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Scrub typhus, caused by Orientia tsutsugamushi , is a re-emerging zoonotic disease in the tropics with considerable morbidity and mortality rates. This disease, which is mostly prevalent in rural areas, remains underdiagnosed and underreported because of the low index of suspicion and non-specific clinical presentation. Limited access to healthcare, diagnostics, and treatment in rural settings further makes it challenging to distinguish it from other febrile illnesses. While easily treatable, improper treatment leads to severe forms of the disease and even death. As there is no existing public health program to address scrub typhus in India, there is an urgent need to design a program and test its effectiveness for control and management of the disease. With this backdrop, this implementation research protocol has been developed for a trial in few of the endemic "pockets" of Odisha, an eastern Indian state that can be scalable to other endemic areas of the country, if found effective. The main goal of the proposed project is to include scrub typhus as a differential diagnosis of fever cases in every tier of the public health system, starting from the community level to the health system, for the early diagnosis among suspected cases and to ensure that individuals receive complete treatment. The current study aimed to describe the protocol of the proposed Scrub Typhus Control Program (STCP) in detail so that it can receive valuable views from peers which can further strengthen the attempt., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jain, Das, Dixit, Kaur, Pati, Ranjit, Dutta and Bal.)

Introduction: The COVID-19 outbreak has posed a major challenge to healthcare providers. Due to its communicable nature, very stringent public health interventions have been put in place worldwide; yet, it still poses new emerging challenges, one of the most recent being a multisystem inflammatory condition with clinical features resembling Kawasaki-like disease and toxic shock syndrome in children and adolescents. The data on this novel condition are scarce which need to be reported to identify its clinico-epidemiological and geographical distribution. There is an urgent need to generate evidence for diagnosis and management of this condition in the midst of a pandemic., Methods and Analysis: This systematic review will be conducted using Medline database searched through PubMed, Embase, Ovid; and Google Scholar, ProQuest and EBSCO databases will also be searched along with grey literature with the aim to identify the clinical features, aetiopathology, laboratory findings, treatment modes and outcomes of Kawasaki-like disease among paediatric patients suffering from COVID-19. Original articles reporting Kawasaki-like disease in paediatric patients with COVID-19 will be retrieved after screening by two independent reviewers. Data will be extracted in a specially designed form and studies will be assessed independently for risk of bias. Data will be extracted for the following: author, journal title, publication year, study design, study setting, demographic characteristics, sample size, clinical features, aetiopathology, laboratory findings, modes and doses of treatment given, strength and weakness of studies. A descriptive and quantitative analysis will be completed., Ethics and Dissemination: This is a literature-based review study with no ethical concerns. We will publish the results in a peer-reviewed journal and present at a conference., Prospero Registration Number: CRD42020187427., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Public health ethics has been receiving increasing attention in recent years. Frequently, public health practitioners have to confront complex decisions, with numerous and often conflicting ethical implications. The objective of this study was to obtain information on the teaching of public health ethics in India by making a detailed examination of the public health and community medicine curricula. The specific areas of interest included the content and structure of the courses and electives available to students. The results of this study indicate that ethics courses are yet to find their rightful place in the teaching of public health in India. The curricula vary across institutes in terms of the time and content devoted to the teaching of public health ethics. It is suggested that public health programmes in India develop and incorporate ethics courses so as to keep pace with the emerging challenges in the field. An interdisciplinary consortium should preferably be formed at the national level to take up this academic endeavour.

Background: Limited evidence exists on the effectiveness of using an entertainment-education methodology to address multiple public health issues and of using participatory street theatre to improve public understanding related to public health. Objective: To assess the feasibility, acceptability and impact of the Actor-Doctor project, an intervention involving theatre professionals and medical specialists to jointly deliver street-theatre-based public health education. Design: A real-world, mixed-methods post-intervention study evaluated the Actor-Doctor project among 486 participants in Ahmedabad, India, in 2017. Setting and method: Focus group discussions with actors and semi-structured interviews with doctors and implementers assessed project feasibility, acceptability and perceived impact. Post-intervention surveys among actors, audience and a control group assessed impact on knowledge and attitudes related to select public health issues. Quantitative data were analysed using multivariable regression, and qualitative data were analysed using an inductive thematic analysis. Results: The Actor-Doctor project was feasible to implement, as 20 street theatre performances on five public health themes were developed and staged. Members of the audience showed higher knowledge of environmental health, anaemia and openness to discussing sexual health issues, compared to a control group (omega squared 0.03-0.24; p < 0.001). Actors and doctors collaborating to create theatre-based public health education derived satisfaction from the project. Balancing scientific accuracy and entertainment, especially humour was challenging. Conclusion: The Actor-Doctor project was instrumental in improving public-health-related engagement between actors, doctors and the public.

Background: Maintaining optimal hearing health and preventing ear infections is crucial across all life stages, spanning from before birth and infancy to middle age and beyond. The primary aim of the research was to evaluate and compare the effectiveness of the telemedicine-enabled otoscope (TEO) in diagnosing ear diseases with that of the conventional otoscope. Materials and Methods: The databases PubMed, Cochrane, and Embase were thoroughly searched to find original studies on TEO at the community as well as hospital levels along with meta-analysis for comparison with standard diagnostic methods using traditional otoscopes. Results: The telemedicine-equipped otoscope displays a sensitivity of 82% (confidence interval 0.78-0.95) and a specificity of 95% (confidence interval 0.93-0.96). When employed by physicians, the combined sensitivity and specificity become 84% (confidence interval 0.79-0.88) and 91% (confidence interval 0.87-0.94), respectively. Community Health Workers (CHWs) using telemedicine-enabled otoscopes exhibit a collective sensitivity of 80% (confidence interval 0.72-0.87) and a collective specificity of 97% (confidence interval 0.95-0.98). Snapping multiple photographs and removal of cerumen where necessary in increasing the quality of the photographs for diagnosis. Conclusions: The TEO holds the promise of substantially enhancing the accessibility of audiology services, encompassing evaluation, public outreach, and fundamental care. Its implementation has the potential to fortify primary health care environments, contributing to the prevention of ear diseases and assisting in mitigating the shortage of skilled ear care professionals. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis (LF) is a significant public health issue in India. Despite 10–15 rounds of mass drug administration (MDA) in India, the global LF elimination target of 2030 appears challenging. To strengthen the program, community and provider perspectives on ways to bridge a gap in MDA are needed. Through the motivation–opportunity–ability–behaviour (MOAB) lens, we systematically reviewed the facilitators and barriers encountered in LF elimination in India. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched PubMed, Embase, ProQuest and Google Scholar databases to explore factors related to MDA program implementation in India through 30 June 2021. We analysed the data using a thematic framework. We identified 576 studies; of these, 20 studies were included. This review revealed that the public health system for distributing MDA drugs in India created a better enabling environment, including zero out-of-pocket expenditure, door-step distribution of medicines and ample capacity-building training and follow-up. However, community members were unaware of the rationale for drug consumption, leading to a gap in drug distribution and consumption. Motivation is required among community members, which suggests capacity-building training for service providers to counsel the community. [ABSTRACT FROM AUTHOR]

Background: Childhood mortality and morbidity has become a major public health issue in low-middle-income countries. However, evidence suggested that Low birth weight(LBW) is one of the most important risk factors for childhood deaths and disability.This study is designed to estimate the prevalence of low birth weight (LBW) in India and to identify maternal correlates associated with LBW. Methods: Data has been taken from National Family Health Survey 5 (2019–2021) for analysis. 149,279 women belonging to reproductive age group (15–49) year who had last recent most delivery preceding the NFHS-5 survey. Results: Mother's age, female child, birth interval of less than 24 months, their low educational level, low wealth index, rural residence, lack of insurance coverage, women with low BMI, anaemia, and no ANC visits during pregnancy are predictors that contribute to LBW in India. After adjusting for covariates, smoking and alcohol consupmtion is strongly correlated with LBW. Conclusion: Mother's age, educational attainment and socioeconomic status of living has a highly significant with LBW in India. However, consumption of tobacco and cigarrettes are also associated with LBW. [ABSTRACT FROM AUTHOR]

Community engagement and involvement (CEI) was crucial for the COVID-19 pandemic response, particularly among the urban poor in low-and middle-income countries (LMICs). However, no evidence synthesis explores how CEI can benefit public health emergencies. We conducted a systematic scoping review of the CEI with an emphasis on stakeholder identification, accountability mapping, the support system, and the engagement process among urban poor populations in LMICs during the COVID-19 pandemic. We searched eleven databases, including PubMed, Embase, Web of Science, and CINAHL, following the PRISMA-2020 guidelines to find articles published between November 2019 and August 2021. PROSPERO registration No: CRD42021283599. We performed the quality assessment using a mixed-method appraisal tool. We synthesized the findings using thematic framework analysis. We identified 6490 records. After the title and abstract screening, 133 studies were selected for full-text review, and finally, we included 30 articles. Many stakeholders were involved in COVID-19 support, particularly for health care, livelihoods, and WASH infrastructure, and their accountability mapping by adopting an interest – influence matrix. This review emphasizes the significance of meaningful CEI in designing and implementing public health efforts for pandemic management among urban slum populations. The interest – influence matrix findings revealed that specific community volunteers, community-based organizations, and civil society organizations had high interest but less influence, indicating that it is necessary to recognize and engage them. Motivation is crucial for those with high influence but less interest, such as corporate responsibility/conscience and private food supply agencies, for the health system's preparedness plan among urban populations. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is a neglected zoonotic disease found predominantly in lower- and middle-income countries (LMICs), causing significant public health concern in India. The objective of this study was to assess the prevalence of human brucellosis in Odisha, India among community members involved in animal husbandry as a common practice. Method: This cross-sectional study included 817 adult participants from 11 districts in Odisha. Four districts from the Northern division, four districts from the Central division, and three districts from the Southern division were selected for the study. Blood samples were collected during a COVID-19 serosurvey in Odisha conducted from 1st to 17th September 2021. Immunoglobulin-G (IgG) antibodies were measured against Brucella using a commercial ELISA kit. Point estimates at 95% confidence intervals (CIs) and adjusted odds ratio were calculated. Results: The overall prevalence of anti-Brucella IgG antibodies was calculated at 16.65% (95% CI: 14.19-19.42). The highest seropositivity was found in Sambalpur district (29.73%; 95% CI: 16.43-47.16) and the lowest was determined in Mayurbhanj district (4.44%; 95% CI: 0.99-15.60). Compared to males, females were more prone to contracting the disease (AOR: 1.13; 95% CI: 1.05-1.67). Participants from rural settings had higher prevalence of anti-Brucella IgG antibodies than urban dwellers (AOR: 4.53; 95% CI: 1.73-11.86). Conclusion: This study revealed that human brucellosis was associated with sociodemographic factors like gender, living settings, and household numbers. To prevent brucellosis, screening should be initiated, infected humans should be treated early, and the public should be educated about risk factors and preventive measures. [ABSTRACT FROM AUTHOR]

Introduction: Lymphatic filariasis (LF) is a debilitating and disabling parasitic disease of immense public health concern in India with more than 650 million people at risk. Mass drug administration (MDA) is the recommended preventive chemotherapy strategy to eliminate LF. But, its coverage and compliance has been a mixed success. There is an urgent need of evidence to strengthen the program further, which can be done by exploring and understanding implementer as well as beneficiary perspectives. Objective: To systematically review the facilitators and barriers experienced during the coverage and compliance of MDA for LF elimination in India from both beneficiary and provider’s (health system) perspective. Methods and Analysis: We will search at Medline database through PubMed and Embase, along with ProQuest and Google Scholar to retrieve literature. Original qualitative observational studies exploring challenges and enablers in MDA program will be screened by two independent reviewers systematically based on title and abstract followed by full text. The risk of bias will be assessed through critical appraisal skills program checklist for each included article. Data will be extracted in a pre‑designed proforma with study characteristics, demographic features, and texts and quotes of qualitative data. Data will be analyzed through thematic analysis and motivation‑opportunity‑ability‑behavior framework using MAXQDA software. Ethics and Dissemination: This is a literature‑based review with minimal privacy concerns. The findings of this study will be published in a peer‑reviewed journal and disseminated through policy brief to program implementers. [ABSTRACT FROM AUTHOR]

Enteric fever (typhoid and paratyphoid fever) is a public health concern which contributes to mortality and morbidity all around the globe. It is caused mainly due to ingestion of contaminated food and water with a gram negative, rod-shaped, flagellated bacterium known as Salmonella enterica serotype typhi (typhoid fever) or paratyphi (paratyphoid fever). Clinical problems associated with Salmonellosis are mainly bacteraemia, gastroenteritis and enteric fever. The bacteria undergo various mechanisms to escape itself from immune reaction of the host, modulating immune response at the site of infection leading to virulence factor production and anti-microbial resistance. Biofilm is one of the adaptation mechanisms through which Salmonella survives in unfavourable conditions and thus is considered as a major threat to public health. Another property of the bacteria is "Quorum Sensing", which is a cell–cell communication and most of the pathogenic bacteria use it to coordinate the production of several virulence factors and other behaviours such as swarming and biofilm formation. Earlier, quorum sensing was believed to be just a medium for communication but, later on, its role in virulence has been studied. However, there are negligible information relating to interaction between quorum sensing and biofilm formation and how these events play crucial role in Salmonella pathogenesis. The review is a summary of updated information regarding how Salmonella uses these properties to spread more and survive better, making a challenge for clinicians and public health experts. Therefore, this review would help bring an insight regarding how biofilm formation and quorum sensing are inter-related and their role in pathogenesis and virulence of Salmonella. [ABSTRACT FROM AUTHOR]

Universal Newborn Hearing Screening (UNHS) is a significant public health initiative as early diagnosis and intervention are critical for children's cognitive development. In India, priority for UNHS has been provided since 2013; however, there are various operational challenges associated with it. There is a lack of multi-stakeholders perspective on UNHS, which is crucial for improving the service intake. Therefore, this study attempted to understand the perspective of various stakeholders to explore the practices, processes and technologies used in the existing UNHS landscape in Odisha, India. The qualitative in-depth interviews were conducted among various stakeholders including 15 mothers, 5 service providers (audiologists), 10 districts and state-level programme managers. Data were analysed using content analysis approaches. Two major themes emerged were 'social-shaping of technology for UNHS' and 'mothers' understanding and experience on UNHS'. Employee retention, equipment limitations, facilities maintenance and little knowledge among mothers about hearing screening have been described as major operational challenges. The study revealed that to increase universal coverage 'screening technology should be socially shaped'. There seems to be a need for 'portable technology with ease to use and better diagnostic accuracy' for first-stage screening at various levels of healthcare facilities along with community literacy on UNHS. [ABSTRACT FROM AUTHOR]

Background: Anthrax is a major but neglected zoonotic disease of public health concern in India with Odisha contributing a major share to the disease burden. Bacillus anthracis spores can be found naturally in soil and commonly affect both animals and humans around the world. Domestic and wild animals such as cattle, sheep, goats, and deer can become infected when they inhale or ingest spores from contaminated soil, plants, or water. Anthrax can be fatal if patients are not treated promptly with antibiotics. This protocol aims to describe the implementation and evaluation of the 'One Health' intervention model based on the principles of Theory of Change (ToC) to eliminate human anthrax from a tribal district in Odisha, India. Methods: This study would test the effectiveness of a complex public health intervention package developed using the ToC framework for the elimination of human anthrax in Koraput district by a comparative analysis of baseline and end-line data. We plan to enroll 2640 adults across 14 geographically divided blocks in Koraput district of Odisha for baseline and end-line surveys. After baseline, we would provide capacity building training to stakeholders from the department of health, veterinary, forest, academic and allied health institutions followed by workshops on sensitization and awareness through IEC (Information Education Communication)/BCC (Behavior Change Communication) activities in the community. We would establish a state-level laboratory facility as a robust system for timely diagnosis and management of human anthrax cases. Surveillance network will be strengthened to track the cases in early stage and risk zoning will be done for focused surveillance in endemic areas. Advocacy with district level administration will be done for maximizing the coverage of livestock vaccination in the entire district. Interdepartmental coordination would be established for the effective implementation of the intervention package. Conclusion: This would be a first study applying One Health concept for the elimination of human anthrax in India. The findings from this study will offer important insights for policy-making and further replication in other endemic regions of the state and country. Trial registration: The authors confirm that all ongoing and related trials for this intervention are prospectively registered with the Clinical Trials Registry of India [CTRI/2020/05/025325] on 22 May 2020. [ABSTRACT FROM AUTHOR]

Estimation of the spread and advancement of Plasmodium falciparum artemisinin-resistant parasites can be done by probing polymorphisms in the kelch (Pfk13) domain (a validated molecular marker). This study aimed to provide baseline information for future artemisinin surveillance by analyzing the k13-propeller domain in P. falciparum field isolates collected from 24 study areas in 14 malaria hot spots of Odisha (previously Orissa) during July 2018-January 2019. A total of 178 P. falciparum mono infections were assessed. An 849-base pair fragment encoding the Pfk13 propeller was amplified by nested polymerase chain reaction and sequenced in both directions (PCR). After DNA alignment with the 3D7 reference sequence, all samples were found to be wild type. It can be anticipated that malaria public health is not under direct threat in Odisha relating to ART resistance. [ABSTRACT FROM AUTHOR]

Context: Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha. Aim: To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities Settings and Design: A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers. Statistical Analysis Used: Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method. Results: Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level. Conclusions: On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major public health challenge in India with significant economic burden and healthcare utilization and contributes to patients' daily life limitations. Health-related quality of life (HRQoL) reflects the health- and disease-related aspects of QoL. Limited studies have examined this dimension in healthcare settings. We explored the HRQoL among patients with COPD attending a tertiary care facility and the factors (enablers and constraints) influencing it. Materials and Methods: A parallel mixed-method study design was adopted to undertake the study. Data were collected from 110 patients with COPD attending the outpatient department of the tertiary care hospital at Bhubaneswar, Odisha, during June and July 2014. The translated and pretested version of St. George Respiratory Questionnaire (SGRQ) was used. In addition, in-depth interviews were held with 11 patients. Results: The overall HRQoL was significantly lower in females and patients from rural area. It declined with increasing age and was worst in patients age 70 years or above. Patients having two or more comorbid conditions had the poorest HRQoL. Reason for not using inhalers was mentioned to be perceived harm due to prolonged use. Family support and better financial condition were enablers while easy accessibility of healthcare facilities helped in early interventions. Conclusion: COPD has considerable negative impact on the QoL with advancing age and is worse among the geriatric age group population. Acute exacerbations impair HRQoL. The degree of severity of COPD could be determined by SGRQ which reflects the impairment of their HRQoL. [ABSTRACT FROM AUTHOR]

The growing epidemic of noncommunicable diseases (NCDs) has impacted the national health systems, policies, and socioeconomic developments, thereby leading to increasing country level disparities. Despite substantial improvements in health indicators made in the past decade, the Indian health-care system continues to contribute disproportionately to the global disease burden, wherein NCDs holds significant prominence. Against this background, the present review analyzes the current NCD landscape from the perspective of India's health system preparedness toward meeting this growing challenge. Implementation and delivery of strategies and interventions are often impeded by existing grass root level challenges. Recognizing the importance of effective primary care, the review highlights the importance of implementing affordable, accessible, and comprehensive interventions, and delivering them at societal, a community and individual level. This simultaneously calls for strengthening of the primary care system through appropriate strategy and policy frameworks. Toward addressing India-specific needs in NCD prevention and management, concerted efforts on development of robust surveillance mechanisms, intersectoral and interdepartmental collaborations, integration of national programs, enhanced role of education and awareness should be made, to ensure effectivity, scale-up, and outreach of services in primary care. [ABSTRACT FROM AUTHOR]

India is currently undergoing a rapid demographic transition along with a dramatic upsurge in the number of elderly adults. Creating a cadre of specialized health care professionals in geriatric medicine is clearly vital to address the health care needs of this growing population. The authors undertook a mapping of the available academic programs in geriatric health in India and examined their content, duration, architecture, and student intake. A total of 20 programs were identified in geriatric health, thus highlighting a paucity of training options in this field. Compared to Western countries, relatively few programs are offered in clinical and public health geriatrics in India. This is further compounded by an insignificant thrust of geriatrics in undergraduate health professional curricula. Our results underscore the need for a national-level curricular initiative to strengthen and mainstream the teaching of geriatric health in the country. Alternative educational strategies such as blended learning and interprofessional education should be explored to enhance geriatric health workforce competence. [ABSTRACT FROM AUTHOR]

Maternal and child health (MCH) has been a global priority for many decades and is an essential public health service. Ensuring seamless delivery is vital for desirable MCH outcomes. This systematic review outlined the challenges in accessing and continuing MCH services during public health emergencies—pandemics and disasters. A comprehensive search approach was built based on keywords and MeSH terms relevant to 'MCH services' and 'pandemics/disasters'. The online repositories Medline, CINAHL, Psyc INFO, and Epistemonikos were searched for studies. We included twenty studies—seven were on the Ebola outbreak, two on the Zika virus, five related to COVID-19, five on disasters, and one related to conflict situations. The findings indicate the potential impact of emergencies on MCH services. Low utilization and access to services have been described as common challenges. The unavailability of personal safety equipment and fear of infection were primary factors that affected service delivery. The available evidence, though limited, indicates the significant effect of disasters and pandemics on MCH. However, more primary in-depth studies are needed to understand better the overall impact of emergencies, especially the COVID-19 pandemic, on MCH. Our synthesis offers valuable insights to policymakers on ensuring the uninterrupted provision of MCH services during an emergency. [ABSTRACT FROM AUTHOR]

Health care is one of the key essential services to be traditionally impacted by financial turbulences. The Government of India announced the demonetization of INR 500 and INR 1000 currency notes in November 2016 to curb corruption and introduce economic transparency. The present commentary analyzes the impact of this economic reform on the availability/delivery of health-care services and also its transient effect on the general population availing such services during the first 2 weeks post demonetization. While print and electronic media indicated initial setback and displeasure with reference to delivery and access of health-care services, personal interaction with caregivers or patients suggested that there was no lasting adverse effect on health-care delivery. In fact, the enthusiasm for a cleaner economy meant for the greater good of the country prevailed among the general public and allowed them to bear these hardships. Our assessment suggests that demonetization and its consequential transition were viewed favorably. Financial and economic reforms initiated in the national interest can therefore be managed well with public support. [ABSTRACT FROM AUTHOR]

Background: Evidence-based research has documented the association between alcohol intake during pregnancy and increased risk of miscarriage, stillbirth and congenital birth defects. Alcohol consumption is a complex behavior whose origins lay in cultural norms and the social structure. In tribal communities in India, alcohol misuse among women is a public health problem. This study is intended to explore perceptions and beliefs among tribal women and the community towards alcohol consumption during pregnancy.Methods: A qualitative study was conducted in a tribal-dominated district of Odisha, India. The WHO AUDIT tool was used to identify women who consumed alcohol during their pregnancies. In-depth interviews were conducted with 19 eligible women and 18 family members. Additionally, two focused group discussions were held with local community leaders and health workers. The data was transcribed, systematically coded and analyzed following the thematic framework approach.Results: The findings suggest that a complex interplay of drivers contributes to the unrestricted intake of alcohol by pregnant women. This could be attributed to: a lack of social monitoring, easy access to alcohol, low alcohol literacy and alcohol's normative status in daily customs and traditions. Another contributing factor is a community-wide perception that home-made alcohol poses no ill effects.Conclusion: Alcohol consumption is deeply embedded in the daily rituals of indigenous tribal women. To address this issue, community counselling utilizing platforms of RMNCHA and VHND could be Ideal. A well-designed, culture-based intervention encompassing alcohol researchers, mental health specialists, public health workers and anthropologists is necessary. [ABSTRACT FROM AUTHOR]