficiency in patient care. [ABSTRACT FROM AUTHOR]

A lack of a universal adult immunization scheme in India poses a challenge to achieve universal health coverage. Healthcare disparity is one of the biggest challenges in low- and middle-income countries such as India. We aimed to estimate the disparities in coverage of various adult vaccines among older adults in India using nationally representative data. An observational analysis among 31,464 participants aged ≥60 years from the Longitudinal Ageing Study in India, 2017–2018, was conducted. Vaccination coverage across wealth quintiles and selected non-communicable diseases were reported as frequencies and weighted proportions along with their 95% confidence intervals as a measure of uncertainty. The highest coverage was of the diphtheria and tetanus vaccine (2.75%) followed by typhoid (1.84%), hepatitis B (1.82%), influenza (1.59%), and pneumococcal (0.74%). The most affluent groups had a higher coverage of all vaccines. Participants having high cholesterol, psychiatric conditions, and cancer had the highest coverage of all vaccines. Overall, a very low coverage of all vaccines was observed. The coverage was influenced by social determinants of health, depicting a disparity in accessing immunization. Hence, at-risk groups such as the deprived and multimorbid patients need to be covered under the ambit of free immunization to achieve universal health coverage. [ABSTRACT FROM AUTHOR]

Background. Dengue, caused by mosquito bite, is an emerging disease of international concern. Evidence regarding the prevalent dengue serotypes is scarce, but essential for its management during the outbreaks. Hence, we mapped the distribution and trends of currently prevalent dengue virus (DENV) serotypes in Odisha. Methods. We conducted a facility-based retrospective study from referral samples sent for the diagnosis/confirmation of dengue in 2018. The samples were serologically tested for enzyme-linked immunosorbent assay (ELISA) IgM antibody and NS1. Only NS1-positive samples were chosen for serotyping. A pool of 8-10 NS1-positive samples were analysed for district-wise serotypes. Ribonucleic acid extraction and nested polymerase chain reaction (PCR) was done from NS1-positive samples. The PCR products were then subjected to gel electrophoresis. Results. A total of 2892 samples were screened for dengue virus across various districts of Odisha where 763 samples were found to be NS1-positive. Thirteen of 18 districts covering all topographies of Odisha predominantly had DENV2 serotype. Only few districts such as Balangir, Kalahandi and Rayagada had mixed serotypes. Conclusion. Although DENV2 is predominantly prevalent, mixed serotypes too exist in Odisha. Evidence based on variations of dengue serotypes across topographies, seasons, gender and age groups may support public health efforts in preventing the disease. [ABSTRACT FROM AUTHOR]

The neglected but highly prevalent Plasmodium vivax in South-east Asia and South America poses a great challenge, with regards to long-term in-vitro culturing and heavily limited functional assays. Such visible challenges as well as narrowed progress in development of experimental research tools hinders development of new drugs and vaccines. The leading vaccine candidate antigen Plasmodium vivax Duffy Binding Protein (PvDBP), is essential for reticulocyte invasion by binding to its cognate receptor, the Duffy Antigen Receptor for Chemokines (DARC), on the host's reticulocyte surface. Despite its highly polymorphic nature, the amino-terminal cysteine-rich region II of PvDBP (PvDBPII) has been considered as an attractive target for vaccine-mediated immunity and has successfully completed the clinical trial Phase 1. Although this molecule is an attractive vaccine candidate against vivax malaria, there is still a question on its viability due to recent findings, suggesting that there are still some aspects which needs to be looked into further. The highly polymorphic nature of PvDBPII and strain-specific immunity due to PvDBPII allelic variation in Bc epitopes may complicate vaccine efficacy. Emergence of various blood-stage antigens, such as PvRBP, PvEBP and supposedly many more might stand in the way of attaining full protection from PvDBPII. As a result, there is an urgent need to assess and re-assess various caveats connected to PvDBP, which might help in designing a long-term promising vaccine for P. vivax malaria. This review mainly deals with a bunch of rising concerns for validation of DBPII as a vaccine candidate antigen for P. vivax malaria. [ABSTRACT FROM AUTHOR]

Introduction: Lymphatic filariasis (LF) is a debilitating and disabling parasitic disease of immense public health concern in India with more than 650 million people at risk. Mass drug administration (MDA) is the recommended preventive chemotherapy strategy to eliminate LF. But, its coverage and compliance has been a mixed success. There is an urgent need of evidence to strengthen the program further, which can be done by exploring and understanding implementer as well as beneficiary perspectives. Objective: To systematically review the facilitators and barriers experienced during the coverage and compliance of MDA for LF elimination in India from both beneficiary and provider’s (health system) perspective. Methods and Analysis: We will search at Medline database through PubMed and Embase, along with ProQuest and Google Scholar to retrieve literature. Original qualitative observational studies exploring challenges and enablers in MDA program will be screened by two independent reviewers systematically based on title and abstract followed by full text. The risk of bias will be assessed through critical appraisal skills program checklist for each included article. Data will be extracted in a pre‑designed proforma with study characteristics, demographic features, and texts and quotes of qualitative data. Data will be analyzed through thematic analysis and motivation‑opportunity‑ability‑behavior framework using MAXQDA software. Ethics and Dissemination: This is a literature‑based review with minimal privacy concerns. The findings of this study will be published in a peer‑reviewed journal and disseminated through policy brief to program implementers. [ABSTRACT FROM AUTHOR]

In the coming decades, eliminating malaria is the foremost goal of many tropical countries. Transmission control, along with an accurate and timely diagnosis of malaria, effective treatment and prevention are the different aspects that need to be met synchronously to accomplish the goal. The current review is focused on one of these aspects i.e., transmission control, by looking deeper into the event called gametogenesis. In the Plasmodium life cycle, gametocytes are the first life forms of the sexual phase. The transmission of the parasite and the disease is critically dependent on the number, viability and sex ratio of mature gametocytes and their further development inside mosquito vectors. Gametogenesis, the process of conversion of gametocytes into viable gametes, takes place inside the mosquito midgut, and is a tightly regulated event with fast and multiple rounds of DNA replication and diverse cellular changes going on within a short period. Interrupting the gametocyte-gamete transition is ought to restrict the successful transmission and progression of the disease and hence an area worth exploring for designing transmission-blocking strategies. This review summarizes an in-depth and up-to-date understanding of the biochemical and physiological mechanism of gametogenesis in Plasmodium , which could be targeted to control parasite and malaria transmission. This review also raises certain key questions regarding gametogenesis biology in Plasmodium and brings out gaps that still accompany in understanding the spectacular process of gametogenesis. [ABSTRACT FROM AUTHOR]

Background: Fall, a multifaceted health condition, is one of the major causes of mortality among older adults. Rapid ageing and increased multimorbidity in low-and middle-income countries (LMICs), including India, might elevate the risk of fall. Although, fall is associated with significant healthcare utilization, it still remains an under-recognized public health issue. This accentuates a need for evidence on fall to integrate it into existing healthcare programs, a gap in geriatric care. The present study aimed to assess the association of fall with multimorbidity among older adults in India.Methods: We included 28,567 participants aged ≥ 60 years from Longitudinal Ageing Study in India (LASI), wave-1 conducted during 2017-19. Descriptive statistics were used to compute the prevalence of self-reported falls along with 95% confidence interval as a measure of uncertainty. The association between falls and multimorbidity was assessed by multivariable logistic regression and presented as an adjusted odds ratio (AOR).Results: The prevalence of falls was 12.5%, being higher among women (13.6% vs. 11.4%) than men. The major determinants of fall were females, rural residents and smokeless tobacco use. We observed multimorbidity [AOR: 1.29 (1.14-1.46)] to be significantly associated with falls.Conclusion: Falls are commonly prevalent among older adults having multimorbidity as its important predictor. Existing health programs should incorporate falls as an important part of geriatric care. Additionally, primary health care facilities should be strengthened to provide comprehensive care for injuries sustained due to falls. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "75 years' journey of malaria publications in English: what and where?" published in the Malaria Journal. The correction states that an acknowledgement declaration was omitted in error and has since been updated in the article. The authors apologize for any inconvenience caused. The publisher, Springer Nature, remains neutral regarding jurisdictional claims and institutional affiliations. The authors of the original article are Nimita Deora, Sonalika Kar, Veena Pande, and Abhinav Sinha. [Extracted from the article]

Introduction: This highly contagious zoonotic corona virus (SARS-CoV-2) spread to most parts of the world (200 countries) and created a public health emergency. Due to its novel nature and indistinctness, different sources of information and suggestions were developed to guide the individuals about its transmission and prevent its infection. Responses to the active intervention efforts have posed some relevant questions on population understanding and attitudes toward COVID-19. The present study is aims to assess the COVID-19 related knowledge, attitude, and practices (KAP) in a heterogeneous Indian population. Material and methods: 501 respondents across India participated in a questionnaire-based online survey from April 2020 to May 2020. The questionnaire incorporated 56 questions about demographic characteristics and KAP dimensions. The mixed (quantitative and qualitative) methods were employed to evaluate KAP dimensions. Descriptive analysis was estimated as means, SD, and proportion. The bivariate (χ2), correlation, and regression analysis were utilized for the response analysis. In addition, qualitative analysis, including content and thematic analysis were done for open-ended questions. Result: High knowledge and positive attitude were reported in more than half of the study population, with a proportion of 58.6% and 62.1%, respectively. Education shows a significant difference in the knowledge and attitude dimensions. The good practice (50.5% of the total population) reported a significant difference in age and gender categories with the test of independence (χ2). Prevention (56.89%) in knowledge domain and risk (17.56%), information-seeking (45.51%), prevention (51.50%), and treatment-seeking (54.29%) in attitude domains recorded low proportion. KAP variables were found in association in Pearson correlation analysis. In logistic regression analysis, knowledge was the strongest predictor for the positive attitude, whereas attitude was reported as the best predictor for good practice outcome. Conclusion: The study presents a moderate level of covid related knowledge, Attitudes, and Practices in Indian population. [ABSTRACT FROM AUTHOR]

This paper considers a pursuit-evasion scenario among three agents– an evader, a pursuer, and a defender. We design cooperative guidance laws for the evader and the defender team to safeguard the evader from an attacking pursuer. Unlike differential games, optimal control formulations, and other heuristic methods, we propose a novel perspective on designing effective nonlinear feedback control laws for the evader-defender team using a time-constrained guidance approach. The evader lures the pursuer on the collision course by offering itself as bait. At the same time, the defender protects the evader from the pursuer by exercising control over the engagement duration. Depending on the nature of the mission, the defender may choose to take an aggressive or defensive stance. Such consideration widens the applicability of the proposed methods in various three-agent motion planning scenarios such as aircraft defense, asset guarding, search and rescue, surveillance, and secure transportation. We use a fixed-time sliding mode control strategy to design the control laws for the evader-defender team and a nonlinear finite-time disturbance observer to estimate the pursuer's maneuver. Finally, we present simulations to demonstrate favorable performance under various engagement geometries, thus vindicating the efficacy of the proposed designs. [ABSTRACT FROM AUTHOR]

Background: Smokeless Tobacco (SLT) use is culturally rooted and more acceptable among women in India. SLT is a significant risk for oral cancers and has other adverse health outcomes on women's general as well as reproductive health. This study aimed to estimate and compare the prevalence and correlates of SLT among adult females in India using Global Adult Tobacco Survey (GATS), 2009-2010 (GATS 1) and 2016-2017 (GATS 2).Methods: Data from a nationally representative cross-sectional study GATS 1 (n = 35,529) and GATS 2 (n = 40,265) were analysed for adult female smokeless tobacco users. Correlates of SLT exposure were assessed separately using binary logistic regression. Multivariable logistic regression analysis was done for the variables which computed p < 0.1. The association was expressed as Adjusted Odds ratio with 95% confidence intervals.Results: There was a reduction in prevalence of SLT use among women in India between GATS 1 (18.4%) and GATS 2 (12.8%). SLT use was highest among the North-Eastern women in both rounds [AOR: 4.567 (3.942-5.292) during GATS-1 and 9.149 (7.722-10.839) during GATS-2]. Odisha had highest prevalence of 56.53% while Himachal Pradesh had lowest 0.14% during the recent GATS 2 survey. 33.3% vs. 34.80% of the participants were willing to quit tobacco in Central region across both rounds of survey.Conclusions: Although, smokeless tobacco prevalence among females has reduced between 2009 and 2016 in India, yet tobacco control strategies need further pace. Hence, more focused gender-based tobacco control programs and policies are the need of time. [ABSTRACT FROM AUTHOR]

The present paper deals with some basic questions of methodology in labour history. It deals with three main questions: the question of class and social identities in labour history; the question of the category of 'labouring poor' vis-à-vis the category of working class; and finally, the question of the place of state in treating the relation between labour and capital. On the first question, it argues that social identities become sites of social oppression in the moment of class. On the second question, it argues that while the category of 'labouring poor' has descriptive power, it lacks analytical rigour and can make sense only in conjunction with the category of working class. Finally, it contends that labour history must understand the relative autonomy of the state while dealing with the question of relation between labour and capital and yet it must not take the question of tripartite arrangement between labour, capital and state too literally or formally, as state does serve the long-term collective class interests of capital. The essay also refutes the valorization of the so-called 'everyday forms of resistance' over the importance of the collective class resistance of the working class. [ABSTRACT FROM AUTHOR]

Keywords: Malaria; COVID-19; ACE2 variants; Natural selection EN Malaria COVID-19 ACE2 variants Natural selection 702 705 4 02/25/21 20210301 NES 210301 Auley De, Aparna Tiwari and Manoswini Dash have contributed equally. As per the malaria-hypertension hypothesis, the T-allele of rs2106809 might be positively selected in populations that are chronically exposed to malaria and hence increase the likelihood of Ang II-mediated hypertension via downregulating I ACE2 i [[7]]. [Extracted from the article]

The fundamental requirement of every gametocytocidal drug screening assay is the sufficient numbers of healthy and viable gametocytes. The number of in vitro gametocytes grossly depends on the genetic capacity of parasites to produce gametocytes and on various environmental factors that are not precisely elucidated. In the present study, we tested multiple environmental factors that are reported, hypothesized, or predicted to influence gametocyte numbers. We observed that hypoxanthine and the use of freshly drawn human blood significantly enhance gametocytemia (p < 0.05) in vitro. However, other tested factors did not significantly affect gametocytemia. The addition of N-acetyl glucosamine to the culture enriched the gametocytes but d-sorbitol (5% v/v) in amounts and duration of incubation tested was unable to do so without negatively affecting the maturity and health of the gametocytes. Although the in vitro gametocyte production depends on the genetic capability of the parasite strain tested, various environmental factors also control the ability of the strain to produce gametocytes up to a certain extent. This is the first study testing the role of various environmental factors that might affect the gametocyte development in a gametocyte producing strain. The results presented herein will help in the optimization of gametocyte production procedures for various gametocytocidal drug screening assays. [ABSTRACT FROM AUTHOR]

Background: Under-nutrition has got serious and lasting impact on health, development, society and economy. It may result in poor growth, development of child and can cause increase mortality, morbidity, health care cost, low productivity and economic growth. Nutritional rehabilitation is one of key intervention to address the under nutrition. It is questionable that nutritional intervention has potential to improve multiple domains. Methods: Follow up study evaluated the multi-domain impact of nutritional interventions on 204 admitted Severe Acute Malnutrition (SAM) children. Data was analyzed with SPSS version 20. Results: Significant positive changes were observed in physical, biochemical, developmental domains. Macnemar, paired t- test, co relation, z test were applied for data analysis. Conclusion: Nutritional intervention was found to be effective in improving selected physical, biochemical and developmental parameters. After discharge rate of improvement in anthropometric parameters was less. Actual quantification of recovery especially in biochemical and developmental parameters due to nutritional intervention is difficult. [ABSTRACT FROM AUTHOR]

Summary: When the same type of event is experienced by a subject more than once it is called recurrent event, which possess two important characteristics, namely "within‐subject correlation" and "time‐varying covariate." As a result, the traditional statistical methods do not work well on recurrent event data. Over the past few decades, many alternatives methods have been proposed for the analysis of recurrent event data. In this article, the six most prominent methods for recurrent event analysis have been compared on pediatric asthma data. Three variance corrected models (viz "Anderson and Gill [AG] model," "Prentice, William, and Peterson‐Counting Process [PWP‐CP] model," and "Prentice, William, and Peterson‐Gap Time [PWP‐GT] model") and three corresponding frailty variants (AG‐frailty, PWP‐CP‐frailty, and PWP‐GT‐frailty) were compared using three mathematical criterion (AIC, BIC, and log‐likelihood) and one graphical criteria (Cox‐Snell goodness of fit, visual test). All model comparison indices showed the PWP‐GT model as the most appropriate model on asthma data over other models. By using PWP‐GT model, seven predictors of asthma exacerbation (viz "abdominal pain at previous visit," "Z5 (%) at previous visit," "diagnosis of asthma at previous visit," "calendar month of exacerbation," "history of maternal asthma," "monthly per capita income," and "emotional stress") were identified. The PWP‐GT model was identified as the most appropriate model over other models on pediatrics asthma data. [ABSTRACT FROM AUTHOR]

This article proposes a leader–follower cooperative salvo guidance strategy to intercept nonmaneuvering targets by exploiting the advantages of supertwisting sliding mode control. An improved estimate of time-to-go, that does not assume interceptor's small heading angle, is used in the guidance design. This allows the guidance strategy to remain effective even for large initial heading of the interceptor. Under the action of supertwisting control, the error in impact time settles precisely to zero in finite time. The proposed guidance strategy provides robustness against uncertainties and a smooth control signal, along with finite-time convergence of error. The guidance performance has been shown for one-to-one engagement, and in a cooperative framework, to achieve a salvo in a predetermined time. Numerical simulations are presented for various engagement scenarios to aid the analysis, and illustrate the efficacy of the proposed guidance scheme, even under noisy environment. [ABSTRACT FROM AUTHOR]