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Background: Watching television and other electronic devices can adversely affect children’s sleep. This study aims to ascertain the association of sleep problems with digital screen exposure (DSE) among 2- to 5-year-old children in Chandigarh, India. Methods: A cross-sectional study was conducted among 400 randomly selected families having 2- to 5-year-old children, using a validated DSE questionnaire and the standard child’s sleep habits questionnaire abbreviated, from October 2017 to March 2018. The American and Indian Academy of Pediatrics guidelines were used to define higher DSE as more than 1 h per day. The multivariate binary logistic regression analysis was performed using IBM SPSS Statistics for Macintosh, Version 26.0 (IBM Corp., New York, USA), to identify significant predictors of sleep problems. Results: Boys (51.5%) and girls (48.5%) were equally represented. On average, children (3.5 ± 0.9 years) slept for 10 ± 1.6 h per day. Bedtime sleep resistance (15.1% vs 11%) and sleep behavior problems (11.8% vs 5.6%) were significantly ( P < .05) higher among children with higher DSE than children having DSE of less than 1 h per day. The significant predictors of sleep problems were children living in a nuclear family (adjOR = 2.4, CI [1.1, 5.3]), watching non-educational digital media content (adjOR = 2.6, 2.36, CI [1.1, 6.2]), and absence of digital media rules at home (adjOR = 3.9, CI [1.3, 12]). In the subgroup analysis, children having higher DSE (adjOR = 2.4, CI [1.1, 4.9]) had a significantly greater probability of bedtime resistance, and those living in a nuclear family (adjOR = 1.7, CI [1.1, 2.7]) had a significantly greater probability of morning waking-up problems. Conclusion: Sleep problems were significantly associated with higher DSE among young children in Chandigarh, India.

BackgroundDiverse socio-economic and cultural issues contribute to adverse health outcomes and increased mortality rates among rural Indian women across different age categories. The present study aims to comprehensively assess age-specific mortality rates (ASMR) and their temporal trends using a composite measure at the sub-national level for rural Indian females to capture cross-state differences.Materials and methodsA total of 19 states were included in the study to construct a composite age-specific mortality index for 2011 (base year) and 2018 (reference year) and examine the incremental changes in the index values across these years at the sub-national level in India. Sub-index values were calculated for each component age group and were subsequently used to compute the composite ASMR index using the geometric mean method. Based on the incremental changes, the performance of states was categorized into four different typologies.ResultsImprovement in mortality index scores in the 0–4 years age group was documented for all states. The mortality rates for the 60+ age group were recorded to be high for all states. Kerala emerged as the overall top performer in terms of mortality index scores, while Bihar and Jharkhand were at the bottom of the mortality index table. The overall mortality composite score has shown minor improvement from base year to reference year at all India level.ConclusionAn overall reduction in the mortality rates of rural Indian women has been observed over the years in India. However, in states like Bihar and Jharkhand, mortality is high and has considerable scope for improvement. The success of public health interventions to reduce the under-five mortality rate is evident as the female rural mortality rates have reduced sizably for all states. Nevertheless, there is still sizable scope for reducing mortality rates for other component age groups. Additionally, there is a need to divert attention toward the female geriatric (60+ years) population as the mortality rates are still high.

BackgroundCOVID-19 vaccination of the healthcare workers (HCWs) is a key priority in the fight against the SARS-CoV-2 pandemic. India launched its COVID-19 vaccination program in January 2021. We aimed to understand the trends in willingness to receive COVID-19 vaccines and its associated factors among HCWs in India.MethodsUsing a repeated cross-sectional survey design, we collected information from HCWs in three critical time points: before (n = 937, October 2020), during (n = 1346, January 2021); and after (n = 812, May 2021) the introduction of COVID-19 vaccines in India. The third survey coincided with the peak of the second wave of COVID-19 pandemic in India.FindingsOf the study participants, 43.7, 60.2, and 73.2% were willing to receive COVID-19 vaccines during the first, second and third rounds of surveys, respectively. In multivariable logistic regression analysis, participants who trusted the health care system were more likely to report willingness to receive a COVID-19 vaccine; medical trust emerged as a significant factor in all the three rounds of surveys (First survey—aOR: 2.24, 95% CI: 1.67–2.99; Second survey—aOR: 3.38, 95% CI: 2.64-4.33; Third survey—aOR: 2.54, 95% CI: 1.65–3.91). Having confidence in domestic vaccines (Second survey—aOR: 2.21, 95% CI: 1.61–3.02; Third survey—aOR: 2.05, 95% CI: 1.24–3.37); and high perceived risk of contracting COVID-19 (Second survey—aOR: 1.48, 95% CI: 1.13–1.93; Third survey—aOR: 2.02, 95% CI: 1.31–3.13) were found to be associated with willingness to receive vaccines. Among socio-demographic characteristics, being married (aOR: 1.71, 95% CI: 1.08–2.71) and having high socio-economic status (aOR: 3.01, 95% CI: 1.65–5.51) emerged as significant factors associated with willingness to receive COVID-19 vaccines in the third round of the surveys.InterpretationWillingness to receive COVID-19 vaccine increased with time, as the severity of the pandemic increased. To increase COVID-19 acceptance and coverage among HCWs, it is important to instill confidence in domestic vaccines and assist in accurate assessment of risk toward contracting COVID-19 infection.

BackgroundDiverse socio-economic and cultural issues contribute to adverse health outcomes and increased mortality rates among rural Indian women across different age categories. The present study aims to comprehensively assess age-specific mortality rates and their temporal trends using a composite measure at the sub-national level for rural Indian females to capture cross-state differences.MethodsA total of 19 states were included in the study to construct a composite age-specific mortality index for 2011 (base year) and 2018 (reference year) and examine the incremental changes in the index values across these years at the sub-national level in India. Sub-index values were calculated for each component age group and were subsequently used to compute the composite ASMR index using the geometric mean method. Based on the incremental changes, the performance of states was categorized into four different typologies.ResultsImprovement in mortality index scores in the 0-4 years age group was documented for all states. The mortality rates for the 60+ age group were recorded to be high for all states. Kerela emerged as the overall top performer in terms of mortality index scores, while Bihar and Jharkhand were at the bottom of the mortality index table. The overall mortality composite score has shown minor improvement from base year to reference year at all India level.ConclusionsAn overall reduction in the mortality rates of rural Indian women has been observed over the years in India. The success of public health interventions to reduce the under-five mortality rate is evident as the female rural mortality rates have reduced sizably for all states. Nevertheless, there is still sizable scope for reducing mortality rates for other component age groups. Additionally, there is a need to divert attention toward the female geriatric (60+ years) population as the mortality rates are still high.

BackgroundResponding to the fast transmission rates and increasing fatality rates, countries across the world expedited the development and deployment of the vaccine for coronavirus disease 2019 (COVID-19). Evaluation of individuals' willingness to pay (WTP) would provide pertinent information regarding future demand and financing preferences, which shall help to devise the effective payment strategy for COVID-19 vaccination.MethodsA nationwide, cross-sectional, and self-administered online survey using a structured questionnaire was conducted to identify the sociodemographic determinants of willingness and extent to pay for COVID-19 vaccine in India. A non-probability convenience sampling followed by snowball sampling was employed to recruit participants (n = 3,341). The likelihood of sociodemographic determinants to predict willingness and extent to pay was modeled using the multivariate binary logistic regression analysis.ResultsOut of 3,341 participants, 68% (n = 2,271) were willingness to pay for COVID-19 vaccine. Results showed significantly higher odds for willingness to pay among participants who were single [adjusted odds ratio (aOR) = 1.394, p < 0.01] and having a family size of 4 members (aOR = 1.346, p < 0.01). The adjusted odds ratio sizably increased from 1.396 for participants whose monthly income was between INR 10,000 and 20,000/month to 2.240 for participants whose monthly income was above INR 50,000/month. Further, out of 2,271 of those participants who were willingness to pay for COVID-19 vaccine, majority (n = 1,246, 54.9%) of participants were willingness to pay below 50% of COVID-19 vaccine cost. This study found that those who are single (aOR = 0.688, p < 0.01), having an income between INR 20,000 and 50,000/month (aOR = 0.686, p < 0.05), and those who belonged to socially disadvantaged category (aOR = 0.450, p < 0.01) were estimated to have significantly lower odds of willingness to pay more than 50% of COVID-19 vaccine cost.ConclusionThis study observed that majority of those participants who willingness to pay for COVID-19 vaccine were willingness to pay only up to 50% of COVID-19 vaccine and income was observed as a precursor predictor of the willingness and extent to pay for COVID-19 vaccine. The understanding on the willingness and extent to pay for COVID-19 vaccine and its sociodemographic determinants will be helpful for making the strategic decisions related to the financing of COVID vaccine in India.

Background Expansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index, map India by categorizing it into low, medium and high zones and examine its incremental changes over time. Methods Utilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel ‘Maternal Health Service Coverage Index’ (MHSI) for 29 states and 5 union territories of India for the base (2017–18) and reference (2019–20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approaches. We categorized India into low, medium and high maternal health service coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year. Results India registered the highest mean percentage coverage (93.7%) for ‘institutional delivery’ and the lowest for ‘treatment for obstetric complications’ (9.3%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approaches, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015—0.019 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. The states of Mizoram (east zone) and the Union Territory of Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone), along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition. Conclusion Overall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health services, which can momentously help India identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.

Background: Students act as messengers in delivering effective messages for better uptake of health-promoting behavior. Understanding their knowledge about coronavirus disease 2019 (COVID-19), intentions to use the COVID-19 vaccine, and its associated factors will help develop promising strategies in vaccine promotion concerning the current COVID-19 pandemic.Methods: A cross-sectional online survey was carried out among students in the healthcare and non-healthcare sectors to assess their intentions to get vaccinated against the COVID-19. A non-probability snowball sampling technique was used to recruit study participants (N = 655) through social media platforms and emails. Study participants were recruited across the country, including six major geographical regions (Eastern, Western, Northern, Southern, North-east, and Central) in India between November 2020 and January 2021 before the introduction of the COVID-19 vaccine. Descriptive statistics were used to present the sociodemographic, and vaccine-related behaviors of the study participants. Key determinants that likely predict vaccine acceptance among students were modeled using logistic regression analysis. For each analysis, p < 0.05 was considered significant.Results: A total of 655 students were recruited, 323 from healthcare and 332 from non-healthcare sectors, to assess their intentions to receive the COVID-19 vaccine. Of the 655 students, 63.8% expressed intentions to receive the COVID-19 vaccine. The acceptance was higher among non-healthcare students (54.07 vs. 45.93%). At the time of the study, 27.8% of the students indicated that they had been exposed to a confirmed COVID-19 patient. A vast majority (93.4%) of the students knew about the COVID-19 virus, and most (89.3%) of them were aware of the development of a COVID-19 vaccine. The history of vaccine hesitancy was found to be low (17.1%). Only one-third (33.4%) of the students showed concern about contracting COVID-19. Trust in the healthcare system [adjusted odds ratio (aOR): 4.13; (95% CI: 2.83–6.04), p < 0.00] and trust in domestic vaccines [aOR: 1.46; (95% CI: 1.02–2.08), p < 0.05] emerged as the significant predictors of student's intention to get vaccinated. Higher acceptance for vaccine was observed among students in the non-healthcare [aOR: 1.982; 95% CI: 1.334–2.946, p < 0.00].Conclusion: This study shows that the Indian college students had relatively high levels of positive intentions to receive COVID-19 vaccines, although about one-third were not sure or unwilling to receive the vaccine, highlighting possible vaccine hesitancy. Informational campaigns and other strategies to address vaccine hesitancy are needed to promote uptake of COVID-19 vaccines.

BackgroundDespite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India.MethodsA cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents.ResultsSeven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15–3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30–4.67). Parental concerns centered around vaccine safety and side effects.ConclusionIndian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers' willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India.A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine.Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18-7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51-8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24-4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17-4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12-0.88), p = 0.027].Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.

The aim of this study was to analyze the clinical features of patients attending the screening clinic of a dedicated COVID-19 hospital (DCH), including COVID-19 RT-PCR test positivity rate, symptom predictors for COVID-19 positivity, the proportion of recovery, and the mortality among COVID-19 positive cases.We conducted a cross-sectional study of the patients who reported in the screening clinic of a DCH. Data were retrieved from medical records. Step-wise binary logistic regression was applied to determine the symptom predictors for determining the likelihood of the suspects turning out to be COVID-19 positive.A total of 573 patients reported to the screening clinic were enrolled, and their median age was 36 ± 14 years. Of the total patients, 237 (41%) were females and 112 (20%) patients were COVID-19 suspects. Fifty (45%) suspects tested COVID-19 positive. The majority of the positives had complaints of cough, fever, and sore throat. Running nose (OR = 7.951) and history of contact with a COVID-19-positive case (OR = 169.9) were found to be statistically significant symptom predictors for COVID-19 positivity. All patients recovered with nil case fatality.Running nose and history of contact with COVID-positive patients were significant predictors for COVID-19 positivity. In this pandemic state, patients who present with any of the upper respiratory infection (URI) symptoms such as cough, sore throat, running nose, headache, and loss of taste/smell should be tested for COVID-19 for early identification and isolation to break the chain of transmission. The public should be encouraged to undergo COVID-19 testing if they develop any of the URI symptoms.

Background: Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. Community health workers (CHWs) bridge the gap between the community and the health care system. Their intention to get vaccinated will not only affect them but will also affect the community’s perception of the vaccine. This study aims to understand the intention to get vaccinated against COVID-19 among community health care workers in India and its determinants.Methods: A web-based, cross-sectional study was conducted among 357 community health workers using snowball sampling. A self-administered anonymous questionnaire was shared with study participants across major geographical regions in India through social media during the first wave (November-December 2020).Results: Among 357 community health workers, 208 (58%) responded positively regarding their intention to get a COVID-19 vaccine. Graduate [aOR 2.26 (95% CI: 1.27-4.01), p=0.006] and post-graduate participants [aOR 2.85 (95% CI: 1.43-5.68), p=0.003], those with lower risk perception [aOR 1.86 (95% CI: 1.03-3.35), p=0.038] and respondents who trusted the healthcare system [aOR 2.60 (95% CI:1.59-4.26), pConclusions: Increasing knowledge regarding the COVID-19 vaccine might not be enough to improve vaccine acceptance rates. Enhancing trust among community health workers in the healthcare system and regarding the available vaccines seem necessary. In addition, targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance of the vaccine.

Deviance at the workplace is the displaying of counterproductive work behavior by the employees that includes in its ambit a set of behavioral activities that jeopardize, sabotage, and undermine the motives, goals, objectives, and interests of the organization at large. The present study makes a modest attempt to study the occurrence of negative deviance in the banking sector through the use of Counterproductive Work Behavior Checklist (CWD-C). The choice of this particular sector has been motivated by the researchers' academic interest and due to the presence of limited number of empirical studies in this area. Further, the study aims to identify the role of gender with regard to the occurrence of counterproductive work behavior among the bank employees. The results of the study point out female bank employees were found to be engaging in abuse and theft significantly more than the male employees, while the men were found to be significantly more likely to commit production deviance than their female counterparts.

Micronutrient soil deficiency, usage of crop residue and assessment of soil health are the critical factors that have strong bearing on crop productivity. Therefore, in this backdrop, the present study has utilized the econometric tools of ANOVA regression and ordinal logistic regression approach to capture the impact of micronutrient soil deficiency, crop residue usage and soil health assessment on wheat crop productivity across selected wheat growing areas (districts) of Indian Punjab. The empirical analyses pointed out that the farmlands suffering from micronutrient soil deficiency witnessed decreased levels of wheat crop productivity. The results further indicated that farmers are more likely to suffer from low wheat crop productivity and the probability of high wheat yield status of their farmlands is significantly lowered in the absence of crop residue usage and soil health assessment. Thus, from the perspectives of wheat productivity augmentation and provision of higher economic returns, there is a strong need for motivating the farmers to (a) adopt effective soil fertility management practices, (b) utilize crop leftovers to restore the nutrient content of the farming fields and (c) avail soil health assessment facilities and apply fertilizers in amounts recommended by the soil test results.

Background Death is inevitable, but healthy ageing is possible with proper nutrition and health care. This systematic review and meta-analysis conducted to estimate the nation-wide prevalence and malnutrition and risk of malnutrition among the elderly in India. Methods PubMed, EMBASE, Web of Science, Cochrane`s library, Google Scholar were searched for the articles reporting the prevalence of malnutrition among the elderly using MNA or MNA-SF tools. The study published between the year 2010–2019 were included. Sensitivity analysis, quality assessment was done using standard methods. The publication biasness was also determined using Doi plot and LFK index. The pooled prevalence was reported with effect size and considering the random effect model and quality effect model. The subgroup analysis was also conducted for gender, study setting, study area and study regions. Results The prevalence of malnutrition and risk of malnutrition among the elderly was 18.29% and 48.17% respectively. The prevalence of malnutrition was higher among female (16.67%), clinic setting (28.87%), urban areas (19.29%) and northern region (27.37%) of India. This trend differs with the prevalence of risk of malnutrition. Meta-regression analysis shows a region-based prediction of malnutrition and setting based prediction of risk of malnutrition. Conclusion The prevalence of malnutrition was not considerably higher among the elderly population but about half of the elderly population were at risk of malnutrition. This trend differs with the gender, study setting, study area and study region. Additional study using other nutritional assessment tools were needed. Intervention studies among the elderly were recommended.

The present study investigated the nature of Public–Private Partnership (PPP) in various subsectors of social and commercial infrastructure in India for better understanding of significant characteristics, attributes and factors governing the public private participation. The Indicator Analysis approach has been adopted to study a total of 119 Public–Private-partnered projects involving four qualitative and three quantitative indicators to help build a detailed profile of partnered projects in various subsectors of social and commercial infrastructure in India. The subnational government has been unravelled as the dominant form of government participation across all the subsectors of the social and commercial infrastructure in India. The infrastructure projects in the subsector of tourism have registered high average cost and time overruns. Further, Build-Operate-Transfer (BOT) mode has been identified as the most preferred PPP entry mode in the social and commercial infrastructure in the Indian economy. Since, the Indian economy comprises a large workforce, investment in social and commercial infrastructure projects through PPP mode can tap and harness the demographic dividend, which is critical for sustaining the growth of developing and emerging economies. The study provides a detailed account of qualitative and quantitative information about the nature of social and commercial infrastructure sector that shall facilitate successful implementation of the PPP projects in this soft infrastructure sector, which has a substantial bearing on the economic growth and human development in the Indian economy.

The present study investigated and analysed the impact of family size on monthly savings and consumption expenditure of the industrial workers. The results showed that with increasing household size, savings not only dwindled in absolute terms but also in relative terms as witnessed by decreasing saving to income ratios. Conversely, the consumption to income ratios witnessed an increasing pattern, which is indicative of income being diverted away from savings with every addition to the family size. The MANOVA post hoc analyses revealed that the mean monthly savings of each of the higher family size group (more than 3 members) were observed to be significantly lower than the smallest family group (3 members), which is symptomatic of low propensity towards saving in context of the workers with higher family size. Though, the mean monthly consumption expenditure of family size of 4, 5 and 6 members was observed to be significantly higher than that of the largest family group (7 members), however its consumption income ratio was observed to be greater than that of all the lower family size groups. This is logically plausible as the workers having the largest family size were observed to have the lowest mean monthly income, thereby implying the presence of large number of economically inactive members in this group, which resulted in diversion of a large part of their income towards their consumption expenses. The results of the ANOVA regression analysis confirmed that family size has a significant positive impact on the consumption expenditure of the industrial workers. Further, the reduction of savings due to increased burden of the additional family member corroborated the proposed negative effect of family size on savings of the workers.