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Justification: Mumps, despite being a widely prevalent disease in the country, is considered as an insignificant public health problem mainly because of poor documentation of clinical cases and lack of published studies. In the absence of adequate published data on disease burden, Government of India has recently decided to introduce measles-rubella (MR) vaccine in its National Immunization Program and neglected mumps component. Process: Following an IAP ACVIP meeting on December 6 and 7, 2014, a detailed review of burden of mumps in India along with vaccination strategies to control the disease was prepared. The draft was circulated amongst the members of the committee for review and approval. Revised final draft was later approved by IAP executive board in January 2015. Objectives: To provide a review of community burden of mumps in India; and to discuss the vaccination strategies to impress upon policymakers to include mumps vaccination in National immunization program. Recommendations: A total of 14 studies and two media reports on mumps outbreak were retrieved. The outbreaks were reported from all the regions of the country. Mumps meningoencephalitis was responsible for 2.3% to 14.6% of all investigated hospitalized acute encephalitis syndrome or viral encephalitis cases in different studies. Data from Infectious Disease Surveillance (ID Surv) portal of IAP and Integrated Disease Surveillance Program (IDSP) of Government of India (GoI) were also reviewed. While a total of 1052 cases were reported by the IDSurv, IDSP had investigated 72 outbreaks with 1564 cases in 14 states during different time periods. Genotypes G (subtype G2) and C were found to be main genotypes of the mumps virus circulating in the country. Three studies studied serological status of young children and adolescents against mumps, and found susceptibility rates ranging from 32% to 80% in different age groups. Conclusions: Mumps poses a significant disease burden in India. This calls for inclusion of mumps vaccine in the National immunization program. [ABSTRACT FROM AUTHOR]

Context: Rabies poses a serious public health concern in developing countries such as India. Aims: The study focuses on molecular diagnosis of street rabies virus (RABV) from human clinical specimens received from Maharashtra, India. Materials and Methods: Nucleoprotein gene from eight (of total 20 suspected samples) rabies cases that tested positive for rabies antigen using reverse transcriptase-polymerase chain reaction (RT-PCR) were sequenced. Results: Sequence analysis using basic local alignment search tool (BLAST) and multiple sequence alignment (MSA) and phylogenetic analysis showed similarity to previously reported sequences from India and those of Arctic lineages. Conclusions: The circulating RABV strains in Maharashtra, India show genetic relatedness to RABV strains reported from Indo-Arctic lineages and India-South and Japan. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents are preventable public health issues and are becoming more common. These accidents can be linked to a number of factors, including an increase in the number of vehicles on the roads, changes in daily life, a nasty habit of breaking traffic laws, anarchic traffic systems, and risky driving practices. Thoraco-abdominal injury in different forms is one of the major causes of mortality in the victims of fatal road traffic accidents. The aim of this study was to know the pattern of thoraco-abdominal injuries in victims of fatal road traffic accident cases. Material & Method: The present study was conducted at the tertiary healthcare centre in southern Haryana. Total of 75 cases of fatal road traffic accident cases were enrolled during one year of study period. The basic information about the deceased like age, gender, mode of travel of the victim was obtained from investigating officer narration and inquest papers. During autopsy, detailed examination of injuries was carried out and the autopsy findings were recorded and analyzed. Results: It was observed that out of 75 cases male outnumbered females in ratio 5.25:1. Majority of the victims belonged to the age group 21-30 years. The commonest injury of the thoracic region was rib fracture (41.3%). It was also observed that 17.3% of victims had pelvic fracture. Conclusion: Human error is a major contributing factor to fatal RTAs, which can be avoided in many cases. A more stringent licensing policy, particularly for four-wheelers, increased knowledge of traffic laws, the reduction of drug abuse and an appropriate road network that is in line with traffic volume can help to reduce the number of fatal road traffic accidents. [ABSTRACT FROM AUTHOR]

A well-structured digital database is essential for any national priority project as it can provide real-time data analysis and facilitate quick decision making. In recent times, particularly after the COVID-19 pandemic, invasive fungal infections (IFIs) have emerged as a significant public health challenge in India, affecting vulnerable population, including immunocompromised individuals. The lack of comprehensive and well-structured data on IFIs has hindered efforts to understand their true burden and optimize patient care. To address this critical knowledge gap, the ICMR has undertaken a Pan-India pioneer initiative to develop a network of Advanced Mycology Diagnostic research centres in different geographical zones of the country (ICMR-MycoNet). Under the aegis of this project, a clinical registry on IFIs in the ICUs is initiated. This process paper presents a detailed account of the steps involved in the establishment of a web-based data entering and monitoring platform to capture data electronically, ensuring robust and secure data collection and management. This system not only allows participating ICMR-MycoNet centres to enter patient information directly into the database using standardized Case Report Form (CRF) but also includes data validation checks to ensure the accuracy and completeness of entered data. It is complemented by a real-time, web-based, and adaptable data visualization platform. This registry aims to provide crucial epidemiological insights, promote evidence-based hospital infection control programs, and ultimately improve patient outcomes in the face of this formidable healthcare challenge. [ABSTRACT FROM AUTHOR]

Although it is well known that vaccines against many infectious diseases confer positive economic externalities via indirect protection, analysts have typically ignored possible herd protection effects in policy analyses of vaccination programs. Despite a growing literature on the economic theory of vaccine externalities and several innovative mathematical modeling approaches, there have been almost no empirical applications. The first objective of the paper is to develop a transparent, accessible economic framework for assessing the private and social economic benefits of vaccination. We also describe how stated preference studies (for example, contingent valuation and choice modeling) can be useful sources of economic data for this analytic framework. We demonstrate socially optimal policies using a graphical approach, starting with a standard textbook depiction of Pigouvian subsidies applied to herd protection from vaccination programs. We also describe nonstandard depictions that highlight some counterintuitive implications of herd protection that we feel are not commonly understood in the applied policy literature. We illustrate the approach using economic and epidemiological data from two neighborhoods in Kolkata, India. We use recently published epidemiological data on the indirect effects of cholera vaccination in Matlab, Bangladesh (Ali et al., 2005) for fitting a simple mathematical model of how protection changes with vaccine coverage. We use new data on costs and private demand for cholera vaccines in Kolkata, India, and approximate the optimal Pigouvian subsidy. We find that if the optimal subsidy is unknown, selling vaccines at full marginal cost may, under some circumstances, be a preferable second-best option to providing them for free. (Contains 14 footnotes, 2 tables, and 8 figures.)

Considering the prevailing situations, the mathematical modeling and dynamics of novel coronavirus (2019-nCoV) particularly in India are studied in this paper. The goal of this work is to create an effective SEIRS model to study about the epidemic. Four different SEIRS models are considered and solved in this paper using an efficient homotopy perturbation method. A clear picture of disease spreading can be obtained from the solutions derived using this method. We parametrized the model by considering the number of infection cases from 1 April 2020 to 30 June 2020. Finally, numerical analysis and graphical representations are provided to interpret the spread of virus. [ABSTRACT FROM AUTHOR]

In this paper, the existing Susceptible-Infected-Recovered-Deceased (SIRD) compartmental epidemiologic process model is modified for forecasting the coronavirus effect in India. The data from India was studied for weekly fatalities, weekly infected, weekly recovered, new cases, infected and recovered individuals, Reproductive Number R0, recovery rate, death rate, and coefficient of transmission from 30 January 2020 to 31 July 2021. SARS Coronavirus 2 (SARS-CoV-2) is the Covid strain that causes Covid sickness (COVID-19), a respiratory ailment that triggered the outbreak of COVID-19 at the beginning of December 2019. We aim to provide a hybrid SIRD model for predicting the COVID-19 outbreak. In the proposed method, to improve the exploration ability of the Grey Wolf Optimizer (GWO) or to avoid stagnation in the swarm, a modified Grey Wolf Optimization Algorithm is used to optimize the initial value of Infected individuals. The modified SIRD model is further applied to get the predicted values. The data is examined on weekly basis to prevent noise. Depending on the fact, that the precise mode of transmission is highly dependent on how and when different precautions such as isolation, confinement, and other preventative measures were implemented, we put together our projections concerning satisfactory speculations based on genuine realities. The experimental results show the various trends observed in the pandemic in terms of number of peaks, increasing trend, decreasing trend, and continuous trend for infected individuals, weekly change in number of cases, weekly deaths, weekly infected, and weekly recoeverd cases of Covid-19. The proposed modified SIRD model could be a valuable tool for assessing the impact of government measures on COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumonia, have become a severe global problem with a significant threat to public health, but few studies have investigated the risk factors and epidemiology of carbapenem-resistant K. pneumonia (CRKP) infections in India. Methods: We performed a retrospective observational study of 224 participants with K. pneumoniae who were admitted to the medical intensive care unit (ICU) of Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India, between January 1 and December 30, 2020. Antibiotic susceptibility testing was done by automated broth microdilution VITEK® 2 (BioMerieux, Inc., Hazelwood, USA). The Clinical and Laboratory Standards Institute document M100-S22 (January 2020) was used to interpret antimicrobial susceptibility testing. Data were obtained from paper medical records. Results: Two hundred and twenty-four subjects with culture-positive for K. pneumonia were retrieved during the study period, out of which 108 had CRKP. The risk factors for univariate analysis were Acute Physiology and Chronic Health Evaluation II, ICU length of stay (LOS), invasive mechanical ventilator days, central venous catheter days, and arterial line days. The multivariate analysis showed invasive mechanical ventilation and ICU LOS were independent risk factors for CRKP infection. Mortality in the CRKP group was 48 (44%) compared to 27 (23%) in the carbapenem-sensitive K. pneumonia (CSKP) group, which was statistically significant (P < 0.01). Conclusion: Infection due to CRKP in the ICU was associated with 1.9 times higher mortality as compared to CSKP. Invasive mechanical ventilation and ICU LOS were found to be independent risk factors for CRKP infection. [ABSTRACT FROM AUTHOR]

Background and Aim: Burden of hepatitis C in India is not known. We therefore conducted a systematic review of the available data on anti‐hepatitis C virus (HCV) seroprevalence in the Indian population. Methods: We searched several publication databases for English language papers that reported data on anti‐HCV seroprevalence from India and also identified other unpublished sources of such data. Data on groups likely to represent seroprevalence in general population and in selected high‐risk groups were extracted and subjected to meta‐analysis. Results: Of the 3995 published papers and 94 additional data sources identified, 327 were selected; these provided 414 anti‐HCV seroprevalence data points. Pooled anti‐HCV seroprevalence rates in community‐based studies, blood donors, and pregnant women were 0.85% (95% confidence interval: 0.00–3.98%), 0.44% (0.40–0.49), and 0.88% (0.21–1.90), respectively. Among groups considered at high risk of HCV, pooled anti‐HCV seroprevalence rates were as follows: people living with HIV (40 studies from 17 states: 3.51% [2.43–4.76]), persons on maintenance hemodialysis (37, 13; 19.23% [13.52–25.65]), people who inject drugs (46, 14; 44.71% [37.50–52.03]), multi‐transfused persons (38, 12; 24.06% [20.00–28.36]), persons with sexually transmitted diseases (7, 5; 4.10% [0.98–9.04]), and those with high‐risk sex behavior (6, 5; 4.06% [1.79–7.10]). Conclusions: Community‐based data on HCV seroprevalence in India were limited. Large amount of data on blood donors and pregnant women were identified, with pooled anti‐HCV seroprevalence rates of 0.44% and 0.88%, respectively. Among high‐risk groups, anti‐HCV prevalence was higher among people living with HIV, those with sexually transmitted diseases, high‐risk sex behavior or injection drug use, and those receiving hemodialysis or frequent transfusions. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via a link at the top of the paper. [ABSTRACT FROM AUTHOR]

Research in mental health is a complex phenomenon that requires the use of more than one technique. It is extremely crucial to study and understand people's perceptions, beliefs, healing practices and coping strategies related to mental health. Stipulating only one between the medical/biomedical and medical anthropology perspectives may not be adequate to understand the dynamics of mental health research. The number of variables and components associated with the respondents and their social environments give diverse results. Research on mental health is very crucial and different from other kinds of health-related researches. Thus, while conducting mental health research, it is important that the researchers be careful in choosing and applying appropriate methodology. It is a very critical field of research, requiring Interdisciplinary research methodological approaches. An eclectic strategy is required to give an innate understanding of the phenomenon of mental health. Studies should follow both anthropological and epidemiological notions to understand human behaviour, for better management and planning of the mental health services. The proposed paper discusses 'cultural epidemiology' as a methodology and explores its contribution to the contemporary mental health research. [ABSTRACT FROM AUTHOR]

Purpose: This paper discusses the need for government and healthcare organization to implement mobile phone-based solutions for healthcare during the Coronavirus (Covid-19) pandemic. It also highlights the challenges and/or barriers to the rapid introduction, implementation and management of these and other innovative solutions to health service delivery during the current situation Design/methodology/approach: The data include both qualitative and quantitative, collected from the primary interview-based case study and questionnaire survey. It also uses insights from the general populations, healthcare professionals and health information technology developers to understand the role of a mobile health intervention in the COVID-19 pandemic outbreak. Findings: Healthcare professionals and health information technology developers are confident that the use of mobile health technology and applications has the ability to assist in monitoring and controlling the COVID-19 outbreak. The key advantages of using mobile phone technology are: increased awareness, improved assistance in tracking and testing casualties, improved assistance in seeking and scheduling health information and medical appointments, increased social distancing, improved overall productivity and quality of life. However, data demonstrated that lack of awareness and accessibility or unwillingness to use the technology, complex healthcare needs, application infrastructure, policies and a dearth of training and support are all barriers to successful implementation of this useful tool. Practical implications: This research has the potential to make a significant impact on government and healthcare policy through presenting a coherent argument for the importance of designing and deploying mobile health technology and applications for the general population. Originality/value: prior literature in this domain is inadequate in explaining the importance of mobile phone-based healthcare solutions for health service and during serious disease outbreaks and, in particular, within the Indian context. The findings of this study can be used by government and healthcare organizations to improve health governance during the current global pandemic. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents (RTAs) have emerged as a major public health concern due to the growing number of motorized vehicles all over the world. In India, the burden of road traffic accidents is increasing and from 1991 to 2011, the number of fatal deaths has more than doubled. Madurai district is among road accident-prone regions of the state of Tamil Nadu. Objective: This paper aims to examine and understand trends and patterns of RTAs in rural areas of Madurai District between 2014-2018. Methods: The researchers collected RTAs data from Madurai District Crime Records Bureau. we have considered time-series data from 2014 to 2018 and the number and percentage of deaths by the distribution of relevant factors such as timing, gender, road type, and vehicles to understand holistic patterns of RTAs. Results: Totally 9950 road accidents were reported by Madurai District Crime Records Bureau between 2014 and 2018 and on an average over 1990 accidents have occurred every year. Nearly 40 per cent fatal accidents occurred between 15-21 h. Men were the victims in 87 per cent of deaths and men died 6.8 times higher than females during 2014-2018. Over 57 per cent of fatalities have occurred in National Highways. The proportion of two-wheelers contributed to road deaths is 28 per cent and two-wheelers caused maximum road deaths than other vehicles. Conclusion: The study shows a decreasing trend in road accidents and fatalities in Madurai district. However, a significant number of men dying in road accidents highlights the difficulties of their families. [ABSTRACT FROM AUTHOR]

Chronic pain and psychiatric conditions often coexist with shared risk factors and a reverse causal link. Depression and anxiety comorbidities are associated with increased pain intensity, less favorable response to treatments, and higher medical costs. The management of psychiatric comorbidities in chronic pain conditions is less explored in India. This paper aims to review the current literature landscape of comorbid depressive and/or anxiety disorders with chronic pain conditions in the Indian populations and identify need gaps for future research. A literature search on MEDLINE database and other sources conducted from January 2010 through March 2020 retrieved 84 shortlisted eligible articles and their findings were synthesized into a narrative review. There was a high prevalence of comorbid depression and anxiety with chronic pain observed across multiple pain etiologies and population groups in the Indian setting. Women had a higher burden of psychiatric comorbidities in chronic pain conditions compared with men. Poor socioeconomic conditions and pain severity were important risk factors that predisposed individuals to psychological distress. There was limited data on evidence-based management of chronic pain and comorbid depression or anxiety for Indian populations. Barriers toward effective pain management in India occur at the level of patients, physicians, or healthcare systems; some of these challenges relate to patient's health-seeking behavior, stigma associated with psychiatric treatment, physician awareness, and education, and access to pain medications. Future initiatives are needed toward building an evidence base for effective management of pain and comorbid psychiatric conditions in India. [ABSTRACT FROM AUTHOR]

This paper describes the interrelationship among men's self-reports of symptoms, unsafe sexual behavior, and biologically tested sexually transmitted infections (STIs). Data are drawn from the baseline survey of six-year (2001-2007) research and intervention project on men's sexual health and HIV/STI risk reduction conducted in three urban poor communities in Mumbai, India. The survey collected a wide range of demographic, attitudinal, knowledge, and behavioral data. In addition, men were tested for common STIs by selecting a systematic random sub-sample of 816 men (assuming 20% non-response). Data in this paper are based on 641 men who had completed the survey interview and for whom the testing of blood and urine samples was conducted. Results suggest that the self-reported STI-like symptoms and unsafe sexual behavior taken together as a predictor of confirmed STIs improve the sensitivity to a significantly greater degree (χ 2=2.83, p<0.05) as compared to the sensitivity of self-reported STI-like symptoms or unsafe sexual behavior alone as a predictor of confirmed STIs. In addition, the consistency of self-report was found to vary among socio-demographic and behaviorally defined sub-groups. These results provide preliminary support for the importance of population-based surveys, which collect all the three types of data such as reported behavior, symptoms and laboratory confirmed STIs for a full understanding of sexual risk and STIs and for identification of sub-groups within communities that vary in their ability to identify STI symptoms. [ABSTRACT FROM AUTHOR]

COVID-19 is an extremely infectious disease with a relatively large virus incubation period in the affected people, who may or may not exhibit known symptoms. Therefore, to reduce the transmission of this pathogen, worldwide countries have taken several intervention measures. In this paper, we study the impact of these measures in India using mathematical models based on the available data until June 10, 2020. It is shown that an early lockdown in late March 2020 changed the initial exponential growth curve of COVID-19 to a linear one, but a surge in the number of cases from late April 2020 brought India to a quadratic growth trajectory. A regional analysis demonstrates that these interventions have a disparate impact on different states in India. It is further shown that the number of reported infections correlates with the number of tests, and therefore regions with limited diagnostics resources may not have a realistic estimate of the virus spread. This insufficiency of diagnostic test data is also reflected in an increasing positivity rate for India nearly 2.5 months after the lockdown, inconsistent with the trends observed for other geographical regions across the world. Nonetheless, future projections are made using different epidemiological models based on the available data and a comparative study is presented. In the absence of a reliable estimate of the true number of infections, these projections will have a limited accuracy; with that limitation, the most optimistic prediction suggests the virus transmission continuing through September 2020. [ABSTRACT FROM AUTHOR]

Homicide is a brutal crime where one person kills another, robs them of their life. Forensic pathologists must distinguish between suicide, murder and accidents using autopsy. Homicides can involve various methods, including assault, strangulation, drowning, burns and poisoning. The rising incidence of homicides prompts a study to identify vulnerable age groups, sex incidence, motives, injury patterns, crime locations and survival periods. The study was conducted from January to December 2023 on 103 cases from 4172 autopsies in the Department of Forensic Medicine & Toxicology at B. J. Medical College, Ahmedabad. In this study we included the cases with alleged homicide history and those later converted to homicide. Most of the cases were in the age group of 21 years to 30 years and least in the age group of 0 to 10 years. Injuries were most common (36.89%) between 6 pm and 12 midnight and least common (17.48%) between 12 noon and 6 pm. The majority of homicidal deaths involved hard and blunt weapons (39.80%), followed by sharp and penetrating weapons (31.06%). Argument was the most common reason for homicidal death in 42.72% of instances. Homicides occurred most common on the street in 38.83% of cases. The majority of victims died within 30 minutes to 24 hours (45.63%) of infliction of injuries. 42.72% of incidents involved an acquaintance as the assailant. [ABSTRACT FROM AUTHOR]

Background: India is a large and populous country where reliable data on headache disorders are relatively scarce. This study in northern India (Delhi and National Capital Territory Region [NCR], including surrounding districts in the States of Haryana, Uttar Pradesh and Rajasthan) continues the series of population-based studies within the Global Campaign against Headache and follows an earlier study, using the same protocol and questionnaire, in the southern State of Karnataka. Methods: This cross-sectional study used the Global Campaign's established methodology. Biologically unrelated Indian nationals aged 18–65 years were included through multistage random sampling in both urban and rural areas of NCR. Interviews at unannounced household visits followed the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire in its original English version or in the validated Hindi version. Demographic enquiry was followed by a neutral headache screening question and diagnostic questions based on the International Classification of Headache Disorders edition 3 (ICHD-3), which focused on each respondent's most bothersome headache. Questions about headache yesterday (HY) enabled estimation of 1-day prevalence. A diagnostic algorithm first identified participants reporting headache on ≥ 15 days/month (H15+), diagnosing probable medication-overuse headache (pMOH) in those also reporting acute medication use on ≥ 15 days/month, and "other H15+" in those not. To all others, the algorithm applied ICHD-3 criteria in the order definite migraine, definite tension-type headache (TTH), probable migraine, probable TTH. Definite and probable diagnoses were combined. Results: Adjusted for age, gender and habitation, 1-year prevalences were 26.3% for migraine, 34.1% for TTH, 3.0% for pMOH and 4.5% for other H15+. Female preponderance was seen in all headache types except TTH: migraine 35.7% vs. 15.1% (aOR = 3.3; p < 0.001); pMOH 4.3% vs. 0.7% (aOR = 5.1; p < 0.001); other H15 + 5.9% vs. 2.3% (aOR = 2.5; p = 0.08). One-day prevalence of (any) headache was 12.0%, based on reported HY. One-day prevalence predicted from 1-year prevalence and mean recalled headache frequency over 3 months was slightly lower (10.5%). Conclusions: The prevalences of migraine and TTH in Delhi and NCR substantially exceed global means. They closely match those in the Karnataka study: migraine 25.2%, TTH 35.1%. We argue that these estimates can reasonably be extrapolated to all India. [ABSTRACT FROM AUTHOR]

Of the 70 million persons with epilepsy (PWE) worldwide, nearly 12 million PWE are expected to reside in India; which contributes to nearly one-sixth of the global burden. This paper (first of the two part series) provides an in-depth understanding of the epidemiological aspects of epilepsy in India for developing effective public health prevention and control programs. The overall prevalence (3.0-11.9 per 1,000 population) and incidence (0.2-0.6 per 1,000 population per year) data from recent studies in India on general population are comparable to the rates of high-income countries (HICs) despite marked variations in population characteristics and study methodologies. There is a differential distribution of epilepsy among various sociodemographic and economic groups with higher rates reported for the male gender, rural population, and low socioeconomic status. A changing pattern in the age-specific occurrence of epilepsy with preponderance towards the older age group is noticed due to sociodemographic and epidemiological transition. Neuroinfections, neurocysticercosis (NCC), and neurotrauma along with birth injuries have emerged as major risk factors for secondary epilepsy. Despite its varied etiology (unknown and known), majority of the epilepsy are manageable in nature. This paper emphasizes the need for focused and targeted programs based on a life-course perspective and calls for a stronger public health approach based on equity for prevention, control, and management of epilepsy in India. [ABSTRACT FROM AUTHOR]

Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence. [ABSTRACT FROM AUTHOR]

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]

Background: Cardiovascular disease (CVD) is a group of conditions affecting the functioning of the heart or blood vessels and is one of the leading causes of death globally. Like other countries, CVD prevalence is also rising among the adults in Bangladesh. Epidemiological studies have shown not only a high CVD prevalence but also a significant increase in its prevalence in Bangladesh in the last few decades. To have a better understanding of the current CVD prevalence scenario, we conducted this systematic review and meta-analysis. Our objective was to assess the prevalence of CVD among the Bangladeshi adult population using evidence from the published scientific literature.Methods: Electronic databases such as MEDLINE, Embase and PubMed were searched. We also manually checked the references of all relevant publications that describe the prevalence of CVD in Bangladeshi adults. To pool the CVD prevalence, we used random-effects meta-analysis. We assessed heterogeneity using both the formal tests and the subgroup analyses. We also assessed study quality and examined publication bias.Results: We retrieved 755 potentially relevant papers through searches of electronic and gray literature, of which only 13 met inclusion criteria after the screening and were included in this review. Of the studies that met inclusion criteria, three were carried out in rural populations, five in both urban and rural populations and two in strictly urban populations. Male and female participation in the studies was almost equal. The weighted pooled prevalence of CVD was 5.0%, regardless of the types of CVD, gender and geographical location of the study participants. There was also a high heterogeneity in the observed CVD prevalence. Weighted pooled prevalence of overall CVD in the Bangladeshi population was higher in urban areas (8%) compared to rural areas (2%). However, no such difference was observed in terms of gender (3% for both males and females). The highest reported prevalence (21%) was for heart disease, while the lowest reported prevalence (1%) was for stroke. Sources of heterogeneity were often unexplained. The criteria used to assess study quality were fulfilled by only a few studies, and adequate sample size criteria was missed by almost all of them. In addition, there was evidence of small-study effects.Conclusion: A high CVD prevalence along with an upward trend was observed in Bangladeshi adults. Proper strategies are required for primary prevention of CVD so that a further increase can be alleviated and the morbidity and mortality associated with it can be reduced. [ABSTRACT FROM AUTHOR]

Background: Road traffic accident are by far the most common mode of death worldwide. With the increase in number of vehicles with economic development in India accompanied with congested roads, poor road infrastructure & general disregard for the safety measures result in high rate of vehicular accidents. Material & Method: Out of all cases coming to Autopsy of M.P. shah Medical college, Jamnagar, cases of Road Traffic Accidents were taken in study for the period of one year. Basic Information was obtained from police papers, inquiry accompanying police personnel & relatives. Detailed routine post-mortem examination was conducted. The data so collected was than analysed and compared with previous similar studies. Results: In superficial injuries, Abrasions were mostly found on Limbs, contusions mostly found on Head & Face. Most of the cases skeletal Injuries were seen on skull Bones with Face Bones & Mandible. Injury to chest region is more common in patients with three or four-wheeler accidents. Head injury is the leading cause of death in vehicular accidents. Conclusion: Many deaths in injury due to vehicular accidents can be prevented from increasing the awareness to the road-safety measures like Wearing Helmet while riding the two-wheelers, not over-loading the vehicles & wearing the seat-belts. [ABSTRACT FROM AUTHOR]

Spatial epidemiology can play a vital role in the health care systems especially in a developing country like India. Application of data analytics is one such field which is gaining momentum in the field of health care. This paper proposes one way to meet the growing need for better and efficient health care systems in the rural regions. We report the work on spatial epidemiology and Bayesian analytics for identifying diseases and its determinants among school children in a rural area of Andhra Pradesh, South India. Bayesian models have become a standard approach to disease mapping and decision making process. Data analytics models such as these, not only speed up the process of diagnosis but also reduce human error. Analytics can be used to identify important correlations between diseases and their causes as well as coexistence of two or more diseases based on specific geographic variations. These predefined correlations can greatly help healthcare in rural India where lack of doctors and medical equipment are the major constraints. The predefined correlations between diseases and demographic factors help the government to take better and informed decisions while introducing new schemes. [ABSTRACT FROM AUTHOR]

A growing number of studies have linked the incidence of leptospirosis with the occurrence of flood events. Nevertheless, the interaction between flood and leptospirosis has not been extensively studied to understand the influence of flood attributes in inducing new cases. This study reviews leptospirosis cases in relation to multiple flood occurrences in Kerala, India. Leptospirosis data were obtained for three years: 2017 (non-flood year) and two years with flooding—2018 (heavy flooding) and 2019 (moderate flooding). We considered the severity of flood events using the discharge, duration and extent of each flooding event and compared them with the leptospirosis cases. The distribution of cases regarding flood discharge and duration was assessed through descriptive and spatiotemporal analyses, respectively. Furthermore, cluster analyses and spatial regression were completed to ascertain the relationship between flood extent and the postflood cases. This study found that postflood cases of leptospirosis can be associated with flood events in space and time. The total cases in both 2018 and 2019 increased in the post-flood phase, with the increase in 2018 being more evident. Unlike the 2019 flood, the flood of 2018 is a significant spatial indicator for postflood cases. Our study shows that flooding leads to an increase in leptospirosis cases, and there is stronger evidence for increased leptospirosis cases after a heavy flood event than after a moderate flooding event. Flood duration may be the most important factor in determining the increase in leptospirosis infections. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the prevalence and attributable burden of headache disorders in India is sparse, with only two recent population-based studies from South and East India. These produced conflicting results. A study in North India is needed. We report the methodology of such a study using, and validating, a Hindi translation of the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire developed by Lifting The Burden (LTB). Almost half of the Indian population speak Hindi or one of its dialects. Methods: The study adopted LTB's standardized protocol for population-based studies in a cross-sectional survey using multistage random sampling conducted in urban Delhi and a surrounding rural area. Trained interviewers visited households unannounced, randomly selected one adult member from each and applied the Hindi version of HARDSHIP in face-to-face interviews. The most bothersome headache reported by participants was classified algorithmically into headache on ≥ 15 days/month (H15 +), migraine (including definite and probable) or tension-type headache (including definite and probable). These diagnoses were mutually exclusive. All participants diagnosed with H15 + and a 10% subsample of all others were additionally assessed by headache specialists and classified as above. We estimated the sensitivity and specificity of HARDSHIP diagnoses by comparison with the specialists' diagnoses. Results: From 3,040 eligible households, 2,066 participants were interviewed. The participating proportions were 98.3% in rural areas but 52.9% in urban Delhi. In the validation subsample of 291 participants (149 rural, 142 urban), 61 did not report any headache (seven of those assessed by HARDSHIP, eight by headache specialists and 46 by both) [kappa = 0.83; 95% CI: 0.74-0.91]. In the remaining 230 participants who reported headache in the preceding year, sensitivity, specificity and kappa with (95% CI) were 0.73 (0.65-0.79), 0.80 (0.67-0.90) and 0.43 (0.34-0.58) for migraine; 0.71 (0.56-0.83), 0.80 (0.730.85) and 0.43 (0.37-0.62) for TTH and 0.75 (0.47-0.94), 0.93 (0.89-0.96) and 0.46 (0.34-0.58) for H15 + respectively. Conclusion: This study validates the Hindi version of HARDSHIP, finding its performance similar to those of other versions. It can be used to conduct population surveys in other Hindi-speaking regions of India. [ABSTRACT FROM AUTHOR]

Background: The lack of focus on the health status of shrimp cultivators by previous studies while the production of shrimp has been rising over the years after the introduction of the blue revolution in India. The present study estimated the burden of diseases among shrimp cultivators in India. Methods: Primary data were collected by using simple random sampling. The sample size was 357. The classification of diseases were made by using the international classification of diseases, tenth revision (ICD-10), version 2019. Disability-adjusted life years (DALY) were used to measure the health status of shrimp cultivators. DALY is the summation of the burden of disease from mortality and morbidity. Sensitive and uncertainty analysis was used by changing the value of the parameter and method, respectively. Results: The burden of disease among shrimp cultivators in 2020 ranges from 101.03 DALY based on equal age weightage, without discount rate, and potential life expectancy (DALY0,0,PLE) to 84.02 DALY based on unequal age weightage, discount rate, and standardized life expectancy (DALY1,0.03,SLE). The burden of disease per 100,000 shrimp cultivators was 28,477.74 DALY and 23,600.84 DALY when calculated by using DALY0,0,PLE and DALY1,0.03,SLE method, respectively. The higher burden of diseases from non-communicable diseases was followed by injury and communicable diseases for both methods. The disease burden from mortality was more than two-thirds of the total burden of disease and the rest from morbidity. The burden of disease among shrimp cultivators was sensitive to parameter changes because it changes between 92.10 DALY and 63.03 DALY with the change in the parameter. Uncertainty in the burden of disease among them was due to method variation, which ranges from 120.03 DALY to 74.06 DALY. Conclusion: The higher burden of non-communicable diseases, and the lower burden of communicable, and injuries per 100,000 shrimp cultivators compared to the national level in India. [ABSTRACT FROM AUTHOR]

Background Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention. Methods The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using respondent-driven sampling. Multiple logistic regression was used to assess the association of programme exposure with consistent condom use and whether this association varied over time. Results The proportion of FSWs having no exposure or only receptive exposure to the intervention decreased over time, while active utilisation increased from 19.4% in 2006 to 48.5% in 2009-2010. Consistent condom use with clients also increased from 56.3% in 2006 to 75.3% in 2009-2010. Multivariate analysis showed that age, age at start of sex work, venue, living conditions and programme exposure were significantly associated with condom use. The positive association between programme exposure and consistent condom use did not vary significantly over time. Conclusions Findings indicate improvements in HIV risk reduction behaviour among FSWs and suggest that the intervention has substantial reach in the FSW population. The intervention's strategies may be contributing to population-level HIV risk reduction among FSWs. [ABSTRACT FROM AUTHOR]

Objective: There is increasing evidence to suggest that the epidemiologic transition is well underway in India and other less industrialized countries. Hence there is a need to review the status of our understanding of the impending epidemic of non-communicable chronic diseases (NCD) in India, given their chronic nature and their impact on society. Materials and Methods: In this paper, attempt has been made to study the extent to which the risk factors contribute to chronic diseases. Specifically, inside the chronic disease afflicted group, one could be interested to quantify the extent of influence of each of the risk factors and behaviors. Data set used here is a primary one collected through a household survey. Baye's method has been used to calculate the posterior probabilities. Results: Given a person suffers from a chronic disease; the probabilities of him/her belonging to a particular group are calculated. Conclusion: Such an exercise can help in focusing attention to the risk factors. [ABSTRACT FROM AUTHOR]

Context: With rotavirus vaccines now available globally, it will be useful to assemble the available evidence on the epidemiology and burden of rotavirus gastroenteritis in India, in order to weigh the urgency of introducing a vaccine to help control rotavirus disease. Evidence Acquisition: We reviewed published studies on rotavirus infection and genotype distribution in India, as well as safety and immunogenicity studies of currently available vaccines. PubMed was searched for papers published after 1990, and several authors who are experts in the field recommended papers of known significance. Results: Rotavirus accounts for close to 40% of hospitalizations for diarrhea in India, with more recent studies showing an increased proportion compared with older studies. There is substantial serotype diversity in India, although there is less intra-country variation than previously thought. Two genotypes, G1P[8] and G2P[4], account for roughly 50% of symptomatic infections in non-neonates. Currently licensed vaccines are safe, and although the efficacy appears lower in developing countries, given the extremely high incidence of diarrhea these could still be cost-effective interventions. Conclusions: The epidemiology and burden of rotavirus diarrhea is fairly well characterized in India. Introducing rotavirus vaccine into the UIP, along with adequate surveillance, should be an important part of efforts to reduce diarrhea mortality, the third leading cause of death among Indian children, and achieve the country's MDG goals. [ABSTRACT FROM AUTHOR]

This paper explores the ways in which women's sterilisation decisions are influenced by the combination of a preference for male children and a desire for smaller family size among young married women in two urban slums in Bengaluru, India. While both son preference and an emphasis on sterilisation are well-known demographic characteristics of most South Asian countries, relatively little research has been conducted that links the two. We take advantage of a longitudinal survey of 416 unsterilised married women aged 16-25 to explore how having sons and the number of children influence a woman's sterilisation decision. Discrete-time event history techniques are used to estimate two models: the first examines the effect of having sons and number of children separately, and the second examines them in combination in the form of an interaction. The results suggest sterilisation is motivated by son preference mainly at lower parities (three or fewer children) and by concerns about family size at higher parities. Understanding how sterilisation and other reproductive behaviours are influenced by the interaction of family size and sex preferences will help policy-makers and programmers to meet the needs of women while continuing to address discriminatory behaviour against females. [ABSTRACT FROM AUTHOR]

im: To report the prevalence and causes of suicide in Kerala, which is a well-developed Indian state in terms of better demographic and health indicators. Subject and methods: This paper is based on the data accessed from the annual statistical report of the National Crime Records Bureau. Data pertaining to suicides that occurred in Kerala in 2007 were analyzed. Results: Despite Kerala’s good standard of living with comparatively low birth and death rates, the state reports a high rate of suicides with 26.3 per 100,000 population, compared to the national rate of only 10.8 (in 2007). Family problems are cited as the major cause of suicide, followed by ill health and economic reasons. In Kerala state, men outnumber women (74% vs. 26%). While the majority of the male victims were self-employed, most of the female victims were home makers. More than 80% of the victims were in the age group between 15 and 59 years. Conclusions: The problem of suicide is discussed in the context of Kerala’s better demographic and health status compared to other Indian states. This problem has to be analyzed within the frame of reference of the broad and extensive socioeconomic status information concerning the victims and their settings. It is not adequate to intervene to change an individual’s suicidal behavior when the issue is related to the problems of the society as a whole. [ABSTRACT FROM AUTHOR]

This paper examines technical practices, such as epidemiological modeling, used to produce HIVprevalence estimates within India's national policy establishment. These technical practices are a useful site within which to investigate the shifting politics between India's national government and international agencies such as the World Bank and UNAIDS. The paper argues that international actors, and the technical practices they purvey, carry a 'foreknowledge' about the epidemic. This foreknowledge provides a pre-existing template of an AIDS epidemic; it helps the government imagine what an AIDS epidemic looks like, anticipate patterns of risk, and plan public health interventions. However, pre-packaged foreknowledge leaves relatively little room for surprises, and sits alongside a selective silencing of local experiences and public health history. [ABSTRACT FROM AUTHOR]

Due to the availability of a huge amount of epidemiological and public health data that require analysis and interpretation by using appropriate mathematical tools to support the existing method to control the mosquito and mosquito-borne diseases in a more effective way, data-mining tools are used to make sense from the chaos. Using data-mining tools, one can develop predictive models, patterns, association rules, and clusters of diseases, which can help the decision-makers in controlling the diseases. This paper mainly focuses on the applications of data-mining tools that have been used for the first time to prioritize the malaria endemic regions in Manipur state by using Self Organizing Maps (SOM). The SOM results (in two-dimensional images called Kohonen maps) clearly show the visual classification of malaria endemic zones into high, medium and low in the different districts of Manipur, and will be discussed in the paper. [ABSTRACT FROM AUTHOR]

Background: Even though cholera has existed for centuries and many parts of the country have sporadic, endemic and epidemic cholera, it is still an under-recognized health problem in India. A Cholera Expert Group in the country was established to gather evidence and to prepare a road map for control of cholera in India. This paper identifies cholera burden hotspots and factors associated with an increased risk of the disease. Methodology/Principle findings: We acquired district level data on cholera case reports of 2010–2015 from the Integrated Disease Surveillance Program. Socioeconomic characteristics and coverage of water and sanitation was obtained from the 2011 census. Spatial analysis was performed to identify cholera hotspots, and a zero-inflated Poisson regression was employed to identify the factors associated with cholera and predicted case count in the district. 27,615 cholera cases were reported during the 6-year period. Twenty-four of 36 states of India reported cholera during these years, and 13 states were classified as endemic. Of 641 districts, 78 districts in 15 states were identified as “hotspots” based on the reported cases. On the other hand, 111 districts in nine states were identified as “hotspots” from model-based predicted number of cases. The risk for cholera in a district was negatively associated with the coverage of literate persons, households using treated water source and owning mobile telephone, and positively associated with the coverage of poor sanitation and drainage conditions and urbanization level in the district. Conclusions/Significance: The study reaffirms that cholera continues to occur throughout a large part of India and identifies the burden hotspots and risk factors. Policymakers may use the findings of the article to develop a roadmap for prevention and control of cholera in India. [ABSTRACT FROM AUTHOR]

The present paper attempts to explore the socio-demographic profile of patients with rhinosporidiosis in an endemic area. A cross-sectional study was carried out in a tertiary-care hospital in Purulia district, India, including consecutive patients with histologically-proved rhinosporidiosis. Their socio-demographic profiles were obtained through a pre-designed proforma with given epidemiologic parameters. Data was statistically analyzed with inputs from literature review. Of the 39 patients included, 87 % were fresh/new cases. The age-group of 10-20 years was mostly involved, with multiple peaks around 50. About 82 % were from rural background, commonly involved in cattle farming and agriculture, with a universal habit of pond-bathing. There was a male preponderance; however women were being increasingly affected. Nasal cavity was the predominant site involved; nasal obstruction and epistaxis were the primary complaints. About 13 % had recurrent lesions that were statistically related to higher age-group (≥15 years) and occupation (agriculture, labor). Rhinosporidiosis is predominantly the disease of young rural adults engaged in field activities and habituated to pond-bathing. A bimodal age distribution was noticed. The present article provides an update on the socio-demographic perspectives of rhinosporidiosis in an endemic zone. It also summarizes the factors that would identify the vulnerable population and help formulate preventive measures. [ABSTRACT FROM AUTHOR]

Context: A number of local dialects and languages exist in India, which leads to a single disease being addressed by a number of names which may overlap with other disease names also. This creates misunderstanding and is a hindrance to effective patient–doctor communication. Aims: The paper aims to find out how effectively the name of the respiratory disease is communicated to the patient. The terminology used by patients to describe their disease was also noted at limited level. Settings and Design: The study was conducted in the form of parallel cross-sectional surveys, among pulmonologists and patients. Methods: Among the members of the Indian Chest Society and those attending the National Conference on Pulmonary Diseases (NAPCON-2015), 1028 pulmonologists participated in the online survey which was the first part of the study. The term used to address the common respiratory disease was inquired in the survey. To find the response of patients, a questionnaire was given to the patients attending four respiratory disease clinics of a city. They were inquired about the name of respiratory disease they were suffering from. Results: Pneumonia was the disease which was communicated with exact terminology by 898 (87.4%) doctors to their patients. In contrast, idiopathic pulmonary fibrosis was communicated with precise terminology by only 171 (16.6%) doctors. Pulmonary tuberculosis was exactly told by 708 (69%), asthma by 731 (71.1%), and chronic obstructive pulmonary disease by 593 (57.7%) doctors. However, only 17.6% of the 1122 patients participating in the survey had a knowledge of the name of disease they were suffering from. Conclusions: The exact terminology of the common respiratory diseases is not effectively used by many doctors and most of the patients. The study identifies an important gap in patient–doctor communication, and therefore, highlights the need of effective patient education. [ABSTRACT FROM AUTHOR]

This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011. We used a modified version of the Spectrum tool that included an Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, gender-ratio at birth, age and gender-specific pattern of mortality, and volume and age-gender distribution of net migration were derived from census records, the Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced by 8% between 2007 and 2011. While children accounted for approximately 6.3% of total HIV infections in 2007, this proportion increased to about 7% in 2011. With changing priorities and epidemic patterns, the programme has to customise its strategies to effectively address the emerging vulnerabilities and adapt them to suit the requirements of different geographical regions. [ABSTRACT FROM AUTHOR]

An oral leukoplakia register was established among 50,000 villagers in five districts of India in 1967-68. The paper describes the results after a 5-year follow-up study among 30,000 subjects from three of the districts with regard to spontaneous regression of leukoplakias. The follow-up rate for the three districts varied from 66.6 % to 794 %. The corresponding rates for individuals with leukoplakias varied from 67.6 % to 759 %. The regression, comprising a total or partial disappearance, varied from 26.1 % to 437 % in the three districts. The upper labial mucosa, the left commissure and left buccal mucosa were the sites of maximum regression. In Ernakulam, leukoplakias appeared to regress more often among chewers than among smokers. Although 23.2 % of the patients with regressed leukoplakias had changed their chewing or smoking habits, none had stopped either chewing or smoking. [ABSTRACT FROM AUTHOR]

Background: Tobacco is a public health concern at global and national levels. The state of Gujarat has 28.6% prevalence of tobacco use, 22% in males and 8% in females. Rajkot, the fourth largest and fastest growing city in Gujarat, is not free from the burden of tobacco use. Aim: The aim of this study was to assess the patterns of tobacco use and utilization of tobacco cessation services in the city of Rajkot. Methodology: This was a cross-sectional observational study conducted on adult tobacco users attending rural and urban primary healthcare centers (PHCs) in Rajkot. At least 16 participants were recruited from all 75 PHCs (a total of 1152) using probability sampling. Study instruments comprised semi-structured proforma, Fagerstrom Test for Nicotine Dependence, and readiness to change questionnaire. Responses were analyzed using SPSS version 26.0. Results: A total of 1161 participants were included. Smokeless tobacco (n = 967, 83.3%) was preferred over smoking. Mava was the most common smokeless tobacco preparation consumed. The median age of onset was 28 years (interquartile range [IQR]: 22-37), and the median duration of use was 5 years (IQR: 4-10). Males had a significantly greater duration of abstinence (U = 1218.6, P = 0.002), greater readiness to quit (χ² [df] = 35.66 [8], P = 0.001), and anticipated success (χ² [df] = 28.71 [8], P = 0.004) in abstaining. While utilization of tobacco cessation services was poor overall, counseling (32.5%) and nicotine replacement therapy (19%) were the most commonly used. Conclusion: There is a need for in-depth research on tobacco use among smaller communities, upscaling harm reduction services for tobacco use. Prevention and IEC initiatives need to be revamped considering the special needs of female tobacco users. [ABSTRACT FROM AUTHOR]

Background: A staggering 85% of the global population resides in low- and middle-income countries (LAMICs). India stands as an exemplary pioneer in the realm of mental health initiatives among LAMICs, having launched its National Mental Health Program in 1982. It is imperative to effectively evaluate mental health systems periodically to cultivate a dynamic learning model sustained through continuous feedback from mental healthcare structures and processes. Materials and Methods: The National Mental Health Survey (NMHS) embarked on the Mental Health Systems Assessment (MHSA) in 12 representative Indian states, following a pilot program that contextually adapted the World Health Organization's Assessment Instrument for Mental Health Systems. The methodology involved data collection from various sources and interviews with key stakeholders, yielding a set of 15 quantitative, 5 morbidity, and 10 qualitative indicators, which were employed to encapsulate the functional status of mental health systems within the surveyed states by using a scorecard framework. Results: The NMHS MHSA for the year 2015--16 unveiled an array of indices, and the resultant scorecard succinctly encapsulated the outcomes of the systems' evaluation across the 12 surveyed states in India. Significantly, the findings revealed considerable interstate disparities, with some states such as Gujarat and Kerala emerging as frontrunners in the evaluation among the surveyed states. Nevertheless, notable gaps were identified in several domains within the assessed mental health systems. Conclusion: MHSA, as conducted within the framework of NMHS, emerges as a dependable, valid, and holistic mechanism for documenting mental health systems in India. However, this process necessitates periodic iterations to serve as critical indicators guiding the national mental health agenda, including policies, programs, and their impact evaluation. [ABSTRACT FROM AUTHOR]

Background: As Bangladesh, India and Nepal progress towards visceral leishmaniasis (VL) elimination, it is important to understand the role of asymptomatic Leishmania infection (ALI), VL treatment relapse and post kala-azar dermal leishmaniasis (PKDL) in transmission. Methodology/ Principal Finding: We reviewed evidence systematically on ALI, relapse and PKDL. We searched multiple databases to include studies on burden, risk factors, biomarkers, natural history, and infectiveness of ALI, PKDL and relapse. After screening 292 papers, 98 were included covering the years 1942 through 2016. ALI, PKDL and relapse studies lacked a reference standard and appropriate biomarker. The prevalence of ALI was 4–17-fold that of VL. The risk of ALI was higher in VL case contacts. Most infections remained asymptomatic or resolved spontaneously. The proportion of ALI that progressed to VL disease within a year was 1.5–23%, and was higher amongst those with high antibody titres. The natural history of PKDL showed variability; 3.8–28.6% had no past history of VL treatment. The infectiveness of PKDL was 32–53%. The risk of VL relapse was higher with HIV co-infection. Modelling studies predicted a range of scenarios. One model predicted VL elimination was unlikely in the long term with early diagnosis. Another model estimated that ALI contributed to 82% of the overall transmission, VL to 10% and PKDL to 8%. Another model predicted that VL cases were the main driver for transmission. Different models predicted VL elimination if the sandfly density was reduced by 67% by killing the sandfly or by 79% by reducing their breeding sites, or with 4–6y of optimal IRS or 10y of sub-optimal IRS and only in low endemic setting. Conclusion/ Significance: There is a need for xenodiagnostic and longitudinal studies to understand the potential of ALI and PKDL as reservoirs of infection. [ABSTRACT FROM AUTHOR]

Background. There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middleincome countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites. Method. In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants. Results. Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan. Conclusion. Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings. [ABSTRACT FROM AUTHOR]

Considering the high burden of injuries, the Health Authority - Abu Dhabi developed a draft electronic and paper-based injury and poisoning notification system (IPNS) to generate better data on the nature and severity of injuries. The pilot testing and evaluation of IPNS was conducted with the specific objectives to (1) identify the characteristics of injury cases, (2) explore potential risk factors, (3) illustrate the nature and type of data, and (4) the working mechanism of data collection. Data were collected from selected hospitals on patient demographics, injury information and clinical assessment. Descriptive, bivariate and multivariate analyses were conducted. Of 4226 injury cases, nearly three-fourths were male, majority were non-UAE nationals, and the mean age was 21.9. Multivariate findings suggested that compared to UAE nationals, non-UAE nationals were 27% more likely to experience fatal, severe or moderate injuries (p= 0.01). Individuals with health insurance were 31% less likely to suffer a fatal, severe or moderate injury compared to those having no health insurance (p< 0.001). This is the first systematically standardised collection of injury data across three facilities in Abu Dhabi, and provides initial information on characteristics and injury risk factors that will help identify the need for evidence-based intervention for injury prevention and control. [ABSTRACT FROM PUBLISHER]

Background:The occurrence of juvenile nasopharyngeal angiofibroma is reportedly higher in India than in some other parts of the world, and our centre has seen a four-fold increase in its occurrence across seven decades.Methods:This paper reports a retrospective archival analysis of 701 juvenile nasopharyngeal angiofibroma cases from 1958 to 2013, and considers probable environmental factors in an Indian context that may affect its biology and the global distribution, as reported in the literature.Results:A continuously progressive increase in occurrence was evident, but the rapid rise observed in the current decade was alarming. The world map of juvenile nasopharyngeal angiofibroma incidence does not reflect true global distribution given the paucity of reporting. Our centre has dealt with approximately 400 cases in the last 24 years.Conclusion:With the alarming increase in juvenile nasopharyngeal angiofibroma incidence, there is a need for a registry to define its epidemiology. The world literature needs to reflect the status of juvenile nasopharyngeal angiofibroma incidence in the third world as well. Environmental factors known for hormone disruptive actions may influence its occurrence. Such aspects need to be considered to plan specific prevention policies. [ABSTRACT FROM PUBLISHER]

Sexually transmitted diseases (STD) consist of different group of endemic diseases of varying clinical presentation, characterized epidemiologically as sexually transmitted infections. Sexually transmitted diseases in individuals have far reaching health, social and economic consequences. Sexually transmitted infections are very important because of their potential complication and interaction with HIV/AIDS. Recognition of HIV/STI cases has tremendous contribution for targeted intervention in the hospital. By evaluating the HIV/STI cases it will be a signal to know the affected groups and major determinants. In this Paper, the study was conducted to evaluate the clinical, epidemiological and laboratory characteristics of the sexually transmitted diseases (STD) found in the government general Hospital, Nizamabad in the year 2013. [ABSTRACT FROM AUTHOR]