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BACKGROUND: Screening of hemoglobin (Hb) before blood donation is one among the vital tests. It is performed to select a blood donor to prevent the collection of blood from an anemic person. However, no accurate, cost-effective, reliable, and standardized method is available to estimate Hb. OBJECTIVE: The aim is to evaluate the efficacy of filter paper cyanmethemoglobin (FPCH) method with the automated hematology analyzer in the estimation of Hb concentration for screening of a suitable donor. METHODOLOGY: This was a cross-sectional study in which the blood samples of 2000 patients visiting KLE's Dr. Prabhakar Kore Charitable Hospital, Belagavi, were collected in vials and directly estimated for Hb using automated hematology analyzer. To evaluate the efficacy of FPCH, 20 μL of blood sample was transferred onto Whatman filter paper and dried at room temperature. After drying, it was placed in 5 mL of Drabkin's solution for 30 min. Optical density was estimated by measuring the absorbance. Data were analyzed using SPSS version 20. The correlation coefficient, paired t-test, and difference between the means of both the methods were calculated. RESULTS: The mean Hb estimated by FPCH was 11.25 g/dL and automated hematology analyzer gave 11.35 g/dL. The difference in the means of both the methods was 0.1 g/dL. Paired t-test was done to test the level of significance and the result was 8.151 (95% confidence interval: 0.08–0.13 g/dL, P < 0.001). The correlation coefficient was found to be 0.976 (P < 0.001). CONCLUSION: FPCH is an efficient method, which is comparable to the automated hematology analyzers for Hb estimation. It could be used as an alternative screening tool for detection of Hb in a blood donation camp. [ABSTRACT FROM AUTHOR]

Background: Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. Data and Methods: The study uses data from the fifth round of the National Family Health Survey conducted in 2019–2021 and analyzed 26,552 (15–49 aged) currently married women who had a live birth in the last 5 years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Results: Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. Conclusion: There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality. Significance: What is already known about this subject? Existing literature in India mostly highlights a clear connection between women's autonomy and maternal healthcare services utilization. Women with higher autonomy, decision-making power, and mobility are more likely to use these services. However, in exploring the link between women's empowerment and maternal healthcare, some studies focus on education, employment, and media access among Indian mothers, sidelining broader empowerment dimensions. What this study adds? This study is likely the first to investigate the relationship between women's empowerment and the level of maternal healthcare service utilization in India. It covers key dimensions of women's empowerment, including Attitude to Violence, Social Independence, and Decision-making Power. Moreover, it is possibly the first Indian research paper to employ a survey-based women's empowerment index in this context. Notably, the assessment highlights Social Independence as a significant dimension. [ABSTRACT FROM AUTHOR]

The Indian economy and food grain production are intricately tied to the spatial distribution and the amount of rainfall during the summer monsoon period (June to September). Numerous studies have delved into modeling methods for forecasting Indian summer monsoon rainfall. This paper utilizes monthly rainfall data spanning 72 years (1950–2021) to analyze, model, and predict the monsoon over Northwest India using Dynamic Linear Modeling (DLM). In view of this, the well-accepted dynamic linear model with significant components is selected from the parsimonious models of DLM based on Bayesian Information Criteria (BIC), significant tests, and statistical fit. The dynamic linear model comprises a significant linear time trend component, a deterministic trigonometric seasonal component, a deterministic cycle component, and a stochastic irregular component has been selected. The validation of the selected model passed through the normal and correlation diagnostics of model residuals. The analysis reveals a subtle decreasing trend in monsoon rainfall, showcasing consistent behaviour in deterministic seasonality, and highlighting the deterministic nature of cyclical component with a period of approximately 2.5 years, alongside irregular variations. Utilizing this model, future monsoon rainfall over Northwest India has been forecasted for the years 2022–2027, providing a 95% confidence interval. [ABSTRACT FROM AUTHOR]

Background The implementation of comprehensive smoke-free laws has been associated with reductions in second-hand smoke exposure at home in several high income countries. There is little information on whether these benefits extend to low income and middle income countries with a growing tobacco-related disease burden such as India. Methods State and individual-level analysis of cross-sectional data from the Global Adult Tobacco Survey India, 2009/2010. Associations between working in a smoke-free indoor environment and living in a smoke-free home were examined using correlation at the state level, and multivariate logistic regression at the individual level. Results The percentage of respondents employed indoors (outside the home) working in smoke-free environments who lived in a smoke-free home was 64.0% compared with 41.7% of those who worked where smoking occurred. Indian states with higher proportions of smoke-free workplaces had higher proportions of smoke-free homes (rs=0.54, p<0.005). In the individual-level analysis, working in a smoke-free workplace was associated with a significantly higher likelihood of living in a smoke-free home (adjusted OR=2.07; 95% CI 1.64 to 2.52) after adjustment for potential confounders. Conclusions Implementation of smoke-free legislation in India was associated with a higher proportion of adults reporting a smoke-free home. These findings further strengthen the case for accelerated implementation of Article 8 of the Framework Convention on Tobacco Control (FCTC) in low and middle income countries. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM), a significant public health problem across the nations, is among the top ten leading causes of death. More than 370 million indigenous people (referred to as tribal people in India) are spread across 90 countries. India has the largest tribal people of 104 million. Tribal populations are not exceptional to the threat of type 2 DM (T2DM) and other non-communicable diseases, and hence, public health programmes are addressing this problem. This paper reports the systematic review and meta-analysis of the literature on the prevalence of T2DM. We conducted a systematic review and meta-analysis of the literature to understand the prevalence of T2DM among the tribal populations of India, following the guidelines of the PRISMA Statement for Reporting Systematic Reviews and Meta-Analysis. The gender-wise prevalence was recalculated by extracting the data wherever possible. Forest plots were depicted based on the prevalence, and other analyses were performed. On initial searches from three databases, 5422 citations were identified, and ultimately 27 studies were included in the review. These studies were undertaken amongst different tribes in different parts of India. The pooled prevalence of T2DM among men, women and combined were 6.04% (95% confidence interval (CI): 5.55% to 6.57%), 6.48% (95% CI: 6.01% to 6.99%) and 4.94% (95% CI: 4.72% to 5.17%), respectively. Considerable heterogeneity was found among these studies. This systematic review provides an overview of the prevalence of T2DM among the Indian tribal population. The pooled overall prevalence is slightly lower than the general population. This situation is worrisome as the epidemic of T2DM will affect the poor tribal communities, who can least afford to bear the health care costs. Hence, the public health care services must be strengthened in all tribal areas. This review further warrants establishing surveillance of T2DM in tribal areas. [ABSTRACT FROM AUTHOR]

Background: Selective publication of studies has important scientific, ethical, and public health implications. Aim: We studied selective publication among mood disorder research protocols registered in the Clinical Trials Registry of India (CTRI) database. We also examined the frequency and nature of protocol deviations among the published articles. Methods: Using a systematic search strategy, we examined the publication status of all mood disorder-related research protocols registered in the CTRI database from inception till December 31, 2019. Logistic regression analysis was used to identify variables associated with selective publication. Results: Of 129 eligible protocols identified, only a third (n = 43, 33.3%) were published in literature; among those published, only 28 (21.7%) were placed in MEDLINE indexed journals. Protocol deviations were observed in more than half of the published papers (n = 25, 58.1%); many of these (41.9%) were related to sample size deviations, though, importantly, deviations in primary and secondary outcomes were also noted (16.2%). Retrospective registration of trials (odds ratio, 2.98, 95% confidence interval, 1.32--6.71) was significantly associated with publication; other variables, such as funding status or multicentric sampling, were not associated with eventual publication. Conclusions: Two out of three mood disorder research protocols registered in India do not translate into published research. These findings from a low- and middle-income country with limited spending on health care research and development represent wastage of resources and raise scientific and ethical concerns about unpublished data and futile patient participation in research. [ABSTRACT FROM AUTHOR]

Background: Utilisation of continuum of maternal health care services is crucial for a healthy pregnancy and childbirth and plays an important role in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) related to maternal and child health. This paper aims to assess the percentage of dropouts across various stages of utilization of continuum of maternal health services (CMHS) in India and also investigates the factors hindering the utilization of these services.Methods: We used recent data from National Family Health Survey(NFHS) encompassing a total sample of 1,70,937 pregnant women for the period 2015-16. The percentage of women dropping out while seeking maternal health care is measured using descriptive statistics. While, the factors impeding the utilization of maternal health services is estimated using a Multinomial Logistic Regression Model, where dependent variable (CMHS) is defined as complete care, incomplete care and no care.Results: Only17% of pregnant women availed the utilisation of complete care and 83% either did not seek any care or dropped after seeking one or two services. For instance, it is found that 79% of women who registered for antenatal care services (ANC) did not avail the same adequately. An empirical investigation of determinants of inadequate utilization of CMHS revealed that factors like individual characteristics, for instance- access to media (RRR: 2.06) and mother's education play (RRR: 3.61) a vital role in the uptake of CMHS. It is also found that the interaction between wealth index and place of residence plays a pivotal role in seeking complete care. Lastly, the results revealed that male participation (RRR: 2.69) and contacting multi-purpose worker (MPW) (RRR: 2.33) are also at play.Conclusion: The study suggests that the major determinants of utilisation of CMHS are access to media, mother's education, affordability barriers and male participation. Hence, policy recommendations should be oriented towards strengthening these dimensions and the utilisation of adequate ANC has to be considered as the need of the hour. [ABSTRACT FROM AUTHOR]

Objective: In India, about one third of tuberculosis (TB) patients diagnosed at tertiary hospitals are missed during a referral to peripheral health institutes for treatment. To address this, we assessed whether mobile voice call reminders to TB patients after diagnosis at a tertiary hospital decrease the proportion of "pretreatment loss to follow-up" (PTLFU), compared with the conventional paper-based referral. Design: A two-group parallel-arm randomized controlled trial was conducted. Setting: The study was conducted in a tertiary care hospital at Puducherry, South India. Participants: All newly diagnosed TB patients, both pulmonary and extrapulmonary, who were referred for treatment from the selected tertiary care hospital and possessed a mobile phone were eligible to participate. The participants were enrolled between March 2015 and June 2016 and were randomized to study groups using the block randomization with allocation concealment. Intervention: The participants in the intervention arm received standardized mobile voice calls reminding them to register for anti-TB treatment on the second and seventh day after referral in addition to the conventional paper-based referral received by the control group. Primary outcomes: Patients not started on anti-TB treatment within 14 days of referral were considered as PTLFU. The outcome of PTLFU was ascertained through phone calls made on the 14th day after referral. The intention-to-treat analysis was used, and the proportion of PTLFU in the study groups and the risk difference with 95% confidence interval (CI) were calculated. Results: Of the 393 patients assessed for eligibility, 310 were randomized to the intervention (n = 155) and control (n = 155) arms. In the intervention arm, 14 (9%) out of 155 were PTLFU compared with 28 (18%) of the 155 patients in the control arm. The absolute risk difference was 9% (95% CI [1.5, 16.6], P = 0.01). Conclusion: Mobile voice call reminder to patients is a feasible intervention and can reduce PTLFU among referred TB patients. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to document the participation of intra-household decision-making activities by older adults in India. Design/methodology/approach: This study has used a nationally representative sample of 21,662 older adults (aged 60 and above) from the Longitudinal Ageing Study of India data of 2017–2018. Intra-household decision-making participation is measured based on decision-making activities that includes marriage of daughter/son, buying and selling of property, giving a gift to the family, education of family member and arrangement of social/religious events. This paper used bivariate analysis and binary logistic regression model to examine the factors associated with the participation of older adults in the intra-household decision-making activities. Findings: The result has shown that older persons' participation declined with increased age. This study has also found a difference in the participation of intra-households decision-making activities between male and female, rural and urban older adults, poor and rich older adults. Older adults with good health status who maintain social engagement and a good lifestyle are more likely to participate in the household's decision-making activities. Practical implications: Older adults with better economic and social status are more likely to participate in intra-household decision-making activities that make their life happier than the counterpart. Therefore, emphasis should be given to those vulnerable older adults who do not have any social and economic security in the society. Originality/value: There are limited studies available on intra-household decision-making participation by older adults. This paper documents the intra-household decision-making participation by older adults in India with a nationally representative large sample. [ABSTRACT FROM AUTHOR]

Background: In India, the prevalence of overweight among adolescents is on the rise, setting the stage for an increase in metabolic syndrome (MS). This paper presents the national prevalence of MS in adolescents in India. Methods: A nationally representative data of adolescents (10–19 years) from the Comprehensive National Nutrition Survey was used. MS was defined based on the NCEP–ATP III criteria for adolescents. Bivariate analysis was used to report socio-demographic differentials in prevalence and to assess interstate variability. Multivariate logistic regression model was constructed to measure the association between socio-demographic characteristics and prevalence of MS. Census data from 2011 was projected to 2017 to calculate burden. Results: The prevalence of MS was 5.2% among adolescents. 11.9%, 15.4%, 26.0%, 31.9% and 3.7% had central obesity, high blood pressure, hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, respectively. The prevalence was higher among males (5.7% vs. 4.7%, adjusted odds ratio (AOR): 1.3, 95% confidence interval [CI]: 1.0, 1.6), those residing in urban areas (7.9% vs 4.2%, AOR: 1.4, 95% CI: 1.1, 1.8), and from wealthier households as compared to their counterparts (8.3% vs. 2.4%, AOR: 3.4, 95% CI: 2.1, 5.5). There was wide interstate variability in the prevalence of MS (0.5% – 16.5%). In 2017, 14.2 million adolescents had MS in India. Conclusions: The prevalence of MS among adolescents in India is low and clustered in urban areas and richer households. Early prevention interventions promoting a healthy lifestyle, especially in high prevalence areas, are needed to keep MS from becoming a public health issue. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is a significant public health concern in India, with Kerala being labeled as the diabetes capital of the country. The study aims to evaluate the prevalence, treatment, and management of diabetes to examine the unmet need for care to propose cost-effective strategies. Design: A cross-sectional study was conducted on a geographically defined cohort population in Ernakulam. Sample: This paper presents diabetes data of adults ≥30 years enrolled from the community cohort. The interviews were conducted with 997 participants at their residence. Measurement: Random blood glucose was assessed for each participant using a finger prick test. Results: The overall prevalence of diabetes was 30.1%, of which 4.1% of participants had undiagnosed diabetes. Among those with diabetes, 86.3% were aware of their diagnosis; among those aware, 86.5% were on treatment. Among those on treatment for diabetes, 54% achieved controlled blood sugar. Conclusion: The challenge in diabetes management is controlling the blood glucose levels of people who adhere to treatment. Younger employed females from lower-income quartiles have the highest risk. The study also raises questions about quality and strategies for medication compliance. The findings inspire future research on care needs, policies, and program responses to reduce the diabetes disease burden. [ABSTRACT FROM AUTHOR]

From 2005-06 to 2015-16, proportion of cesarean deliveries in total deliveries has almost doubled in India. In this paper, we study changes in prevalence of cesarean deliveries across different social-economic groups and study factors affecting odds of undergoing cesarean delivery. The present paper was based on National Family Health Surveys and employs logistic regression. We find that rise in cesarean deliveries has been across social groups, religions, urban/rural India, wealth groups, though increase has not been uniform. Further, many economically affluent states have high proportion of cesarean deliveries. We find that women delivering at private hospitals had significantly higher odds of opting for cesarean delivery. Further, women belonging to rich households were more likely to go through surgery for birth. In case of earlier terminated pregnancies, odds were higher too. The higher odds of cesarean sections in the relatively affluent geographic regions, richer households and private institutions indicate that these procedures may be driven by non-medical reasons in many cases, pointing toward the use of surgical procedures for the convenience. [ABSTRACT FROM AUTHOR]

In the context of a growing adolescent population globally, it is imperative to understand which interventions will most effectively advance their sexual and reproductive health (SRH). In India and globally, peer education is often utilised as an intervention for promoting the SRH of young people. Globally, the evidence of its effectiveness is mixed. A systematic review of the literature from the Indian context gave insight into the knowledge, attitudinal, and behavioural (KAB) outcomes affected by peer education, as well as the inputs, coverage, content, and context of such interventions. Out of the over 1500 publications initially identified through the database and bibliographic searches, 13 were included in the review; no quality assessment was done, given the dearth of publications matching the inclusion criteria. Analysis of the included publications highlights the multiple ways that peer education is implemented in the Indian context, as part of multi-component programmes and as a stand-alone intervention. The KAB outcomes from these initiatives are mixed, with some multi-component and some stand-alone initiatives affecting statistically significant outcomes and others not–a finding consistent with global literature reviewed for this paper. Despite the mixed results and the limited effects of behaviour relative to knowledge, this paper proposes that peer education has a place in an overall response to improving the SRH of young people. It calls for better research on peer education in India, and for research in relation to the optimal conditions for peer education to succeed in affecting KAB and other outcomes. [ABSTRACT FROM AUTHOR]

Background This study is part of a multicountry matched-cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI) of children exposed to invasive group B Streptococcus (iGBS). The specific objective of this paper is to compare NDI across domains of iGBS survivors with a matched non iGBS group in our population. Methods Survivors of iGBS in a South Indian hospital were identified and recruited between January 2020 and April 2021. Cases were compared with age- and gender-matched non iGBS children. Participants were assessed using Bayley Scales of Infant and Toddler Development–3rd edition (BSID-III), Wechsler Preschool and Primary Scale of Intelligence–4th edition (WPPSI-IV), Wechsler Intelligence Scale for Children–5th edition (WISC-V), Child Behavior Checklist (CBCL), and Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2), depending on age. Results Our cohort comprised 35 GBS-exposed and 65 matched non iGBS children, aged 1–14 years. The iGBS-exposed group had 17 (48.6%) children with impairment in ≥1 domain compared to 25 (38%) in the non iGBS group (unadjusted OR, 1.51; 95% CI,.65–3.46), 9 (26%) children with "multi-domain impairment" compared to 10 (15.4%) in the non iGBS group (unadjusted OR, 1.90; 95% CI,.69–5.24), and 1 (2.9%) child with moderate to severe impairment compared to 3 (4.6%) in the non iGBS group (unadjusted OR,.60; 95% CI,.06–6.07). In the iGBS group, more children had motor impairments compared with the non iGBS group (unadjusted OR, 10.7; 95% CI, 1.19–95.69; P  = .034). Conclusions Children with iGBS seem at higher risk of developing motor impairments compared with a non iGBS group. [ABSTRACT FROM AUTHOR]

There is limited research in India to understand young people's decision-making processes about intimate relationships before marriage. This paper, adopting a life course perspective, explains relationship choices and diachronic trajectories of relationships from adolescence to young adulthood. Retrospective data were collected from 1240 never married 20–29-year-old men and women living in Pune using a relationships history calendar. All the relationships from 10 years of age onwards were plotted on the calendar, and information on predictor variables was collected through structured questionnaires. Data were analysed using descriptive statistics. Sequence analysis approach was used to identify different typologies. Overall, 76% of the participants reported having at least one relationship. More women compared to men (84% vs 70%) ever had a relationship. The median age of starting the first relationship was 17 years for women and 18 for men. Different relationship types were reported, such as "serious", casual, "friends with benefit", and "exploring". The level of emotional involvement, commitment, and physical intimacy significantly differed in different relationship types with significant gender differences. Four typologies of relationships were observed, labelled as (1) Commitment–No sex (N = 187); (2) Commitment–Sex-Some exploration (N = 189); (3) No commitment–Exploration (N = 281), and (4) No relationship (N = 583). Compared to men, women were more likely to follow the trajectory of "Commitment-No sex" (RR 2.13, CI 1.5–3.03). Family environment was significantly related to young people's relationship choices. The findings strongly suggest the need to adopt a developmental perspective towards intimate relationships to understand and address the vulnerabilities of young people across the life course. [ABSTRACT FROM AUTHOR]

Women in low-and-middle income countries (LMICs) are disproportionately exposed to secondhand smoke (SHS), particularly in the home environment. Girls married before the age of 18 are more likely to remain at home and may be at higher risk of SHS exposure. This paper investigates whether women who were married as child brides had a higher risk of SHS exposure than their peers who were married as adults in India, where both burden of smoking and child marriage are critical public health concerns. Data were obtained from the 2015–2016 wave of the nationally representative India National Family Health Survey and included 306,788 married women ages 18 to 35 years. We estimated bivariate and multivariate logistic regressions to obtain odds ratios in favor of SHS exposure. The prevalence of SHS exposure for those who were married as adults was 50.3% while that was 55.2% for those who were married before age 18. After controlling for sociodemographic characteristics, the adjusted odds of SHS exposure for those who were married as child were 1.06 (95% CI: 1.03, 1.09) times that of those who were married as adults. Findings of this study inform policies for coordinated efforts to eliminate child marriage and strengthen tobacco control. [ABSTRACT FROM AUTHOR]

Background: Timely initiation of breastfeeding, also known as early initiation of breastfeeding, is a well-recognized life-saving intervention to reduce neonatal mortality. However, only one quarter of newborns in Uttar Pradesh, India were breastfed in the first hour of life. This paper aims to understand the association of community-based prenatal counselling and postnatal support at place of delivery with early initiation of breastfeeding in Uttar Pradesh, India. Methods: Data from a cross-sectional survey of 9124 eligible women (who had a live birth in 59 days preceding the survey) conducted in 25 districts of Uttar Pradesh, India, in 2018, were used. Simple random sampling was used to randomly select 40 Community Development Blocks (sub district administrative units) in 25 districts. The Primary Sampling Units (PSUs), health service delivery unit for frontline workers, were selected randomly from a linelisting of PSUs in each selected Community Development Block. Bivariate and multivariate logistic regression analyses were performed to assess the association of prenatal counselling and postnatal support on early initiation of breastfeeding in public, private and home deliveries. Results: Overall 48.1% of mothers initiated breastfeeding within an hour, with major variation by place of delivery (61.2% public, 23.6% private and 32.6% home). The adjusted odds ratio (aOR) of early initiation of breastfeeding was highest among mothers who received both counselling and support (aOR 2.67; 95% CI 2.30, 3.11), followed by those who received only support (aOR 1.99; 95% CI 1.73, 2.28), and only counselling (aOR 1.40; 95% CI 1.18, 1.67) compared to mothers who received none. The odds of early initiation of breastfeeding was highest among mothers who received both prenatal counselling and postnatal support irrespective of delivery at public health facilities (aOR 2.49; 95% CI 2.07, 3.01), private health facilities (aOR 3.50; 95% CI 2.25, 5.44), or home (aOR 2.84; 95% CI 2.02, 3.98). Conclusions: A significant association of prenatal counselling and postnatal support immediately after birth on improving early initiation of breastfeeding, irrespective of place of delivery, indicates the importance of enhancing coverage of both the interventions through community and facility-based programs in Uttar Pradesh. [ABSTRACT FROM AUTHOR]

Introduction: Although India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels. Methods: The study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015–16, India. The sample size of this study was 148,145 women aged 15–49 years who gave last birth in the institution during 5 years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran's I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization. Results: The value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only. Conclusion: It is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels. [ABSTRACT FROM AUTHOR]

This study reviews student's perspectives of an American Indian and Alaska Native Indian Studies center in a Master of Social Work degree (MSW) program from the Brown School at Washington University in St. Louis. The article describes the Kathryn M. Buder Center for American Indian Studies many contributions over the years and how it continues to grow in innovative ways. This article begins by considering the social, economic, and historical circumstances that make Native-focused training in social work critical to the future of Indian Country. The article then discusses the founding of the center, the curriculum, program offerings and the effectiveness of the center's services. Additionally, results of the evidence indicates that financial assistance and support programs are strong factors in recruitment, student motivation to pursue a degree, and persistence to completion of a Master of Social Work credential. Lastly, the paper offers recommendations for recruiting, retaining and graduating American Indian and Alaska Native graduate students. [ABSTRACT FROM AUTHOR]

The poor often experience illness and the treatment costs are high and even catastrophic for the poor. This paper reports the extent of illness, treatment‐seeking behaviour and out of pocket healthcare expenditures and the determinants of treatment‐seeking behaviour and healthcare expenditures among the urban poor living in Delhi. A total of 2,998 households participated in the study. Socio‐demographic details, illness experiences (episodic illness in the past 3 months, hospitalisation in the past 1 year and any chronic illness), treatment seeking and healthcare expenditures were collected for all household members through a pretested, interviewer‐administered questionnaire. Logistic regressions were carried out for factors associated with treatment‐seeking choices. Multiple linear regressions were carried for factors associated with out of pocket expenditures (OOPE). Of the total 15,218 household members (of the 2,998 households), 4,052 (26.6%) experienced episodic illness (mainly fever, respiratory illnesses, food‐ and waterborne diseases and eye infections) in the past 3 months, 230 (1.5%) were hospitalised and 976 (6.4%) have chronic illness (mainly hypertension, diabetes, arthritis and respiratory problems). Of the 2,998 households, 2,225 (74.2%) households reported at least one event of illness. Unqualified practitioners were the main source of care for episodic illnesses. Perceived seriousness of the illness, having Employees State Insurance Scheme (ESIS) benefit, higher educational status of the head of the household, higher monthly household incomes, belonging other backward castes and settled‐migrant status led to seeking formal care. Dengue was the main reason for hospitalisation. Government including ESIS hospitals were mainly utilised for hospitalisation. Healthcare expenditures were higher for private healthcare. Possession of mandatory health insurance was protective against OOPEs. OOPEs were more for the men/boys and for the young. Improving access to government healthcare services is important. Extending the ESIS to the unorganised workers including urban poor migrants should be considered so as to bring them under mandatory social protection. [ABSTRACT FROM AUTHOR]

Background: To improve coverage of key child health community practices, Home Based Infant Care (HBNC+) was implemented with support of Norway India Partnership Initiative (NIPI) in 4 States of Rajasthan, Madhya Pradesh, Bihar and Odisha. The innovation aimed at improving coverage of key child health interventions through home visits by community health worker, Accredited Social Health Activist (ASHA). Aims & Objective: This paper elucidates the results from the assessment of implementation in intervention versus control districts of Rajasthan. Material & Methods: A cross-sectional intervention-control design with a sample size of 3211 mothers of children in age group 0 to 23 months was adopted. Results: 85 percent of the children (aged 3-23 months) received at least one infant care home visit in the intervention districts in comparison to 32 percent in control. Significant improvements were found in terms of exclusive breastfeeding, weighing and Iron Folic Acid (IFA) consumption and availability of ORS and Iron Syrup in intervention districts. 15 percent additional children had weight plotted in growth charts and 24 percent more consumed IFA syrup bi-weekly in intervention districts. Conclusion: Home visits in infancy is a scalable model and can lead to improvement of community child health practices. [ABSTRACT FROM AUTHOR]

Background: Condom is an integral part of all interventions for female sex workers (FSWs). However, certain situations hinder them from practicing consistent condom use. This paper aims at identifying the situations that predict inconsistent condom use by FSWs of Sonagachi red-light area, Kolkata. Subjects and Methods: The cross-sectional community-based observational study was conducted among 296 brothel-based FSWs of Sonagachi. Outcome variable, that is, inconsistent condom use was said to be present if any sex act with any type of partner was not protected by condom. Association with sociodemographic, occupational, and behavioral characteristics of FSWs was examined. Results: Inconsistent condom use was present among 37.5% of the study participants, and this was predicted by the presence of a nonpaying partner (NPP) (adjusted odds ratio [AOR] [95% confidence interval (CI)]: 15.04 [7.52-30.08]), violence (AOR [95% CI]: 2.08 [1.07-4.03]) and sexual intercourse under the influence of alcohol (AOR [95% CI]: 1.86 [1.02-3.39]). The major cause behind nonuse of condom as reported by the participants was trust on partner. Conclusion: NPPs need to be given emphasis in program strategies for FSWs. The FSWs should constantly be motivated for safe sex emphasizing the fact that trust on partner may be detrimental for their health. [ABSTRACT FROM AUTHOR]

Objectives This study measures the prevalence of risk factors among pregnant women and young children aged 12-24 months in a rural community in West Bengal, India. Methods Community health workers (CHWs) enrolled women and children into this 2015 cross-sectional study. Pregnant women were evaluated for underweight, anemia, and abnormal blood pressure. Children were evaluated for underweight, abnormal head and upper arm circumferences, and low scores from the Ages and Stages Questionnaire (ASQ). Data were collected on smartphones and tablets or by paper. Results More than half of the 279 women (59.9%) had a risk factor during pregnancy: 48.7% were anemic, 35.1% had low blood pressure, and 7.5% were underweight. Among the 366 children, 59.3% had a risk factor, including 24.0% with low ASQ scores and 49.7% who had abnormal anthropometric measures. Conclusions for Practice Vulnerable populations, such as pregnant women and young children, needed a greater connection to doctors in this rural community. This study demonstrated the feasibility of CHWs to listen to health concerns and connect underserved populations with health care services. [ABSTRACT FROM AUTHOR]

Background: The immunization coverage in India is far away from satisfactory with full immunization coverage being only 62% at national level. Targeting the intensive efforts to poor performing areas and addressing the determinants of nonimmunization and dropouts offers a quick solution. In this paper, we assess the inter-district variations in Haryana state, and the association of social determinants with partial and no immunization. Methodology: This analysis is based on data collected as part of a large household survey undertaken in the state of Haryana to measure the extent of Universal Health Coverage. A multistage stratified random sampling design was used to select primary sampling units (i.e., subcenters), villages, and households. A total of 11,594 mothers with a child between 12 and 23 months were interviewed on receipt of immunization services. Determinants of nonimmunization and partial immunization were assessed using multiple logistic regression. Results: About 21% of children aged 12-23 months were partially immunized, while 4.3% children aged 12-23 months had received "no immunization." While the coverage of full immunization was 74.7% at the state level, it varied from 95% in best performing district to 38% in poorest performing district. Odds of a partially immunized child were significantly higher in urban area (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.1-1.38), among Muslim household (OR = 3.52; 95% CI = 3.03-4.11), children of illiterate parents (OR = 1.58; 95% CI = 1.22-2.05), and poorest quintile (OR = 1.61; 95% CI = 1.36-1.89). Conclusions: Wide interdistrict variations call for a need to consider changes in resource allocation and strengthening of the government initiatives to improve routine immunization in these districts. [ABSTRACT FROM AUTHOR]

Objectives:With changing attitudes to alcohol and an increasing life span in India, the prevalence of alcohol use and misuse in successive cohorts of older people is likely to increase. In this paper, we attempt to review the most recent evidence covering alcohol use and alcohol-use disorders in the Indian elderly. Methods:PubMed, PsycINFO and Indmed databases were searched using relevant keywords. Papers meeting eligibility criteria were selected through a sequential process of screening title, abstract and full text. Data were extracted into Excel sheets. Results:There was a dearth of pan-national studies. There were several methodological issues with many studies especially related to measurement. A substantial proportion of individuals above the age of 50 years are current consumers of alcohol and the prevalence is generally higher in urban compared to rural areas. Older women are generally likely to be alcohol abstainers. The general trend appears to be a reduction in current drinking among successive age cohorts over the age of 50. Alcohol consumption in the older adults is associated with educational status, health status, chronic morbidity, employment status, socioeconomic status, auditory/locomotor impairment and asthma. Conclusion:Alcohol use and misuse is a problem among the Indian older adults. With socio-demographic changes that will further increase longevity, this problem is likely to increase and policy-makers need to plan for it. Future research needs to improve validity and reliability in study methodology, as well as add to the current evidence base. [ABSTRACT FROM PUBLISHER]

Background: Studies that have looked at the effect of polio eradication efforts in India on routine immunization programs have provided mixed findings. One polio eradication project, funded by US Agency for International Development (USAID) and carried out by the CORE Group Polio Project (CGPP) in the state of Uttar Pradesh of India, has included the strengthening of routine immunization systems as a core part of its polio eradication strategy. This paper explores the performance of routine immunization services in the CGPP intervention areas concurrent with intensive polio eradication activities. The paper also explores determinants of routine immunization performance such as caretaker characteristics and CGPP activities to strengthen routine immunization services. Methods: We conduct secondary data analysis of the latest project household immunization survey in 2011 and compare these findings to reports of past surveys in the CGPP program area and at the Uttar Pradesh state level (as measured by children's receipt of DPT vaccinations). This is done to judge if there is any evidence that routine immunization services are being disrupted. We also model characteristics of survey respondents and respondents' exposure to CGPP, communication activities against their children's receipt of key vaccinations in order to identify determinants of routine immunization coverage. Results: Routine immunization coverage has increased between the first survey (2005 for state level estimates, 2008 for the CGPP program) and the latest (2011 for both state level and CGPP areas), as measured by children's receipt of DPT vaccination. This increase occurred concurrent with polio eradication efforts intensive enough to result in interruption of transmission. In addition, a mothers' exposure to specific communication materials, her religion and education were associated with whether or not her children receive one or more doses of DPT. Conclusions: A limitation of the analysis is the absence of a controlled comparison. It is possible routine immunization coverage would have increased even more in the absence of polio eradication efforts. At the same time, however, there is no evidence that routine immunization services were disrupted by polio eradication efforts. Targeted health communications are helpful in improving routine immunization performance. Strategies to address other determinants of routine immunization, such as religion and education, are also needed to maximize coverage. [ABSTRACT FROM AUTHOR]

Objectives In low-income settings, neonatal mortality rates (NMR) are higher among socioeconomically disadvantaged groups. Institutional deliveries have been shown to be protective against neonatal mortality. In Gujarat, India, the access of disadvantaged women to institutional deliveries has increased. However, the impact of increased institutional delivery on NMR has not been studied here. This paper examined if institutional childbirth is associated with lower NMR among disadvantaged women in Gujarat, India. Methods A community-based prospective cohort of pregnant women was followed in three districts in Gujarat, India (July 2013-November 2014). Two thousand nine hundred and nineteen live births to disadvantaged women (tribal or below poverty line) were included in the study. Data was analyzed using multivariable logistic regression. Results The overall NMR was 25 deaths per 1000 live births. Multivariable analysis showed that institutional childbirth was protective against neonatal mortality only among disadvantaged women with obstetric complications during delivery. Among mothers with obstetric complications during delivery, those who gave birth in a private or public facility had significantly lower odds of having a neonatal death than women delivering at home (AOR 0.07 95% CI 0.01-0.45 and AOR 0.03, 95% CI 0.00-0.33 respectively). Conclusions for Practice Our findings highlight the crucial role of institutional delivery to prevent neonatal deaths among those born to disadvantaged women with complications during delivery in this setting. Efforts to improve disadvantaged women's access to good quality obstetric care must continue in order to further reduce the NMR in Gujarat, India. [ABSTRACT FROM AUTHOR]

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems. [ABSTRACT FROM AUTHOR]

Objectives Few Indian studies have examined the relationship between birth size and stunting in children. Studies on recovery from stunting in India are even fewer. This study, thus, investigates the relationship between birth size and stunting in Andhra Pradesh, India. This study further examines the factors associated with recovery from stunting using a longitudinal data. Methods We used data from the three waves of Young Lives Study (YLS) conducted in Andhra Pradesh in the years 2002, 2006-2007, and 2009 respectively. We used data from 1965 children in wave 1 to examine the association between birth size and stunting. For examining the factors associated with recovery from stunting between 1 and 5 years of age, and between 5 and 8 years, we use data from 582 and 670 children who were stunted at age 1 and age 5 respectively. We use multivariable logistic regression models to fulfil the objectives of the paper. Results The children who were of average- or large- size at birth were significantly less likely to be stunted than children who were of small size at birth (OR 0.61 and 0.47 respectively). Children of average/tall mothers were 0.41 times less likely to be stunted than children of shorter mothers. Severely stunted children were less likely than other stunted children to recover from stunting between 1 and 5 years of age, and between 5 and 8 years. Mother's height was statistically associated with recovery. Change in wealth status of the household was statistically associated with recovery between 1 and 5 years of age. In comparison, child immunization was associated with recovery between 5 and 8 years. Conclusions for Practice This study contributes to the understanding of the impact of birth size on childhood stunting, and to the extent of recovery from stunting in India. Further follow-up is necessary to demonstrate the impact during adolescence and adulthood. [ABSTRACT FROM AUTHOR]

Background: Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization. Methods: The present study uses data from the 66th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009-10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE. Results: The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states Category B (richest/poorest = 14.60), followed by (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts. Conclusions: In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE. [ABSTRACT FROM AUTHOR]

Aims: In India, opioid substitution therapy (OST) has been scaled-up in the recent years for HIV prevention among injecting drug users. This study aimed to assess the change in knowledge and attitude of the OST staff who underwent a five-day training programme on OST.Methods: Using a “pre-test post-test” design, routine data collected from 267 staff who underwent the OST training was analysed. The staff composition was: doctors (n = 42, 15.7%), nurses (n = 49, 18.4%), counsellors (n = 45, 16.9%) and other programme staff (n = 131, 49.1%). A 20-item, pen and paper questionnaire was administered right before the beginning of and immediately after the completion of the training. The questions were categorised into one of the five domains to assess whether changes in scores are confined to certain domains. Overall scores and scores in different domains were compared using paired-sample t-tests. The score difference in different cadres was compared using univariate general linear model with post-hoc comparisons.Findings: The difference between the total mean pre-test scores (9.24) (out of maximum possible score of 20) and post-test score (13.8) was significant. Comparison between various domains showed significant differences across all cadres. Doctors recorded significantly higher scores compared to other cadres.Conclusion: It is feasible to train different cadres of service providers together on OST in five days. The training was able to improve the participants’ knowledge and their attitude towards injecting drug users. [ABSTRACT FROM PUBLISHER]

The HIV epidemic has had a widespread impact on global scientific and cultural discourses related to gender, sexuality, and identity. ‘Male sex workers’ have been identified as a ‘key population’ in the global HIV epidemic; however, there are methodological and conceptual challenges for defining inclusion and exclusion of transgender women within this group. To assess these potential implications, this study employs self-critique and reflection to grapple with the empiric and conceptual implications of shifting understandings of sexuality and gender within the externally re-created etic category of ‘MSM’ and ‘transgender women’ in epidemiologic HIV research. We conducted a sensitivity analysis of our previously published meta-analysis which aimed to identify the scope of peer-reviewed articles assessing HIV prevalence among male sex workers globally between 2004 and 2013. The inclusion of four studies previously excluded due to non-differentiation of cisgender male from transgender women participants (studies from Spain, Thailand, India, and Brazil: 421 total participants) increased the overall estimate of global HIV prevalence among ‘men’ who engage in sex work from 10.5% (95% CI 9.4–11.5%) to 10.8% (95% CI 9.8–11.8%). The combination of social science critique with empiric epidemiologic analysis represents a first step in defining and operationalising ‘reflexive epidemiology’. Grounded in the context of sex work and HIV prevention, this paper highlights the multiplicity of genders and sexualities across a range of social and cultural settings, limitations of existing categories (i.e. ‘MSM’, ‘transgender’), and their global implications for epidemiologic estimates of HIV prevalence. [ABSTRACT FROM AUTHOR]

• The study investigates the association between food security and physical frailty among older adults in India. • Older adults with food insecurity had a higher likelihood of physical frailty. • Physical frailty was found to increase with age and was higher among non-working older adults, older adults with poor SRH status, multimorbidity and ADL and IADL disability. • Education had a protective effect against physical frailty among older adults. Food security can be directly linked to nutritional status and either directly or indirectly, it has an impact on health status and well-being of the population. Physical frailty is one of the most important phenotypes used to understand the vulnerable nature of older adults. This paper examined the association between food security and physical frailty in older adults. We used data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1. The sample size was 31,464 older adults aged 60 years and above. Physical frailty was assessed using the modified version of frailty phenotype proposed by Fried and colleagues. Multivariable logistic regression was used to establish the association between food insecurity with physical frailty. A proportion of 30.65% of older adults were frail in this study. Older adults with food insecurity had higher prevalence of exhaustion (12.1% vs 6.5%), unintentional weight loss (65.5% vs 5.1%), and weak grip strength (8.6% vs 7.9%) in comparison to their food secure counterparts. After adjusting for a large number of confounders, older adults who reported food insecurity had significantly higher odds of being frail [AOR: 2.68; CI: 2.26-3.19] in comparison to older adults with no food insecurity. The study showed that food insecurity is associated with physical frailty among older adults in India. It is suggested that food security programs in the country may be considered as an effective strategy to prevent physical frailty among older adults. [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]

Background and Objective: In the analysis of dichotomous type response variable, logistic regression is usually used. However, the performance of logistic regression in the presence of sparse data is questionable. In such a situation, a common problem is the presence of high odds ratios (ORs) with very wide 95% confidence interval (CI) (OR: >999.999, 95% CI: <0.001, >999.999). In this paper, we addressed this issue by using penalized logistic regression (PLR) method. Materials and Methods: Data from case-control study on hyponatremia and hiccups conducted in Christian Medical College, Vellore, Tamil Nadu, India was used. The outcome variable was the presence/absence of hiccups and the main exposure variable was the status of hyponatremia. Simulation dataset was created with different sample sizes and with a different number of covariates. Results: A total of 23 cases and 50 controls were used for the analysis of ordinary and PLR methods. The main exposure variable hyponatremia was present in nine (39.13%) of the cases and in four (8.0%) of the controls. Of the 23 hiccup cases, all were males and among the controls, 46 (92.0%) were males. Thus, the complete separation between gender and the disease group led into an infinite OR with 95% CI (OR: >999.999, 95% CI: <0.001, >999.999) whereas there was a finite and consistent regression coefficient for gender (OR: 5.35; 95% CI: 0.42, 816.48) using PLR. After adjusting for all the confounding variables, hyponatremia entailed 7.9 (95% CI: 2.06, 38.86) times higher risk for the development of hiccups as was found using PLR whereas there was an overestimation of risk OR: 10.76 (95% CI: 2.17, 53.41) using the conventional method. Simulation experiment shows that the estimated coverage probability of this method is near the nominal level of 95% even for small sample sizes and for a large number of covariates. Conclusions: PLR is almost equal to the ordinary logistic regression when the sample size is large and is superior in small cell values. [ABSTRACT FROM AUTHOR]

Purpose: The American Society of Clinical Oncology and the Oncology Nursing Society have proposed a set of standards for safe chemotherapy administration. The state of implementation of these standards in oncologic practices in India is not understood properly. Methods: An anonymized survey was designed that consisted of items from all 37 standards that were described in the 2013 update of the standards. The survey was distributed via e-mail as well as in paper format among oncologists working in various oncology practices in the country. A standard was considered as fully implemented if more than 90% of the items beneath it had the most positive response (Yes/ Always). Results: Responses were obtained from 75 of 114 (65.8%) of the institutions surveyed. Only one institution had fully implemented the standards, whereas only six (8.0%) institutions had implemented more than 90% of the standards fully. The general chemotherapy administration-related domain was implemented fully by the least number of institutions. Although characteristics such as location, funding, and type of institution (teaching or not) failed to influence implementation rates, institutions of respondents who were aware of chemotherapy practice–related standards reported full implementation of a larger number of standards. Lack of national-level guidelines/ policies was identified as the most common difficulty in implementing standards. Conclusion: This survey indicates that there is an urgent need to formulate national-level guidelines for safe chemotherapy administration. [ABSTRACT FROM AUTHOR]

Background: Measurement of physical activity in epidemiological studies requires tools which are reliable, valid and culturally relevant. We attempted to develop a physical activity questionnaire (PAQ) that would measure physical activity in various domains over a year and which would be valid for use in adults of different age groups with varying levels of activity in urban and rural settings in low and middle income countries like India. The present paper aims to assess the reliability and validity of this new PAQ- termed the Madras Diabetes Research Foundation- Physical Activity Questionnaire (MPAQ). Methods: The MPAQ was administered by trained interviewers to 543 individuals of either gender aged 20 years and above from urban and rural areas in 10 states of India from May to August 2011, followed by a repeat administration within a month for assessing reliability. Relative validity was performed against the Global Physical Activity Questionnaire (GPAQ). Construct validity was tested by plotting time spent in sitting and moderate and vigorous physical activity (MVPA) against body-mass index (BMI) and waist circumference. Criterion validity was assessed using the triaxial accelerometer, in a separate subset of 103 individuals. Bland and Altman plots were used to assess the agreement between MPAQ and accelerometer. Results: The interclass correlation coefficients (ICC) for total energy expenditure and physical activity levels were 0.82 and 0.73 respectively, between baseline and 1st month. The ICC between GPAQ and the MPAQ was 0.40 overall. The construct validity of the MPAQ showed linear association between sitting and MVPA, and BMI and waist circumference independent of age and gender. The Spearman's correlation coefficients for sedentary activity, MVPA and overall PA for MPAQ against the accelerometer were 0.48 (95%CI-0.32-0.62), 0.44 (0.27-0.59) and 0.46 (0.29-0.60) respectively. Bland and Altman plots showed good agreement between MPAQ and accelerometer for sedentary behavior and fair agreement for MVPA. Conclusion: The MPAQ is an acceptable, reproducible and valid instrument, which captures data from multiple activity domains over the period of a year from adults of both genders and varying ages in various walks of life residing in urban and rural India. [ABSTRACT FROM AUTHOR]

Background Despite harmful drinking causing a significant burden on global health, there is a large treatment gap, especially in low- and middle-income countries. A major barrier to care is the lack of adequately skilled human resources to deliver contextually appropriate treatments. This paper describes the systematic process used to develop Counselling for Alcohol Problems ( CAP), a brief psychological treatment (PT) for delivery by lay counselors in routine primary care settings to men with harmful drinking in India. Methods CAP was developed using a methodology involving 3 sequential steps: (i) identifying potential treatment strategies; (ii) developing a theoretical framework for the treatment; and (iii) evaluating the acceptability and feasibility of the treatment. Results CAP is a 3-phase treatment delivered over 1 to 4 sessions based on a motivational interviewing ( MI) stance and involves the following strategies: assessment and personalized feedback, family engagement, drink refusal skills, skills to address drinking urges, problem-solving skills and handling difficult emotions, and relapse prevention and management. Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment, for example expansion of the target group to include alcohol-dependent patients and the extension of the delivery settings to include home-based delivery. There was preliminary evidence of the effectiveness of CAP. Conclusions CAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a randomized controlled trial based in primary care in Goa, India. [ABSTRACT FROM AUTHOR]

This paper examines the relationships between self-reported loneliness and living arrangements. A structured questionnaire with some open-ended questions was administered face-to-face in English, Hindi or Punjabi to a sample of 161 elderly South Asian immigrants 60 or more years of age living in Edmonton, Alberta, Canada in 2003. The majority of respondents said that they never felt lonely. More than one in three (37.3%) respondents indicated that they felt lonely occasionally, frequently or all of the time. Those living alone were significantly more likely to report feeling lonely at least occasionally than were those living with others, especially those living with their spouse in an extended family. The fact that South Asian immigrant seniors typically lived with others, often in an extended family with or without their spouse, and rarely lived alone protected them to some extent from loneliness. However, our findings showed that among those living with others, it was the amount of waking time spent alone at home and the quality of family relationships rather than living arrangement per se that significantly predicted self-reported loneliness. Nevertheless, living in a larger household was associated with spending less time alone. We discuss plausible influences of culture on expectations regarding family and social relationships and on the meaning of being alone, as well as practical implications for addressing loneliness in a multi-cultural society. [ABSTRACT FROM PUBLISHER]

Manipur is a geographically isolated state of India characterised by a high HIV prevalence among people who inject drugs (PWID). A low-to-moderate lifetime rate of HIV testing has been documented amongst PWID in Manipur. Little is known about the extent of undiagnosed HIV in this setting and whether uptake of HIV testing (and knowledge of a positive diagnosis) leads HIV-positive PWID to change their risk behaviours. The cross-sectional data (n= 821) analysed for this paper were collected in 2009 for the Integrated Behavioural and Biological Assessment (IBBA) using interviewer-administered questionnaires and the collection of de-linked blood and urine samples. Almost one-third (30.7%) of the participants tested HIV positive. The majority knew where to obtain a confidential HIV test (80.7%), however, half of the HIV-positive participants had either never had an HIV test (37.7%), or had undertaken a test without collecting the result (12.7%). Almost one-quarter (23.4%) of the HIV-positive participants and 17.4% of the HIV-negative participants had shared a needle/syringe with at least one other injector during the preceding month. Encouragingly, HIV-positive participants were significantly more likely than HIV-negative participants to use condoms with their regular sexual partners, however, there was still a high proportion of HIV-positive participants who did not use a condom at last sex with their regular (47.2%) or casual (48.0%) partners. Having taken an HIV test and collected the result was associated with a reduction in HIV-risk behaviours among HIV-positive participants, but not among HIV-negative participants. In conclusion, we found that a substantial proportion of the HIV-positive PWID in Manipur were not aware of their positive status, and risky injecting and sexual practices were commonplace. However, HIV-positive PWID appear to reduce their high-risk behaviours when they become aware of their HIV status highlighting the importance of taking HIV testing coverage to scale. [ABSTRACT FROM PUBLISHER]

Sexual partner mixing among men who have sex with men (MSM), based on both gender and partnership status, is an understudied theme in India. Using data from Round 2 of the Integrated Bio-behavioral Survey, this paper reports on gender and partnership status-based sexual mixing and levels of consistent condom use (CCU) among MSM in Maharashtra. A total of 689 MSM were sampled using probability-based sampling. Bivariate and regression analyses were carried out on condom use and partnership mixing. Over half (52%) of all MSM reported having only male partners while about one-third (34.5%) reported having partners of both gender. Over 70% of MSM engaged in sex with a mix of casual, regular, commercial and non-commercial partners. MSM with only male partners reported lower CCU as compared to MSM with partners of both genders (47.3% and 62%, respectively,p= 0.11). CCU levels differed significantly by status of sex partner. Overall, MSM having ‘men only’ as partners and those with partners of mixed status have greater risk behaviour in terms of low CCU. HIV prevention interventions need to focus attention on men in ‘exclusively male’ sex partnerships as well as MSM with a mix of casual, regular and commercial partners. [ABSTRACT FROM AUTHOR]

Age-appropriate infant and young child feeding (IYCF) practices are critical to child nutrition.The objective of this paper was to examine the associations between age-appropriate IYCF practices and child nutrition outcomes in India using data from ~18 463 children of 0-23.9 months old from India's National Family Health Survey, 2005-06-3. The outcome measures were child height-for-age z-score (HAZ), weight-for-age z-score (WAZ), weight-for-height z-score, stunting, underweight and wasting. Linear and logistic regression analyses were used, accounting for the clustered survey data. Regression models were adjusted for child, maternal, and household characteristics, and state and urban/rural residence. The analyses indicate that in India suboptimal IYCF practices are associated with poor nutrition outcomes in children. Early initiation of breastfeeding and exclusive breastfeeding were not associated with any of the nutrition outcomes considered. Not consuming any solid or semi-solid foods at 6-8.9 months was associated with being underweight (P < 0.05). The diet diversity score and achieving minimum diet diversity (⩾4 food groups) for children 6-23 months of age were most strongly and significantly associated with HAZ, WAZ, stunting and underweight (P < 0.05). Maternal characteristics were also strongly associated with child undernutrition. In summary, poor IYCF practices, particularly poor complementary foods and feeding practices, are associated with poor child nutrition outcomes in India, particularly linear growth. [ABSTRACT FROM AUTHOR]

This paper examines the trends in economic inequality in infant mortality across urban-rural residence in India over last 14 years. We analysed data from the three successive rounds of the National Family Health Survey conducted in India during 1992-1993, 1998-1999, and 2005-2006. Asset-based household wealth index was used as the economic indicator for the study. Concentration index and pooled logistic regression analysis were applied to measure the extent of economic inequality in infant mortality in urban and rural India. Infant mortality rate differs considerably by urban-rural residence: infant mortality in rural India being substantially higher than that in urban India. The findings suggest that economic inequalities are higher in urban than in rural India in each of the three survey rounds. Pooled logistic regression results suggest that, in urban areas, infant mortality has declined by 22 % in poorest and 43 % in richest. In comparison, the decline is 29 and 32 % respectively in rural India. Economic inequality in infant mortality has widened more in urban than in rural India in the last two decades. [ABSTRACT FROM AUTHOR]

Since the beginning of the HIV/AIDS epidemic in India, pregnant women attending antenatal clinics (ANC) have been considered as a low HIV risk population. Yet, a substantial proportion of new HIV infections are occurring among stable heterosexual couples. This paper sought to investigate the proportion and profile of women who, within the low-risk population, are potentially at higher risk of HIV infection. HIV risk perception of pregnant women enrolled within the ANRS 12127 Prenahtest trial was described and associated socio-behavioral characteristics, husband's characteristics, and HIV-related characteristics were analyzed using univariate and multivariate logistic regression models. Among 484 women enrolled, baseline data were collected for 479 women and 460 women with completed data were considered for the present analysis (96%). Eighty-nine (19.4%) women perceived themselves at risk of HIV. Women with educational level <11years (Adjusted Odds Ratio, AOR = 2.4 [CI = 1.28–4.53]), who stayed in joint families (AOR = 1.89 [CI = 1.12–3.12]), who had experienced insult or hurt from the partner (AOR = 1.91 [CI = 1.11–3.27]) and whose partner were alcoholic (AOR = 2.19 [CI = 1.31–3.66]) were significantly more likely to perceive themselves at risk of HIV. Women who had heard about sexually transmitted infections were also more likely to report HIV risk perception (AOR = 3.36 [CI = 1.83–6.18]). Substantial proportion of women (one out of five) perceived themselves at risk of HIV and most of these have reported some form of vulnerability in their couple relationship such as intimate partner violence, alcoholic partner, lack of communication, and spaces for communication with partner. Though awareness and knowledge is the first step for prevention, considering the vulnerabilities associated with HIV risk perception, HIV prevention interventions in India should target overall sources of vulnerability to HIV. Targeted risk reduction for women in ANC should be considered for primary HIV prevention among couples. [ABSTRACT FROM AUTHOR]

The main aim of this paper was to identify job stressors, gender responses and association of psychosocial work stressors with prevalence of work related musculoskeletal disorders (MSDs) among foundry workers. The data were obtained with ergonomics checklist using Likert scale. The results of this study showed a high prevalence of MSDs among workers. The male workers were more prone to pain in neck while the female workers were more prone to MSDs in upper back and shoulders. Correlation analysis showed significant relationship of dimensions of work aspects with pain and discomfort. It proved that the work-related MSDs are the results of interaction of multiple stressors associated with work and work environment, and other personal factors. ANOVA indicated that the perception of work aspects as stressors differed significantly between male and female workers. [ABSTRACT FROM AUTHOR]

HIV epidemic in India is predominantly concentrated in subgroups of population, such as female sex workers (FSWs) and their clients, whose behavior exposes them to a higher risk of acquiring HIV infection. This paper aims to present the changing patterns of socio-demographic characteristics, behaviors, reported sexually transmitted infections (STIs), and associated factors among FSWs over 11 years. Multistage cluster sampling with probability-proportional-to-size (PPS) method was used in the surveys. A sample of 400 FSWs was studied every year. The mean age and literacy at the baseline level increased significantly over the years. House-based sex increased by 40% from 43.3% in 1997 to 83% in 2008 (p<0.001). Condom use at last sex with one-time clients; consistent condom use (CCU) with one-time and regular clients indicated increasing trends. FSWs reported low levels of condom use at last sex (14.5% in 1997 to 5% in 2008;p<0.001) and CCU (12.6% in 2004 to 3.6% in 2008;p<0.01) with regular partners. FSWs who used condom with one-time clients at last sex reported significantly less STI symptoms. A two-third reduction in genital ulcers was found from 13.1% in 1997 to 4.5% in 2008 (p<0.001). Nonliterate and hotel-based sex workers were 1.6 (1.0–2.5; 95% CI) and 2.2(1.3–3.7; 95% CI) times more likely to have reported STI symptoms. The percentage of FSWs who underwent HIV testing increased (p<0.001); similarly, a 20% increase was found in FSWs who availed counseling services from 65.2% in 1997 to 85.4% in 2008 (p<0.001). Poor, illiterate, and marginalized were more likely to get involved in risky behaviors which suggest the need for structural interventions as part of HIV prevention strategy. [ABSTRACT FROM AUTHOR]

• The likelihood of spousal violence is higher among families who belonged to the poorest living standard. • The prevalence of IPV is higher among those women whose husbands are currently unemployed due to the COVID-19 lockdown. • The women whose husbands have a loan were at more risk for experiencing IPV. • Partner's daily liquor consumption nature is also associated with IPV. Worldwide the incidents of intimate partner violence (IPV) have increased due to lockdowns related to the COVID-19 pandemic. This paper aims to identify the association between IPV and different socio-economic factors of women & their most recent partner during the COVID-19 pandemic in returnee migrant worker families in Balurghat Block (area 363.9 sq. km), Dakshin Dinajpur district, West Bengal, India. A total of 159 ever-married women were included in this present study, whose husbands were engaged as workers elsewhere at least two years before the lockdown. The result of the multinomial logistic regression model revealed that, after controlling for other variables, the women who had the poorest wealth background were 37% more likely (RRR: 1.37; 95% CI [1.18, 1.47]) to experience IPV almost every day in a week than those who had a middle wealth background. Conversely, the women who had the poorest wealth background were 37% (95% CI [0.57, 0.82]) less likely to experience IPV for three to four days in a week. Furthermore, the women whose partners were currently unemployed were 21% more likely (RRR: 1.21; 95% CI [1.16, 1.36]) to experience IPV almost every day in a week than those whose husbands were currently employed. The women whose husband's had a loan were 26% more likely (RRR: 1.26; 95% CI [1.25, 1.33]) to experience IPV for three to four days in a week than those whose husbands did not have any loans. The likelihood to experience IPV almost every day in a week is higher among those women whose husbands attain weekly (31%) loan instalment pattern and consume alcohol daily (31%). Interventions are needed at the grassroots level and some economic planning is required at an urgent basis. [ABSTRACT FROM AUTHOR]

Background Socioeconomic development has been considered as a solution to the problem of sex differentials at birth and under-five mortality. This paper analyses longitudinal data from the Ballabgarh Health and Demographic Surveillance System (HDSS) site in north India to check its veracity.Methods A cohort of children born between 1 January 2006 and 31 December 2011 at Ballabgarh HDSS were followed till death, emigration, 3 years of age or end of the study. Socioeconomic status (SES) was measured by caste, parental combined years of schooling and wealth index and divided into low, mid and high strata for each of them. Sex ratio at birth (SRB) was reported as the number of girls per 1000 boys. The Kaplan-Meier survival curves were drawn and a Cox Proportional HR of girls over boys was estimated. Results A total of 12 517 native born children (25 797 child years) were enrolled of which 710 died (death rate of 56.7/1000-live births and 27.5/1000 child-years. Socioeconomically advantaged children had significantly lower death rates. The SRB (10–16% lower) and neonatal death rate were consistently adverse for girls in the advantaged groups by all the three indicators of SES. The first month survival rates were better for girls in the lower SES categories (significant only in caste (HR 0.58; 0.37 to 0.91). High SES categories consistently showed adverse survival rates for girls (HR of 1.22 to 1.59). Conclusions Better socioeconomic situation worsened the sex differentials, especially at birth. Therefore,specific interventions targeting gender issues are required, at least as a short-term measure. [ABSTRACT FROM AUTHOR]

Background: Selection bias is common in clinic-based HIV surveillance. Clinics located in HIV hotspots are often the first to be chosen and monitored, while clinics in less prevalent areas are added to the surveillance system later on. Consequently, the estimated HIV prevalence based on clinic data is substantially distorted, with markedly higher HIV prevalence in the earlier periods and trends that reveal much more dramatic declines than actually occur. Methods: Using simulations, we compare and contrast the performance of the various approaches and models for handling selection bias in clinic-based HIV surveillance. In particular, we compare the application of complete-case analysis and multiple imputation (MI). Several models are considered for each of the approaches. We demonstrate the application of the methods through sentinel surveillance data collected between 2002 and 2008 from India. Results: Simulations suggested that selection bias, if not handled properly, can lead to biased estimates of HIV prevalence trends and inaccurate evaluation of program impact. Complete-case analysis and MI differed considerably in their ability to handle selection bias. In scenarios where HIV prevalence remained constant over time (i.e. β = 0), the estimated β1 derived from MI tended to be biased downward. Depending on the imputation model used, the estimated bias ranged from -1.883 to -0.048 in logit prevalence. Furthermore, as the level of selection bias intensified, the extent of bias also increased. In contrast, the estimates yielded by complete-case analysis were relatively unbiased and stable across the various scenarios. The estimated bias ranged from -0.002 to 0.002 in logit prevalence. Conclusions: Given that selection bias is common in clinic-based HIV surveillance, when analyzing data from such sources appropriate adjustment methods need to be applied. The results in this paper suggest that indiscriminant application of imputation models can lead to biased results. [ABSTRACT FROM AUTHOR]

Background This paper examines the association between degree of confidence in collective efficacy and self-efficacy for condom use and empowerment among heterogeneous female sex workers (FSWs) in two metropolitan Indian cities with high HIV prevalence. Methods The study utilises data from the Behavioural Tracking Survey, a cross-sectional behavioural study with 2106 FSWs recruited from 411 intervention sites in Mumbai and Thane. The key independent measures used determine the degree of confidence in collective efficacy (belief in the power to achieve goals and address problems together) and outcome measures included: self-efficacy for condom use with occasional clients and condom use with regular partners, self-confidence in handling a crisis situation and public speaking ability. Univariate and multivariate statistical methods were used to examine the study objectives. Results Of the analytical sample of 2106 FSWs, 532 (25.3%) reported high degree of collective efficacy for achieving certain goals and 1534 (72.8%) reported collective efficacy for addressing specific problems. FSWs reporting a higher collective efficacy as compared with those reporting lower collective efficacy were as follows: more likely to negotiate condom use with occasional clients (60.3% vs 19.7%; adjusted OR (AOR) =6.3, 95% CI 4.8 to 8.4) as well as regular partners (62.8% vs 20.2%; AOR =6.4, 95% CI 4.9 to 8.4); confident in facing troublesome stakeholders (73.5% vs 38.8%; AOR =4.3, 95% CI 3.3 to 5.6), confident in supporting fellow FSWs in a crisis (76.1% vs 49.6%; AOR =2.9, 95% CI 2.2 to 3.7), received help from other FSWs when a client or partner was violent (73.9% vs 46.3%; AOR =3.5, 95% CI 2.7 to 4.5) and had stood up to the police or madams/brokers to help fellow FSWs in the past 1 year (5.8% vs 3.3%; AOR =2.7, 95% CI 1.5 to 4.9). Conclusion The results suggest that the strategy of collectivisation in HIV prevention programme has much broader benefits than merely the promotion of safer sex practices. Future HIV prevention interventions in India and elsewhere may include collectivisation as the core strategy within HIV prevention programmes. [ABSTRACT FROM AUTHOR]