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The COVID-19 pandemic has swept the entire world in a few months' time, much faster than any epidemic before. The scientist, doctors, and politicians worldwide are fervently working round the clock to bring an end to this pandemic which has otherwise stalled the lives of the populations. In the absence of any reliable treatment or vaccine, nonpharmaceutical interventions are presently are the mainstay to prevent and possibly end the COVID-19 pandemic. The development of herd immunity either through natural infection or induced through vaccine can bring down the epidemic. However, it may take a few more months before the normalcy returns.

Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.

Background: In 2017, the sampling procedure for HIV sentinel surveillance (HSS) among all high-risk groups was changed from the consecutive sampling to random sampling along with the introduction of linked anonymous testing strategy with informed written consent. Objective: The objective of this study was to assess whether the inclusion of informed consent affects the HIV positivity rate among the participants and nonparticipants injecting drug users (IDU) in HSS 2017 in four states of Central Zone of India. Methods: This study was a cross-sectional study. All sentinel sites from Delhi, Uttar Pradesh, Jharkhand, and Uttarakhand located at targeted intervention facilities in 2017 were included in the study. Information about the participation and nonparticipation of each high-risk individual at the sentinel site was gathered from the master list, respective registers, and website portal of the National AIDS Control Organization. A total of 8639 individuals were included in the analysis. Results: Overall, 16 sites in four states were included in the study. Overall, the nonparticipation rate of IDUs was 14.3%; highest being for Delhi (17.2%), followed by Uttar Pradesh (14.6%), Uttarakhand (10.9%), and Jharkhand (4.4%). Overall, the HIV-positivity rate among nonparticipants (9.6%) was significantly higher (P = 0.009) compared to the participants (6.7%). Conclusion: Change in methodology and seeking written informed consent might have an effect on the nonparticipation in all four states. This, in turn, could have led to the underestimation of HIV-positivity rates among IDU in the states.

Background and Objectives: Sexual health disorders are an important but less researched public health issue in India. We aimed to estimate the prevalence of sexual health disorders and their associated factors among adult men in a rural community of Haryana, India. Materials and Methods: A community-based cross-sectional study was conducted among adult men aged 18–60 years using a multistage stratified random sampling. Information pertaining to sociodemographic characteristics, lifestyle and sexual practices, and self-reported sexual problems were collected. Sexual health disorders were defined based on International Statistical Classification of Diseases-10 classification of mental and behavioral disorders. Step-wise logistic regression was carried out to identify factors independently associated with sexual disorders. Results: At least one sexual health disorder was reported by 81% of the men. The most commonly reported disorder was self-perceived defect in semen (64.4%), followed by loss of libido (21%), masturbation guilt (20.8%), erectile dysfunction (5%), and premature ejaculation (4.6%). Factors significantly associated with sexual health disorders among all men were being never married (odds ratio = 2.04; 95% confidence interval: 1.51, 2.77), smoking (1.57; 1.16, 2.14), cannabis use (4.20; 1.68, 10.48), diabetes (2.40; 1.22, 4.73), and hypertension (3.17; 1.12, 8.92). Interpretation and Conclusions: A high burden of sexual health disorders was identified among the rural men. Wider recognition of this issue is needed among the health-care providers and policymakers.

Disability is complex, dynamic in nature, multidimensional, and most contested. Quality of life is an abstract concept that is related to the level of disability in the population. Approaches to measuring disability vary across different regions, and purpose and application of the findings. We systematically reviewed the studies that have been undertaken to study the prevalence of disability and its association with sociodemographic factors and quality of life among the general population in India, between January 2000 and June 2018. The prevalence of impairment ranged from 1.6% to 43.3%. In major surveys, males had higher impairment than females. Studies that used the International Classification of Functioning, Disability and Health concept for measuring disability reported prevalence ranging from 70.0% to 93.2%. Most studies used semi-structured questionnaires for measurement of disability. Some studies have used Barthel Index for Activity of Daily Living, Instrumental Activities of Daily Living, Indian Disability Evaluation and Assessment Schedule, Rapid Assessment of Disability scale, and Standard Health Assessment Questionnaire. The quality of life was low among females. This review brings out the heterogeneity in the concepts for measuring disability and quality of life. Lack of standardization in the measurement of disability restrains any comparison between these studies.

Background: Due to wider access to and free antiretroviral therapy (ART) program, the number of children dying due to acquired immune deficiency syndrome (AIDS)-related causes has declined and the nature and duration of human immunodeficiency virus (HIV)/AIDS caregiving has also dramatically altered. The care of children living with HIV/AIDS (CLHA) places a significant additional burden on the caregivers. Aims: This study was conducted to assess the perceived burden among caregivers of children living with HIV in North India. Materials and Methods: A hospital-based cross-sectional study among 156 CLHA-caregiver dyads in North India was conducted from June 2010 to May 2011. Data were collected by using a pretested structured interview schedule. The caregiver burden was measured with a 36-item scale adapted from Burden Assessment Schedule of Schizophrenia Research Foundation (BASS). Child characteristics, caregiver characteristics, caregiving burden, the knowledge of caregivers, and issues related to health care, nutrition, education, and psychological aspects were studied. Results: Caregivers had a mean age of 35.9 ± 10.2 years. Women accounted for over three-fourth (76.9%) of the caregivers. Nearly two-third of them (65.4%) reported as living with HIV. The mean caregiver burden score was 68.7 ± 2.9. A majority of the caregivers reported either low or moderate burden. Standardized percentage score was high in the domains of physical and mental health, external support, patients’ behavior, and caregivers’ strategy and seemed to be comparatively less in the other domains such as support of the patient and taking responsibility. Conclusions: Caring of children is a universal practice but there is a need of special care for children living with HIV. The majority of caregivers who were usually the mothers perceived the burden and need to be assisted in caring for the child. Stigma and discrimination with HIV infection further increased the burden as caregivers did not disclose the HIV status to any near and dear one.

Background & objectives : Epidemiological information on tuberculosis (TB) has always been vital for planning control strategies. It has now gained further importance for monitoring the impact of interventions to control the disease. The present study was done to estimate the prevalence of bacillary tuberculosis in the district of Faridabad in Haryana State of India among persons aged older than 15 years. Methods: In this cross-sectional study, residents of Faridabad district were assessed for the prevalence of tuberculosis. Twelve rural and 24 urban clusters with estimated populations of 41,106 and 64,827 individuals were selected for the study. Two sputum samples were collected from individuals found eligible for inclusion. The samples were also cultured by modified Petroff′s method and were examined for growth of Mycobacterium tuberculosis once a week for eight weeks. A person found positive by smear and/or culture was identified as sputum-positive pulmonary TB positive. Results: A total of 105,202 subjects were enumerated in various clusters of the Faridabad district. There were 50,057 (47.58%) females and 55,145 (52.42%) males. Of these 98,599 (93.7%) were examined by the study group (47,976 females; 50,623 males). The overall prevalence of sputum smear or culture positive pulmonary tuberculosis in our study was found to be 101.4 per 100,000 population. Interpretation & conclusions : The present results showed that the prevalence of sputum positive pulmonary tuberculosis was higher in Faridabad district than the notification rates recorded by the World Health Organization for the contemporary period, a disparity that could be explained by a difference in case detection strategy employed for the study.

Proximal focal femoral deficiency (PFFD) is a rare congenital anomaly resulting in limb shortening and disability in young. The exact cause of the disease is not known and it may present as varying grades of affection involving the proximal femur and the acetabulum. Recognition of this rare abnormality on radiographs can help manage these cases better since early institution of therapy may help in achieving adequate growth of the femur.

Background: The number and proportion of elderly persons is increasing, in India, as well as the world. Disability is an important indicator to measure disease burden in this group. While some chronic conditions may not be amenable to complete cure, their functional disabilities can be improved with timely and appropriate management. Objectives: The objective of the following study is to estimate the prevalence of functional disability and study its association with socio-demographic variables and self-reported chronic conditions among elderly persons in a rural area of Haryana. Materials and Methods: All persons aged 60 years and above in the randomly selected six clusters were included in this community-based cross-sectional study. Information was collected on socio-demographic variables and self-reported chronic conditions. Functional disability was defined as having disability in activities of daily living, or blindness or hearing impairment, or a combination of these. In multivariate analysis, backward stepwise logistic regression was carried out to study the association between the independent and dependent variables, after adjusting for confounding variables. Results: Among the 836 participants studied, the prevalence of functional disability was estimated to be 37.4% (95% confidence interval: 34.2, 40.7). The prevalence was less among men (35.9%) than women (38.8%). The prevalence increased with age, was more common among persons who were not currently married, had diabetes and chronic obstructive pulmonary disease. Conclusion: Functional disability is common among elderly persons in the rural area. Community-based interventions are needed to address them. Management of chronic conditions should include prevention and control of associated disability.

Background: Sentinel surveillance reported high human immunodeficiency virus positivity rates among men who have sex with men. The current study has described the high-risk behavior and self-reported sexually transmitted infection(s) among self-identified men who have sex with men. Aims: The present study was to find out the extent of high-risk behavior and prevalence of self-reported sexually transmitted diseases among self-identified men who have sex with men, registered with selected nongovernmental organizations in Delhi. Materials and Methods: A facility-based cross-sectional study was done among 250 men who have sex with men during March 2009 to February 2010, through consecutive sampling strategy. Results: Majority (80%) were anal-receptive, received money for sex (61%) and were involved in all types of sexual intercourse with men (oral-86%, manual-97%, and anal-94%). Consistent condom use with male partner was low (46%), most common reason (52%) for not using condom was, that either the condoms were not available or the partner objected. Self-reported sexually transmitted infection(s) was 41% in the past 12 months. Conclusions: This study underscores the increased vulnerability of men who have sex with men of Delhi and need for sustained interventions.

Background: There is dearth of information about psychiatric morbidity at secondary level health facility in India. Aim: To study psychiatric morbidity amongst patients attending psychiatry clinic in secondary level health facility. Settings and Design: Present study is based on hospital record review of psychiatry clinic at secondary care hospital in Ballabgarh, Haryana. Materials and Methods: Service record of psychiatry clinic at civil hospital Ballabgarh was reviewed. Diagnosis of psychiatric morbidity was done according to DSM IV and ICD 10 classification. Statistical Analysis: Descriptive analysis of data was carried out. Results: A total of 724 (0.7%) new OPD patients consulted psychiatry clinic. Common Mental Disorders comprising of mood disorders, neurotic stress -related and somatoform disorders were the most commonly diagnosed disorders (60.5%) amongst reported psychiatric morbidity in the hospital. Conclusion: Substantial burden of psychiatry morbidity highlights necessity of psychiatry clinic at secondary care hospital in India.

Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women′s health.

Adherence to therapies is a primary determinant of treatment success in HIV/AIDS. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems.(1) It is often said that the most effective regimen for an HIV-infected individual is the one they will take. Both patients and healthcare providers face significant challenges with respect to adherence to antiretroviral therapy (ART). Once initiated, highly active antiretroviral therapy (HAART) is a life-long treatment that consists of multiple medications to be taken two to three times a day with varying dietary instructions. These medications also have side effects, some of which may be temporary, while others may be more permanent requiring a change of treatment. Unlike other chronic diseases, the rapid replication and mutation rate of HIV means that very high levels of adherence are required to achieve a durable suppression of viral load. Inadequate adherence to treatment is associated with detectable viral loads, declining CD4 counts, disease progression, episodes of opportunistic infections, and poorer health outcomes.(2,3) India-specific data on adherence is sparse. In the light of the expansion of free ART in the country, there is a need to learn what works and what does not. The reasons for non-adherence to ART need to be studied in order to identify patients who may need support in maintaining adherence and explore the means to do so.

The art of infant feeding is a blend of biology and culture and has been shown by several studies to be under strong influence of the socio-cultural milieu, which could be detrimental to the health of both mother and child. Blanket health messages to the community on infant feeding may fail to account for this cultural determinant. The following report is a case in point.