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This paper analyzes the work of two Indian sociologists who defined the contours of sociology in India in the immediate post-independence decades, M. N. Srinivas and A. R. Desai. It argues that their scholarship can be linked to sociology's legacy as anthropology in India and its embeddedness in the episteme of colonial modernity. It contends that Srinivas's methodology, the field view, attempted to make a break with earlier methods, such as book view. However, his three concepts, that of dominant caste, Sanskritization and Westernization were perceived as civilizational attributes and which had organized social change in India. A. R. Desai, a Marxist historical sociologist, made an incisive critique of capitalist exploitation and elaborated the material conditions that led to peasant and working-class revolts. However, his sociology could not unravel the caste-class linkages that organized the Indian 'social' which was embedded in Indian nationalism. This paper suggests that a definitive understanding of modernity emerges in Indian sociology in the late 70s when the feminist, dalit and tribal movements interrogated the material basis of contemporary India's developmentalism and its capitalist and exploitative character. [ABSTRACT FROM AUTHOR]

The paper rekindles a three-decade-old debate in the annals of Indian anthropology / sociology which became dormant after no significant headway was made. The debate which goes by the name of "crisis in sociology" in India provides the backdrop against which the paper makes sense of current regimes of knowledge production that a doctoral candidate in India must navigate. By doing so, the paper reflects on the limitations of epistemological critiques wherein an epistemic critique stops at the corridors of an academic workplace. The paper argues that doctoral candidates in India today are cognitive workers engaged in exploitative relations of knowledge production. However, these exploitative relations are obfuscated by the postcolonial epistemological critiques that indulge in foregrounding the hegemony of the North / West. The paper proposes an infrastructural critique of knowledge that does not respond with despair to perceived transformations and crises. [ABSTRACT FROM AUTHOR]

The sociology of culture is an important field that examines how societies create, maintain, and transform their cultural practices and beliefs. In the context of Bangladesh and India, this field is particularly relevant due to their rich and diverse cultural heritage. This paper explores the sociology of culture in these countries, focusing on cultural similarities and differences. Through a literature review of research from anthropology, sociology, history, and related fields, we will examine the historical background of cultural development in both countries, considering the impact of colonialism, nationalism, globalization, language, ethnicity, and religion. We will then present a comparative analysis of cultural practices, beliefs, and values, drawing on empirical data and case studies. This paper aims to contribute to our understanding of the sociology of culture in Bangladesh and India by shedding light on their diverse cultural heritage and exploring the ways in which cultural practices and values are shaped by historical, social, and political factors. By comparing the cultural similarities and differences between these nations, we hope to deepen our understanding of how culture is influenced by the broader social and political context. [ABSTRACT FROM AUTHOR]

A study of Indian botany during the colonial period provides us with an interdisciplinary sphere covering science, politics, sociology, economics, and other associated domains. The presentation of this rich legacy to general readers often restricts itself to the descriptive accounts of explorers with little analysis of the intermingling of socio-political dynamics, landscape, and geography. We attempt to revisit the colonial plant exploration history through spatio-temporal analyses to understand how explorers with divergent interests traversed the country in different periods and directions. Our findings show that the Himalayas drove most of the explorations followed by the Deccan peninsula, the Western Ghats, and the Gangetic plain. In general, company/crown administered areas were better surveyed and documented than native states. Furthermore, through a prioritization exercise, we identify the centers of prominence, highlighting their political, economic, and social importance in contemporary India. In sum, this article shows the potential of applying Historical Geographic Information System (HGIS) mapping for spearheading future research and creating space for possible dialogs among historians, political scientists, and ecologists., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Bibliometric analysis of the journal Guru Nanak Journal of Sociology has been done for the ten year period. The analysis was done to know the type of publications, authorship pattern, geographical distribution, length of pages and degree of collaboration. A total of 93 articles were contributed along with 1889 citations. Predominantly highest contributions were from India. Most of the papers were contributed by single authors. [ABSTRACT FROM AUTHOR]

The present paper summarizes papers given at the 8th International Family Research Seminar in Oslo, Norway, 1963, which describe and explain differential frequencies of those decisions to marry which result in teenage marriage. Sociological analysis of marriage usually points out that age at marriage varies with the type of society and, therefore, reflects the stage of industrialization and urbanization. The lowest ages at marriage are generally found in peasant agricultural countries, such as India and China. During the rapid growth phase of urban industrial nations, age at marriage apparently rises, but later the age at marriage once again turns downward, though not rapidly. One way of viewing trends of teenage marriage is in terms of the percentage of males and females under 20 years of age involved in marriages contracted. During 1961, in 6% of all marriages contracted in Yugoslavia one or both spouses were under the age of 18. However, in such marriages the wife was under 18 years of age in 91 % of the cases, the husband in only 9 %. From 1953-1961 there was a gradual decrease in the percentage married under 18 years from 6.6 % to 6.0 %.

This paper describes an exploratory field study carried out to ascertain the pattern of assimilation among East Indian immigrants in California. It was found that the Hindustani immigrants, because of their small numbers and their pattern of living in individual isolation, are prevented from forming their own ethnic communities. In this paper, the term Hindustani refers to immigrants from India and includes Hindu, Sikh, and Moslem immigrants. They constitute one of the smallest Oriental groups in the U.S.— 2,405 in 1940— and are the least known of all ethnic groups in this country. Of the total Hindustani population in the U.S. in 1940, 61.4 percent resided in California. Many have lived there for over thirty years. The majority of California Hindustanis are emigrants from rural villages in the Punjab, with a handful from Gujarat, Bengal, Oudh, and Madras. This study focused on four aspects of Hindustani life— residential pattern, occupational interactions, community life, family and home life.

Introduction: Role of vaginal sex in heterosexual transmission of HIV has been investigated but that of heterosexual anal sex (HAS) is not fully understood. This paper examines practice of HAS among Female Sex Workers (FSWs) and its correlates in India where the HIV epidemic is being primarily driven by core groups like FSWs. Methods: Data for this paper are drawn from Round I survey of 9667 FSWs in the Integrated Biological and Behavioral Assessment (IBBA) from 23 districts of 4 high HIV prevalent states of India. Bivariate and multivariate analysis identified factors associated with HAS. Results: Ever having anal sex was reported by 11.9% FSWs (95% CI: 11.3%–12.6%). Typology (AOR 2.20, 95% CI 1.64–2.95) and literacy (AOR 1.28, 95% CI 1.10–1.49) were positively associated with practice of HAS. Longer duration in sex trade (AOR 1.69, 95% CI 1.44–1.99), entertaining larger number of clients the previous week (AOR 1.78, 95% CI 1.47–2.15), alcohol consumption (AOR 1.21, 95% CI 1.03–1.42) and inability to negotiate condom use (AOR 1.53, 95% CI 1.28–1.83) were also correlated with HAS. Self-risk perception for HIV (AOR 1.46, 95% CI 1.25–1.71) did not impede HAS. Although symptoms of sexually transmitted infections (STIs) in the last 12 months were associated with anal sex (AOR 1.39, 95% CI 1.13–1.72) there was no significant association between laboratory confirmed HIV and other STIs with HAS. Conclusion: Practice of HAS by FSWs might significantly contribute to HIV transmission in India. This study also shows that despite self-risk perception for HIV, even literate FSWs with longer duration in sex work report HAS. General messages on condom use may not influence safe HAS. FSWs need to be targeted with specific messages on HIV transmission during anal sex. Women controlled prevention methods, such as rectal microbicides and vaginal microbicides are needed. [ABSTRACT FROM AUTHOR]

The American anthropology of India has a fairly lengthy and detailed history as the area studies go, drawn in part by its association with related disciplines in the sciences and humanities and through interaction with anthropologists in other countries. In terms of method and theory, the anthropological study of India has evolved closely with Indian sociology, overlapping topically with religious studies, political science, geography and literary studies. In this paper, I will explore the role of anthropology in India studies by summarizing the professional motivations, interdisciplinary pursuits, and topical interests of anthropologists. In the latter half of the paper, I will look in detail at the last ten years of scholarly contributions made by anthropologists to the study of India. [ABSTRACT FROM AUTHOR]

Learning analytics is the measurement, collection, analysis and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs (LAK, 2011). Analyzing learners' profile, their learning environment vis-à-vis their learning performance may play an important role for the educators in determining strengths and weaknesses of learning contents. The present paper is a case study of postgraduate sociology students of Indira Gandhi National Open University, India. Analyzing learners' profile including their socio-economic environment, learning behavior and performance in their academic pursuits may reveal dynamic lessons to be seriously discussed in the fraternity of teachers. The tangible outcome of the data mining of admission records and examination performances formulates an advisory for effective pedagogy for learners. [ABSTRACT FROM AUTHOR]

In this paper, we model the bus networks of six major Indian cities as graphs in L-space, and evaluate their various statistical properties. While airline and railway networks have been extensively studied, a comprehensive study on the structure and growth of bus networks is lacking. In India, where bus transport plays an important role in day-to-day commutation, it is of significant interest to analyze its topological structure and answer basic questions on its evolution, growth, robustness and resiliency. Although the common feature of small-world property is observed, our analysis reveals a wide spectrum of network topologies arising due to significant variation in the degree-distribution patterns in the networks. We also observe that these networks although, robust and resilient to random attacks are particularly degree-sensitive. Unlike real-world networks, such as Internet, WWW and airline, that are virtual, bus networks are physically constrained. Our findings therefore, throw light on the evolution of such geographically and constrained networks that will help us in designing more efficient bus networks in the future. [ABSTRACT FROM AUTHOR]

Introduction: Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India’s vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS) to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign. Materials and Methods: The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre. Results: The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers. Discussion: A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen’s behavioural model of health services use. Conclusion: The findings assisted with refining the intervention prior to large-scale implementation and evaluation. [ABSTRACT FROM AUTHOR]

We estimate the returns (measured by hourly earnings) to education, experience, and social networking in India using individual-level panel data from the India Human Development Surveys. We combined the two latest waves of this survey using individual-level identifiers to generate a balanced panel and merged it with various household characteristics. We provide estimates of private returns for an additional year of education and experience by consumption quintiles, gender, caste, and religion in a fixed-effects Heckman model that controls for selection bias. This methodology improves upon estimates of all earlier studies on earnings in India, as most of the literature has relied on cross-section data or pseudo-panel data. We also examine the impact of social networking on earnings, which is under-explored in nationwide studies in India. We find that education significantly and positively affects earnings for all consumption quintiles, gender, caste (except schedule castes), and religious groups. Among economic groups, the highest returns are observed for the third quintile above the poverty line. Returns to females for an additional year of education are nearly double that of males but the difference in starting earnings keeps earnings of males higher for long periods. Among the castes, scheduled castes have the highest returns to education and other minorities among religious groups. Social networking positively impacts males, Hindus, and the quintile just above the poverty line. Experience positively impacts women's earnings, general caste and scheduled caste, Hindus and Other minorities and two consumption quintiles (two and five) above the poverty line. Plain Language Summary: Impact of Education, Experience, and Social Networks Impact Earnings in India by Class, Gender, Caste and Religion Purpose: Enhancing human capital is critical for India's development. It would help overcome existing labor market hierarchies based on economic class, gender, religion, and caste. We study the impact on private earnings of (a) an additional year of education and experience, and (b) social networking. Methods: We use an individual level panel dataset assembled from the two latest rounds of the Indian Human Development Survey (I&II). Our Heckman type earnings equation controls for selection bias. Results: An additional year of education increased earnings between (a) 2.4% and 8.8% among different consumption quintiles (b) 3.7% for males to 5.2% for females, (c) 1.5% (STs), to 5.9% (SCs), and (d) 2.3% (Muslims), to 9.9% (Other Minorities). Experience increased earnings of two economic groups, females, the General and Scheduled castes, and of Hindus and Other Minorities. Social networking increased earnings of males, Hindus, and one economic quintile. Conclusions: Higher marginal returns to education for females justifies greater investment in women's education. Lower returns on education among STs and Muslims indicate the need for affirmative action for these groups. The positive returns to education for the poor suggests that anti-poverty programs in combination with educational opportunities for the less privileged would meet the goals of social justice. Implications Better education (SDG4) would help achieve gender equality (SDG5), and social justice for marginalized (economic, caste and religious) groups (SDG1, SDG10). Limitations: We were unable to account for ability bias. Stratification by state and sector would provide better estimates. [ABSTRACT FROM AUTHOR]

Introduction: The institutionalization of community mobilization is not well understood in literature. This paper aims to understand the role of the community-to-community learning strategy in the institutionalization of community mobilization among sex workers communities across eight districts of Andhra Pradesh, India. Materials and Methods: Data collected during baseline (March, 2010) and endline (June, 2012) under an HIV prevention project (SAKSHAM project) was used to investigate the strength (as score) of community mobilization based on two learning strategies: non-government organization (NGO)-to-community-based organization (CBO) strategy, and community-to-CBO strategy. The strength of community mobilization was assessed based on different parameters. The change in scores were computed as a percentage of the improvement to the total potential improvement from baseline to endline on specific indicators and overall. Results: Most of the CBOs considered in the pre-post assessment had been registered during 2004–2008. At baseline, the community ownership and preparedness index scores for the eight CBOs under the community-to-CBO strategy ranged between 21.5 and 27.7 while the scores for the three CBOs under the NGO-to-CBO strategy ranged between 16.3 and 21.5. By endline, the strength of community mobilization among CBOs under the community-to-CBO strategy increased 18 points (equivalent to 23% potential improvement) whereas the strength of community mobilization among CBOs under the NGO-to-CBO strategy increased only 10 points (equivalent to 13% potential improvement). The average percentage difference in improvement between the strategies was 10% (p = 0.102). Further analyses indicate that a greater improvement in community-to-CBO learning strategy was noted around managerial capacities and engagement with stakeholders than other parameters. Conclusion: The community –to- CBO learning strategy presents promising results for HIV prevention with regard to institutionalization of community mobilization among sex workers communities. Findings support the scaling-up of community mobilization initiatives within HIV prevention interventions using well trained community members in India and elsewhere. [ABSTRACT FROM AUTHOR]

The main focus of the paper is that caste system has always been resilient and dynamic due to its inner inconsistencies and contradictions on the one hand, and due to its interpenetration into economy, polity and culture on the other. The aim of this paper is to understand continuity and change in the caste system. Caste has engaged people, hence it has acquired a meta-legal approval. Caste has never been a simple ritual hierarchy because it has encompassed the entire matrix of socio-economic and political relations. It has been argued that there is a need to reconceptualize caste. Caste is no more simply a system of idea and values. More important is to see actual behaviour of the people vis-à-vis the role of caste as a system. Caste has become a matter of interpretation rather than substantialization. It refers to a purposive rationality. Its discrete use provides a description of the problems of Indian society, polity and economy. However, besides caste, there are new status groups, varied forms of social mobility, and structural processes of change and dominance. In such a situation, "family" and "individual" are emerging as agencies of reproduction of inequality/equality. Caste is becoming more of a state of mind of an individual. Contemporary changes have reshaped caste. The policy of reservations based on caste has kept it alive and vibrant. Protests against caste-based reservations have also contributed to the continuity of caste. Caste may be elusive for some who have distanced from their social and cultural roots, but for others, who continue to be there in villages and towns, caste is enduring, and it is there in practice in one way or other. At times, caste-based outbursts surface, though in everyday life, caste is not so visible as a means of social control. [ABSTRACT FROM AUTHOR]

The paper describes and analyses the Hadrami migration to and adaptations in Hyderabad, India. The various adaptive niches exploited by the Hadramis in Hyderabad before the merger with India in 1948 are outlined, particularly the ones relating to the military field. Hadrami officers and soldiers were a typical features of the Nizam's army. But this was to change with the Indian take-over in 1948. The second part of the paper outlines these changes as they relate to Hyderabad in general and to the new adaptive strategies adopted by the Hadramis in particular. The new evolving adaptations during the 1950s was based on petty trade and represented a downward turn in the fortunes of the Hadramis. During this period the Hadrami identity was fading and they tended to disappear among the other Muslims in the city. In the 1970s, however, labour migration to the Gulf helped improve the economic status of the Hadrami families, and it lead to a strengtheneing of the diasporic organisations that could facilitate the migration and which also strengthened the Hadrami diasporic identity. [ABSTRACT FROM AUTHOR]

This paper uses household level data from National Sample Survey Organization (NSSO) of India, the 55th round (1999–2000), to show that for urban male children there exists significant wage incentive for schooling, though school dropout rate and child labour incidence are not so small. The parents’ level of education plays an important role in reducing this tendency; thus establishing the linkage between social and human capital outcomes in the family. We also look at the incidence of harmful and manual occupations among the child labour. Mother’s education now appears as a very important factor in curbing these incidences; supporting earlier findings that women’s empowerment (one important indicator of which would be female educational level) is indeed instrumental in increasing parental awareness. [ABSTRACT FROM AUTHOR]

This paper determines the materials cited in Ph.D. theses of Sociology, submitted to the Panjab University, Chandigarh during the years 2002-2012 to improve the existing collection development policy of University library. The study reveals that Books are the most preferred sources of information used by the researchers in the field of Sociology, accounting for 57.65% of the total citations, although citations from journals, proceedings, internet resources and reports are also found. It is also observed those researchers are not taking much advantage of internet resources. Bradford's law of scattering was applied. More cited materials were contributed by single authors and degree of collaboration of books was calculated as 0.28 and the degree of collaboration of authors in cited journal articles were calculated as 0.35. [ABSTRACT FROM AUTHOR]

In this paper I have tried to suggest some probable extensions and projections into the future of what is at present a dimly visible and restricted condition. As previously reported, the situation at present is stable, in the sense that the attitudes supporting the traditional way of life of both Ladinos and Indians are dominant, and some of the tensions are capable of being drained off by desertion of Indians to other areas. Moreover, the average Indian is so securely orientated and integrated to a pattern of poverty, illness, and hard work that he seems quite capable of taking considerable slack in his psychological belt to adjust to still more of the same. The dynamics of alienation from tradition are at present cumulating their forces. How quickly the power which they contain will be recognized by or forced upon the Indians and Ladinos is a matter of speculation. The evidence would seem to point to considerable resistance to any variation in the way of life to adjust to the new forces at work. It is for this reason that in a previous paper the situation was described as one which has much promise of long life. For, there always remains the alternative that the Indians will grow increasingly small in numbers, but will nevertheless stubbornly keep up their traditions. If this alternative is pursued, it may be some generations yet before they either effectively disappear as a local community, or, through various other mechanisms, become so altered as to be no longer recognizable for what they were in 1940. It seems of significance to note here, finally, that the stratification by age and generation and the vertical division of the sexes in the community have come to have special significance. It makes considerable difference to the observer whether he views the situation through the eyes of a young man or an old man, a father or a son, a mother or a daughter. One does not get the same picture from any randomly selected individual in the community. This in some measure is a decided qualification on the usual assumption of homogeneity of such peasant or primitive communities, an assumption which underlies the use of one or two "trust- worthy informants" as the principal sources of information about such communities. These materials therefore incidentally suggest that a more adequate sampling of peasant populations in transition is called for than has hitherto been practiced in typical ethnographic investigation. [ABSTRACT FROM AUTHOR]

Numerous studies have examined the empirical evidence concerning the influence of demographic and socio-economic factors influencing child immunization, but no documentation is available which shows the actual impact of antenatal care (ANC) visits on subsequent child immunization. Therefore, this paper aims to examine the net impact of ANC visits on subsequent utilization of child immunization after removing the presence of selection bias. Nationwide data from India’s latest National Family Health Survey conducted during 2005–06 is used for the present study. The analysis has been carried out in the two separate models, in the first model 1–2 ANC visit and in the second model three or more ANC visits has been compared with no visit. We have used propensity score matching method with a counterfactual model that assesses the actual ANC visits effect on treated (ANC visits) and untreated groups (no ANC visit), and have employed Mantel-Haenszel bounds to examine whether result would be free from hidden bias or not. Using matched sample analysis result shows that child immunization among the groups of women who have completed 1–2 ANC visits and those who had more than two visits was about 13 percent and 19 percent respectively, higher than the group of women who have not made any ANC visit. Findings of nearest neighbor matching with replacement method, which completely eliminated the bias, indicate that selection bias present in data set leads to overestimates the positive effects of ANC visits on child immunization. Result based on Mantel-Haenszel bounds method suggest that if around 19 percent bias would be involved in the result then also we could observe the true positive effect of 1–2 ANC visits on child immunization. This also indicates that antenatal clinics are the conventional platforms for educating pregnant women on the benefits of child immunization. [ABSTRACT FROM AUTHOR]

This article is based on a bibliometric study of contribution to Indian Sociology, period from 2000 to 2009. It includes bibliometric analysis of 5683 citations appended to 139 articles published in the same journal. However, no citations were appended to 3 articles published in the maiden volume 1 in 1957. The study reveals the distribution of contributions, authorship pattern, citation analysis, geographical distribution of contributions, number of pages used in each volume and gender distribution. A comparative study of articles published in ten volumes as well as in the maiden volume has been made. Results indicate that there is not equal distribution pertaining to number of contributions in each volume due to publisher restrictions. Highest numbers of papers have been written by single authors and male authors have a slight edge over female contributors. The most cited documents are articles or chapters from books. The foreign authors' contributions are greater than India. Among the Indian states New Delhi is the top contributor whereas among Indian universities or institutes University of Delhi is at the top. At the international level UK is the top contributor followed by USA. The growth and popularity of this journal is found to be showing an upward trend. [ABSTRACT FROM AUTHOR]

Background: Although effective communication has been the most important attribute of success in the workplace, poor communication has hindered employees from performing well. This outcome worsens when communication occurs between cross-generational groups in an organization. Literature review: Prior research suggests that Millennials, who make up a large cohort of the population in workplaces, are technologically savvy, multitasking, and result-oriented but considered to be deficient in their communication skills. There exists a divergence between Millennials and previous generations in terms of their attitude, behavior, and value system. Research questions: 1. Is there a significant difference in the communication styles of Millennials and their predecessors in India? 2. Are Millennials communication deficient? 3. Do their Gen X predecessors lack the skills to recognize different generational preferences in order to effectively lead a multigenerational workforce? Research methodology: For this investigation, a 36-item questionnaire measured 12 interpersonal styles through three items each on a Likert-type scale. Results: The results presented in this study are not limited to generational stereotyping but rather claim to be accurate and context-sensitive. Millennials defied general stereotypes in several ways. The findings confirmed that although Millennials are different, they are not necessarily communication deficient. Conclusion: To flourish, Millennials and their predecessor and successor generations should strive to adapt to each other by avoiding stereotypes. [ABSTRACT FROM AUTHOR]

Background: India poses a novel tobacco problem with majority of the tobacco users consuming smokeless form of tobacco (21.4%). Gul is one such Smokeless Tobacco (ST) product that is manufactured commercially as a dentifrice to be applied to the teeth and then to gums many times during the day, making it a cheap and easy tobacco source. Hence, the aim of the present study was to estimate the usage of Gul and its social determinants among adults in the capital city of India, Delhi.Methods: The cross-sectional study was conducted among 1300 adults across 27 Delhi government dispensaries across 3 districts of Delhi through multistage stratified random sampling. A structured, close-ended, validated questionnaire inquiring about the tobacco practices was used for all the participants and a specially constructed, structured, close-ended, validated proforma was used for Gul users to assess practice and pattern of use.Results: The overall prevalence of Gul users was found to be 4.9% with a mean usage duration of 6.28 ± 6.75 years. The usage was found to be more among males (67.7%) and unskilled workers (45.2%). 74.9% started using Gul to treat dental pain with 93.47% of them reporting pain relief.Conclusion: Gul usage is an emerging menace in Delhi. Awareness programs and initiatives are the need of the hour to bring this tobacco product under the tobacco control policy radar and at the same time educate people about the actual contents and ill effects of Gul usage. [ABSTRACT FROM AUTHOR]

Background: Malnutrition among children is one of the most pressing health concerns middle- and low-income countries face today, particularly those in Sub-Saharan Africa and South Asia. Early-life malnutrition has been shown to affect long-term health and income. One hypothesized channel linking early-life malnutrition and long-term outcomes is cognitive development. However, there is limited empirical evidence on the relationship between nutritional status and cognitive achievement in middle childhood. Study design: As part of the South India Community Health Study (SICHS), we collected educational attainment and anthropometric data from 1,194 children in rural Vellore district of Tamil Nadu, India, and assessed their math and reading skills. We analyzed the relationship between continuous and binary anthropometric measures of nutritional status and three measures of cognitive achievement (reading, math, and grade level), adjusting for potential confounders, using a regression framework. Results: Lower height-for-age and weight-for-age and their corresponding binary measures (stunting, underweight) were associated with lower reading scores, lower math scores, and lower grade level, with the exception of the association between weight-for-age and reading, which was marginally significant. A stunted child had one-third of a grade disadvantage compared to a non-stunted counterpart, whereas an underweight child had one-fourth of a grade disadvantage compared to a non-underweight counterpart. Lower BMI-for-age was associated with grade level and marginally associated with lower math scores, and its binary measure (thinness) was marginally associated with lower math scores. Conclusions: Acute and chronic malnutrition in middle childhood were negatively associated with math scores, reading scores, and educational attainment. Our study provides new evidence that cognitive achievement during middle childhood could be an important mechanism underlying the association between early-life malnutrition and long-term wellbeing. [ABSTRACT FROM AUTHOR]

There has been growing recognition of menstrual hygiene management (MHM) as a significant public health issue. However, research has predominately focused on the experiences of adolescent girls in school settings. The purpose of this research is to examine detailed accounts of menstruation for women in rural Odisha, India at various life stages with a view toward improving international monitoring of MHM. Focus group discussions and in-depth interviews were conducted to understand women’s experiences of menstruation across four life stages (unmarried women, recently married women, married women, and older women). Thematic analysis was used to identify menstruation-related challenges and needs. We found women voiced needs that aligned with those captured by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) definition for MHM: access to clean materials, privacy for changing materials, soap and water for bathing, and disposal facilities for materials. However, we also found women require materials that are not only clean but comfortable and reliable; soap and water for more than bathing; privacy for the full spectrum of menstruation-related practices, not just when changing; and disposal facilities that are private and safe, not just accessible. Additionally, we identified needs that extend beyond the existing definition: pain management, social support, and an enabling sociocultural environment. Overall, women representing all life stages discussed menstruation challenges, including bathing, pain, and washing, drying, and storing cloth materials. Cloth management challenges were most acute for unmarried and recently married women, who were concerned that practices could reveal their menstrual status and harm their reputations, thus informing their preference for disposable materials, if attainable. We propose a revised definition of adequate MHM for this population that more comprehensively captures their needs. This definition may also prove useful for other populations, future research, creating measures of assessment, and guiding interventions and program priorities. [ABSTRACT FROM AUTHOR]

Introduction: The National Rural Health Mission (NRHM) was launched in India in 2005 to address the health needs of under-served populations in rural areas, and to support universal access to care. Despite this initiative, unaccredited informal providers (IPs) often remain patients’ first point of contact, which has led to inconsistencies in treatment, and has compromised the quality of care. Aim: To explore the factors that influence patients’ decisions about healthcare providers in rural areas of central India. Methods: Nine focus group discussions (FGDs) were held in nine villages in central India. Framework analysis using an inductive approach was used to analyse the data. Results: The crosscutting theme across the discussions was not choice but need—the need for affordable and accessible health care regardless of the provider’s qualification. Results highlighted that IPs play a pivotal role in villagers’ lives. Formal healthcare services were accessed infrequently, and mainly when a condition was judged severe or possibly even fatal. Even then, affordability was carefully weighed. Villagers’ distance from formal providers contributed to high cost and low preference of formal providers. When opting for IPs, familiarity and trust were more important to villagers than qualifications. IPs have operated in rural communities in India for a long time and have adapted their services to meet the needs, preferences, social norms, and economic conditions of villagers. Conclusion: IPs have captured a niche and are often the first contact point in rural settings even when patients ultimately are diagnosed and treated by trained doctors. Merely tackling the undersupply of qualified doctors is not effective or sufficient to impact on the rural healthcare system: the strong and prevalent influence of IPs needs to be addressed also. [ABSTRACT FROM AUTHOR]

Background: As population health and well-being are influenced by multiple factors that cut across sectoral boundaries, an intersectoral approach that acknowledges and leverages the multiple determinants, actors and sectors at play is increasingly seen as critical for achieving meaningful and lasting improvements. In this study, we utilize social network analysis (SNA) to characterize the intersectoral collaboration between the organizations working on maternal & child health (MCH) and water & sanitation (WASH) before and immediately after the implementation of HCL Foundation (HCLF)-funded HCL Samuday Project (2015–2017) in a rural block of Uttar Pradesh state, India. While SNA has been used to examine public health issues, few have used it monitor stakeholder relationships, intervene, improve and facilitate project implementation involving intersectoral partnerships, particularly in the context of a low-and middle-income countries. Method: An organization-level SNA was conducted with 31 key informants from 24 organizations working on MCH and/or WASH in Kachhauna, Uttar Pradesh, India. Data were collected using face-to-face, semi-structured interviews between June and September 2017. Density, centrality and homophily were calculated to describe the network and a qualitative analysis was also conducted to identify the strengths and weaknesses of collaboration between organizations working on MCH and WASH. Results: Overall, our findings showed that the network of organizations working on MCH and WASH in Kachhauna grew in number since the implementation of Samuday. HCLF rapidly achieved centrality, thus positioning the organization to serve as a gatekeeper of information and enabling it to play a coordinator role within the network. Direct collaboration between other organizations working on MCH and WASH was low at both time points. Interviews with key informants indicated widespread interest in increasing interorganizational interactions and engagement throughout the network. Conclusion: This study demonstrates the feasibility and practical application of SNA for projects like Samuday that involve intersectoral collaboration. It also provides lessons about the use of SNA with organizations as the unit of analysis and in the context of rural India, including challenges, practical considerations, and limitations. [ABSTRACT FROM AUTHOR]

Background: Although most Indians live in rural settings, data on cardiovascular disease risk factors in these groups are limited. We describe the association between socioeconomic position and cardiovascular disease risk factors in a large rural population in north India. Methods: We performed representative, community-based sampling from 2013 to 2014 of Solan district in Himachal Pradesh. We used education, occupation, household income, and household assets as indicators of socioeconomic position. We used tobacco use, alcohol use, low physical activity, obesity, hypertension, and diabetes as risk factors for cardiovascular disease. We performed hierarchical multivariable logistic regression, adjusting for age, sex and clustering of the health sub-centers, to evaluate the cross-sectional association of socioeconomic position indicators and cardiovascular disease risk factors. Results: Among 38,457 participants, mean (SD) age was 42.7 (15.9) years, and 57% were women. The odds of tobacco use was lowest in participants with graduate school and above education (adjusted OR 0.11, 95% CI 0.09, 0.13), household income >15,000 INR (adjusted OR 0.35, 95% CI 0.29, 0.43), and highest quartile of assets (adjusted OR 0.28, 95% CI 0.24, 0.34) compared with other groups but not occupation (skilled worker adjusted OR 0.93, 95% CI 0.74, 1.16). Alcohol use was lower among individuals in the higher quartile of income (adjusted OR 0.75, 95% CI 0.64, 0.88) and assets (adjusted OR 0.70, 95% CI 0.59, 0.82). The odds of obesity was highest in participants with graduate school and above education (adjusted OR 2.33, 95% CI 1.85, 2.94), household income > 15,000 Indian rupees (adjusted OR 1.89, 95% CI 1.63, 2.19), and highest quartile of household assets (adjusted OR 2.87, 95% CI 2.39, 3.45). The odds of prevalent hypertension and diabetes were also generally higher among individuals with higher socioeconomic position. Conclusions: Individuals with lower socioeconomic position in Himachal Pradesh were more likely to have abnormal behavioral risk factors, and individuals with higher socioeconomic position were more likely to have abnormal clinical risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers and women from the general population which integrated horizontal health services for the general population with existing vertical targeted interventions aimed at sex workers with an aim to improve SRH and HIV services. We present an outcome evaluation of the DIFFER project in terms of uptake rates for SRH services among sex workers in Mysore, India. Methods: Ashodaya Samithi, a sex worker-led organization, implemented the DIFFER strategy through their community-based clinic and a Well Women Clinic (WWC), established at a partner private hospital that provided SRH services for women living with HIV. Mixed methods were used to evaluate the intervention that included a baseline (2012–13) and end of project (2015–16) cross sectional surveys (CSS), focus group discussions (FGDs), key informant interviews, and analysis of service statistics from 2013–2016. Results: The CSS found that condom use, STI testing, and treatment were high before, and throughout the intervention; cervical cancer screening and treatment increased significantly, from 11.5% to 56% (aOR 9.85, p<0.001) and HIV testing in the last 3 months increased from 26.3% to 73.3% (aOR 7.25, p<0.001). The proportion of sex workers using any SRH service in the past year doubled from 25.7% to 51.4% (aOR 2.91, p<0.001). Service statistics showed similar trends. The FGDs and key informant interviews showed that women and stakeholders held high levels of satisfaction with the strategy, and affirmed potential for scale up. Conclusion: The DIFFER strategy demonstrated that SRH service uptake can occur in conjuction with HIV services offered to sex workers. This model of integrated service delivery has been accepted by policy makers and needs further analysis for scaling up. [ABSTRACT FROM AUTHOR]

Despite the efforts of community health workers to increase access to healthcare among ethnic minority groups in low- and -middle income countries, members of ethnic minorities are less likely than women from other ethnic groups to use maternal and child healthcare services. However, much less is known about the factors that limit access of ethnic minorities to healthcare services, including the services of community health workers in Nepal, who are known as Female Community Health Volunteers (FCHVs). To address this issue, we conducted a qualitative study to explore perceived barriers to accessing maternal and child healthcare services among ethnic minority groups in two different geographical locations (the hill and Terai regions- flatland bordering south India) with varying degrees of access to local healthcare centres. Between April 2014 and September 2014, semi-structured interviews were conducted with twenty FCHVs, 26 women service users and 11 paid local health workers. In addition, 15 FCHVs participated in four focus group discussions. A thematic analysis of the data identified five major themes underlying barriers to accessing available maternal and child healthcare services by ethnic minority groups such as Dalits, Madhesi, Muslim, Chepang and Tamang. These themes include: a) lack of knowledge among service users; b) lack of trust in volunteers; c) traditional beliefs and healthcare practices; d) low decision-making power of women; and e) perceived indignities experienced when using health centres. We conclude that community health programmes should focus on increasing awareness of healthcare services among ethnic minority groups, and the programmes should involve family members (husband and mothers-in-law) and traditional health practitioners. Both the FCHVs and local healthcare providers should be trained to communicate effectively in order to deliver respectful care among ethnic minorities if we want to achieve universal healthcare coverage for maternal and child health in low- and -middle income countries. [ABSTRACT FROM AUTHOR]

Background: Evidence highlights a global shortage of wheelchair service provision education and training that results in inappropriate wheelchair provision with associated health and economic consequences. Two learning methodologies, a hybrid and an in-person course, based on the World Health Organization Wheelchair Service Training Package Basic Level, currently are available to train wheelchair service providers worldwide. The effectiveness of the in-person methodology, used as the standard of practice, has never been tested. Meanwhile, the Hybrid Course, which combines online and in-person training, was developed to reduce training costs and to scale training interventions and has shown potential effectiveness in increasing basic level wheelchair service provision knowledge. The objective of this study was to compare the effectiveness of both learning methodologies based on knowledge and satisfaction among a group of wheelchair service providers in India and Mexico. Methods: We conducted a controlled quasi-experimental study to evaluate changes in basic wheelchair knowledge and levels of satisfaction between Hybrid and In-person course learners in India and Mexico. A convenience sampling method guided by local stakeholders’ input was used to recruit participants. Outcomes were assessed using self-administered online surveys, the International Society of Wheelchair Professionals Wheelchair Service Provision Basic Test (primary outcome) completed pre- and post- the learning intervention and an anonymous Satisfaction Survey (secondary outcome) completed post- intervention. Baseline characteristics were compared among groups using hypothesis tests based on their assumptions. The primary analysis was intention-to-treat. To address missing values and lost to follow-up, multiple chained imputations were conducted. The primary outcome was analyzed using linear mixed models. The secondary outcome was analyzed using a two-tailed two independent samples t-test. Results: A total of 81 participants, 43 (53.1%) in the In-person group and 38 (46.9%) in the Hybrid group, participated in the study. Mean baseline knowledge scores were below the passing cutoff of the test (53 points) in both groups. Both study groups experienced statistically significant improvements in the primary outcome when comparing pre- and post-test scores (p<0.0001) with total mean scores above the passing cutoff of the test. The in-person group experienced, on average, larger effects on the primary outcome. The difference in mean change from post-test to pre-tests between In-person groups and Hybrid was 3.6 (95% Confidence Interval: 1.7;5.4), Cohen’s d = 0.36, with a small effect size favoring the In-person training. With regards to satisfaction, the difference between the two interventions was 0.23±0.07 in favor of the In-person group (p = 0.0021). Conclusions: Both learning methodologies had a statistically significant effect in increasing wheelchair service knowledge with overall high levels of satisfaction. However, the In-person group reported overall larger effects when compared with the Hybrid methodology. This study provided recommendations on how organizations can improve blended learning interventions to enhance participants’ learning experiences and reduce potential barriers and limitations. [ABSTRACT FROM AUTHOR]

Background: Evidence on where in the hypertension care process individuals are lost to care, and how this varies among states and population groups in a country as large as India, is essential for the design of targeted interventions and to monitor progress. Yet, to our knowledge, there has not yet been a nationally representative analysis of the proportion of adults who reach each step of the hypertension care process in India. This study aimed to determine (i) the proportion of adults with hypertension who have been screened, are aware of their diagnosis, take antihypertensive treatment, and have achieved control and (ii) the variation of these care indicators among states and sociodemographic groups.Methods and Findings: We used data from a nationally representative household survey carried out from 20 January 2015 to 4 December 2016 among individuals aged 15-49 years in all states and union territories (hereafter "states") of the country. The stages of the care process-computed among those with hypertension at the time of the survey-were (i) having ever had one's blood pressure (BP) measured before the survey ("screened"), (ii) having been diagnosed ("aware"), (iii) currently taking BP-lowering medication ("treated"), and (iv) reporting being treated and not having a raised BP ("controlled"). We disaggregated these stages by state, rural-urban residence, sex, age group, body mass index, tobacco consumption, household wealth quintile, education, and marital status. In total, 731,864 participants were included in the analysis. Hypertension prevalence was 18.1% (95% CI 17.8%-18.4%). Among those with hypertension, 76.1% (95% CI 75.3%-76.8%) had ever received a BP measurement, 44.7% (95% CI 43.6%-45.8%) were aware of their diagnosis, 13.3% (95% CI 12.9%-13.8%) were treated, and 7.9% (95% CI 7.6%-8.3%) had achieved control. Male sex, rural location, lower household wealth, and not being married were associated with greater losses at each step of the care process. Between states, control among individuals with hypertension varied from 2.4% (95% CI 1.7%-3.3%) in Nagaland to 21.0% (95% CI 9.8%-39.6%) in Daman and Diu. At 38.0% (95% CI 36.3%-39.0%), 28.8% (95% CI 28.5%-29.2%), 28.4% (95% CI 27.7%-29.0%), and 28.4% (95% CI 27.8%-29.0%), respectively, Puducherry, Tamil Nadu, Sikkim, and Haryana had the highest proportion of all adults (irrespective of hypertension status) in the sampled age range who had hypertension but did not achieve control. The main limitation of this study is that its results cannot be generalized to adults aged 50 years and older-the population group in which hypertension is most common.Conclusions: Hypertension prevalence in India is high, but the proportion of adults with hypertension who are aware of their diagnosis, are treated, and achieve control is low. Even after adjusting for states' economic development, there is large variation among states in health system performance in the management of hypertension. Improvements in access to hypertension diagnosis and treatment are especially important among men, in rural areas, and in populations with lower household wealth. [ABSTRACT FROM AUTHOR]

This study examined the burden of food insecurity in India’s un-notified slums, using an SDG framework to identify correlates of food insecurity. A convenience sampling approach was employed in selecting 38 slums from 675 un-notified slums across four geographic zones. Ten percent of the households in each slum site were selected from each zone, and one household member was interviewed, based on their availability and fulfilment of the eligibility criteria. Eligible individuals included those aged 18 years and above, who were resident in the selected slums and provided consent. Individuals with mental or physical challenges were excluded. A total sample of 907 study participants were included. Results showed that 43% (n = 393) of the participants were food insecure. More than half were females (73%, n = 285), who had not completed any schooling (51%, n = 202). One-third (n = 128) resided in the Northern Region of Delhi. SDG-related predictors of food insecurity included: household educational level (SDG 4 Quality education) (p = 0.03), coverage of health service needs (SDG 3 Good health and well-being) (p = 0.0002), electricity needs (SDG 7 affordable and clean energy) (p<0.0001), and employment needs (SDG 8 Decent and economic growth) (p = 0.003). Having healthcare needs that were partially or fully met was equally associated with higher food insecurity: this could be attributed to high healthcare costs and the lack of federal subsidies in un-notified slums, collectively contributing to high out-of-pocket health costs. Failure to fully meet employment needs was also significantly associated with higher food insecurity. However, met needs for electricity, finance, women’s safety and satisfactory family relationships, were associated with lower food insecurity. Household predictors of food insecurity included: number of household members, and the presence of physically disabled household members. Necessary interventions should include connecting food insecure households to existing social services such as India’s Public Distribution System, and multi-sector partnerships to address the existing challenges. [ABSTRACT FROM AUTHOR]

Commercial surrogacy in emerging countries such as India is often associated with exploitation of vulnerable women, the assumption being that it is performed by poor and uneducated women for rich intended parents. However, the hypothesis that surrogates are poor women has rarely been confronted with field data. The objective was to compare the socioeconomic characteristics of Indian surrogates interviewed in social studies with those of Indian women in the general population in order to provide preliminary data on whether surrogates have a specific profile and are indeed disadvantaged compared with their counterparts. The study analyzes the data from four cross-sectional studies carried out in India among surrogates between 2006 and 2014. Surrogates were recruited through clinics, agencies and agents. Data were collected during face-to-face interviews. The resulting convenience sample included 96 Indian surrogates. Their sociodemographic characteristics were compared with those of the general population extracted from Indian national surveys. The surrogates interviewed had their first child at a younger age than women in the general population, but they tended to have a smaller family. Their social situation tended to be better than that of the general population in terms of education, employment and family income. These results provide first empirical evidence moderating the common assumption that Indian surrogates are the poorest and least educated women. This does not mean, however, that exploitation does not exist. More studies are needed to confirm these results and to explore the issue in new international destinations for surrogacy. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.Methods and Findings: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys.Conclusions: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the leading cause of mortality in India. Yet, evidence on the CVD risk of India's population is limited. To inform health system planning and effective targeting of interventions, this study aimed to determine how CVD risk-and the factors that determine risk-varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics.Methods and Findings: We used 2 large household surveys carried out between 2012 and 2014, which included a sample of 797,540 adults aged 30 to 74 years across India. The main outcome variable was the predicted 10-year risk of a CVD event as calculated with the Framingham risk score. The Harvard-NHANES, Globorisk, and WHO-ISH scores were used in secondary analyses. CVD risk and the prevalence of CVD risk factors were examined by state, rural-urban residence, age, sex, household wealth, and education. Mean CVD risk varied from 13.2% (95% CI: 12.7%-13.6%) in Jharkhand to 19.5% (95% CI: 19.1%-19.9%) in Kerala. CVD risk tended to be highest in North, Northeast, and South India. District-level wealth quintile (based on median household wealth in a district) and urbanization were both positively associated with CVD risk. Similarly, household wealth quintile and living in an urban area were positively associated with CVD risk among both sexes, but the associations were stronger among women than men. Smoking was more prevalent in poorer household wealth quintiles and in rural areas, whereas body mass index, high blood glucose, and systolic blood pressure were positively associated with household wealth and urban location. Men had a substantially higher (age-standardized) smoking prevalence (26.2% [95% CI: 25.7%-26.7%] versus 1.8% [95% CI: 1.7%-1.9%]) and mean systolic blood pressure (126.9 mm Hg [95% CI: 126.7-127.1] versus 124.3 mm Hg [95% CI: 124.1-124.5]) than women. Important limitations of this analysis are the high proportion of missing values (27.1%) in the main outcome variable, assessment of diabetes through a 1-time capillary blood glucose measurement, and the inability to exclude participants with a current or previous CVD event.Conclusions: This study identified substantial variation in CVD risk among states and sociodemographic groups in India-findings that can facilitate effective targeting of CVD programs to those most at risk and most in need. While the CVD risk scores used have not been validated in South Asian populations, the patterns of variation in CVD risk among the Indian population were similar across all 4 risk scoring systems. [ABSTRACT FROM AUTHOR]

Introduction: Improving maternal health outcomes remains a priority in Low and Middle Income Countries. With the rapid proliferation of mobile health technologies, there is an increased interest in understanding how these technologies can effectively improve maternal health outcomes particularly maternal health seeking knowledge and behaviors. However, few studies present clear explanations of the program developers’ rationale (theory of change) and contextual factors that could influence program outcomes. This mixed-methods study assesses Mobile for Mothers, a community health workers (CHW) utilized maternal mHealth intervention. We present the program developers’ rationale and utilize it as a framework to guide our study that aimed to identify intervention-related and contextual factors, which influence the observed outcomes of a CHW, utilized mHealth intervention. Materials and methods: Quantitative methods (a questionnaire with 740 women who received the intervention and survey of 57 CHWs who utilized the intervention) and qualitative methods (12 interviews and 4 group discussions with CHWs and 20 interviews and 5 group discussions with pregnant and lactating women and 15 interviews and 2 group discussions with men) were conducted. These were used to understand how the mHealth intervention was implemented and to gain insight into contextual factors that potentially influenced the observed intervention outcomes. Results: Results were grouped following three categories: (1) perceptions and experiences of CHWs utilizing the mHealth technology; (2) CHW-related outcomes; and (3) contextual factors that influence maternal health-seeking behavior. The overall response of CHWs and community members to the intervention was positive. However, contextual factors like the relationship between the CHWs and their respective communities, the pregnant women’s decision-making power and lack of access due to financial influenced the observed outcomes. Conclusion: Mobile health applications are promising interventions for improving the performance of CHWs and health-seeking behavior of pregnant women. However, the contextual factors play a crucial role in intervention outcomes and need to be explicated by program developers during intervention design and implementation. [ABSTRACT FROM AUTHOR]

Background and Objective: Understanding medical students’ motivation to select medical studies is particularly salient to inform practice and policymaking in countries—such as India—where shortage of medical personnel poses crucial and chronical challenges to healthcare systems. This study aims to develop and validate a questionnaire to assess the motivation of medical students to select medical studies. Methods: A Motivation for Selection of Medical Study (MSMS) questionnaire was developed using extensive literature review followed by Delphi technique. The scale consisted of 12 items, 5 measuring intrinsic dimensions of motivations and 7 measuring extrinsic dimensions. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), validity, reliability and data quality checks were conducted on a sample of 636 medical students from six medical colleges of three North Indian states. Results: The MSMS questionnaire consisted of 3 factors (subscales) and 8 items. The three principal factors that emerged after EFA were the scientific factor (e.g. research opportunities and the ability to use new cutting edge technologies), the societal factor (e.g. job security) and the humanitarian factor (e.g. desire to help others). The CFA conducted showed goodness-of-fit indices supporting the 3-factor model. Conclusion: The three extracted factors cut across the traditional dichotomy between intrinsic and extrinsic motivation and uncover a novel three-faceted motivation construct based on scientific factors, societal expectations and humanitarian needs. This validated instrument can be used to evaluate the motivational factors of medical students to choose medical study in India and similar settings and constitutes a powerful tool for policymakers to design measures able to increase selection of medical curricula. [ABSTRACT FROM AUTHOR]

We examine the impact of religious identity and village-level religious fragmentation on behavior in Tullock contests. We report on a series of two-player Tullock contest experiments conducted on a sample of 516 Hindu and Muslim participants in rural West Bengal, India. Our treatments are the identity of the two players and the degree of religious fragmentation in the village where subjects reside. Our main finding is that the effect of social identity is small and inconsistent across the two religious groups in our study. While we find small but statistically significant results in line with our hypotheses in the Hindu sample, we find no statistically significant effects in the Muslim sample. This is in contrast to evidence from Chakravarty et al. (2016), who report significant differences in cooperation levels in prisoners’ dilemma and stag hunt games, both in terms of village composition and identity. We attribute this to the fact that social identity may have a more powerful effect on cooperation than on conflict. [ABSTRACT FROM AUTHOR]

Aim: To describe self-reported practices and assess knowledge and attitudes regarding hand hygiene among healthcare workers in a rural Indian teaching hospital. Setting: A rural teaching hospital and its associated medical and nursing colleges in the district of Ujjain, India. Method: The study population consisted of physicians, nurses, teaching staff, clinical instructors and nursing students. Self-administered questionnaires based on the World Health Organization Guidelines on Hand Hygiene in Healthcare were used. Results: Out of 489 healthcare workers, 259 participated in the study (response rate = 53%). The proportion of healthcare workers that reported to ‘always’ practice hand hygiene in the selected situations varied from 40–96% amongst categories. Reported barriers to maintaining good hand hygiene were mainly related to high workload, scarcity of resources, lack of scientific information and the perception that priority is not given to hand hygiene, either on an individual or institutional level. Previous training on the topic had a statistically significant association with self-reported practice (p = 0.001). Ninety three per cent of the respondents were willing to attend training on hand hygiene in the near future. Conclusion: Self-reported knowledge and adherence varied between situations, but hand hygiene practices have the potential to improve if the identified constraints could be reduced. Future training should focus on enhancing healthcare workers’ knowledge and understanding regarding the importance of persistent practice in all situations. [ABSTRACT FROM AUTHOR]

Background: While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE). Aims: Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference. Data and Methods: Using two rounds of nationally representative panel data—the India Human Development Survey (IHDS) 2004–2005 and 2011–2012 (IHDS I & II)—we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors. Results: Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206–0.091). For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male–female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect), whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect). Interpretation: Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE. [ABSTRACT FROM AUTHOR]

Introduction: Overweight and obesity are a public health problem in India not only in adults but also in children. The authors sought to estimate the prevalence of overweight and obesity in school-going children of 6–17 years of age and examine its demographic and dietary correlates in context of their urban-rural status and socio-economic status. Methods: In this cross-sectional survey height and weight were measured in 1266 school children in government and private schools of urban and rural areas. Dietary assessment was done using single day 24-hour dietary recall method. The data were analyzed using SPSS (IBM SPSS Statistics Version 19) and WHO AnthroPlus Software. Factorial ANOVA was used for testing interaction within and between subgroups for continuous variables and Chi-square test was used for categorical variables. Results: It was found that the overall prevalence of overweight was 15.6% of which 5.4% were obese, with maximum prevalence in boys attending urban private schools. The mean caloric intake in the study population with 24-hour dietary recall method was 1558.2 kilocalories (SD: 428 kilocalories). Conclusion: Overweight and obesity is a significant problem in school-going children. Higher socio-economic status continues to remain an important driver of this epidemic in the younger generation and affects demographic and dietary determinants of this problem. [ABSTRACT FROM AUTHOR]

Background: Despite ongoing recommendations to increase male engagement and gender-equity (GE) counseling in family planning (FP) services, few such programs have been implemented and rigorously evaluated. This study evaluates the impact of CHARM, a three-session GE+FP counseling intervention delivered by male health care providers to married men, alone (sessions 1&2) and with their wives (session 3) in India. Methods and Findings: A two-armed cluster randomized controlled trial was conducted with young married couples (N = 1081 couples) recruited from 50 geographic clusters (25 clusters randomized to CHARM and a control condition, respectively) in rural Maharashtra, India. Couples were surveyed on demographics, contraceptive behaviors, and intimate partner violence (IPV) attitudes and behaviors at baseline and 9 &18-month follow-ups, with pregnancy testing at baseline and 18-month follow-up. Outcome effects on contraceptive use and incident pregnancy, and secondarily, on contraceptive communication and men’s IPV attitudes and behaviors, were assessed using logistic generalized linear mixed models. Most men recruited from CHARM communities (91.3%) received at least one CHARM intervention session; 52.5% received the couple’s session with their wife. Findings document that women from the CHARM condition, relative to controls, were more likely to report contraceptive communication at 9-month follow-up (AOR = 1.77, p = 0.04) and modern contraceptive use at 9 and 18-month follow-ups (AORs = 1.57–1.58, p = 0.05), and they were less likely to report sexual IPV at 18-month follow-up (AOR = 0.48, p = 0.01). Men in the CHARM condition were less likely than those in the control clusters to report attitudes accepting of sexual IPV at 9-month (AOR = 0.64, p = 0.03) and 18-month (AOR = 0.51, p = 0.004) follow-up, and attitudes accepting of physical IPV at 18-month follow-up (AOR = 0.64, p = 0.02). No significant effect on pregnancy was seen. Conclusions: Findings demonstrate that men can be engaged in FP programming in rural India, and that such an approach inclusive of GE counseling can improve contraceptive practices and reduce sexual IPV in married couples. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Background: Stigmatising and discriminating attitudes may discourage tuberculosis (TB) patients from actively seeking medical care, hide their disease status, and discontinue treatment. It is expected that appropriate knowledge regarding TB should remove stigmatising and discriminating attitudes. In this study we assessed the prevalence of stigmatising and discriminating attitudes towards TB patients among general population and their association with knowledge regarding TB. Method: A cross-sectional knowledge, attitude and practice survey was conducted in 30 districts of India in January-March 2011. A total of 4562 respondents from general population were interviewed using semi-structured questionnaires which contained items to measure stigma, discrimination and knowledge on TB. Result: Of the 4562 interviewed, 3823 were eligible for the current analysis. Of these, 73% (95% CI 71.4–74.2) had stigmatising and 98% (95% CI 97.4–98.3) had discriminating attitude towards TB patients. Only 17% (95% CI 15.6–18.0) of the respondents had appropriate knowledge regarding TB with even lower levels observed amongst females, rural areas and respondents from low income groups. Surprisingly stigmatising (adjusted OR 1.31 (0.78–2.18) and discriminating (adjusted OR 0.79 (0.43–1.44) attitudes were independent of knowledge regarding TB. Conclusion: Stigmatising and discriminating attitudes towards TB patients remain high among the general population in India. Since these attitudes were independent of the knowledge regarding TB, it is possible that the current disseminated knowledge regarding TB which is mainly from a medical perspective may not be adequately addressing the factors that lead to stigma and discrimination towards TB patients. Therefore, there is an urgent need to review the messages and strategies currently used for disseminating knowledge regarding TB among general population and revise them appropriately. The disseminated knowledge should include medical, psycho-social and economic aspects of TB that not only informs people about medical aspects of TB disease, but also removes stigma and discrimination. [ABSTRACT FROM AUTHOR]

Background: Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for 'catastrophic' health expenditure (CHE), in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education. Methods: We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design. Findings: Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups. Conclusion: During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential to achieve equity of access to healthcare. [ABSTRACT FROM AUTHOR]

Background: Globally, India contributes the largest share in sheer numbers to the burden of maternal and infant under-nutrition, morbidity and mortality. A major gap in our knowledge is how socio-cultural practices and beliefs influence the perinatal period and thus perinatal outcomes, particularly in the rapidly growing urban setting. Methods and Findings: Using data from a qualitative study in urban south India, including in-depth interviews with 36 women who had recently been through childbirth as well as observations of family life and clinic encounters, we explored the territory of familial, cultural and traditional practices and beliefs influencing women and their families through pregnancy, childbirth and infancy. We found that while there were some similarities in cultural practices to those described before in studies from low resource village settings, there are changing practices and ideas. Fertility concerns dominate women’s experience of married life; notions of gender preference and ideal family size are changing rapidly in response to the urban context; however inter-generational family pressures are still considerable. While a rich repertoire of cultural practices persists throughout the perinatal continuum, their existence is normalised and even underplayed. In terms of diet and nutrition, traditional messages including notions of ‘hot’ and ‘cold’ foods, are stronger than health messages; however breastfeeding is the cultural norm and the practice of delayed breastfeeding appears to be disappearing in this urban setting. Marriage, pregnancy and childbirth are so much part of the norm for women, that there is little expectation of individual choice in any of these major life events. Conclusions: A greater understanding is needed of the dynamic factors shaping the perinatal period in urban India, including an acknowledgment of the health promoting as well as potentially harmful cultural practices and the critical role of the family. This will help plan culturally appropriate integrated perinatal health care. [ABSTRACT FROM AUTHOR]

Background: India is the only nation where girls have greater risks of under-5 mortality than boys. We test whether female disadvantage in breastfeeding and food allocation accounts for gender disparities in mortality. Methods and Findings: Secondary, publicly available anonymized and de-identified data were used; no ethics committee review was required. Multivariate regression and Cox models were performed using Round 3 of India’s National Family and Health Survey (2005–2006; response rate = 93.5%). Models were disaggregated by birth order and sibling gender, and adjusted for maternal age, education, and fixed effects, urban residence, household deprivation, and other sociodemographics. Mothers’ reported practices of WHO/UNICEF recommendations for breastfeeding initiation, exclusivity, and total duration (ages 0–59 months), children’s consumption of 24 food items (6–59 months), and child survival (0–59 months) were examined for first- and secondborns (n = 20,395). Girls were breastfed on average for 0.45 months less than boys (95% CI: = 0.15 months to 0.75 months, p = 0.004). There were no gender differences in breastfeeding initiation (OR = 1.04, 95% CI: 0.97 to 1.12) or exclusivity (OR = 1.06, 95% CI: 0.99 to 1.14). Differences in breastfeeding cessation emerged between 12 and 36 months in secondborn females. Compared with boys, girls had lower consumption of fresh milk by 14% (95% CI: 79% to 94%, p = 0.001) and breast milk by 21% (95% CI: 70% to 90%, p<0.000). Each additional month of breastfeeding was associated with a 24% lower risk of mortality (OR = 0.76, 95% CI: 0.73 to 0.79, p<0.000). Girls’ shorter breastfeeding duration accounted for an 11% increased probability of dying before age 5, accounting for about 50% of their survival disadvantage compared with other low-income countries. Conclusions: Indian girls are breastfed for shorter periods than boys and consume less milk. Future research should investigate the role of additional factors driving India’s female survival disadvantage. [ABSTRACT FROM AUTHOR]

Background: Weak health systems in low- and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. Methods: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. Result: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients’ medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Conclusions: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions. [ABSTRACT FROM AUTHOR]

Some seventy to eighty delegates from colleges, universities, institutes, and schools of social work throughout India, as well as several foreign observers, assembled on February 6-8, 1958 for the Third Indian Sociological Conference at Agra University's Institute of Social Sciences. Although the third of its kind since 1955, it was the first conference to be held in the newly-born institute, impressive both for its architecture and atmosphere of scholarship. In the opening session, the spotlight was focussed upon the sociologist of India, exposing the gravity of his responsibilities against a backdrop of rapid social change. His role was delineated as a composite of "social critic" and "social engineer," dedicated to the development of "precise and scientific procedures that will yield stable empirical results." This orientation, linked to pride in the fact that sociological thinking has its roots in ancient India, combines a realistic insight into the immediate with a sensitivity for historical continuity, that should distinguish future sociology in India.