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Background: Ath Waas is a one-of-a-kind health promotion intervention that focuses on chronic disease prevention behaviors through peer support and social support network development. The goal of the study was to see how effective Ath Waas was in a city setting in India., Materials and Methods: From July 2018 to July 2019, we used a mixed-methods intervention research design including many sites. At 0, 2, 3, 5, 7, 9, and 12 months, data were collected using participant surveys and in-person interviews. Throughout the research period, participants met in groups at least once a month to self-monitor health indicators, prepare and share a healthy snack, engage in physical activity, create a healthy lifestyle goal, and socialize. Data were analyzed using a paired t -test, and inferences were drawn thereof., Results: There were statistically significant improvements in the majority of the domains of health from pre- to post-program, and 59% of participants reported specific behavioral changes as a result of their participation in the Ath Waas . Peer support, obtaining particular health knowledge, inspiration, motivation, or accountability, the empowering effect of monitoring one's own health indicators, overcoming social isolation, and knowing how to better access resources were all positive health outcomes. The mean knowledge scores for diabetes, hypertension, and nutrition in the first survey were 20.3 ± 2.1 and 5.2 ± 1.9 and in the last survey were 22.6 ± 3.1 ( P < 0.05), 5.8 ± 2.4 (<.05), and 44.3 ± 3.9 (<0.001) after the intervention, respectively., Conclusion: The necessity to find novel approaches to chronic illness prevention and management drove the implementation and evaluation of Ath Waas . While more research is needed to confirm the current findings, it looks like Ath Waas could be a useful tool for empowering community members to support one another while promoting healthy lifestyle choices and recognizing early changes.Clinical Trial Registry of India: CTRI/2019/01/017028 (registered on 10/01/2019)., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Introduction: Iodine deficiency is the leading cause of preventable brain damage, with 30% of the world's population suffering from iodine deficiency disorders (IDDs). The objectives of the study are to estimate the prevalence of goitre among schoolchildren in the age group of 6-12 years, to find out the proportion of households with adequately iodised salt, and to assess the dietary iodine intake by measuring urinary iodine levels in the urine samples of school-going children., Methods: A cross-sectional study was conducted in four pre-selected districts of the Kashmir division of Jammu and Kashmir in school-going children aged 6 to 12 years. Multi-stage 30 cluster sampling was used to select the study sample. For the selection of 30 clusters in each district, probability proportional to size (PPS) was employed. From each cluster, 90 children were selected. From a sub-sample of children in each district, 540 salt samples and 270 urine samples were also collected., Results: A total of 10,800 children aged 6-12 years were examined. Grade I goitre was present in 1382 (12.8%) and 116 (1.07%) which were having Grade II goitre. The weighted prevalence of goitre for four districts was 12.6%, lowest for district Ganderbal and highest for district Shopian. Half of the population in all the districts consumed salt with iodine levels of <15 ppm. Urinary iodine levels <99.9 mg/L were present in 15.7% indicating mild to moderate iodine deficiency., Conclusion: Though the present survey showed some decline in the total goitre rate (TGR) from a prevalence of 14.8% in 2017 to 12.6% in 2022, it continues to be a public health problem of mild to moderate intensity in Kashmir. The salt consumed at the household level was inadequately iodised. Hence, efforts in IDD elimination activities need to be scaled up further with emphasis on iodised salt quality control and intensive education at the community level., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Endocrinology and Metabolism.)

Background Objectives: The clinical course of COVID-19 and its prognosis are influenced by both viral and host factors. The objectives of this study were to develop a nationwide platform to investigate the molecular epidemiology of SARS-CoV-2 (Severe acute respiratory syndrome Corona virus 2) and correlate the severity and clinical outcomes of COVID-19 with virus variants., Methods: A nationwide, longitudinal, prospective cohort study was conducted from September 2021 to December 2022 at 14 hospitals across the country that were linked to a viral sequencing laboratory under the Indian SARS-CoV-2 Genomics Consortium. All participants (18 yr and above) who attended the hospital with a suspicion of SARS-CoV-2 infection and tested positive by the reverse transcription-PCR method were included. The participant population consisted of both hospitalized as well as outpatients. Their clinical course and outcomes were studied prospectively. Nasopharyngeal samples collected were subjected to whole genome sequencing to detect SARS-CoV-2 variants., Results: Of the 4972 participants enrolled, 3397 provided samples for viral sequencing and 2723 samples were successfully sequenced. From this, the evolution of virus variants of concern including Omicron subvariants which emerged over time was observed and the same reported here. The mean age of the study participants was 41 yr and overall 49.3 per cent were female. The common symptoms were fever and cough and 32.5 per cent had comorbidities. Infection with the Delta variant evidently increased the risk of severe COVID-19 (adjusted odds ratio: 2.53, 95% confidence interval: 1.52, 4.2), while Omicron was milder independent of vaccination status. The independent risk factors for mortality were age >65 yr, presence of comorbidities and no vaccination., Interpretation Conclusions: The authors believe that this is a first-of-its-kind study in the country that provides real-time data of virus evolution from a pan-India network of hospitals closely linked to the genome sequencing laboratories. The severity of COVID-19 could be correlated with virus variants with Omicron being the milder variant., (Copyright © 2024 Copyright: © 2024 Indian Journal of Medical Research.)

Purpose: Due to a lack of effective antiviral treatment, several vaccines have been put forth to curb SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection and to reduce the mortality and morbidity rate by eliciting a protective immune response, primarily through virus-neutralizing antibodies specific for SARS-CoV-2 spike protein. This longitudinal study was designed to evaluate the vaccine effectiveness and immune response following the administration of adenoviral vaccine, COVISHIELD , in Indian population who were previously uninfected with SARS-CoV-2 and to reveal the effect of various sociodemographic, inflammatory and biochemical factors on antibody response., Methods: Briefly, the total immunoglobulin G (IgG) against SARS-CoV-2 spike and nucleocapsid protein along with the immunological markers were estimated by chemiluminescent microparticle immunoassay (CMIA) technology. Biochemical parameters were estimated by spectrometry., Results: A total of 348 subjects received two doses of COVISHIELD (224 males, 124 females). The mean age of the study subjects was 42.03 ± 13.54 years. Although both the doses of COVISHIELD against SARS-CoV-2 spike protein induced a robust immune response that lasted for months in all the subjects, the total IgG titer against SARS-CoV-2 spike protein was found significantly higher in subjects ≥50 years of age, and those with obesity, elevated triglycerides and elevated lactate dehydrogenase levels., Conclusions: There is a definite effect of age and biochemical factors on the immunogenicity of COVISHIELD. An understanding of these factors could not only impact the design of vaccines and help improve vaccine immunogenicity and efficacy but also assist in decisions on vaccination schedules, in order to combat this deadly pandemic., Competing Interests: Conflict of interest: The authors disclose that there are no financial or nonfinancial interests that are directly or indirectly related to the work submitted for publication., (Copyright © 2023, The Authors.)

Objective: To study the impact of coronavirus disease 2019 (COVID-19) vaccination on the menstrual cycle in response to concerns that the vaccines cause menstrual cycle disturbances and affect potential pregnancy., Method: An online survey-based cross-sectional study was conducted from November 20 to 27, 2021. Study participants were women of reproductive age (15-49 years) and the study tool used was a semi-structured pretested questionnaire. A total of 300 participants were recruited for the study., Results: The mean age (± standard deviation) of the participants was 26.2 ± 4.8 years. 232 participants (77.3%) were unmarried. Only 30 participants (10%) reported a change in the regularity of menstruation and 33 (11%) participants reported a change in cycle duration after vaccination., Conclusion: In the present study, a change in the regularity of menstrual cycles was reported in 30 (10%) of the participants and a  change in the duration of the cycle was reported in 11% of the participants (33). There was a significant association between the type of vaccine used and the changes in the menstrual cycle after vaccination. However, its long-term health implications are yet to be determined., (© 2023 International Federation of Gynecology and Obstetrics.)

Background: Children inherently want to remain engrossed in the activities as easily as possible within their ecological environment and academic curricular ambit. Covid-19 adversely affected our physical, social, and mental conditions and children were no exception., Objectives: To understand the experiences of teachers who have been doing virtual teaching to children during COVID-19; To understand the impact of virtual teaching and COVID-19 on physical and mental health of children., Materials and Methods: The qualitative study was conducted in the Kashmir valley and school teachers teaching students from class Ist to class 8 th were involved in the study. Participants were selected purposefully based on the inclusion criteria. One-to-one in-depth interviews were conducted with sixteen (16) school teachers, using a preformed interview guide. Data analysis was performed using the thematic analysis method., Results: Data analysis yielded four overarching themes and twelve subthemes viz:- 1) Attitudes towards online sessions among teachers (2) factors affecting the physical and mental health of children (3) Effectiveness of online classes for individual lines of children's mental development (4) External and internal factors impacting child development and pedagogy., Conclusion: The study result explicitly showed mental and physical health of children got considerably affected by online teaching during the Covid-19 pandemic. Online teaching especially to children is less yielding in terms of effective academic consequences. Nevertheless, blending online teaching with pedagogy can enhance certain multidimensional capabilities of the children., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Psychiatry.)

Background: Within Kashmir, which is one of the topographically distinct areas in the Himalayan belt of India, a total of 2,236 cumulative deaths occurred by the end of the second wave. We aimed to conduct this population-based study in the age group of 7 years and above to estimate the seropositivity and its attributes in Kashmir valley., Methods: We conducted a community-based household-level cross-sectional study, with a multistage, population-stratified, probability-proportionate-to-size, cluster sampling method to select 400 participants from each of the 10 districts of Kashmir. We also selected a quota of healthcare workers, police personnel, and antenatal women from each of the districts. Households were selected from each cluster and all family members with age 7 years or more were invited to participate. Information was collected through a standardized questionnaire and entered into Epicollect 5 software. Trained healthcare personnel were assigned for collecting venous blood samples from each of the participants which were transferred and processed for immunological testing. Testing was done for the presence of SARS-CoV-2-specific anti-spike IgM, IgG antibodies, and anti-nucleocapsid IgG antibodies. Weighted seropositivity was estimated along with the adjustment done for the sensitivity and specificity of the test used., Findings: The data were collected from a total of 4,229 participants from the general population within the 10 districts of Kashmir. Our results showed that 84.84% (95% CI 84.51-85.18%) of the participants were seropositive in the weighted imputed data among the general population. In multiple logistic regression, the variables significantly affecting the seroprevalence were the age group 45-59 years (odds ratio of 0.73; 95% CI 0.67-0.78), self-reported history of comorbidity (odds ratio of 1.47; 95% CI 1.33-1.61), and positive vaccination history (odds ratio of 0.85; 95% CI 0.79-0.90) for anti-nucleocapsid IgG antibodies. The entire assessed variables showed a significant role during multiple logistic regression analysis for affecting IgM anti-spike antibodies with an odds ratio of 1.45 (95% CI 1.32-1.57) for age more than 60 years, 1.21 (95% CI 1.15-1.27) for the female gender, 0.87 (95% CI 0.82-0.92) for urban residents, 0.86 (95% CI 0.76-0.92) for self-reported comorbidity, and an odds ratio of 1.16 (95% CI 1.08-1.24) for a positive history of vaccination. The estimated infection fatality ratio was 0.033% (95% CI: 0.034-0.032%) between 22 May and 31 July 2021 against the seropositivity for IgM antibodies., Interpretation: During the second wave of the SARS-CoV-2 pandemic, 84.84% (95% CI 84.51-85.18%) of participants from this population-based cross-sectional sample were seropositive against SARS-CoV-2. Despite a comparatively lower number of cases reported and lower vaccination coverage in the region, our study found such high seropositivity across all age groups, which indicates the higher number of subclinical and less severe unnoticed caseload in the community., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lone, Khan, Qurieshi, Majid, Pandit, Haq, Ahmad, Bhat, Bashir, Bilquees, Fazili, Hassan, Jan, Kaul, Khan, Mushtaq, Nazir, Qureshi, Raja, Rasool, Asma, Bhat, Chowdri, Ismail, Jeelani, Kawoosa, Khan, Khan, Kousar, Lone, Nabi, Qazi, Rather, Sabah and Sumji.)

Background: Measles surveillance serves as the means of monitoring program success. The quintessential purpose of measles surveillance is to identify gaps and garner effective public health responses to achieve measles elimination., Objectives: There were two key objectives: (i) to conduct an in-depth review of the existing measles surveillance system in Kashmir and highlight its strengths and weaknesses and (ii) to assess the pattern of measles-containing vaccine (MCV1) coverage and MCV2 coverage among under-5 years children and describe the health-seeking patterns of suspected cases of measles., Methods: The mixed methods study was conducted in the Kashmir valley from March 2018 to March 2019. An explorative qualitative design was followed using individual face-to-face interviews with thirty-two (n = 32) different stakeholders from the state, district, medical block, and primary health center (PHC) levels. To complement the qualitative study, a quantitative survey was done in two districts, Srinagar and Ganderbal, which consist of 5 and 4 medical blocks, respectively., Results: Among the suspected cases of measles, 52% had visited PHCs. Sixty-four suspected cases of measles (64) were immunized with two doses of MCV. None of the clinically suspected cases of measles were further investigated. In the qualitative analysis, five themes were generated viz, "measles surveillance description of Kashmir valley;" "factors affecting measles surveillance, perceptions, and experiences of stakeholders;" "barriers to measles surveillance;" "measles surveillance activities need to be intensified;" and "respondent recommendations for building an effective and sensitive measles surveillance system.", Conclusion: The current measles surveillance system in Kashmir was not effectively functioning; case-based measles surveillance is not being done as per the WHO guidelines. There is a lack of planning, advocacy, awareness, and communication of measles surveillance among the stakeholders. The visible barriers in measles surveillance included lack of training, logistics, incentives, and monitoring by internal and external agencies., Competing Interests: None

Background: The tide of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) pandemic has scoured the global community with India, from 30 January 2020 to 30 September 2021, reporting 33,739,980 confirmed cases and over 448,090 deaths from coronavirus disease (COVID-19). Serologic testing for SARS-CoV-2 infection among the general public will provide essential information regarding the risk of infection. So, the present study was conducted to provide relevant information on the proportion of people who hadexperienced either a recent or past infection., Methodology: A cross-sectional study was conducted among adults >18 years in the Department of Community Medicine, Government medical college, Srinagar. Blood samples of the participants were tested for the presence of SARS-CoV-2-specific IgG antibodies using a chemiluminescent microparticle immunoassay-based serologic test., Results: A total of 2,107 participants took part in the study. The overall unadjusted seroprevalence of IgG antibodies against SARS-CoV-2 in our study was 49%. The age-adjusted seroprevalence was 52%., Conclusion: The findings of the study suggested that not only a large proportion (49%) of the participants had been infected with COVID-19 infection but many were also susceptible to infection. Therefore, infection control measures still need to be followed properly., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Background: Active acute flaccid paralysis (AFP) cases surveillance in children under 15 years is ongoing till reaching eradication of poliomyelitis in the globe. As there is always a high risk of importation of wild poliovirus (WPV) from the endemic countries, accurate surveillance for AFP cases to detect WPV circulation and to maintain our achievement is thoroughly essential., Objectives: To evaluate the performance of the AFP surveillance system in Kashmir Valley. To identify gaps, if any, in AFP surveillance., Materials and Methods: The Mixed Methods study was conducted in the Kashmir valley from March 2018 to March 2019. An explorative qualitative design using individual, face-to-face interviews with thirty-two (32) different stakeholders from the State, District, Medical Block, and PHC levels. To complement the qualitative study, a quantitative door-to-door survey was done in two Districts, Srinagar and Ganderbal, which consist of five and four Medical Blocks respectively., Results: The thematic qualitative analysis approach was used, and the analysis process resulted in five themes. 1. Stakeholders' description of AFP surveillance. 2. Perception and awareness, appraisal of AFP Surveillance among stakeholders 3. Barriers in reporting AFP cases 4. Forging stronger linkages, improved planning in the health system to address gaps in AFP surveillance. 5. Enhancement of activities for sensitive AFP surveillance. In door to door survey of households in different sub-centre areas, a total of n = 1304 families were visited in which maximum (n = 647) families had two <15 years' children. In the survey, only one AFP case was recorded from Sub-Centre Kurag., Conclusion: There is a need for sensitive AFP surveillance by working on various factors, including training, behavioural change of health workers, improving reporting of cases, especially efforts are needed for the formation of effective AFP surveillance system by forging cooperation with different segments of the health system., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Parathyroid carcinoma is very rare in pregnancy. Clinical features are similar to primary hyperparathyroidism. A 38-year-old pregnant woman had repeated hospital admissions for palpitations, headaches, dizziness and polydipsia. Blood investigations showed severe hypercalcaemia with raised parathyroid hormone and 24-hour ECG showed ventricular bigeminy and premature ventricular contractions. Neck ultrasound showed a lesion in the right thyroid lobe. Consequently, she underwent an en bloc resection of the right parathyroid and thyroid lobe at 23 weeks gestation. Histology results confirmed parathyroid cancer. This case highlights the complexities of identifying hypercalcaemia in pregnancy due to the overlapping features with common disorders of pregnancy. Early recognition and timely surgical management can prevent maternal and fetal complications. Also, the case demonstrates the value of interprofessional collaboration between different specialities in providing quality care and improving outcomes. An abridged version of this case was presented at European Congress of Endocrinology 2021., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: India began COVID-19 vaccination in January 2021, initially targeting healthcare and frontline workers. The vaccination strategy was expanded in a phased manner and currently covers all individuals aged 18 years and above. India experienced a severe second wave of COVID-19 during March-June 2021. We conducted a fourth nationwide serosurvey to estimate prevalence of SARS-CoV-2 antibodies in the general population aged ≥6 years and healthcare workers (HCWs)., Methods and Findings: We did a cross-sectional study between 14 June and 6 July 2021 in the same 70 districts across 20 states and 1 union territory where 3 previous rounds of serosurveys were conducted. From each district, 10 clusters (villages in rural areas and wards in urban areas) were selected by the probability proportional to population size method. From each district, a minimum of 400 individuals aged ≥6 years from the general population (40 individuals from each cluster) and 100 HCWs from the district public health facilities were included. The serum samples were tested for the presence of IgG antibodies against S1-RBD and nucleocapsid protein of SARS-CoV-2 using chemiluminescence immunoassay. We estimated the weighted and test-adjusted seroprevalence of IgG antibodies against SARS-CoV-2, along with 95% CIs, based on the presence of antibodies to S1-RBD and/or nucleocapsid protein. Of the 28,975 individuals who participated in the survey, 2,892 (10%) were aged 6-9 years, 5,798 (20%) were aged 10-17 years, and 20,285 (70%) were aged ≥18 years; 15,160 (52.3%) participants were female, and 21,794 (75.2%) resided in rural areas. The weighted and test-adjusted prevalence of IgG antibodies against S1-RBD and/or nucleocapsid protein among the general population aged ≥6 years was 67.6% (95% CI 66.4% to 68.7%). Seroprevalence increased with age (p < 0.001) and was not different in rural and urban areas (p = 0.822). Compared to unvaccinated adults (62.3%, 95% CI 60.9% to 63.7%), seroprevalence was significantly higher among individuals who had received 1 vaccine dose (81.0%, 95% CI 79.6% to 82.3%, p < 0.001) and 2 vaccine doses (89.8%, 95% CI 88.4% to 91.1%, p < 0.001). The seroprevalence of IgG antibodies among 7,252 HCWs was 85.2% (95% CI 83.5% to 86.7%). Important limitations of the study include the survey design, which was aimed to estimate seroprevalence at the national level and not at a sub-national level, and the non-participation of 19% of eligible individuals in the survey., Conclusions: Nearly two-thirds of individuals aged ≥6 years from the general population and 85% of HCWs had antibodies against SARS-CoV-2 by June-July 2021 in India. As one-third of the population is still seronegative, it is necessary to accelerate the coverage of COVID-19 vaccination among adults and continue adherence to non-pharmaceutical interventions., Competing Interests: The authors have declared that no competing interests exist.

Background: Tuberculosis (TB) is among the top 10 causes of death worldwide and there are estimated 10.4 million new (incident) patients, of which about one fourth are in India. There has been calls for rigorous investigations and interventions that may address other factors known to have effect on adherence of treatment like Depression but the amount of research into comorbidity is surprisingly low. The aim of the study was to assess magnitude and impact of depression among TB patients and determine the treatment outcomes of TB in District Srinagar., Methods: In this prospective study the adults with newly diagnosed TB were recruited within one month of initiating treatment and were followed upto the end of treatment. Data collection was done at three time-points: baseline, after 2 months and after 6 months of treatment initiation. The sample size of 200 was calculated using OpenEpi, V3 and identified 202 TB patients were interviewed in their local language and PHQ-9 scale was used to measure Depression., Results: The prevalence of Depression at baseline was 50.5% with CI (43.7%-57.3%). After two months of treatment the prevalence reduced to 9.4% with CI (5.9%-14.0%) and at the end of treatment to 2.5% with CI (0.91%-5.4%). Association between Depression in TB patients and treatment failure was found to be small to medium as revealed by Cramer's V test (0.29-0.59). Binary logistic regression estimated that at baseline TB patients with Depression were at 4.46 times at more risk of treatment failure than patients without Depression and those patients who continued Depression even after intensive phase were 34.5 times at higher risk., Conclusion: Our findings indicate Depression is associated with poor treatment outcome in these patients, despite TB treatment. TB treatment strategies should consider screening and managing the psychologically distressed individuals among TB patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Background: Adherence to antihypertensive therapy is an important factor in determining the clinical course of hypertension. This study was planned to estimate adherence to antihypertensive therapy and its determinants among OPD patients attending two primary care hospitals in Kashmir valley., Methods: This study employed a cross-sectional study design. All subjects who reported to OPD between October and December 2020 and had been prescribed antihypertensive medications for at least 1 year were included. Sociodemographic information was collected on a pretested schedule and adherence to medications was assessed by using the-14 item Hill-Bone HBP Compliance to High Blood Pressure Therapy Scale (HB-HBP). Mann-Whitney test and Spearman's rank correlation coefficient were used., Results: A total of 406 subjects were included in the final analysis with a mean age of 58 years for women and 56 years for men. The sample comprised 54% women. More than 60% of subjects were currently married, urban area residents, and belonged to middle strata of social class. The mean score obtained in the HB-MAS (maximum score 56) was 19.26 (SD ± 4.3). Subjects aged 60 years and above, those belonging to lower socioeconomic class, and subjects prescribed three or more drugs with more than once-daily dosing regimen had higher odds of having poor adherence., Conclusion: There is suboptimal adherence among OPD patients at primary care level. There is a need for enhanced counselling regarding medication adherence particularly for elderly, poor, illiterate persons and those prescribed multiple medicines with more than once-daily dosing., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

Objectives: We designed a population-based survey in Kashmir to estimate the seroprevalence of SARS-CoV-2-specific IgG antibodies in the general population aged 18 years and above., Setting: The survey was conducted among 110 villages and urban wards across 10 districts in Kashmir from 17 October 2020 to 4 November 2020., Participants: Individuals aged 18 years and above were eligible to be included in the survey. Serum samples were tested for the presence of SARS-CoV-2-specific IgG antibodies using the Abbott SARS-CoV-2 IgG assay., Primary and Secondary Outcome Measures: We labelled assay results equal to or above the cut-off index value of 1.4 as positive for SARS-CoV-2-specific IgG antibodies. Seroprevalence estimates were adjusted for the sampling design and assay characteristics., Results: Out of 6397 eligible individuals enumerated, 6315 (98.7%) agreed to participate. The final analysis was done on 6230 participants. Seroprevalence adjusted for the sampling design and assay characteristics was 36.7% (95% CI 34.3% to 39.2%). Seroprevalence was higher among the older population. Among seropositive individuals, 10.2% (247/2415) reported a history of COVID-19-like symptoms. Out of 474 symptomatic individuals, 233 (49.2%) reported having been tested. We estimated an infection fatality rate of 0.034%., Conclusions: During the first 7 months of the COVID-19 epidemic in Kashmir Valley, approximately 37% of individuals were infected. The reported number of COVID-19 cases was only a small fraction of the estimated number of infections. A more efficient surveillance system with strengthened reporting of COVID-19 cases and deaths is warranted., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Yellow fever is a viral hemorrhagic fever transmitted through the bite of mosquitoes. World Health Organization guidelines advocate a single dose of vaccine for life-long protective immunity against yellow fever. Yellow fever vaccine is included in routine childhood immunization schedules in countries at medium or high risk of yellow fever. For some travelers, visiting endemic countries, yellow fever vaccination is recommended to protect the travelers. We calculated the yellow fever vaccine wastage rate at a designated center in North India., Materials and Methods: This is a record-based study. The data for the study was obtained from the immunization center of Government Medical College, Srinagar, Jammu and Kashmir. The particulars for every vaccine recipient were present in the register. The vaccine wastage rate was calculated. The analysis was done in IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) and results were presented as numbers and frequencies., Results: A total of 136 doses were issued out of which 111 doses were administered from November 2017 till October 2020. The maximum number of travelers was young adults (26.1%). In 83.7% of cases, the area of the visit was Africa. The vaccine wastage rate was 18.4%., Conclusion: The vaccine wastage rate was not very high and was within that recommended for vaccines in routine immunization., Competing Interests: No potential conflict of interest relevant to this article was reported., (© Korean Vaccine Society.)

Background: Earlier serosurveys in India revealed seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) of 0.73% in May-June 2020 and 7.1% in August-September 2020. A third serosurvey was conducted between December 2020 and January 2021 to estimate the seroprevalence of SARS-CoV-2 infection among the general population and healthcare workers (HCWs) in India., Methods: The third serosurvey was conducted in the same 70 districts as the first and second serosurveys. For each district, at least 400 individuals aged ≥10 years from the general population and 100 HCWs from subdistrict-level health facilities were enrolled. Serum samples from the general population were tested for the presence of immunoglobulin G (IgG) antibodies against the nucleocapsid (N) and spike (S1-RBD) proteins of SARS-CoV-2, whereas serum samples from HCWs were tested for anti-S1-RBD. Weighted seroprevalence adjusted for assay characteristics was estimated., Results: Of the 28,598 serum samples from the general population, 4585 (16%) had IgG antibodies against the N protein, 6647 (23.2%) had IgG antibodies against the S1-RBD protein, and 7436 (26%) had IgG antibodies against either the N protein or the S1-RBD protein. Weighted and assay-characteristic-adjusted seroprevalence against either of the antibodies was 24.1% [95% confidence interval (CI) 23.0-25.3%]. Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI 23.5-27.8%)., Conclusions: Nearly one in four individuals aged ≥10 years from the general population as well as HCWs in India had been exposed to SARS-CoV-2 by December 2020., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The first national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in India, done in May-June, 2020, among adults aged 18 years or older from 21 states, found a SARS-CoV-2 IgG antibody seroprevalence of 0·73% (95% CI 0·34-1·13). We aimed to assess the more recent nationwide seroprevalence in the general population in India., Methods: We did a second household serosurvey among individuals aged 10 years or older in the same 700 villages or wards within 70 districts in India that were included in the first serosurvey. Individuals aged younger than 10 years and households that did not respond at the time of survey were excluded. Participants were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. 3-5 mL of venous blood was collected from each participant and blood samples were tested using the Abbott SARS-CoV-2 IgG assay. Seroprevalence was estimated after applying the sampling weights and adjusting for clustering and assay characteristics. We randomly selected one adult serum sample from each household to compare the seroprevalence among adults between the two serosurveys., Findings: Between Aug 18 and Sept 20, 2020, we enrolled and collected serum samples from 29 082 individuals from 15 613 households. The weighted and adjusted seroprevalence of SARS-CoV-2 IgG antibodies in individuals aged 10 years or older was 6·6% (95% CI 5·8-7·4). Among 15 084 randomly selected adults (one per household), the weighted and adjusted seroprevalence was 7·1% (6·2-8·2). Seroprevalence was similar across age groups, sexes, and occupations. Seroprevalence was highest in urban slum areas followed by urban non-slum and rural areas. We estimated a cumulative 74·3 million infections in the country by Aug 18, 2020, with 26-32 infections for every reported COVID-19 case., Interpretation: Approximately one in 15 individuals aged 10 years or older in India had SARS-CoV-2 infection by Aug 18, 2020. The adult seroprevalence increased approximately tenfold between May and August, 2020. Lower infection-to-case ratio in August than in May reflects a substantial increase in testing across the country., Funding: Indian Council of Medical Research., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The antenatal period is an important landmark where the services provided to mothers through antenatal care (ANC) checkups also act as a way for additional interventions influencing maternal and child health. This study aimed to know about the perception and practice among the patients of ANC checkups (ANCs) regarding COVID-19 and what are the implications of it on their routine check-ups., Methods: We conducted this study from 15 April, 2020 to 03 May, 2020, Phase 2 {Country wide lockdown in India}, which was imposed for over 19 days. The sample size was kept open and we used convenient type of sampling and included all those pregnant women who attended the clinic for ANC checkup amid the countrywide lock down. Each patient of ANC checkup was interviewed by the treating doctor using a predesigned structured questionnaire containing questions based on demographic information and the perception and practices regarding corona virus infection., Results: The majority, 66 (79.5%) were in the age group of 26-35 years, 63 (75.9%) were in the second and third trimester of their pregnancy, 72 (86.7%) were from urban areas, 26 (31.3%) and 17 (20.5%) were having education level of bachelor's and higher, respectively. The majority 39 (47%) reported that they are worried that someone they know may have the coronavirus infection and they are unaware about it, 57 (68.7%) feel the nature of the disease as fatal, all ANCs reported that their families are taking initiatives to prevent corona virus infection and they should take extra precautions for corona virus infection, 6 (7.2%) reported that any member of their family has been quarantined during the period, 81 (97.6%) feel that primary precautions like hand washing, social distancing, wearing a face mask, and isolation and quarantine will help in the reduction of infection, 69 (83.1%) choose to report to hospital if any of their close relatives are down with symptoms of corona virus., Conclusion: Our study showed that the respondents had a good attitude, perception, and were following sensible positive practices regarding COVID-19 prevention., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Background: Prevalence of IgG antibodies against SARS-CoV-2 infection provides essential information for deciding disease prevention and mitigation measures. We estimate the seroprevalence of SARS-CoV-2 specific IgG antibodies in District Srinagar., Methods: 2906 persons >18 years of age selected from hospital visitors across District Srinagar participated in the study. We tested samples for the presence of SARS-CoV-2 specific IgG antibodies using a chemiluminescent microparticle immunoassay-based serologic test., Results: Age- and gender-standardized seroprevalence was 3.6% (95% CI 2.9% to 4.3%). Age 30-69 years, a recent history of symptoms of an influenza-like-illness, and a history of being placed under quarantine were significantly related to higher odds of the presence of SARS-CoV-2 specific IgG antibodies. The estimated number of SARS-CoV-2 infections during the two weeks preceding the study, adjusted for test performance, was 32602 with an estimated (median) infection-to-known-case ratio of 46 (95% CI 36 to 57)., Conclusions: The seroprevalence of SARS-CoV-2 specific IgG antibodies is low in the District. A large proportion of the population is still susceptible to the infection. A sizeable number of infections remain undetected, and a substantial proportion of people with symptoms compatible with COVID-19 are not tested., Competing Interests: The authors have declared that no competing interests exist.

Background: Aggression among the dogs has been stated as the most common cause of their biting nature by many dog experts. Most of the dog experts' opinion that many of the dog's bites are preventable., Objectives of the Study: Explore the victim's perception regarding dog bite, its circumstances and events that led to the bite and prevention of future bites by dogs., Methodology: This study involved one-to-one detailed interviews of dog bite victims to tell their tale and allowed the interviewer to ask questions related to all the circumstances that led to the bite. We included adults aged >20 years living in the Srinagar city who had been bitten by the street dog within last 24 h. Qualitative research protocol was adapted to conduct the study., Results: The perception of the victims vary from person to person which makes it difficult for public health practitioners to formulate standardized prevention tools. In our study, the participants had different perceptions regarding what constitute a dog bite. Some discussed a skin contact with piercing and oozing of blood as a dog bite while other perceived a simple jumping of dog over them. Some blamed the society; some blamed the dog; whereas some blamed themselves for the incident. Most of the participants never perceived that they will be bitten by the dog, so they did not use any strategies to prevent themselves. Reaction to the bite and the perception of responsibility and preventability appeared to be more related to the individual experiences of the victim and their belief about dogs in particular, than the actual circumstances which led to the bite and how preventable a bite could have been., Conclusion: Our findings suggest that the apparent instantaneous nature of bites and recognized psychological barriers to being receptive to educational intervention may mean bites are not as easily preventable as previously assumed., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Dog bites in humans are a major public health problem in India in general and Kashmir in particular. Canine rabies is almost non-existent in developed countries and exists mainly in the poorer, low socioeconomic strata of society in the developing world. The objective of this study was to determine the characteristics, pattern, and burden of dog bite injuries in the Kashmir valley. Data from Anti-Rabies Clinic of a tertiary care hospital in Srinagar, the summer capital of the state of Jammu & Kashmir, was collated and analyzed. Analysis of records of all the patients who had reported between April 2016 and March 2017 was done. A total of 6172 patients had reported to the Anti-Rabies Clinic for management of animal bites from 1st April 2016 to 31st March 2017. Most of the patients were young males. Almost half (47.7%) of the patients were bitten in the afternoon. Lower limbs were the most common site of bite (71.7%). Most of the bites were of Category III (57.6%) followed by Category II (42.3%); only one case of Category I was recorded. Almost all (98.0%) cases reported being bitten by dogs. Conclusions: Category III dog bites on lower limbs were the most common type of animal bites presenting to the Anti-Rabies Clinic of a tertiary care hospital. Children have more chances of a bite on head and neck region. Serious and workable efforts have to be made to reduce the incidence and consequences of animal bites., Competing Interests: The authors have declared that no competing interests exist.

Background: A series of measures have been suggested to reduce Covid-19 infection, including knowledge training for prevention and control, isolation, disinfection, classified protections at different degrees in infection areas, and protection of confirmed cases., Objectives: We conducted this study with an aim to assess the knowledge, attitude and practice among the general population regarding COVID-19., Methods: This was a cross-sectional study carried out by the Department of Community Medicine, Government Medical College, Srinagar in the month of April 2020. The questionnaire had four segments to collect data regarding social-demographic details, knowledge regarding Covid-19, attitude and practice based questions. The questionnaire was shared via social media applications like face book and Whatsapp to reach the target population. Continuous variables were summarized as frequency and percentage. All the analysis was done using Microsoft Excel 2016. Among participants who responded, 1252 (82%) were in the age group of 18-40 years and 912 (60%) from urban areas., Results: A total of 934 (61%) respondents had heard details on COVID-19 from the social media, 1358 (89%) knew all ways of coronavirus transmission, 602 (40%) felt that COVID-19 is a serious disease, 1184 (78%) responded that they totally agree with the lockdown decision, and 1296 (85%) responded that lockdown is helping in reducing the number of cases. The majority, i.e. 1318 (87%), followed advisories and reported washing hands with soap and water regularly, 1108 (73%) reported regularly wearing masks, 1344 (89%) reported following lockdown guidelines, and 1306 (87%) reported maintaining social distancing. The respondents exhibited good knowledge, positive attitude, and sensible practices regarding COVID-19., Conclusion: Our study showed that the respondents have exhibited good knowledge, positive attitude and sensible practices regarding covid-19 during the pandemic., Competing Interests: None

Background: The World has seen an emerging trend of diabetes among adolescents and moderately aged people over the last decade. The aim of the study was to identify the risk factors associated with impaired glucose metabolism and the prevalence of impaired glucose metabolism among the adult population of district Srinagar., Methods: Multi-stage cluster random sampling design was used and from each household, participants were selected using a Kish grid method. Socio-demographic and clinical data were collected. The participants were then subjected to fasting venous blood glucose estimation., Results: Age, waist circumference, hip circumference, weight, and body mass index were all statistically significant between normoglycemic participants and those with impaired glucose metabolism (p < 0.018). On logistic regression, subjects who had a higher BMI were more likely to develop Impaired glucose metabolism (OR = 3.52, OR 95% CI = 1.25-9.87); Moreover, consumption of carbonated drinks, (3-6 times/week OR = 4.40, OR 95% CI = 2.06-9.40; >6 times/week OR = 11.04, OR 95% CI = 0.86-140.66) was found to be a potential risk factor. Participants with a family history of diabetes were more susceptible to develop impaired glucose metabolism (OR = 6.41, OR 95% CI = 3.22-12.78). The risk effect of these factors was even stronger before adjusting for age, sex, family history of diabetes, and BMI in participants., Conclusion: Risk factors for impaired glucose metabolism include increasing age, obesity, and higher consumption of carbonated drinks, hypertension, smoking behavior, high-calorie diet intake and positive family history of diabetes., (Copyright © 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background: As long as one case of tuberculosis is replaced by another, elimination of tuberculosis cannot be achieved. Contact tracing is an important strategy for detection of more TB cases early. The present study is concerned with an innovative method of contact tracing., Methods: A quasi randomized interventional study was conducted in two TB Units of Kashmir for evaluation of newly designed interventional model for its effectiveness, acceptance and feasibility. Data was collected from 1st Jan 2014 to 30th June 2015., Results: In interventional group of 598 eligible household contacts, total 27 (4.51%) contacts were detected as suffering from active pulmonary TB cases. Out these, 21 (3.51%) cases were diagnosed during initial home visit and 6 (1.04%) cases were diagnosed at 6th monthly follow up visit. In controlled group 593 eligible household contacts, total 7 (1.18%) contacts were found suffering from active pulmonary -TB during routine practice under RNTCP for contact screening. In interventional group, during initial home visit by the investigator, 423 (70.74%) of household contacts participated for study and during follow up visit at 6th month, 356 (59.53%) household contacts participated., Conclusion: Newly designed "home-based intervention model" for active-case finding among household contacts of index pulmonary-TB case has been found an effective method for contact tracing. This intervention has adequate acceptance by the community and feasible for implementation under existing revised national tuberculosis control programme., (© 2019 The Authors. Published by Elsevier Ltd.)