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Background Social support and maternal education throughout the antenatal, delivery, and postpartum phases contribute to the optimization of health and well-being of mothers and infants. Understanding deficits among support and educational resources can contribute to improved public health decision-making and maternal and child healthcare and wellbeing. Methods We conducted a qualitative study among 20 postpartum North Indian women to better understand current resources and identify gaps in support across the perinatal continuum of care. Data was analyzed thematically. Results Participants in this study have considerably low maternal knowledge surrounding delivery, in addition to low levels of maternal knowledge and social support around postpartum care and practices. Participants received the most social and educational support during the antenatal phase of pregnancy, which is consistent with the implementation of government and community program goals to increase antenatal care among pregnant women. Notable issues among women during these phases involved consent, and satisfaction and comfort with childbirth care. Participant narratives described the important role of both formal and informal support structures in addressing maternal health needs. Formal structures of support include health systems at the community and facility levels whereas informal structures include family, friends, and the community. Participants also relied heavily on advice from formal modes of support including community health workers (ASHAs), midwives, and doctors. While many participants’ support needs were met by their support networks, our study identified certain areas where support needs remained unmet such as post cesarean section diet and care, institutional delivery, support of ASHA etc., in addition to areas of discrepancy between the advice provided compared to evidence-based practices. Conclusion This study identified a major lack of informational support during the delivery and postpartum phases of pregnancy, which may lead to complications for pregnant women. Programs targeting improved maternal health and wellbeing throughout the continuum of care need to educate pregnant women more about the institutional delivery process. Additionally, programs need to further supply women with support and education with regard to the postpartum phase, which remains neglected. Trial registration: This research is part of the formative phase of a larger intervention trial prospectively registered with Clinical trial registry of India. (CTRI/2020/12/029800 [Registered on: 15/12/2020] and clinicaltrials.gov (phase 1: NCT04636398, phase 2: NCT04693585)

In settings with limited resources that lack standards to ensure the quality of childbirth and newborn care, the use of antenatal corticosteroids is potentially harmful. Safe, effective use of antenatal corticosteroids requires providing standardized evidence-based practices and supportive supervision, training staff, and a facility-level actionable health information system., Key Findings Most of the 37 public health facilities in northern India that we assessed were not readied for providing quality care for threatened preterm birth and ensuring the safe use of antenatal corticosteroids (ACS).Deficiencies were identified in areas of evidence-based practices, competent workforce, actionable health information system, physical resources, and communication.The existing ACS guidelines were not up-to-date with current evidence and were not disseminated or implemented uniformly across facilities.Attention to accurate gestational age estimation and the quality of childbirth and preterm care were inadequate in all the facilities. Key Implications Increasing uptake of ACS for threatened preterm birth without providing adequate-quality maternal and newborn care and meeting essential preconditions outlined by World Health Organization recommendations will not improve preterm outcomes.Facility-level actions are needed for the safe and effective use of ACS in support of the delivery of quality care., Introduction: In 2014, the Government of India (GOI) released operational guidelines on the use of antenatal corticosteroids (ACS) in preterm labor. However, without ensuring the quality of childbirth and newborn care at facilities, the use of ACS in low- and middle-income countries is potentially harmful. This study assessed the readiness to provide ACS at primary and secondary care public health facilities in northern India. Methods: A cross-sectional study was conducted in 37 public health facilities in 2 districts of Haryana, India. Facility processes and program implementation for ACS delivery were assessed using pretested study tools developed from the World Health Organization (WHO) quality of care standards and WHO guidelines for threatened preterm birth. Results: Key gaps in public health facilities’ process of care to provide ACS for threatened preterm birth were identified, particularly concerning evidence-based practices, competent workforce, and actionable health information system. Emphasis on accurate gestational age estimation, quality of childbirth care, and quality of preterm care were inadequate. Shortage of trained staff was widespread, and a disconnect was found between knowledge and attitudes regarding ACS use. ACS administration was provided only at district or subdistrict hospitals, and these facilities did not uniformly record ACS-specific indicators. All levels lacked a comprehensive protocol and job aids for identifying and managing threatened preterm birth. Conclusions: ACS operational guidelines were not widely disseminated or uniformly implemented. Facilities require strengthened supervision and standardization of threatened preterm birth care. Facilities need greater readiness to meet required conditions for ACS use. Increasing uptake of a single intervention without supporting it with adequate quality of maternal and newborn care will jeopardize improvement in preterm birth outcomes. We recommend updating and expanding the existing GOI ACS operational guidelines to include specific actions for the safe and effective use of ACS in line with recent scientific evidence.

Background: Patient satisfaction is pertinent for measuring the performance of health-care service delivery, which is a multidimensional construct that depends on many factors. The main objective of this study was to assess the satisfaction of patients visiting a tertiary care hospital in Haryana. Materials and Methods: A cross-sectional study was conducted among patients visiting the outpatient department (OPD) and inpatient department (IPD) of the hospital from January to March 2019. Exit interviews were conducted using a structured questionnaire among patients visiting the OPD or IPD. The patient satisfaction was assessed based on four domains, namely registration process and experience before meeting the doctor, interaction with the doctor, hospital infrastructure, and medicine availability. The responses were captured on a Likert scale from one to five, and the scores were used to calculate the overall satisfaction. Results: Overall 84% of the patients were satisfied with the OPD services, whereas 77% of the patients were satisfied with the inpatient services. Male (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.04–4.14) and literate patients (OR = 2.77; 95% CI: 1.4–4.14) had higher chances of being satisfied with the OPD services. Whereas students, retired and unemployed patients (OR = 4.67; 95% CI: 1.46–14.6), and those from a reserved social caste (OR = 3.38; 95% CI: 1.58–7.21) were more satisfied with the IPD services. Conclusion: This study suggests that patients were satisfied to a larger extent with both OPD and IPD services. Therefore, effective strategies should be in place to maintain high satisfaction among patients, and the institutes should strive to provide 100% satisfaction.

Context: During ongoing passive surveillance in Burail, Chandigarh an unexpected rise in number of acute viral hepatitis (AVH) was reported during December 2016. Aims: An outbreak of AVH was investigated in an urbanized village, Burail, in Chandigarh, India with an objective of describing its epidemiological features. Settings and Design: A house-to-house survey was conducted in Burail (population 51,958). Subjects and Methods: WHO's standard case definition for AVH was used to identify cases. Suspected cases were tested for hepatitis A virus (HAV) and E virus (HEV) using enzyme-linked immunosorbent assay. Drinking water samples were tested for fecal contamination. Control measures were implemented to contain the outbreak. Statistical Analysis Used: Descriptive analysis was done as per time, person, and place. Results: Out of 141 confirmed cases of AVH, 85.1% were positive for HEV, 12.8% for HAV, and 2.1% for both HAV and HEV. The attack rate was 27.1 per 10,000 in a population. Males were affected more than females (P < 0.05). One of the areas reported a leakage in drinking water pipeline and had highest attack rate (36.8/10000 population). Drinking water samples were found negative for contamination. Around 27% of confirmed cases reported history of taking food from local vendors in Burail 2–6 weeks prior to the onset of symptoms. Conclusion: This study described the epidemiological features of dual hepatitis outbreak due to HAV and HEV from Chandigarh, Union Territory, north India.

Background As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. Objective We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. Methods A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. Results The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards for mother and infant during the pregnancy or postpartum period. Conclusions These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions.

BACKGROUND As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. OBJECTIVE We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. METHODS A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. RESULTS The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards for mother and infant during the pregnancy or postpartum period. CONCLUSIONS These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions.

ObjectiveTo quantify the extent of awareness regarding the harmful effects of tobacco among the users (both smoked and smokeless) and non-users in India, and explore the determinants of comprehensive knowledge among the participants of the Global Adult Tobacco Survey (GATS), India.DesignCross-sectional study.Setting and participantsThe nationally representative GATS I (2009–2010) included 69 296 participants using a multistage sampling method, while GATS II (2015–2016) interviewed 74 037 respondents aged >15 years using a similar sampling method from all the states and union territories in India.Primary and secondary outcome measuresComprehensive score were derived from nine items that explored awareness regarding the adverse effects of tobacco use among both users and non-users of tobacco in GATS II. Secondary outcome included predictors of awareness regarding adverse effects of tobacco and changes in the awareness compared with the previous round of the survey.ResultsAbout 60.2%, 57.5% and 66.5% of the smokers, smokeless tobacco (SLT) users and non-users were aware of the adverse effects of tobacco, respectively. The awareness depicted significant age, gender, marital status, education status, urban–rural, wealth and regional disparities (pConclusionsComprehensive awareness of tobacco’s harmful effects is far from desirable among Indian users. We recommend further customised health promotion campaigns to counter the regional disparities, adopt a gender-neutral approach and target adolescents.

OBJECTIVES: Anemia is a public health problem in women of reproductive age in many low- and medium-income countries including India. Maternal anemia can cause low birth weight, impaired fetal growth, and preterm birth. We assessed the baseline prevalence of anemia, iron deficiency (ID), iron deficiency anemia (IDA), and inflammation using c-reactive protein (CRP) among non-pregnant, non-lactating women of reproductive age living in the Ambala District, Haryana, India prior to the start of a wheat flour fortification program. METHODS: We conducted a multistage cluster probability household and biomarker survey and analyzed venous blood samples from non-pregnant, non-lactating women aged 18–49 years residing in rural areas of two subdistricts in the Ambala District. Factors of interest were: anemia, hemoglobin 5 mg/L. We used the BRINDA regression adjustment for ferritin to account for inflammation. Prevalence and 95% confidence intervals (CI) for anemia, ID, IDA, and CRP were estimated. RESULTS: Among 775 non-pregnant, non-lactating women of reproductive age, 54.3% (95% CI; 50.7, 58.0) had anemia, 86.9% (95% CI; 84.3, 89.2) were iron deficient, and 15.1% (95% CI; 12.5, 18.1) had inflammation. Among those with anemia, 58.2% (95 CI; 54.3, 62.0) had iron deficiency anemia. CONCLUSIONS: Anemia, iron deficiency, and iron deficiency anemia among non-pregnant, non-lactating women of reproductive age in Haryana are significant public health concerns. The findings from the survey helped quantify the burden of inadequate iron intake and informed the Haryana government's prevention strategy aimed at reducing micronutrient deficiencies through a wheat flour fortification program. FUNDING SOURCES: Centers for Disease Control and Prevention.

Aim To determine the prevalence of falls and to assess its relationship with cognitive deficits, depression, visual impairment and self-reported hearing impairment among the elderly. Methods This was a community-based, cross-sectional study conducted in 52 villages in the Naraingarh and Barara block of Ambala district which involved 468 participants. A pretested predesigned questionnaire was used to collect data regarding demographic profile, falls, and physical morbidities. Geriatric Depression Scale-Hindi, Hindi-mini-mental state examination, Snellen chart, Katz- Activity of Daily Living were used to collect data for depression, cognitive decline, vision and activity of daily living respectively. Results The prevalence of falls was found to be 28.7%. An association was found between falls and slippery floors in the houses, hearing loss, vertigo, hypertension, use of multiple medications, depression and functional disability in univariate analysis. On multivariate regression analysis, slippery floors (OR = 2.28), use of multiple medications (OR = 1.71), hearing loss(OR = 1.83) and presence of depression (OR = 1.62) were found to be independent risk factors with falls. Conclusion There is high prevalence of falls among the elderly and these are commonly related to preventable factors. Appropriate environmental modifications and exercise programs can help reduce the rate of falls as well as injuries related to falls among the elderly.

To study the factors associated with waist-to-height ratio (WHtR) among school children aged 5-15 y and its association with hypertension.In this cross-sectional study, data on background characteristics, socioeconomic status (SES), anthropometric parameters, and blood pressure were obtained from school children from three states of India. WHtR ≥ 0.5 was defined as obesity and hypertensives were defined based on Fourth Report criteria. Descriptive statistics were applied and multiple linear regression was done to identify factors associated with WHtR. A receiver operating characteristics (ROC) analysis was used to evaluate the predictive ability of WHtR to predict hypertension RESULTS: The mean WHtR among the 12,068 students was 0.40 (± 0.05) and it showed a U-shaped distribution with age with trough at 10 y of age for both genders. Mean WHtR was higher among residents of Manipur, among boys and hypertensives. WHtR was positively associated with weight 30 kg, male gender, schools with high SES, Manipur and Goa region, and negatively associated with age 10 y. The area under the ROC curve of WHtR for diagnosis of hypertension was low 0.544 (95% CI 0.532, 0.556).There is a nonlinear relation between age, gender, and WHtR, which varies by geographical region and HT. This would need to be kept in mind while using it to identify obesity in children, though its discriminant value for hypertension is low.

Objectives: Diabetes is commonly observed to be associated with several comorbidities, out of which cardiovascular comorbidities are most frequently observed. The present study has been done to estimate the proportion of cardiovascular comorbidities among patients of diabetes and to compare it with that of matched nondiabetics. It also aimed to compare the quality of life (QOL) scores and the cost of treatment between diabetics and nondiabetics with cardiovascular comorbidities. Methodology: A hospital-based comparative analytical study was conducted in a tertiary care hospital of Uttarakhand, India. One hundred and ninety-five diabetic were compared with an equal number of age- and gender-matched nondiabetics. We compared the two groups for the presence of comorbidities by Chi-square test and for QOL and cost of care by independent t-test. Regression was done to study factors associated with direct cost incurred for treatment among diabetics with cardiovascular comorbidity. Results: The present study reported about four-time higher risk (odds ratio: 3.9; confidence interval: 2.5–6.1) of comorbidities of cardiovascular system (CVS) among diabetics as compared to nondiabetics. QOL scores were reported to be significantly lower among diabetics with comorbidities of CVS in comparison to nondiabetics. Significant predictors of direct cost among diabetics were religion, marital status, income, and use of alcohol. Conclusion: Cardiovascular comorbidities have been reported to be four times higher among diabetics in comparison to nondiabetics, leading to an adverse effect on QOL and increased expenditure on treatment.

In this ongoing SARS-CoV2 Corona virus pandemic, we are witnessing an uninhibited spread of mis-information on various social media platforms. This spread of mis-information or “mis-infodemic” is playing a negative role in our fight against the virus with far reaching consequences. International organizations like the WHO and other governmental organizations have geared up to the occasion to limit the spread of these and bring clarity in this context. In this time of crisis, risk communication is vital in the communication between organizations/government and the people. But apart from the organizations, the onus is on the people and media to realise the importance and verify the authenticity of information being circulated. It is imperative that information, being a double edged sword, is handled with caution and effective communication strategies are devised for the dissemination of accurate and scientific health related information. Social media can be used in a constructive way in mitigating the effects of this pandemic for the betterment of the society.

BACKGROUND The Indian national program stresses implementation of cervical cancer screening by health workers/nurses using VIA (Visual Inspection under Acetic acid). We demonstrate its feasibility and reliability in rural setting, assessing the role of smartphone-imaging for continuous training of nurses. DESIGN A cross-sectional design to assess the reliability of the nurse-led VIA test. To assess feasibility, VIA positive patients were observed till confirmative diagnosis was made. SAMPLE Hospital-based purposive sampling was used to recruit participants. MEASURES A structured questionnaire for recording participants' details, VIA findings and follow-up information; and an observational checklist to record implementation parameters during each clinic. An expert assessed the nurse's judgment using smartphone-images of cervix. RESULTS During October 2016-June 2017, 2758 patients attended the weekly clinic; 238 (8.6%) met the criteria, of those 180 (75.6%) tested after consent. Nurse reported 25 (13.8%) VIA-positive cases, but only 19 accessed the referral service. Kappa statistic: 0.45 (CI: 0.26-0.63) suggested moderate nurse-expert agreement. Image retrieval and quality affected expert's evaluation. Implementation challenges include low awareness among the population and referral link-up. CONCLUSION Appropriately trained nurses can reliably conduct screening. Real-time expert feedback might improve reporting. Rigorous awareness activities and on-site treatment can reduce drop-outs. The medical institute's involvement and administrative will were instrumental.

Context: Light-emitting diode fluorescence microscopy (LED-FM) has been recommended by the WHO and the Government of India over the conventional bright-field microscopy using Ziehl–Neelsen (ZN) staining for the diagnosis of sputum smear-positive tuberculosis (TB) suspects. Aim: The aim of this study was to assess the effectiveness of LED-FM in detecting TB cases. Setting and Design: This retrospective cohort study was carried out in December 2016 using secondary data of the years 2011–2012 from designated microscopy centers (DMCs) at Chandigarh, India. Methodology: Two peripheral DMCs where conventional ZN microscopy was used were taken as controls comparable to two peripheral DMCs which used LED-FM services in programmatic settings. The record of all suspected TB patients who underwent sputum smear examination pre- and post-LED-FM introduction was compared for measuring smear-positive cases, conformational grading, and time taken to read per slide examined. Chi-square was applied to access the statistical significance. Results: Out of total 8850 cases registered after the inception of LED-FM microscopy services, case detection rate was 13.3%, with significant decrease in case detection rate at tertiary level DMCs, there was significant increase in case detection rate at peripheral DMCs operating with LED-FM in contrast to ZN microscopy which was used previously. Scanty grade smear increased significantly by 9.0%. The time taken per slide examination decreased by 57.1% (from 7 min on an average to 3 min on an average) after LED-FM was used. Conclusion: LED-FM is easy to use, takes lesser time to examine slides, and has longer self-life. It also eases laboatory technician's task in reporting scanty grade positives which use to be challenging previously. The results of this study provide enough evidences to scale up the installation process and usage of LED-FM at DMCs for TB diagnosis in Indian settings.

Purpose To assess the knowledge and attitude of school-going adolescents regarding corneal donation in government and private schools in an urban area of Northern India. Methods A school-based cross-sectional study was conducted in an urban field practice area of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. A total of 365 participants of the seventh to 10th grade were enrolled from a government school and a private school. A pretested, semistructured, self-administered, bilingual (English and Hindi) questionnaire was used to assess the sociodemographic profile and knowledge and attitude related to corneal donation. Results Most (87%) (confidence interval, 83.1%-90.0%) participants had heard about corneal donation. Only 2% of students answered all the knowledge-related questions correctly. None knew about the national toll-free number for corneal donation. Three-fourth (72%) supported the idea of corneal donation. Of them, only 44% (confidence interval, 41.0-47.1) were willing to pledge to donate their own eyes. Fears and myths were the persistent barriers. The government and private schools differed in both knowledge and attitude, with the latter performing better. Conclusions Knowledge among the selected high school children was poor. Although many supported the idea, only a few were willing to donate. We suggest that program components be evaluated from time to time. Future studies should explore the role of strengthening Information Education and Communication (IEC) activities among high school students for motivating community members to pledge to donate for corneal donation.

OBJECTIVES: To study the nutritional status and prevalence of RBC folate, Serum folate and vitamin D deficiency among adolescents. METHODS: A cross sectional pilot study was carried out among 96 adolescents visiting outpatient department for refraction at tertiary care hospital in North India. Anthropometric data was obtained for height in centimetres and weight in kilograms. A pretested questionnaire was used to capture quantitative data. Venous blood samples were collected where red blood cell (RBC), serum folate and serum Vitamin D concentrations were measured. Anaemia was defined as normal, mild, moderate and severe as Hb > 12gm/dl, 11–11.9 gm/dl, 8–10.9 gm/dl and

Background: Cancer has become an epidemic disease. Nearly ten million new cancer cases are diagnosed annually in the world and out of these about half are from the developing world. To appropriately plan for treatment, management and prevention of the disease, it becomes necessary to study the trends about morbidity caused by cancers. Materials and Methods: Data for patients diagnosed with any form of gastrointestinal (GI) cancers was extracted from records maintained in the outpatient department registers of the Oncology Department of Government Medical College and Hospital in Chandigarh from 1999 to 2012. Trends were analysed for different categories of GI cancers for the period of 12 years. Results: In present study GI cancers accounted for 23 % of all registered cases (n-9603) of carcinomas. Males predominated for all GI cancers except in the gall bladder. Gastrointestinal cancers as a proportion of total cancers increased from 21% in 1999 to 25.9% in 2012 with a significant increasing trend in our series ( χ 2 for linear trend=9.36, p

Objective: Our study includes the investigation of the phytochemical composition and in vitro free radical content and antiinflammatory activity of Mimosa pudica. Materials and Method: Free radical scavenging assay was done to evaluate the dose dependent reduction of free radical by ethanolic extract of Mimosa pudica, this activity was compared with a reference antioxidant i.e. Ascorbic acid. The anti-inflammatory potential of ethanolic extract of Mimosa pudica has been determined by using carrageenan-induced paw edema assay and Cotton wool granuloma in rats. Results: The IC50 of our sample was 24.55 μg/ml, it’s a very much promising result comparing to same reference. At the dose of 300 mg/kg the extract shows considerable inhibitory effect on paw increase 1 hour after carrageenan administration, by inhibiting nearly 50%. The maximum inhibition (43.48%; p Conclusion: This finding suggests that ethanolic extract of M. pudica possess potent anti-inflammatory activity possibly due to its free radical scavenging properties. Key words: Anti-oxidant, Carrageenan, Cotton oil, Inflammation, Mimosa pudica, Paw edema.

Background: In India, Janani Shishu Suraksha Karyakaram (JSSK) was launched in the year 2011 to assure cashless institutional delivery to pregnant women, including free transport and diet. Objective: To assess the impact of JSSK on institutional delivery. Materials and Methods: A record review was done at the primary health care facility in Faridabad district of Haryana from August 2010 to March 2013. Focus group discussion/ informal interviews were carried out to get an insight about various factors determining use / non-use of health facilities for delivery. Results: Institutional delivery increased by almost 2.7 times (197 Vs 537) after launch of JSSK (p < 0.001). For institutional deliveries, the most important facilitator as well as barrier was identified as ambulance service under JSSK and pressure by elders in the family respectively. Conclusions: JSSK scheme had a positive impact on institutional deliveries. It should be supported with targeted intervention designed to facilitate appropriate decision-making at family level in order to address barriers to institutional delivery.

Background: This study was conducted to assess the current status of functioning of health facilities in Punjab.Methods: A checklist based on six building blocks of health system proposed by WHO and the IPHS was developed, validated and pretested. District hospital (DH), one sub district hospital (SDH) and two Community Health Centres or Block Primary Health Centres (CHCs/BPHCs) were randomly selected from each of 22 districts of Punjab and evaluated against checklist. Total score was thus assigned to each facility. Additionally, workload of healthcare workforce, presence of health functionaries as against total posted strength and feedback from administrators of these facilities were also recorded.Results: Health services are concentrated at the DH and SDH. Functional equipment like ECG, oxygen, mask, ambubag etc. are deficient at all levels of health facilities. Nearly 50% of expected medicines were in stock at the DH and SDH and 66% at CHC/BPHC level. Patient to doctor ratio is highest at SDH in outpatient department and CHC/BPHC in emergency section. Number of lab tests per lab technician are highest at CHC/BPHC level. Administrators express the need for reducing staff shortage, more intensive training in the financial and administrative processes and simplification of procedures for management of equipment.Conclusions: Strengthening CHC/BPHC level institutions may improve utilization of public health system and reduce referrals. Lifesaving drugs and equipment need to be available and operational at all levels of facilities. Content of training to administrators needs to be tailored to the felt needs.

OBJECTIVES: To conduct a household and biomarker survey to assess the baseline prevalence of folate deficiency and insufficiency and vitamin B12 deficiency in women of reproductive age prior to the start of a wheat flour fortification program in the Ambala District in Haryana, India. METHODS: A multistage cluster probability household and biomarker survey was conducted. Participants were women of reproductive age (18–49 y) who were not pregnant and resided in rural areas of two subdistricts in Ambala District in Haryana. Venous blood samples were collected among 866 women. Plasma, serum, and red blood cells (RBC) were separated by centrifugation, processed, and stored at

Background and Aim: Few studies in India have tried to examine the role of female literacy on contraception usage. This study aimed to determine family planning related knowledge and practices and their association with female literacy. Materials and methods: Facility based cross-sectional study was done among married women aged 15-45 years attending outpatient department of three primary health centres in rural Tamilnadu. Data were collected using pretested semi-structured questionnaire by a convenience sampling technique. To assess family planning related knowledge, a composite score was calculated and final score was categorised into satisfactory and unsatisfactory. Results: A total of 100 women participated. Fifty nine percent had satisfactory Family Planning related Knowledge and practices (FPK). Contraception prevalence rate for modern methods was 60%. Eighty percent had ever undergone abortions and among them, one fifth had undergone uncertified abortions.With increase in the literacy status, proportion having satisfactory family planning related knowledge increased (p Conclusion: This study offers evidence that promotion of female literacy could be considered a strategy for promoting contraceptive usage and addressing population growth in India.

Introduction: Disorders of menstruation are common problems among women. They have several psychological effects on women’s health. Aim: This study aimed to estimate prevalence of menstrual disorders, usage of sanitary pads and their determinants among married women in selected villages of rural Haryana. Materials and Methods: A cross-sectional study was conducted during September 2011 in 10 villages of PHC (Primary Health Centre) Mandi, Haryana, using a systematic random sampling technique. Currently married women in the age group of 18-45 years living in study area for more than 1 year were included in the study while those who were pregnant and unable to understand questions were excluded. Informed verbal consent was obtained from all participants. Results: A total of 344 women were interviewed. The mean (SD) age of participants was 28.0 (5.4) years. Majority of women were housewives (78.8%) and most had education up to middle school (22.7%). Mean (SD) age at menarche was 14.3 (1.2) years. Nearly one-tenth of women had married before 18 years of age. Prevalence of all menstrual disorders was 20.3% and most common disorder was excessive pain. About one fifth reported irregularity of menstrual cycles. Almost half were not using sanitary pads during menses. Menstrual disorders were more common among non-users of contraception (OR=1.7, p = 0.04) and housewives (OR = 2.4, p= 0.03). Conclusion: Disorders of menstruation were fairly common among women surveyed. Usage of sanitary pads was quiet low. Awareness generation among women regarding menstrual problems and Behaviour Change Communication to promote usage of sanitary pads are important measures to reduce related morbidity.

Background: India contributes a large proportion to global under-five child mortality. One of the determinants of child morbidity and mortality is the child rearing practices. Socio-economic environment, child rearing practices and nutritional status play a synergistic role. Materials and Methods: Information was collected by exit interviews from married women attending out-patient departments of three primary health centers. Data was collected during December, 2009 using pretested questionnaire Married women in reproductive age group with youngest child in the age group of 1-5 years were eligible for inclusion. To assess the child rearing knowledge and practices (CRKP), a composite score was calculated based on 10 variables and categorized into satisfactory and unsatisfactory. Results: A total of 100 eligible married women were included in the study. About half of the women were in the age group of 25-35 years, 80% belonged to social class V and VI majority (63%) were literate and 70% had ≥2 children. With the increase in literacy status, there was the increase in proportion of women who had satisfactory CRKP and decrease in proportion of women who had given pre-lacteal feed. Among women who had three children, 15 out of 39 (38%) had fully immunized their first child as compared with 25 out of 39 (64%) for the second child and 38 out of 39 (97%) for the third child. Immunization coverage increased as the birth order increased. Conclusion: Mothers' education has a significant role in determining her child rearing practices, which in turn would lead better child survival.