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Background: Synergistic effects of yoga or physical exercise (PE) along with protein supplementation on children's muscle function in rural India have not been studied. Hence, we aimed to study the effect of yoga and PE along with protein supplementation on muscle function in healthy 6- to 11-year-old rural Indian children post 6 months of intervention. Methods: A randomized controlled trial on 232 children, recruited into 3 groups, each receiving 1 protein-rich ladoo (148 kcal, 7 g protein/40 g ladoo–an Indian sweet snack) daily and performing (1) yoga (n = 78) for 30 minutes 5 times per week, (2) PE (n = 76) for 30 minutes 5 times per week, or (3) control group (n = 78) no additional exercise. Maximum power, maximum voluntary force (Fmax), and grip strength (GS) were measured. Data were analyzed using paired t tests and a 2-way mixed analysis of variance with post hoc Bonferroni adjustment. Results: GS, maximum power, and Fmax within yoga group increased significantly (P <.05) from baseline to endline. GS and Fmax increased significantly within PE group postintervention (P <.001). In controls, GS increased (P <.05) at endline. No significant effect of the intervention was observed on the change in maximum power (P >.05) postintervention. The 2 exercise groups showed significant increase in Fmax compared with the control group (P <.05). Similarly, increase in GS was significantly higher in both the exercise groups compared with the control group (P <.05). No significant difference was observed in change in muscle function between the 2 exercise groups (P >.05). Conclusions: Structured physical activity along with protein supplementation resulted in improved muscle function in children. Yoga and PE showed a comparable impact on muscle force. [ABSTRACT FROM AUTHOR]

This paper examines the link between a mother's autonomy—the freedom and ability to think, express, make decisions and act independently—and the nutritional status of her children. We treat 'autonomy' as a latent variable, and design a novel statistical framework to measure this. This method allows us to separate the direct associations of maternal and family characteristics in our model for nutrition, from their indirect associations that work through maternal autonomy. Using data from India, we explore the sensitivity of our estimates to endogeneity caused by sample selection in the presence of son preference. We find: (i) a one standard deviation (SD) higher autonomy score is associated with a 0.16 SD higher height‐for‐age z‐score (HAZ score); and (ii) a 10% lower prevalence of stunting (HAZ < −2 SD). The latter is equivalent to the prevention of approximately 300,000 children stunting, indicating the important role of maternal autonomy. This paper is part of the Economica 100 Series. Economica, the LSE "house journal" is now 100 years old. To commemorate this achievement, we are publishing 100 papers by former students, as well as current and former faculty. Wiji Arulampalam obtained her PhD from the LSE. [ABSTRACT FROM AUTHOR]

Background: Disabled Children suffer Intellectual Disability/ies (ID) to a varying extent. Role of environmental and non-genetic factors in Intellectual Disability remains largely unexplored in developing nations. The study aimed to determine Intellectual Disability among disabled rural children and its association of various demographic variables. Methods: A cross sectional study was conducted in a randomly selected rural health zone. 52 children of ages 1-18 years with various disabilities were assessed for IQ by a clinical psychologist using Developmental Screening Test, Sequin Form Board test, CM Bhatia test and Vineland Social Maturity Scale. Chi-square test was used to find associations, if any. Results: 16 children out of 52 were suffering from Intellectual Disability thus resulting in a prevalence of 30.7%. Male: Female ratio for Intellectual Disability was 1.3:1. Among the demographic variables, sex of the child and maternal age at child birth were significantly associated with Intellectual Disability (p<0.05).Conclusions: High prevalence of Intellectual Disability among disabled children is a cause of concern. Healthcare team needs to raise awareness among females of reproductive age about various risk factors and screen children with disabilities for Intelligence Quotient (IQ) for early interventions. [ABSTRACT FROM AUTHOR]

Indian official data points out a progressive decline in child labour during last three decades.Nevertheless, there are several gaps that need to be addressed for targed policy intervention. This paper highlights the key socioeconomic vulnerabilities among children in rural and urban India and also summarize the key focus areas to be prioritized. We posit that children's entry into the labour force is driven by varied access to resources such as education, societal status and gender. The children in Scheduled Castes and Scheduled Tribes households are the most vulnerable. We recommend prioritizing easy‐to‐access quality education among the key strategies for eradicating child labour. [ABSTRACT FROM AUTHOR]

Expansion in access to public infrastructure can have varied, microlevel impacts. In this paper, we use a discrete and quasi‐random change in the access to paved roads through a large‐scale rural road construction program in India to study how road access impacts fertility decisions and investments in child health. We find that increased access to paved roads at the district level decreases fertility, improves investments in children, and lowers infant mortality. We also provide evidence that highlights the mechanisms that drive this effect. First, we show that local roads improve access to health care facilities and raise immunization rates, which reduces infant mortality. Then, we demonstrate that last‐mile road connectivity has contrasting effects on employment across gender. Overall, the evidence suggests that rural roads can help accelerate demographic transition through their effects on fertility and infant mortality. [ABSTRACT FROM AUTHOR]

In this paper, we show that the village social structure shapes the learning outcome of marginalised children in rural India. Exploiting the variation in the dominant social group in the village, we find a significant impact of village dominance. The reading and arithmetic skills of Scheduled Castes are better in their own castes-dominated villages compared to higher castes-dominated villages. Our findings show that village dominance affects learning outcomes primarily through differential teachers' behaviour. Children from marginalised castes are more likely to be scolded, beaten up, and treated unfairly by teachers in villages dominated by higher castes compared to their own castes. We do not find evidence of other mechanisms like the difference in parent and children's aspirations, caste diversity, discrimination in the village, or positive group externalities, which could explain why children from Scheduled Castes fare better in their own castes-dominated villages. [ABSTRACT FROM AUTHOR]

Early-childhood interventions are important for poverty reduction but difficult to target. We study two interventions in rural India for children below age 2 that are simple and easy to scale: a durable device for iron fortification at home and caregiver training in dialogic reading. Outcomes were measured blinded. When delivered together, the interventions improved receptive language skills of children who were not anemic at baseline, suggesting that health endowment complements parental investments in the production of human capital. The dialogic reading intervention further shows positive spillovers on untreated children. Overall, shorter-lived interventions are potentially effective in healthier populations. [ABSTRACT FROM AUTHOR]

The 2030 Agenda for sustainable development was launched to achieve Sustainable Development Goals (SDGs) across the globe. This paper is based on the primary database to assess the nutritional status of 5–10 years children and the incidence of deprivation in their households of a backward district (Purulia), India in the context of the first two SDGs, e.g., no poverty and zero hunger. We conclude that around 74% of children are undernourished. The proportion of households multidimensionally deprived is 90%, and the majority of them live on less than $1.25 a day. Results reveal that the BMI of mother and the education of father are the two most statistically significant predictors of child malnutrition. Purulia has long been witnessing the persistent nature of deprivation, which is well reflected in the child's health. The district is quite far from the national targets in achieving the SDGs. Government, private sector, and civil society must come together to accelerate the progress of SDGs. [ABSTRACT FROM AUTHOR]

• The urban-rural gap appeared early, suggesting that interventions aiming at closing this gap have to start since the first years of life. • Family characteristics explained around half of the urbanicity-related gaps on achievement in Peru and Vietnam, but they completely explained these gaps in India. • Urban residency was positively associated with academic achievement through increased attendance to ECE, with larger gains related to attendance to private centers. • Increasing the availability of ECE is a promising pathway to close the urban-rural achievement gap but monitoring the quality is necessary. In low- and middle-income countries, rural children rank below their urban counterparts on academic achievement. Given the importance of early childhood education (ECE) in promoting early learning, the urbanicity disparities may be partially explained by limited ECE availability in rural areas and the proliferation of private centers in urban areas. Using data from 6,000 economically disadvantaged children from India, Peru, and Vietnam, this study estimated the size of the differences in academic achievement between urban and rural children at ages five and eight after controlling by child and family characteristics. Additionally, we explored whether participation in public and private ECE mediated the relation between urbanicity and achievement. Results showed that family characteristics explained around half of the urbanicity-related gaps in achievement in Peru and Vietnam and completely explained these gaps in India. Additional results indicated that living urban areas was positively associated with academic achievement through increased attendance to ECE, with larger gains related to attendance to private centers. These results suggests that ECE access may be a promising pathway to close the urban-rural achievement gap. However, monitoring the quality of ECE settings serving low-income children -especially those in rural areas- is necessary to reap the full benefits of early education on child development. [ABSTRACT FROM AUTHOR]

Introduction: Anaemia is a serious concern for young children because it can result in impaired cognitive performance, behavioural and motor development, coordination, language development, and scholastic achievement, as well as increased morbidity from infectious diseases. While severe anaemia is typically addressed with urgency, mild-to-moderate anaemia is sometimes overlooked. However, even mild cases can have a significant impact on a child's health and development. Thus, oral iron supplementation, by reducing anaemia, can contribute to the development of a healthier and more productive population. Aim: To assess the effect of daily Iron Folic Acid (IFA) supplementation among 36-59 month old children with mild-to-moderate anaemia. Materials and Methods: This quasi-experimental study was conducted in the rural field practice areas of a tertiary care teaching hospital in central Karnataka, India from March 2022 to February 2023. After baseline assessment, 53 children aged between 36-59 months old in Anganwadi centres of the study area with mild-to-moderate anaemia (Haemoglobin - Hb: 10.9 -- 7 g/dL) were recruited for the study after obtaining informed written consent from the parents. The IFA supplementation was administered under supervision for six months. The primary outcome was rise in the Hb concentration. The paired t-test was used to statistically analyse the data. Results: Among the 53 study participants, the majority (27, 51%) were boys, and the mean age of the study participants was 46.6±8.4 months. The study showed that after six months of iron supplementation among 36-59 month old children with mild-to-moderate anaemia, there was a rise in the mean {Standard Deviation (±SD)} Hb by 0.71±0.32 gm/dL in the study participants, and it was found to be statistically significant (2.579, p=0.011). The increase in Hb was found in both girls (0.84±0.41 gm/dL) and boys (0.83±0.39 gm/dL). Conclusion: The study concluded that supervised intervention for mild-to-moderate anaemia in preschool children has the potential to reduce the prevalence of iron deficiency anaemia among this vulnerable population, but it requires a joint effort from all stakeholders involved. [ABSTRACT FROM AUTHOR]

Floods cause extensive damage in high-income countries, including the United States, but problems are more severe in low- and middle-income countries (LMICs) that lack preventative and mitigating infrastructure. Marginalized children's education in LMICs might be particularly vulnerable. Using the Indian Human Development Survey, we investigate flood exposure implications for the education of school-age rural children, paying particular attention to children from marginalized groups. Results show that lower- caste Hindu, Muslim, and poorer children with less-educated parents in agricultural households are more likely to experience flooding. Interactions between flooding and marginalization characteristics indicate that flood exposure is associated with disproportionately negative learning outcomes for girls and that economic resources may mitigate flood exposure effects on delayed school progress. While greater exposures for marginalized groups are concerning, the limited number and modest magnitudes of documented negative effect heterogeneities for marginalized children are somewhat better news. [ABSTRACT FROM AUTHOR]

The study examines differences in learning outcomes across Indian states over ten years from 2009 to 2018. Even today, some states exhibit learning outcomes that are appallingly low and children face disproportionate disadvantages. The paper finds that most of the states show a downward movement of learning achievement over the study period. The fixed effects model is used to understand how the learning indicators are associated with the school infrastructure and the socio-economic background of the state. The regression analysis underscores the importance of female literacy rate, social background and NSDP per capita to predict learning outcomes among children from rural India. We find evidence in favour of σ-convergence in mathematics achievement but not in reading achievement. Also, Indian states exhibit the presence of absolute and conditional β-convergence in the learning indicators. [ABSTRACT FROM AUTHOR]

Handwashing with soap at critical moments is one of the most important factors in controlling the spread of germs and preventing the spread of infection. The objective of this study was to determine the effectiveness of a low-cost, school-based intervention that simulated germs and their spread on hand hygiene knowledge, attitude and practice of primary school children. Five hundred and sixty-two students from 28 rural schools were enrolled in this pre-posttest study. Endline data was collected 4 weeks after conducting the intervention at baseline. The mean scores for knowledge, attitude and practice improved significantly after the intervention (p <.05). Significant positive gains were also observed in children's understanding of germs, the associated illness threat and washing hands with soap as a prevention mechanism. The present study suggests that entertainment-education-based interventions have the potential to improve hygiene behavior among children while being low-cost. [ABSTRACT FROM AUTHOR]

Using a systems analysis approach, the authors analyse forced child labour incidents in Indian cottonseed farms in the years 2003/04 and 2014/15, and explore the role played by human factors in contributing to the illegal use of child labour in the Indian agri-food sector. National policies on labour welfare and rights are reviewed through the case studies used as a lens to explore wider issues associated with forced child labour in supply chains. The study highlights the evolution of organised crime in India with regards to the reliance on forced child labour, using the four conceptual dimensions of modern slavery established by the UK Home Office in 2017. The study does identify limitations and flaws associated with designing policies based on a "work-as-imagined" philosophy and demonstrates how the use of maturity modelling can explore how exploitation, corruption and organised crime is framed and can become more formalised over time. [ABSTRACT FROM AUTHOR]

A two-child policy has been in effect in rural areas in multiple Indian states for over 2 decades. We examine the effectiveness of the policy on fertility, sex ratio, and female infant mortality. We utilize data from the fourth round of the National Family Health Survey (2015–2016) and use propensity score matching models to examine whether the policy influences household fertility behavior. First, fertility behavior of women residing in policy states who married before the mandate are compared to those who married after the mandate. Second, fertility behavior of women residing in policy states are compared to those living in non-policy states. The policy is found to lower the number of children in a household and to decrease the likelihood of having more than two children. However, pre-policy absence of a male child is positively and statistically significantly associated with excess fertility, higher proportion of post-policy male children, and higher female infant mortality among rural households with at least two children before the policy was implemented. [ABSTRACT FROM AUTHOR]

Background: Children are a supreme asset to a nation. Beginning six years of life is pivotal for the social, emotional, cognitive, physical, motor, and psychological upbringing of the child. National Family Health Survey (NFHS) 5 data shows 41.9% of children die before the age of five years, with greater mortality in the rural areas (45.7%). The present study was conducted to assess the anthropometric profile and immunization status of children in Anganwadi centers. Materials and Methods: A community-based cross-sectional study was conducted in 21 Anganwadi centers in a rural area in South India. The anthropometry (height, weight, mid-upper arm circumference), morbidity profile, and immunization status of the enrolled and available children were assessed with the help of WHO growth charts, Salter scale, clinical examination, immunization cards, and data from Anganwadi registers. Statistical analysis: Data were compiled and analyzed using SPSS software version 20. Descriptive data were interpreted as mean and percentages and associations were tested with the Chi-square test, and Fisher's exact test. A P value of <0.05 was considered to be statistically significant. Results: Around 400 children, aged 0-6 years, participated in the study. The mean age of the study population was 42.08 ± 12.55 months. The overall prevalence of underweight, stunting, and wasting was 52%, 54%, and 47.5% respectively. The most common morbidity was upper respiratory tract infection (11.5%). A majority (97.5%) of children were found to be immunized appropriately as per age. Conclusion: The prevalence of malnutrition was alarmingly high which warrants urgent referral and follow-up. The ICDS services, although substantially beneficial, need focal strengthening with regard to the nutritional status of enrolled children. [ABSTRACT FROM AUTHOR]

Childhood stunting is recognized as significant public health concern in India. It is a form of malnutrition with impaired linear growth and creates a range of adversaries among children, including under-5 mortality, morbidity, and physical and cognitive growth. The purpose of the present study was to recognize the various leading determinants causing childhood stunting from both individual and contextual level in Indian context. Data were obtained from the India's Demography and Health Survey (DHS) conducted in 2019–2021. A total of 1, 46,521 children aged 0–59 months were included in this present study. The study applied a multilevel mixed-effect logistic regression model in which individual factors nested within community based contextual-level factors estimating the likelihood of childhood stunting phenomena among Indian children. The variance explained in full model accounted for about 35.8% of the odds of stunting across the communities. The present study elucidates that the recognized factors from individual level characteristics have really increased the odds of childhood stunting: gender of child, multiple births, low birth weight, low BMI among mothers, less educational attainment by mothers, maternal anemic status, breast feeding duration longer than usual, < 4 antenatal care (ANC) visits during gestation period. Similarly, contextual-level factors like rural places of residence, western Indian children, and communities with high poverty rates, lower literacy rates, improper sanitation, and unsafe drinking water were also found to have a significant positive association with childhood stunting. The study finally concludes that cross level interaction between individual and contextual-level factors are identified as significant determinants of linear growth retardation among child in India. In order to reduce this type of malnutrition among the child one should more concentrate on both individual and contextual-level factors as a notable reasons. [ABSTRACT FROM AUTHOR]

In India, the National Education Policy 2020 recommends ensuring universal access to high-quality early childhood care and education for children aged 3–6 years by 2030. Using the 75th round of National Statistical Office data (2017–2018), this paper analyses the regional and socioeconomic inequalities in access to pre-primary education. Also, we investigate the specific role of households' economic status and educational attainment in explaining these inequalities. We find considerable regional (rural/urban) and socioeconomic inequalities in access to pre-primary education in India, with girls and children belonging to historically disadvantaged social groups (scheduled castes and scheduled tribes) less likely to attend early childhood education, particularly in rural areas. We find that a substantial portion of the rural–urban gap in access to pre-primary education can be removed by controls for households' economic condition and household head's educational status. In addition, we find gender and socioeconomic inequalities in the household investment in early years education. These findings highlight the need to put policy efforts and commitments to reducing barriers to accessing pre-primary education for children in disadvantaged conditions in India. [ABSTRACT FROM AUTHOR]

Background: A large proportion of young children in developing countries receive inadequate feeding and face frequent infections. Global research has established the need for improving feeding practices and management of child illnesses. Interventions involving home visits by community health workers (CHWs) for caregiver education have been attempted in many countries. Indian government rolled out an intervention called home-based care of young children (HBYC) in 2018 but no studies exist of its scaled-up implementation. The current study was aimed at assessing the coverage of HBYC in Chhattisgarh state where it has been implemented through 67,000 rural CHWs known as Mitanins. Methods: This cross-sectional study was based on a primary household survey. Households with children in 7–36 months age were eligible for survey. A multi-stage sample of 2646 households was covered. Descriptive analyses were performed and key indicators were reported with 95% confidence intervals. To find out the association between caregiver practices and receiving advice from the CHWs, multivariate regression models were applied. Results: Overall, 85.1% children in 7–36 months age received at least one home visit from a CHW within the preceding three months. Complementary feeding had been initiated for 67% of children at six months age and the rate was 87% at eight months age. Around one-third of the children were fed less than three times a day. Around 41% households added oil in child's food the preceding day. CHWs were contacted in 73%, 69% and 61% cases of diarrhea, fever and respiratory infections respectively in children. Among those contacting a CHW for diarrhea, 88% received oral rehydration. The adjusted models showed that receiving advice from CHWs was significantly associated with timely initiation of complementary feeding, increasing the frequency of feeding, increasing diet diversity, addition of oil, weighing and consumption of food received from government's supplementary nutrition programme. Conclusions: Along with improving food security of households, covering a large share of young children population with quality home visits under scaled-up CHW programmes can be the key to achieving improvements in complementary feeding and child care practices in developing countries. [ABSTRACT FROM AUTHOR]

Objectives: Ecoregion comprises all the environmental factors such as climate, vegetation, geomorphology, and soil taken together. The objectives of this study were to (1) assess differences in growth and body composition (BC) in 9–18‐year‐old children and adolescents (CA), across six ecoregions of India, (2) evaluate and compare the magnitude of the effect of ecoregional and lifestyle factors (LSF) on growth and BC in urban (U) and rural (R) children and adolescents, and (3) reassess the applicability of Bergmann's Rule and Allen's Rule to humans. Subjects and Methods: Data on 1845 CA (925 boys; 920 girls) were collected (2016–2017) from urban and rural areas of six ecoregions of India. Anthropometric and BC parameters were measured; Z‐scores were computed. Lifestyle Index score (LIS) based on LSF—(socioeconomic status [SES], diet, physical activity) was computed (categorized as low, medium, high—indicates better LSF). Univariate analysis was performed to estimate effect size. Results: Significant differences were observed in growth and BC across urban and rural ecoregions. CA with high LIS were taller and heavier than those with low LIS (p <.05). Ecoregion had greater effect on growth (Partial eta square (η2) for R = 0.136 vs. U = 0.057) and BC (η2 for R = 0.094 vs. U = 0.058) of rural CA than urban (p <.01). LSF had more effect on the BC of urban CA (η2 = 0.017) than rural (η2 = 0.002, p <.01). Conclusion: Disparities among the six ecoregions were not large enough to fully support Bergmann's Rule and Allen's Rule. Ecoregion had greater effect on growth and BC of rural CA than urban, while lifestyle factors had more effect on the BC of urban CA. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is emerging as a major public health issue of the twenty- first century with an alarming rise in its prevalence in several developing countries. Obesity has reached epidemic levels in developed countries. It is emerging as a major health problem in developing countries such as India, particularly in urban settings. Most studies related with Obesity and its complications like Hypertension, Diabetes mellitus in early adulthood, but the data's in rural children are less. Aim: To assess the prevalence of obesity among rural school children of 6-12 years of age and to determine factors associated with obesity Methods: A descriptive cross-sectional study was conducted among 100 children aged 6-12 years using a semi structured questionnaire. Risk factors like socio-economic status, BMI were taken into account. Results: The mean age of the children was 9.03±1.8. The prevalence of Overweight, obesity and Underweight is 8%, 6% and 8% respectively and majority of the children, 78% were found to be normal. The proportion of obesity was more among males (4%) than females (2%), whereas the proportion of overweight was more in females 6% compared to males 2%. Conclusions: This study concluded that the overall prevalence of overweight was higher than obesity with 8% and 6% respectively. There was also an equal proportion of underweight. [ABSTRACT FROM AUTHOR]

Female labour force participation (FLFP) in India has gone down from 42.74% in 2005 to 24.53% in 2019. This is the case when education levels have gone up and fertility rate has declined. Against this backdrop, this paper studies the low figures of female employment in India. It draws out the determinants of FLFPduring 2005 to 2019 using NSS EUS and PLFS data. With the use of a probit, shapley value decomposition and IV-probit method, the various supply side factors which aid or impede FLFP are brought out. Results from probit regression show that women's age, education levels, marital status, presence of children, household size, and social & income group of the household and occupation type are significant determinants of FLFP. Shapley value decomposition shows that age and education level of women together explain 37% of the variation in rural areas and 51% in urban areas in 2019. Education's contribution to FLFP is the highest in urban areas at 20% in 2019. State level heterogeneity, an indicator of labour demand, also explains about one-fourth of the total variation in FLFP. Further, regression with the use of IV-probit model, to counter the potential endogeneity of household monthly consumption expenditure, reveals presence of negative income effect in 2019. Being married, presence of children and staying in a large household reduces the probability of FLFP. Occupational structure of the household is also a significant factor. The probability of participation rises when a woman belongs to a regular salaried household vis-à-vis the self-employed. Education levels of secondary school and above are significant and positively associated with FLFP. There is also a caste pattern visible with higher probability of participation among the scheduled tribes (ST) and scheduled castes (SC) vis-à-vis other castes. Higher education has a stronger positive effect on FLFP in urban areas while household income, presence of children and being married have a stronger negative effect on rural FLFP. The variation by caste presents effect of social norms though its significance has reduced over the years. Inter-temporal analysis presents that the effect of children and household income levels has reduced over time; however, that has not translated to higher probability of FLFP. This is an indication of demand side issues in FLFP in India. [ABSTRACT FROM AUTHOR]

This article discusses a case series of children from rural India who developed modified impetigo, known as impetigo incognito, after using topical corticosteroid (TCS) combination creams. The misuse of TCS creams is prevalent in rural India, with studies showing that 80% of people abuse these creams. The use of TCS creams can disrupt the skin's integrity and lead to increased inflammation and bacterial overgrowth. The article emphasizes the need for proper counseling and awareness to prevent the misuse of TCS creams and the associated complications. [Extracted from the article]

Introduction: Anaemia is one of the micronutrient deficiency disorders that have global public health implications. The present study aims to determine the association of minimum dietary diversity (MDD) with anaemia among children aged 6–59 months in rural North India. Methods: In Rohtak (a north Indian city), a cross-sectional survey was conducted in 2018–19 (n = 266). Univariate and bivariate analyses were performed. The Chi-square test was used for assessing the significance level during bivariate analysis. Further, multivariable regression analysis was used for determining the factors for anaemia prevalence among children aged 6–59 months. Results: About 62.4% (n = 166) of the children aged 6–59 months were found to have anaemia in the study area. The prevalence of MDD was 35.3% (n = 94). It was found that children with no MDD have a higher prevalence of moderate (42% vs. 25.5%; P < 0.001) and severe (12.8% vs. 8.5%; P < 0.001) anaemia. It was revealed that the children with no MDD had a significantly higher likelihood of being anaemic than children with MDD in model-1 [aOR: 2.09; CI: 1.23, 3.55] and model-3 [aOR: 1.70; CI: 1.01, 3.01]. Children with mothers who never attended school had significantly higher odds for anaemia in reference to those children whose mothers ever attended school in model-2 [aOR: 3.62; CI: 2.07,6.34] and model-3 [aOR: 3.00; CI: 1.62,5.56]. Conclusion: Measures to alleviate under-five anaemia should include empowering and educating women, expanding access to supplementation, fortification programmes, and promoting and raising awareness about feeding diverse foods, while also considering the socioeconomic status. [ABSTRACT FROM AUTHOR]

Objective: Neurodevelopmental disorders NDD are neurologic processing problems that interfere with learning in children. Primary and preschool teachers who are essential links in public health reach out to such children do not receive any formal training to identify these disorders. Hence, a primary and preschool level intervention addressing the issue is proposed. Materials and Methods: Primary and preschool teachers of government and government-aided schools and Anganwadi/preschools in the Model Rural Health Research Unit Tirunelveli field practice area will be assigned into two groups. The training module will be developed and validated using neurodevelopmental screening tool (NDST). Before identifying the students using the NDST, the teachers in Group A will get training using the module. Group B is the control group, in which untrained teachers administer the NDST to the children and then will be trained. Neurologists will assess the same children over 1 year. Results: The effectiveness of teacher training for the early detection of children with NDD will be assessed. Thus, the validity of the screening for NDD by the teachers will be estimated. Conclusion: If successful, the module can be incorporated into the Rashtriya Bal Swasthya Karyakram program of India for the early identification of children with NDD. [ABSTRACT FROM AUTHOR]

Child under-nutrition is the major public health concern in many developing countries as well as India. The present study is an attempt to evaluate the overall prevalence of undernutrition using CIAF among the rural and urban pre-school children of West Bengal. A total of 240 children aged 3-5 years were included in the present study. The anthropometric measurements like height and weight and Mid Upper Arm Circumference (MUAC) were recorded using standard procedures. Children were considered as underweight, stunting and wasting if their weight-for-age, height-for-age and weight-for-height Z-scores were below -2.0 SD. The overall age and sex combined prevalence of stunting, wasting and underweight were found to be 13.33%, 6.66% and 18.33% among the rural preschool children, and 18.33%, 5.83% and 16.66% among the urban preschool children. CIAF showed a higher prevalence of undernutrition (22.5% in the rural and 24.16% in the urban) among the preschool children than the other three conventional indicators (stunting, underweight and wasting). No significant difference in the overall prevalence of undernutrition was found between the rural and the urban slum preschool children. However, 14.17% of the rural preschool children and 12.5% the urban slum preschool children were found to have multiple anthropometric failure. The present study established that CIAF is a better indicator of nutritional status than the traditional measures of stunting, underweight and wasting. The Composite Index of Anthropometric Failure measure will bring more precision in the identification of the nutritionally vulnerable segment of the population and enhance the efficacy of nutritional intervention programs by identifying single or multiple failure groups. [ABSTRACT FROM AUTHOR]

Background: Rural Indians have higher mortality rates than urban Indians. However, the rural-urban gap in under-five mortality has changed is less researched. This paper aims to assess 1) whether the rural-urban gap in under-five mortality has reduced over time 2) Whether rural children are still experiencing a higher likelihood of death after eliminating the role of other socioeconomic factors 3) What factors are responsible for India's rural-urban gap in under-five mortality.Methods: We used all rounds for National Family Health Survey data for understanding the trend of rural-urban gap in under-five mortality. Using NFHS-2019-21 data, we carried out a binary logistic regression analysis to examine the factors associated with under-five mortality. Fairlie's decomposition technique was applied to understand the relative contribution of different covariates to the rural-urban gap in under-five mortality.Results: India has witnessed a more than 50% reduction in under-five mortality rate between 1992 and 93 and 2019-21. From 1992 to 93 to 2019-21, the annual decrease in rural and urban under-five mortality is 1.6% and 2.7%, respectively. Yet, rural population still contributes a higher proportion of the under-five deaths. The rural-urban gap in under-five mortality has reduced from 44 per thousand live births in 1992-1993 to 30 per thousand in 2004-2005 which further decreased to 14 per thousand in 2019-2021. There is no disadvantage for the rural children due to their place of residence if they belong to economically well-off household or their mothers are educated. It is wealth index rather than place of residence which determines the under-five mortality. Economic (50.82% contribution) and educational differential (28.57% contribution) are the main reasons for rural-urban under-five mortality gaps.Conclusion: The existing rural-urban gap in under-five mortality suggests that the social and health policies need to be need to reach rural children from poor families and uneducated mothers. This call for attention to ensure that the future programme must emphasize mothers from economically and educationally disadvantaged sections. While there should be more emphasis on equal access to health care facilities by the rural population, there should also be an effort to strengthen the rural economy and quality of education. [ABSTRACT FROM AUTHOR]

In the world, malnutrition is a leading communal health problem at the childhood stage. It is a dramatic indicator of poor socio-economic status. Developing countries are highly affected by malnutrition. The purpose of the present study is to assess the incidence of malnutrition amongst the children belonging to rural areas of the Saharanpur district, Uttar Pradesh, aged 1-3 years, and its association with socio- demographic factors. About 800 children were involved in the present cross-sectional investigation, using multi-stage sampling. The socio-demographic shreds of evidence were collected using a self and well- structured questionnaire. Children were screened using anthropometric measurements. The WHO Anthro Plus 1.0.4 software was used to convert the weight, height, and age (months) of children into height-for-age (stunted), weight-for-age (underweight), and weight-for-height (wasted). The statistical significance was declared at a p-value <0.05 with 95% confidence intervals in the final model. The overall prevalence of malnutrition was 39.7; 14%, 21%, and 4.7% being the prevalence of underweight, stunted, and wasted children, respectively. No significant association was found between gender and anthropometric indices (underweight, stunted, and wasted) of children. Malnutrition was high among rural children aged 1-3 years in Saharanpur. The factor affecting underweight was age, while the educational status and occupation of mothers, fathers' occupation, children's age, and caste were the factors affecting stunting. Factors affecting wasting were the educational status and occupation of mothers, fathers' educational status and occupation, and caste. [ABSTRACT FROM AUTHOR]

Introduction: Skin disorders are common in paediatric age group and are associated with significant morbidity and stress. These differ from adults in clinical presentation, treatment and prognosis. Data on pattern of paediatric dermatoses can be used in planning healthcare programs. Aim: To study the clinical pattern and prevalence of various skin conditions in paediatric age group in tertiary care centre of rural Haryana, India. Materials and Methods: The present cross-sectional observational study was conducted in Bhagat Phool Singh Government Medical College (W) Khanpur Kalan, Sonepat, Haryana, India. A total of 1,003 consecutive Outpatient Department (OPD) patients upto age of 14 years presenting with skin conditions were included in study from a period May 2021 to January 2022. Various parameters like age, gender, pattern of distribution and type of skin lesions were assessed. Results were entered in excel sheet and frequency, percentages were calculated. Results: Out of 1,003 patients 56.53% were males and 43.47% were females. Maximum number (33.20%) of patients were in the age group of 1-5 years. Scabies (24.12%) was the most reported dermatological condition. Majority of dermatoses belonged to infections (32.40%) and infestations (24.83%) followed by eczemas (17.34%). Bacterial infections (15.25%) were most common infections followed by fungal (10.37%) and viral (6.78%) infections. Conclusion: In the present study, infections and infestations were most common dermatological conditions. This study provides insight about the pattern of various dermatoses among children in rural setting. [ABSTRACT FROM AUTHOR]

A mother's knowledge about dietary diversity is the key component for providing a highquality diet to her children. However, there is a dearth of literature to assess a mother's knowledge about dietary diversity and its impact on the nutritional status of children. Therefore, an attempt was made in this study to understand a mother's knowledge on dietary diversity and her hygienic practices on the nutritional status of under-five children. This cross-sectional community based study was conducted in rural West Bengal, India. Data was collected using Android-based ODK data collection tools and analysed using WHO Anthro and SPSS (version 25) software. Frequency distribution, bi-variate cross-tabulation and binary logistic regression analysis were performed. 31% of children found underweight, 41.4% stunted and 17% wasted. About 37% of mothers knew about minimum dietary diversity and 24% used to wash their hands with soap and water before feeding their children. A mother's knowledge on dietary diversity was significantly associated with lower odds of being underweight (AOR:0.34), stunted (AOR:0.49) and wasted (AOR:0.33). Other significant predictors were a mother's educational attainment, knowledge on the symptoms of malnourishment and the habit of handwashing. The findings of this study reinforce the importance of enhancing a mothers' knowledge on child nutrition, dietary diversity and hygienic practices to improve the nutritional status of children. [ABSTRACT FROM AUTHOR]

Under- and overnutrition are co-existing health issues in several countries across Asia. Poor complementary feeding (CF) is a significant determinant of malnutrition in children and a major cause of morbidity and mortality. The purpose of this narrative review is to summarize the most recent evidence regarding the CF practices in 3 countries with a high prevalence of stunting and overweight, and currently undergoing rapid economic and nutritional transition: China, India, and Indonesia. We focused particularly on the adequacy of CF, based on the WHO feeding indicators (2021) regarding timing, frequency, diversity, as well as the consumption of specific food groups. According to the findings, the majority of infants in the 3 countries are introduced to CF at an inappropriate time: either too early (particularly in urban/rural areas of China and Indonesia) or too late (India) compared with the WHO recommendation. Furthermore, in all countries, diets are characterized by a low variety and frequency of CF and consist mainly of staple foods with poor nutritional quality, such as rice, cereals, or noodles. Nutrient-dense and protein-rich foods, such as foods of animal origin, are either inadequately consumed (rural areas of China and India) or introduced too late (urban areas of China and Indonesia) in the diets of children. In all countries, the consumption of fruit and vegetables, especially during the early CF period, is poor. In contrast, a significant proportion of both urban and rural children, particularly in Indonesia and India, are consuming energy-dense/nutrient‐poor snacks and sugary drinks during the CF period. The described practices may pose a significant risk for the development of energy and/or nutrient gaps, magnifying the double and triple burden of malnutrition present in these countries. Further research is warranted to understand the significance of the observed practices for stunting and/or overweight/obesity risk. [ABSTRACT FROM AUTHOR]

A disability service organization piloted a parent capacity-building intervention for parents of children with developmental disabilities in rural South India. To examine the impact of this parent capacity-building group intervention on parent empowerment, peer support, social inclusion, advocacy skills, and the factors influencing these outcomes. A qualitative study recruited 37 participants from 17 parent groups through convenience sampling. Six focus groups occurred six months post the start of this intervention and explored these parents' experiences with the groups and their perceived impacts. Qualitative analysis yielded four main themes and corresponding sub-themes: peer support (feeling peaceful and supported, building self-efficacy), social inclusion (space to share, acceptance and identity), knowledge sharing (increasing awareness, accepting advice), and advocacy (building confidence, making requests). Participation in parent groups provided participants with opportunities to find peer support, utilize knowledge sharing, feel socially included, and build advocacy skills. This study provides a greater understanding of the impact and benefits of parent capacity-building interventions in low-resource settings. Results will improve this intervention and guide other organizations in creating similar programs. This paper adds perspectives of parents who are caregivers of children with developmental disabilities in rural South India. More specifically, this paper highlights the impact of a parent-focused intervention in group settings in both rural and urban areas. Parent support group interventions are not common in India and low- and middle-income countries and there is a paucity of literature describing these interventions and their impact. In this study, parents described a need for multifaceted interventions to support their child in the community. These parent groups provided space for caregivers of children with developmental disabilities to make connections, feel validated, and grow confidence to utilize new knowledge or advice shared by other parents to further enhance their lives. Further, parent-group settings provide opportunities to build advocacy skills through timely discussions. Parents reported an increase in feelings of acceptance within the group itself but not within the wider community. This highlights the need for involving the wider community in interventions to promote integration for families with children with disabilities. • Parent-group interventions in LMICs and their impact are not well documented. • Social inclusion increased within parent groups but not within the wider community. • Caregivers share and gain knowledge to support their children in parent groups. • Social inclusion within parent groups helps reduce stigma and feelings of exclusion. [ABSTRACT FROM AUTHOR]

Exposure to lead among children, as well as adults, is a major global health issue. With diverse routes of exposure (e.g., food, air, and water) either environmentally or occupationally, lead among children can cause mild, moderate, to severe health complications in the later stages of life. The average blood lead level reported by CDC in 2021 is 3.5 µg/dL, and the level of blood lead toxicity is ≥ 10 μg/dL. In this study, we planned to systematically analyze the association between blood lead levels (BLLs) (≥ 10 μg/dL and < 10 μg/dL) and the risk of anemia (hemoglobin level < 11 g/dL) among Indian children aged between ≥ 1 and ≤ 18 years. An online literature search of 5 databases, PubMed, Ovid, EMBASE, Web of Science, and Google Scholar was accomplished with a search updated until 8th March 2021. Study designs included cohort, cross-sectional, and case–control studies that have evaluated the association of lead toxicity or exposure with anemia (Hb < 11 g/dL) reported in urban and/or rural Indian children. Meta-analysis was performed among a total of 864 children from 4 cross-sectional studies. The association between lead toxicity (BLLs ≥ 10 μg/dL) and the risk of being anemic was not statistically significant (RR = 1.15 (95% CI: 0.86–1.55, I2 = 77%). The risks of bias in all included studies were low according to the Newcastle Ottawa Scale. Increased blood lead levels did not appear to be the major contributor to anemia in Indian Children. We need to focus primarily on improving the nutritional quality, fortified food supplements, and a balanced diet for children to reduce the anemia burden in India. Lead toxicity should be sought as an etiological factor only in areas of high environmental risk factors which were leaded paints, leaded batteries, a house near major road/traffic areas, and pesticide exposure. [ABSTRACT FROM AUTHOR]

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban–rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017–18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural–urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural–urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation. [ABSTRACT FROM AUTHOR]

This study uses household-level panel data from a nationally representative survey to estimate the effect of agricultural productivity shocks—as proxied by exogenous annual rainfall deviations—on education expenditures and children's work status in rural India. We find that a transitory increase in rainfall significantly reduces education expenditures and increases the likelihood of child labor across multiple work activities. Additionally, households owning land and those with better credit access increase the use of child labor as rainfall increases because labor (and land) markets are incomplete. The effects of productivity shocks are reinforced for marginalized castes and for less educated households, thereby exacerbating inequalities in education. [ABSTRACT FROM AUTHOR]

Background: Malnutrition among under-five children (U5C) in India is a major public health problem due to double burden caused by nutritional transition. WHO cut-offs are adopted as global growth standards which define how children should grow in condition of optimal nutrition and health. Growth references which are representative of population-specific existing growth patterns need to be updated regularly which is cumbersome; hence, the author's group published 'synthetic growth references' for Indian children of age 0-18 years. Objectives: The objective of this study is to field test the new synthetic growth references in U5C for height-for-age, weight-for-age and body mass index (BMI)-for-age against WHO charts in urban and rural Indian children to estimate prevalence of various indices of malnutrition. Methods: A cross-sectional anthropometric assessment of apparently healthy rural and urban Indian U5C attending vaccination centre was performed using standard protocols. They were converted to Z-scores using WHO and Indian synthetic growth references. The equality of proportion of parameters of malnutrition was tested by McNemar's test and P value <0.05 was considered significant. Results: WHO charts significantly overestimated stunting and malnutrition as compared to synthetic references with difference in sensitivity of 7.2% and 8.5%, respectively, and converse for over-nutrition by 2.1%. The most commonly affected parameter of malnutrition was underweight. Stunting was significantly higher in rural population using both cut-offs (P < 0.05). Conclusion: The synthetic references limit the spread of weight and BMI and do not overestimate stunting and wasting. They may be more useful for identification of malnutrition and may thus be recommended for routine screening in Indian U5C. [ABSTRACT FROM AUTHOR]

Unhealthy Body Mass Index (BMI) is a primary manifestation of metabolic disorder. Disruption of sleep is a major factor that has been observed to culminate into metabolic disorders. Sleep parameters are also influenced by the screen exposure duration associated with the use of electronic devices. Screen Exposure Time (SET) also has an effect on metabolism due to sedentary nature of the activity. Both SET and disrupted sleep are related with cognitive performance. Children are affected by sleep disruption and prolonged SET. Efforts to ameliorate in a primordial age may be more effective to reduce their predisposition to unhealthy BMI and detrimental changes of cognitive performance. In order to mitigate the scourge of unhealthy BMI prevalent in developing countries and to improve cognitive performance, it is important to administer proper sleep duration and SET. It is necessary to delineate an optimum duration of sleep and identify the optimum duration of SET in this regard. SET equal to and beyond 2 hours/day lead to increase sleep debt and decline of cognitive performance. Rise in BMI is associated with increase in SET. Sleep duration of 6–7 hours among participants yields better cognitive performance than those with sleep duration below or above 6–7 hours. [ABSTRACT FROM AUTHOR]

Lack of information about health risks may limit the adoption of improved nutrition and other new healthy behaviors. This paper studies the effect of a nutrition-information intervention on household dietary behavior, hemoglobin levels, and cognitive outcomes of children in rural India. Using experimental data and a regression discontinuity design that exploits the exogenous cutoff of hemoglobin level for anemia, we find statistically insignificant treatment effects on dietary improvements, child health, and cognitive outcomes of children. Our findings suggest that light-touch nutrition information alone, even when parents are informed about the health risk of their children, may not induce adoption of healthy behaviors. Our findings also imply that factors other than information might constrain households in making nutritional investments for their children. [ABSTRACT FROM AUTHOR]

Introduction: The health and wellbeing among children is an important parameter for the measurement of the progress of a nation, which is also most precious asset in the community for socio-economic development in long run. It is not wise to neglect the health rights of the children in the process of nation building. The under-five children are the most vulnerable group in a society in which there is lack of guarantee for adequate nutrition and social protection. The lack of essential health services ultimately leads to childhood diseases like diarrhoea, respiratory infections, and measles in various parts of India. Aim: To understand the socio-demographic and morbidity pattern among the children of under five years in a district of Telangana state, India. Materials and Methods: A cross-sectional study was undertaken by interviewing mothers with the help of a predesigned and pretested questionnaire to understand the morbidity pattern of children under five years in the rural areas of Adilabad district, Telangana, India. The study was conducted in one month, March 2015 in 30 villages. The study assessed various determinates of morbidity by applying scientific principles. The sample size was calculated as 210. The data was analysed by using MS Excel spread sheet and Statistical Package for the Social Sciences (SPSS) software to understand the morbidity pattern. Descriptive statistical tests were done to find out the results. Results: The result confirms that 154,73.33% of the children under five years have several forms of morbidities. The most common morbidity is Acute Respiratory Infection (ARI) (25.71%), which is followed by worm infestation (8.09%), and diarrhoea (20%) and fever (7.61%), scabies (7.61%), asthma (2.3%) and seizure (fits) (1.9%) in last three months from the data collection. All these diseases are prevalent in rural areas of high concern due to the impeding morbidity and mortality. Conclusion: ARI and diarrhoea were found to be the cause of concern among under-five children, which dominate the morbidity pattern. The factors responsible with such precarious situation were deeply entrenched conditions like illiteracy, poor socio-economic conditions, poor environmental sanitation, and increased birth order among the population. [ABSTRACT FROM AUTHOR]

Background: Several government schemes exist for the welfare of families having children with intellectual and developmental disorders (IDDs) in India. However, these schemes are often not utilized. An understanding of the barriers to access these social welfare benefits, especially in rural areas of India, can aid in planning social action toward the implementation of these schemes. Methods: A situation analysis of the resources and potential barriers to access social welfare benefits for families of children with IDD was conducted in a rural community. Stakeholder interviews were conducted with families of children with IDD (n = 20), government officials responsible for implementing education at the state level (n = 5), local officials responsible for facilitating social welfare benefits (n = 5), and nongovernmental organization (NGO) working in the area of children with IDD (n = 3). Qualitative thematic analysis was used to understand the barriers to access social welfare benefits for the families of children with IDD. Results: Barriers encountered by families of children with IDD, local officials, and NGOs included lack of awareness about the available welfare schemes, unavailability of social welfare facilities in the local areas, lack of social auditing in the provision of social welfare schemes to the needy, and stringent process of application and regulation for financial aid under the National Trust schemes. Conclusion: There are multiple barriers to access social welfare benefits for families having children with IDD in rural Karnataka. There is a strong need to empower families, sensitize local officials, and advocate for social policies to effectively implement National Trust schemes in rural areas of Karnataka. [ABSTRACT FROM AUTHOR]

Gender equity in education refers to boys and girls experiencing the same advantages or disadvantages in attending school. Boys and girls should receive equal treatment and should not be discriminated against based on gender. Education is considered as one the most effective instrument for achieving gender equity and sustainable development. The key for the future of any country and any educational institution is the capability to develop, retain and attract the best talent. Boys and girls are equally talented and must be treated equally particularly in Education. The present study is seriously focusing on the equal participation of girls and boys in various aspects of society particularly in educational system. Gender is the most pervasive form of inequality, as it operates across all classes, castes and communities. According to the census of India, (2011) there are 914 girls for every 1000 boys in the 0-6 age group in India. In rural areas it is 919 girls for every 1000 boys, whereas 902 girls for every 1000 boys in urban areas. This ratio should be above 950. Female literacy rate in India is lower than the male literacy rate. Many families, especially in rural areas believe that having a male child is better than having a baby girl. So the male child gets all the benefits. Today, the female literacy levels according to the Literacy Rate 2011 census are 65.46% where the male literacy rate is over 80%. The numbers of girls' children who do not get education especially in the rural areas are still high. Genderbased discrimination in education is both a cause and a consequence of deep-rooted disparities in society. Poverty, geographical isolation, ethnic background, disability; traditional attitudes about their status and role all undermine the ability of women and girls to exercise their rights. Hopefully Education will be a gateway to achieve Gender equity. [ABSTRACT FROM AUTHOR]

Lack of environmental awareness or ignorance regarding the ecological role of animals among children has long-term negative consequences for the biodiversity of a nation. We conducted a study in a biodiversity hotspot in southern India to examine the knowledge level of rural school children regarding the mammalian species in their region. The results of the study showed that school children were able to recognize regional mammalian species that are publicized by media sources, but had little knowledge about their conservation status or more significant information about them. Environmental education programmes must focus on making children more aware of the importance of various animals sharing their habitat, so that they have greater knowledge regarding the ecological roles of animals in the ecosystem. [ABSTRACT FROM AUTHOR]

India is a country with huge population, and with that the problem of health care in India is also vast. India spends almost 1.23% of their GDP in healthcare, but there remain many differences in quality between rural and urban areas as well as between public and private health care system. The gap between rural and urban health care system is large where in rural areas there is shortage of proper medical facilities like medicine, doctor etc. Also the disparities between private health care system and private health care system dividend. The public health care system lacks in manifold such as deficient infrastructure, deficit manpower, equivocal quality of services etc. Whereas the condition of private health services in India is good and provide good facilities to patients but in this we have expensive health services. Almost 75% of healthcare expenditure comes from the pockets of households. In this back drop, this study try to investigate the patterns of healthcare expenditure in India from household perspective. The study is based on secondary data collected from NSS 75th Round data on Key Indicators of Social Consumption in India: Health. The pattern of healthcare expenditure is studied using tabular and graphical representation. Also, to investigate the status of disparity between rural and urban areas t test is used. The result signifies that the cost of treatment for hospitalised treatment both for rural and urban areas, cancer consumes highest level of expense. In terms of hospitalized treatment, there are various categories of expenditure like doctor's fee, medicines, diagnostic tests etc. In both rural and urban areas, the expense on medicine is more in public hospitals while in private hospitals package component has highest share of expenses. The t-test result confirmed that there is significant difference between the medical expenditure pattern of rural and urban areas. [ABSTRACT FROM AUTHOR]

Background: Diphtheria is re-emerging as a public health problem in several Indian states. Most diphtheria cases are among children older than 5 years. In this study, we aimed to estimate age-specific immunity against diphtheria in children aged 5-17 years in India.Methods: We used residual serum samples from a cross-sectional, population-based serosurvey for dengue infection done between June 19, 2017, and April 12, 2018, to estimate the age-group-specific seroprevalence of antibodies to diphtheria in children aged 5-17 years in India. 8309 serum samples collected from 240 clusters (122 urban and 118 rural) in 60 selected districts of 15 Indian states spread across all five geographical regions (north, northeast, east, west, and south) of India were tested for the presence of IgG antibodies against diphtheria toxoid using an ELISA. We considered children with antibody concentrations of 0·1 IU/mL or greater as immune, those with levels less than 0·01 IU/mL as non-immune (and hence susceptible to diphtheria), and those with levels in the range of 0·01 to less than 0·1 IU/mL as partially immune. We calculated the weighted proportion of children who were immune, partially immune, and non-immune, with 95% CIs, for each geographical region by age group, sex, and area of residence (urban vs rural).Findings: 29·7% (95% CI 26·3-33·4) of 8309 children aged 5-17 years were immune to diphtheria, 10·5% (8·6-12·8) were non-immune, and 59·8% (56·3-63·1) were partially immune. The proportion of children aged 5-17 years who were non-immune to diphtheria ranged from 6·0% (4·2-8·3) in the south to 16·8% (11·2-24·4) in the northeast. Overall, 9·9% (7·7-12·5) of children residing in rural areas and 13·1% (10·2-16·6) residing in urban areas were non-immune to diphtheria. A higher proportion of girls than boys were non-immune to diphtheria in the northern (17·7% [12·6-24·2] vs 7·1% [4·1-11·9]; p=0·0007) and northeastern regions (20·0% [12·9-29·8] vs 12·9% [8·6-19·0]; p=0·0035).Interpretation: The findings of our serosurvey indicate that a substantial proportion of children aged 5-17 years were non-immune or partially immune to diphtheria. Transmission of diphtheria is likely to continue in India until the immunity gap is bridged through adequate coverage of primary and booster doses of diphtheria vaccine.Funding: Indian Council of Medical Research. [ABSTRACT FROM AUTHOR]

Introduction: Developing countries like India still depend on Replacement Donors (RD) for their blood requirements. Healthcare providers in India often face Replacement Blood Donation (RBD) denials in children especially in rural areas. Aim: To find reasons for RBD denials in children. Materials and Methods: A cross-sectional study was done over six months at a tertiary care centre located in rural part of Northern India. Children requiring Blood Transfusion (BT) whose parents refused RBD were included in the study. Children were divided into three groups based on their age and data on various parameters were collected. Observation parameters included sex, birth order, number of siblings, disease for which admitted, duration between admission and need for transfusion, indication for transfusion, decision maker in the family, resistance to decision of denial by any other member of family, parental education, socio-economic status and reasons for denial. Data were analysed using SPSS software (Statistical Package for the Social Sciences, version 17.0, SPSS Inc, Chicago, Ill, USA). The p-values were computed for categorical variables using Chi-square (X2) test. A p-value of less than 0.05 was considered statistically significant. Results: Out of 356 children requiring BT, parents and relatives of 130 children (36.51%) refused RBD. Of these 130 children, 84 were females and 46 were males with male-female ratio of 1:1.8. Females were more likely to be denied RBD (p-value=0.001). Of these 130 children, only 77 could be included in the study because of various reasons. Age of the study group ranged between 2 days to 15 years. Denials were significantly higher (p-value=0.0032) in children with 3rd or higher birth order. Little benefit in terms of life expectancy was the commonest reason for denials in neonates and was found statistically significant (p-value=0.00368). Fear of donation was the most common reason for denial in all the groups combined (38.9%). Considering themselves ineligible and religious beliefs were the other reasons for denials. Conclusion: RBD denial in children is common in India. Misconceptions, Illiteracy, poverty, sex discrimination and false beliefs are major contributory factors for denial. [ABSTRACT FROM AUTHOR]

Background: Influenza is a cause of febrile acute respiratory infection (FARI) in India; however, few influenza vaccine trials have been conducted in India. We assessed absolute and relative efficacy of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) among children aged 2 to 10 years in rural India through a randomized, triple-blind, placebo-controlled trial conducted over 2 years.Methods and Findings: In June 2015, children were randomly allocated to LAIV, IIV, intranasal placebo, or inactivated polio vaccine (IPV) in a 2:2:1:1 ratio. In June 2016, vaccination was repeated per original allocation. Overall, 3,041 children received LAIV (n = 1,015), IIV (n = 1,010), nasal placebo (n = 507), or IPV (n = 509). Mean age of children was 6.5 years with 20% aged 9 to 10 years. Through weekly home visits, nasal and throat swabs were collected from children with FARI and tested for influenza virus by polymerase chain reaction. The primary outcome was laboratory-confirmed influenza-associated FARI; vaccine efficacy (VE) was calculated using modified intention-to-treat (mITT) analysis by Cox proportional hazards model (PH) for each year. In Year 1, VE was 40.0% (95% confidence interval (CI) 25.2 to 51.9) for LAIV and 59.0% (95% CI 47.8 to 67.9) for IIV compared with controls; relative efficacy of LAIV compared with IIV was -46.2% (95% CI -88.9 to -13.1). In Year 2, VE was 51.9% (95% CI 42.0 to 60.1) for LAIV and 49.9% (95% CI 39.2 to 58.7) for IIV; relative efficacy of LAIV compared with IIV was 4.2% (95% CI -19.9 to 23.5). No serious adverse vaccine-attributable events were reported. Study limitations include differing dosage requirements for children between nasal and injectable vaccines (single dose of LAIV versus 2 doses of IIV) in Year 1 and the fact that immunogenicity studies were not conducted.Conclusions: In this study, we found that LAIV and IIV vaccines were safe and moderately efficacious against influenza virus infection among Indian children.Trial Registration: Clinical Trials Registry of India CTRI/2015/06/005902. [ABSTRACT FROM AUTHOR]

Context: Diarrhea is one of the leading causes of death and morbidity in under-five children. Effective management can significantly influence survival of children with diarrhea. Objectives: This study was carried out to assess extent of diarrhea, its source of treatment, and type of therapy. Settings and Design: This snapshot study was conducted in rural setting of India. Methods and Material: This study was conducted on 217 under-five children selected through multistage sampling procedure. Statistical analysis used: Statistical association of diarrhea with age and gender of children was established by computing Chi-square. Results: Period prevalence (Recall period 2 weeks of visit) of diarrhea in rural under-five children was 35.9% (95%C.I. 29.3–42.2%). Highest prevalence in age group 0–12 months (47.8%) and lowest in 49–59 months (18.2%). Number of episode per child is 1.08. Diarrhea was watery in 69.4%. Quacks were treatment provider for 36.4% cases. In 17.6% episodes, no treatment was taken. Only 9.4% episodes were treated in government facilities. For the treatment of diarrhea, antibiotic was used in 71.8% cases, ORS use was 33.3% cases, and zinc was used 21.8% of diarrhea episodes. Conclusions: Diarrhea is a significant problem in under-five children from a rural area of India. In spite of existence of National Program for Control of Diarrheal Diseases (NPCDD) since four decades, management of diarrhea is not on track. Focusing on primary care provision to under-five children can help in bringing the management of diarrhea on track. [ABSTRACT FROM AUTHOR]

Bone tuberculosis (TB) is relatively uncommon form of extrapulmonary TB in children. It is estimated that 1-6 % children with primary infection may develop bone and joint TB in 1-3 years if left untreated. Though short course chemotherapy has been found to be effective in treating bone and joint TB, due to emergence of multi drug resistant (MDR) TB, the incidence of resistant bone TB is also rising. Here we have 5 cases of bone TB affecting different sites and having a broad spectrum of antitubercular drug sensitivity pattern ranging from drug sensitive bone TB to MDR bone TB. [ABSTRACT FROM AUTHOR]

Pneumococcal carriage studies are important for vaccine introduction and treatment strategies. Pneumococcal carriage rates estimated in this cohort study among children in a rural community of northern India. Between August 2012 and August 2014, trained nurses made weekly home visits to screen enrolled children aged <10 years for acute upper or lower respiratory infections (AURI/ALRI) in Ballabgarh, Haryana. Nasal swab from infants aged <1year and throat swab from children aged ≥1 year were collected. All specimens were cultured for pneumococci; isolates were serotyped and subjected to antimicrobial susceptibility testing. During the study period, 4348 nasal/throat swabs collected from children with clinical features of ARI (836 ALRI, 2492 AURI) and from 1020 asymptomatic children. Overall pneumococcal carriage was 5.1%, the highest carriage rate among children <1 year of age (22.6%). The detection rates were higher among children with ARI (5.6%; 95% CI: 4.8–6.4) than asymptomatic children (3.3%; 95% CI: 2.3–4.6). Among 220 pneumococcal isolates, 42 diverse serotypes were identified, with 6B/C (8.6%), 19A (7.2%), 19F (6.8%), 23F (6.4%), 35A/B/C (6.4%), 15B (5%), 14 (4.5%) and 11A/C/D (3.2%) accounting for 50%. Forty-five percent of the serotypes identified are included in the current formulation of 13-valent pneumococcal conjugate vaccine. Ninety-six percent of isolates were resistant to co-trimoxazole, 9% were resistant to erythromycin, and 10% had intermediate resistance to penicillin with minimum inhibitory concentration ranges (0.125 to 1.5 μg/ml). Pneumococcal detection was relatively low among children in our study community but demonstrated a diverse range of serotypes and half of these serotypes would be covered by the current formulation of 13-valent pneumococcal vaccine. [ABSTRACT FROM AUTHOR]