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Abstract Background Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal. Methods In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital. Results We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% (n=109) in the intervention group and 42.9% (n=64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p

National surveillance data were collected to study the outbreak trends of infectious diseases/syndromes before and during the COVID-19 pandemic period, spanning from 2018 to 2022. The study found that out of 4208 outbreaks, 2972 occurred before the COVID-19 period, affecting 147,425 people, while 1236 outbreaks affected 52,324 people during the pandemic. The number of outbreaks for diseases such as acute flaccid paralysis, fever with rashes, leptospirosis, rabies, and scrub typhus increased during the pandemic. The geographic distribution of outbreaks remained similar for some reemerging diseases in both periods. The trends for dengue, Japanese encephalitis, and cholera remained consistent with peaks mostly from July to September in both periods. We observed a considerable reduction in morbidity and mortality due to outbreaks in India during the pandemic. Despite similar distributional patterns, the study indicates a strong suspicion of persistent outbreak-initiating factors, necessitating an efficient and vigilant surveillance system in the country.

Background: The treatment gap for people with common mental disorders is large, estimated to be 75–95% in India; the reasons are multi-factorial. It was found that 89% of the primary health centers are not providing mental health care services. Technology like the electronic-mental Health Global Action Program-Intervention Guide (e-mhGAP-IG) is necessary to fill this gap, which in turn helps to attain one of the aims of National Mental Health Program-1982. Hence, the study is planned to understand the feasibility and adaptability of WHO’s e-mhGAP-IG by the primary health workers in the delivery of mental health care for child and adolescent mental/behavioral disorders (CMH) and substance use disorders (SUB). Methods: It is an open-label randomized control trial planned to conduct at primary healthcare centers, Chittoor district. Primary health care staff working at PHCs/Sub-centers having one year experience, and being able to handle smart phones will be included in the study. Data will be collected using a self-structured case report form (CRF) and analyzed by applying per protocol analysis using JAMOVI software. The cost of intervention and the impact on disease outcomes will be taken concurrently to estimate the cost-effectiveness of the intervention. Trial registration: CTRI/2023/04/051899 dated 24/04/2023 under the clinical trials registry-India Protocol version: 1.0 dated 24/04/2023

Background: This study aims to analyse the undernutrition burden in India and assess the state-level distribution of nutritional indicators among children under three, using data from NFHSs. Methods: This analysis focused on children under three years old and examined the prevalence and trend of undernutrition indicators in India at national and state levels. Changes over a decade were assessed to determine the burden. The study employed a multilevel logistic regression model to measure undernutrition burden, incorporating household and individual factors. Results: From NFHS-1 to NFHS-5, wasting prevalence increased slightly from 19.9 % to 20.5 %, while stunting and underweight decreased from 51.9 % to 34.1 % and 45.8 %–29.4 %, respectively. Stunting and underweight saw a decrease of 6.36 % (↓) and 5.86 % (↓), respectively, while wasting showed a slight increase of 0.21 % (↑). Mother's education and the child's sex were significant factors influencing children's nutritional status. Conclusion: Despite advancements in reducing undernutrition indicators in India through national nutrition programs, the pace of progress remains slow. Prioritizing the fulfillment of nutrition-related SDG goals is crucial. Policymakers can leverage the study's results to create interventions for improving children's nutritional status. Coordinated efforts at both state and national levels are essential to achieve specific improvements in undernutrition indicators across programs.

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico-mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies (21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21–40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%–100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%–97.2%) and Trichophyton rubrum (0%–69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Background: Yoga therapy can be a promising adjunct to antiretroviral therapy. However, evidence on the effectiveness of Yoga therapy is scanty. The proposed trial will estimate the effect of integrated yoga practice for six months on immune parameters (CD4 (cluster of differentiation 4), viral load) among adult people living with HIV (PLWH) and its cost-effectiveness from the healthcare system’s perspective. Methods: In this randomized open-label parallel-group trial, 110 PLWH in stage 2 HIV, between 18 and 49 years in the intervention arm and 220 PLWH in the same stage will be recruited by block randomization. Integrated yoga practice will be given for six months in the intervention arm, and health education on yoga practice in the control arm, besides antiretroviral therapy. After six months, the difference in immune parameters, cardio-metabolic indicators and quality of life (QOL) will be assessed. Besides, an economic evaluation will be done with sensitivity analysis. If found useful, the intervention can be tested at large scale for further confirmation of the outcomes. Irrespective of the study's outcome, the results will be disseminated through peer-reviewed journals. Trial registration: CTRI/22/09/045909 dated 27/09/2022 under the Clinical Trials Registry-India version: 1.0 dated 27/09/2022

Background: Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC). Objectives: As economic evidence in this area is scanty, especially in low- and middle-income countries, the objectives of the study are to perform an economic evaluation and compare the cost between EDC and PDC. Methods: A cost-comparison study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community-based survey. Step-down cost accounting was adopted with a bottom-up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e-SPSS and p-SPSS, respectively). We conducted scenario analyses based on the usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA, and p-STATA, respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results. Results: In the base-case analysis, total costs of EDC and PDC were ₹72,617 ($1060.9) and 87,717 ($1281.5), respectively, with estimated cost reduction of ₹15,100 ($220.6). In other scenarios, the estimated cost reduction for e-R, e-STATA, p-R, p-STATA was ₹−274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2), respectively, when compared to EDC-SPSS. On one-way and PSA, the results of the cost-comparison analysis were robust. Conclusion: EDC minimizes institutional cost for conducting health research. This finding will help researchers in efficiently planning for the budget for their research.

Context/Background: Malnutrition among children is a long-standing public health problem in India. Objective: To assess the nutritional status of pre-school children and to identify the socio-demographic determinants of malnutrition. Methodology: In this community-based cross-sectional study, 194 under-five children were recruited from rural and urban areas of Chittoor district, Andhra Pradesh. Anthropometric measurements including weight, and mid upper arm circumference were measured and age standardized weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated. The proportion of under nutrition (WAZ

Background: Social mapping, though an old approach in public health education and research, not practiced much in nursing education. This study was conducted to describe the social mapping process in a semi-urban area in the Chittoor district of Andhra Pradesh in India and to describe the implications of such social mapping from the students' perspective. Methods: This participatory rural appraisal was conducted for the Bachelor of Nursing Students in a semi-urban settlement in the state of Andhra Pradesh in India. The social mapping process was conducted in three broad steps- classroom-based teaching of social mapping, conducting social mapping in the community and a debriefing session with the students. The major outcome of this educational activity was the social map. In addition, we also came up with the students’ implications through group discussion. Results: A facility map was constructed by the community members which was replicated by the teachers. The map was triangulated by the teachers through a transect walk in that area. The students came out with various academic, clinical, and administrative implications from this educational session. Conclusion: Social mapping can be used as a potential tool in nursing education. More evidence is required on this learning approach before recommending it in the Community Nursing curriculum.

Background: Self-care practice by diabetic people is key to achieving therapeutic goals. The objectives of the study were to describe the self-care practice of adult people with type 2 diabetes in a rural area of Andhra Pradesh and to identify the determinants of poor self-care practice of this population. Methods: A community-based cross-sectional study was conducted among the known diabetics in a rural PHC between November 2018 and October 2019. Self-care practices among the registered diabetes patients were described in seven domains as recommended by the American Association of Diabetes Educators (AADE). Risk factors were identified using univariate, followed by multivariate logistic regression. The risk for poor self-care score was expressed in odds ratio (OR) with 95% confidence interval (CI). Results: A total of 727 participants were recruited for the study. The mean age of the participants was 57 years (SD: 9.5 years). The self-care was prominent in diet modification, physical activity, and physical activity components. The median self-care score of the participants was 14 (IQR = 12.5 to 15.5). 32.6% (95% CI: 31.6%–33.6%) participants had good self-care scores. With multivariate regression analysis, we found that widowed/separated (aOR 1.85, 95% CI: 1.2–3.0) was a risk factor for poor self-care scores; and skilled workers (aOR 0.28, 95% CI: 0.1–0.6) had a significantly lower risk compared to the unskilled workers. Conclusion: Overall, self-care practices are poor in problem-solving, risk reduction and healthy coping behaviours. Low education and poor socio-economic status could be the most likely reasons for poor self-care practices.

Objectives: To identify risk factors associated with Coronavirus disease 2019 (COVID-19) in a Tertiary care cancer hospital-based cluster and recommend control measures. Methods: We conducted tracing and confirmation among hospital and community contacts. We telephonically interviewed and abstracted information from hospital records and registers. We described the cluster by time, place and person. We conducted unmatched case-control study to compare risk factors and computed Odds Ratio (OR) and 95% confidence interval. Results: We confirmed COVID-19 in 21 of 1478 tested (1.4%). Secondary attack (%) of COVID-19 among 824 contacts was higher among in-patients of block A (18), household contacts (3.4), housekeeping staff (3.3) and nurses (1.7). The cluster started on April 22 with two successive peaks five days apart and lasted until May 8. Being male, patients aged >33 years [OR = 30·7; 95% CI = 3·6 to 264], having hypertension [OR = 4·3; 95% CI = 1·1 to 16·7] or diabetes [OR = 3·8; 95% CI = 1·0 to 14·1] were associated with COVID-19. Mask compliance was poor (20%) among hospital workers. Discussion: We recommended screening of all patients for diabetes and hypertension and isolation/testing of anyone with influenza-like illness for preventing COVID-19 clusters in hospital settings.

BACKGROUND: Diagnostic dilemma arises when patients with clinical suspicion of COVID-19 disease having moderate-to-severe respiratory symptoms yield negative result for COVID-19 in reverse transcription polymerase chain reaction (RT-PCR). This study evaluated the clinical, laboratory and HRCT thorax findings among RT-PCR-negative COVID-19 suspects with moderate-to-severe disease. MATERIALS AND METHODS: A hospital-based retrospective observational study was conducted between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID-19 suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU), who were negative for COVID-19 in RT-PCR. Data were abstracted from the medical records section of the hospital using a predesigned data abstraction form and presented by descriptive statistics. RESULTS: Mean age of study participants was 55.5 years (SD 14.1 years), and majority were males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea (n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C-reactive protein (n = 60, 100%), NLR (n = 49, 81.7%), d-dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%), vascular thickening (n = 35, ≥58.3%), and sub-pleural lines (n = 32, 53.3%). Median CT-SS value was 15 (IQR 11–19), and majority (n = 56, 93.3%) belonged to CO-RADS ≥4. CONCLUSION: Diagnosis of COVID-19 can be presumed in RT-PCR-negative suspected COVID-19 patients with moderate-to-severe disease, with marked rise of inflammatory markers and HRCT revealing typical findings of COVID-19 pneumonia.