Search

Background: Weight estimation in paediatric emergencies is often required to calculate drug dosages, fluid therapy and defibrillation. The ‘gold standard’ of actually weighing the patient is not practically possible in emergency conditions. Many formulae have been developed in an attempt to accurately estimate a child’s weight using age like advanced paediatric life support (APLS), Luscombe, and Argall’s modification. However, these formulae might not be applicable in the Indian context. This study aims is to validate standard age-based formulae (APLS, Luscombe, and Argall’s) and their accuracy in estimating the weight of Indian children. Methods: The study used secondary data from the fourth round of the National Family Health Survey (2015-16). The estimated weights as computed by the APLS guidelines, the Luscombe and the Argall formulae were compared to their respective measured weights during the survey. Results: All three formulae (APLS, Luscombe, and Argall) overestimated the weights. The APLS formula exhibited the least weight difference among the different age groups (-3.51±2.08 kg). The average percentage difference between the estimated weights using the APLS, Luscombe, and Argall formula and the actual weights was 23%, 38%, and 28%, respectively. Conclusions: All the three age-based weight formulae, namely APLS, Argyll, and Luscombe, overestimated the weight among the Indian children, clearly showing the need to adjust the formulae for accurate weight estimation of Indian children.

Increasing body of health planning and policy research focused upon unravelling the fundamental drivers of population health and nutrition inequities, such as wealth status, educational status, caste/ethnicity, gender, place of residence, and geographical context, that often interact to produce health inequalities. However, very few studies have employed intersectional framework to explicitly demonstrate how intersecting dimensions of privilege, power, and resources form the burden of anthropometric failures of children among low-and-middle income countries including India. Data on 2,15,554 sampled children below 5 years of age from the National Family Health Survey 2015-2016 were analysed. This study employed intersectional approach to examine caste group inequalities in the anthropometric failure (i.e. moderate stunting, severe stunting, moderate underweight, severe underweight, moderate wasting, severe wasting) among children in India. Descriptive statistics and multinomial logistic regression models were fitted to investigate the heterogeneities in the burden of anthropometric failure across demographic, socioeconomic and contextual factors. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and caste groups with the likelihood of anthropometric failure among children. More than half of under-5 children suffered from anthropometric failure in India. Net of the demographic and socioeconomic characteristics, children from the disadvantageous caste groups whose mother were illiterate, belonged to economically poor households, resided in the rural areas, and coming from the central and eastern regions experienced disproportionately higher risk of anthropometric failure than their counterparts in India. Concerted policy processes must recognize the existing heterogeneities between and within population groups to improve the precision targeting of the beneficiary and enhance the efficiency of the nutritional program among under-5 children, particularly for the historically marginalized caste groups in India.

Nowadays, the Structural Building Health Damage Monitoring System (SBHDMS) is a crucial technology for predicting the civil building structures' health. SBHDMS contains abnormal changes in the buildings in terms of damage levels. Natural Disasters like Earthquakes, Floods, and cyclones affect the unusual changes in the buildings. If the building undergoes any natural disaster, the sensors capture the vibration data or change the buildings' structure. Due to the vibration data, these unusual changes can be analyzed. Here sensors or Machine Learning based Building Damage Prediction (MLBDP) are used for capturing and collecting the vibration data. This paper proposes a Novel Rough Set based Artificial Neural Network with Support Vector Machine (RAS) metaheuristic method. RAS method is used to predict the damaged building's vibration data levels captured by the sensors. For the feature reduction subset, we use one of the essential pre-processing method called the Rough set theory (RST) strategy. RAS has two contributions. The first one is the Support Vector Machine (SVM) classification method used for identifying the structures of the buildings. The artificial Neural Network (ANN) method used to predict the buildings' damage levels is the second contribution. The proposed method (RAS) is accurately predicting the conditions of the construction building structure and predicting the damage levels, without human intervention. Comparing the results states that the proposed method accuracy is better than SVM's classification methods, ANN. The prediction analysis depicts that the RAS method can effectively detect the damage levels.

Utilization of maternal health care services by tribal population could be detrimental in reducing high maternal mortality in Madhya Pradesh, India. A growing body of evidence indicates the positive association between male involvement and increased use of antenatal care services. Further research is required to understand barriers and possible solutions to develop culturally appropriate interventions to engage men to promote the utilization of maternal health care services. The study used qualitative data collected through 8 focus group discussions with men and women and 8 key informant interviews with either a community representative or health worker in two blocks dominated by Saharia tribes in Gwalior district, Madhya Pradesh, India in 2018. Information on the perception of utilization of maternal and child health services, male involvement, challenges and opportunities were elicited using a structured guide. Framework analysis was used to analyse the data. Findings document barriers at the individual (poor knowledge, fear of loss of wage, choice of home as a place of delivery), community (practices that reinforced the prevailing gender norms) and health care facility level (quality and attitude of health care providers) to male engagement in utilization of maternal health services. Community perceptions on possible solutions to address these were more likely to be gender exploitative interventions. To promote utilization of maternal health care services among Saharia tribes, this study highlights the importance of developing gender sensitive interventions that addresses the individual, community and health care facility level barriers of male involvement and do not reinforce existing gender norms.

Economic progress in India over the past three decades has not been accompanied by a commensurate improvement in the nutritional status of children, and a disproportionate burden of undernutrition is still focused on socioeconomically disadvantaged populations in the poorest regions. This study examined the nutritional status of children under 3 years of age using data from the fourth round of Indian National Family Health Survey conducted in 2015–2016. Child undernutrition was assessed in a sample of 126,431 under-3 children using the anthropometric indices of stunting, underweight and wasting (‘anthropometric failure’) across 640 districts, 5489 primary sampling units and 35 states/UTs of India. Descriptive statistics were used to examine the regional pattern of childhood undernutrition. Multilevel logistic regression models were fitted to examine the adjusted effect of social group (tribal vs non-tribal) and economic, demographic and contextual factors on the risks of stunting, underweight and wasting accounting for the hierarchical nature of the data. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and social group (tribal vs non-tribal) with the likelihood of anthropometric failure among children. The burden of childhood undernutrition was found to vary starkly across social, economic, demographic and contextual factors. Interaction effects demonstrated that tribal children from economically poorer households, with less-educated mothers, residing in rural areas and living in the Central region of India had elevated odds of anthropometric deprivation than other tribal children. The one-size-fits-all approach to tackling undernutrition in tribal children may not be efficient and could be counterproductive.

Abundant research studies has recorded availability, accessibility and quality of antenatal care and safe delivery in India but comparatively less information is known for postnatal care and furthermore limited attempts at capturing the whole spectrum of obstetric and newborn health services. Assessing discontinuity in maternal and child health service utilization provides us holistic information about existing health inequities and barriers in service provision.Current study evaluated the coverage of quality antenatal care (QANC), delivery care (QDC) and postnatal care (QPNC) in India as a part of a single continuum accounting for significant regional and sub-regional disparities.This study analyzed nationally representative data obtained from NFHS-4 (2015-16). Included in the data, were 190 898 Indian women who had a recent birth in last five years. Coverage of QANC, QDC and QPNC was examined at the national, state and district level. Bivariate association of key sociodemographic variables with coverage of services was assessed during chi-squared analysis. Multilevel logistic regression analysis examined correlates associated with coverage of services. The output was presented using odds ratios (OR) with 95% CI.About 23.5% women utilized QANC out of which 92.9% opted for QDC and 35.1% of newborns received QPNC. About 400 and 471 districts out of 640 had less than 30% coverage of QANC and QPNC, respectively. Women residing in rural regions of Bihar and Northeastern states were found with less than 10% coverage of QANC. Regression analysis shows that women with more than 12 years of education and belonging to richest households had increased odds of availing QANC (OR 1.95; 95%CI: 1.84-2.06) and QDC (OR: 2.86; 95%CI: 2.27-3.60), respectively.Focused interventions targeting the delivery of quality services especially ANC and PNC among newborns are imperative to achieve SDG-3 goals to achieve improvement in maternal and newborn health.

Background/Objectives: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. Methods: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. Results: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. Conclusions/Recommendations: A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic.

Despite great progress in recent years in improving access to formal financial services in developing countries, there is still significant access and usage disparity between men and women. We use individual-level data from the World Bank’s Global Findex 2017 database to investigate the differences in the use of accounts by men and women who are account holders and who save and borrow money formally to provide a comprehensive picture of individuals’ financial behaviour in India. Employing treatment effects estimations through the use of propensity scores, we find that although there is improvement in saving behaviour, borrowing behaviour as well as financial resilience among men and women who save and borrow formally as compared to those who do not, women lag significantly behind men in terms of the same. Thus, expanding women’s access to economic opportunity is critical to achieving gender equality in financial inclusion and unlocking the potential for economic empowerment and development. Our findings can aid in the formulation of policies that consider the unique requirements of women in order to increase financial inclusion and close the gender gap in India.

Lack of research data is one of the major challenges identified in traditional medicine (TM). Further, there is an urgent need to strengthen and streamline clinical research processes as well as develop research databases in TM. The Clinical Trials Registry-India (CTRI), a free, online primary register of the WHO's International Clinical Trials Registry Platform, undertakes registration of all clinical trials being conducted in India, including TM trials. However, as the CTRI data set items are primarily designed to capture information of interventional trials of the conventional system of medicine, key fields relevant to the TM system are not adequately captured in the CTRI.The current study was conceptualized with the objective to review the type and quality of trials registered in the CTRI as well as identify the specific data set items in CTRI which may be customized as perThe trials registered from July 1, 2018, to March 31, 2020, were analyzed to decipher the kind of research being undertaken in the field ofThe fields which were identified and need tweaking and customization were the fields "health condition" and "intervention/comparator agent."These modifications in the CTRI would enable the capture of more effective

Perinatal mortality (PM) is a major public health problem in India and multiple maternal and foetal risk factors have been attributed to high perinatal mortality. This review aimed to systematically summarize the epidemiological literature on maternal and fetal risk factors for PM including those for still birth, intrauterine deaths; early neonatal mortality; early neonatal deaths in India. This systematic review was compliant with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We searched for peer-reviewed articles from three electronic bibliographic databases: MEDLINE, Embase, Google Scholar published between 1 January 2000 and 31 March 2019 that reported the risk factors of perinatal mortality in India. Observational studies (cross sectional, case-control and COHORT Studies). Eighteen articles were included in this review. The major risk factors identified for perinatal mortality in India were maternal age, parity, higher birth order and maternal anemia. Complications during pregnancy like ante partum hemorrhage, preeclampsia, obstructed labor, preterm labor and fetal factors like gestational age and low birth weight were documented as risk factors for perinatal deaths. Strengthening national health programs and targeted interventions for both antenatal and institutional care is required to bring down perinatal deaths in India.

Background COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. Methods A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers. Results Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66–3.41), income≥20000(AOR = 1.74, 95% CI, (1.16–2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09–2.46), contact tracing (AOR = 2.05, 95% CI (1.1–3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14–6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28–2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions). Conclusion The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

Cloud computing provides useful services to users with extensive and scalable resources that virtualized over the internet. It defined as a collection of the communication and computing resources located in the data-center. The service based on on-demand is subject to QoS, the load balance, and certain other constraints with a direct effect on the user’s consumption of resources that are controlled by this cloud infrastructure. It is considered a popular method as it has several advantages that have been provided by a cloud infrastructure. The cloud scheduling algorithm’s primary goal was to bring down the time taken for completion (the cost of execution) of the task graph. The start time and the finish time for the task node influence the task graph completion completed to the time (the cost). The task node sort order an essential aspect that influences the start time and the finish time for every task node. In a hybrid cloud, efficient dense particle mass-based cloud scheduling is efficient because users need to maintain the security of the hybrid cloud. Different algorithms with different algorithms suggested by researchers in the cloud. This paper proposes particle swarm optimization (PSO)-based cloud optimal scheduling. Effective results obtained in an efficient fuzzy mass-based PSO cloud scheduling.

Structures are exceptionally helpless against impacts like natural effects, earthquakes, and typhoons. Along these lines, the organizer must know the damage and quality status of the structures in time so that essential maintenance is performed. More imaginative auxiliary damage identification systems connected to the current structures for Structural Strength Monitoring (SSM), particularly substantial scale structures, and many testing strategies are nondestructive. Considerations are attracted to how to utilize the present estimation information to create an outcome with less vulnerability, paying little intelligence to estimate clamors and natural assortments, such as evolving temperature, humidity, and load condition. This work presents two contributions. The role of sensors utilizes the Wireless Sensor Systems for diagnostic faults in the building. So Structural Strength Monitoring System (SSMS) utilizing Wireless Sensor Systems has considered as predominant research area because of its capacity to decrease the expenses related to the establishment and maintenance of SSMS frameworks and provides an extensive study of SSMS utilizing WSNs, drafting the calculations utilized in risk discovery and confinement, laying out system configuration difficulties. Another novel hybrid classification method which combines the features of Rough set (RS) with support vector machine (RS-SVM) and also with artificial neural network (RS-ANN). RS-SVM is used to classify the structures, and RS-ANN is used to predict the damage levels. The experiment results compared with the new SVM classifiers and identified that our approach got higher accuracy.

Exploring Bayesian spatio-temporal methods to analyze spatial dependence in malnutrition at the state level for tribal children (less than 3 years) population of India and change over time (three rounds of NFHS-2(1998-99),3(2005-06) and 4(2015-16)). The Bayesian model, fitted by Markov chain Monte Carlo simulation using OpenBUGS, for spatial autocorrelation (through spatial random effects modeling). The model estimated (1) mean time trend and (2) spatial random effects. Results of spatio-temporal modeling for stunting, wasting and underweight exhibited a declining mean trend across the study region from NFHS-2 to NFHS-4. Spatial random effects exhibited spatial dependence for various states in stunting, wasting and underweight tribal children. Future research should analyze spatio-temporal distribution for malnutrition at district level which will require NFHS-5 data. Also, analysis can be done capturing spatio-temporal interaction and identifying hot spots and cold spots at district level.

Summary Background Many countries, including India, seek locally constructed disease burden estimates comprising mortality and loss of health to aid priority setting for the prevention and treatment of diseases. We created the National Burden Estimates (NBE) to provide transparent and understandable disease burdens at the national and subnational levels, and to identify gaps in knowledge. Methods To calculate the NBE for India, we combined 2017 UN death totals with national and subnational mortality rates for 2010–17 and causes of death from 211 166 verbal autopsy interviews in the Indian Million Death Study for 2010–14. We calculated years of life lost (YLLs) and years lived with disability (YLDs) for 2017 using published YLD–YLL ratios from WHO Global Health Estimates. We grouped causes of death into 45 groups, including ill-defined deaths, and summed YLLs and YLDs to calculate disability-adjusted life-years (DALYs) for these causes in eight age groups covering rural and urban areas and 21 major states of India. Findings In 2017, there were about 9·7 million deaths and 486 million DALYs in India. About three quarters of deaths and DALYs occurred in rural areas. More than a third of national DALYs arose from communicable, maternal, perinatal, and nutritional disorders. DALY rates in rural areas were at least twice those of urban areas for perinatal and nutritional conditions, chronic respiratory diseases, diarrhoea, and fever of unknown origin. DALY rates for ischaemic heart disease were greater in urban areas. Injuries caused 11·4% of DALYs nationally. The top 15 conditions that accounted for the most DALYs were mostly those causing mortality (ischaemic heart disease, perinatal conditions, chronic respiratory diseases, diarrhoea, respiratory infections, cancer, stroke, road traffic accidents, tuberculosis, and liver and alcohol-related conditions), with disability mostly due to a few conditions (nutritional deficiencies, neuropsychiatric conditions, vision and other sensory loss, musculoskeletal disorders, and genitourinary diseases). Every condition that was common in one part of India was uncommon elsewhere, suggesting state-specific priorities for disease control. Interpretation The NBE method quantifies disease burden using transparent, intuitive, and reproducible methods. It provides a simple, locally operable tool to aid policy makers in priority setting in India and other low-income and middle-income countries. The NBE underlines the need for many more countries to collect nationally representative cause of death data, paired with focused surveys of disability. Funding Ministry of Health and Family Welfare, Government of India.

Background: Child undernutrition is a major public health problem in many low and middle income countries and malnutrition alone accounted for 45% (3 million deaths annually) deaths among under-five children. Malnutrition is the concealed cause of one out of every two such deaths. A study was undertaken to examine the trends, determinants and socioeconomic-related inequalities in childhood undernutrition in empowered action group (EAG) states, India. The secondary data of the two rounds of National Family Health Survey, NFHS-3 (2005-06) and NFHS-4 (2015-16) comprising of 16,802 and 128,400 children aged 0-59 months respectively was analysed.Methods: Non-linear Fairlie decomposition was used to identify and quantify the separate contribution of different socioeconomic characteristics in gap of childhood malnutrion between 2006 and 2016.Results: Results show that the prevalence of undernutrition has decreased in EAG states during the last one decade, but the prevalence of wasting is remained almost same as 10 years back. The decomposition analysis shows that maternal education, household wealth and place of residence were contributing to socioeconomic inequality in childhood undernutrition from 2006 to 2016.Conclusions: There is a need to adopt different strategies of health policy intervention. It is important to have policies towards improving female literacy in the EAG states because maternal education plays a vital role in child health and literacy rate is very low among women in EAG states. The existence of a functional health insurance system and increasing universal coverage are recommended to mitigate child undernutrition, so that the vulnerable and deprived populations who are not able to access health care facilities, can easily access health care services for early detection and treatment of undernutrition without any financial constraint.

The Clinical Trials Registry – India (CTRI), launched over 10 years ago, is a free, searchable online platform for registration of clinical trials being conducted in India and as well as countries which do not have a Primary Registry of their own. The objective of the present article is to appraise the current status and the new developments of CTRI, which registers all types of clinical studies, including postgraduate theses. The CTRI which was until now allowing both prospective and retrospective registration is moving towards only prospective trial registration. From April 1, 2018, only those trials where the first patient enrollment has not yet commenced will be registered. Further, the CTRI is in the process of implementing structured summary results disclosure of all interventional clinical trials in the near future.

Since the beginning of the year, the deadly coronavirus pandemic, better known as coronavirus disease 2019 (COVID-19), brought the entire world to an unprecedented halt. In tandem with the global scenario, researchers in India are actively engaged in the conduct of clinical research to counter the pandemic. This review attempts to provide a comprehensive overview of the COVID-19 research in India including design aspects, through the clinical trials registered in the Clinical Trials Registry - India (CTRI) till June 5, 2020. One hundred and twenty two registered trials on COVID-19 were extracted from the CTRI database. These trials were categorized into modern medicine (n=42), traditional medicine (n=67) and miscellaneous (n=13). Of the 42 modern medicine trials, 28 were on repurposed drugs, used singly (n=24) or in combination (n=4). Of these 28 trials, 23 were to evaluate their therapeutic efficacy in different severities of the disease. There were nine registered trials on cell- and plasma-based therapies, two phytopharmaceutical trials and three vaccine trials. The traditional medicine trials category majorly comprised Ayurveda (n=45), followed by homeopathy (n=14) and others (n=8) from Yoga, Siddha and Unani. Among the traditional medicine category, 31 trials were prophylactic and 36 were therapeutic, mostly conducted on asymptomatic or mild-to-moderate COVID-19 patients. This review would showcase the research being conducted on COVID-19 in the country and highlight the research gaps to steer further studies.

Quality of water for consumption and food processing activities is universally accepted as an essential component to ensure food safety at household (HH) level. Along with safe water, hand hygiene is also an important factor for reducing diarrheal illnesses. This was a cross-sectional study conducted in rural and urban HHs to detect hygiene indicators in drinking water samples at point of use (PoU) (n = 150) and their association with the hand hygiene of primary food preparers (n = 150). Overall, 24.7% and 9.3% of drinking water samples (PoU), 48% and 20% of hand rinse samples were contaminated by faecal coliforms and E. coli, respectively. Both drinking water (PoU) and hand rinse samples collected from rural HHs showed higher contamination, followed by those from urban slums and low income HHs. Significant association (p < 0.05) and probable risk with faecal coliforms (OR. 2.5; 95% CI: 1.1–5.4) and E. coli (OR. 14.5; 95% CI: 4.1–50.7) was found between hand rinses and drinking water samples that had bacteriological contamination. These results suggest that there was an extensive cross contamination at HH level. So, targeted education is essential on safe food/water handling practices in HHs to prevent food safety risks.

Background & objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels. Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015. Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed. Interpretation & conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.

Correction for ‘Analysis of dialkyl urine metabolites of organophosphate pesticides by a liquid chromatography mass spectrometry technique’ by Sukesh Narayan Sinha et al., Anal. Methods, 2014, 6, 1825–1834.

Introduction: WHO's International Clinical Trials Registry Platform (ICTRP) has 17 primary registries that collect the information on the minimum set of items of trial information that appear in the register and these registries are also endorsed by the International Committee of Medical Journal Editors. Objective: The objective of this study is to describe the profile of all the primary registries including Clinical Trial Registry-India (CTRI), through features such as magnitude, domain of registration, flagging, audit trail, language, mandatory requirements, and result disclosure. Methodology: The profiling of all registries was based on countries and zones, year of establishment, registrant, flagging, conflict of interest, language, documents, result disclosure, type of study, mode of registration, mandate of registration, quality check method, individual patient data statement and translation of content facility. The mode of search used was online which included advanced search, basic search and also from the audio/video manual on their website. Results: There are 17 primary registries of ICTRP, the first one International Standard Randomised Controlled Trial Number (ISRCTN) of England being initiated in year 2000 and the most recent being Lebanese registry, in September 2019. The trials registered with these registries range from 301 in Cuba to 53972 in European union's EU Clinical Trials Register. The primary registries in WHO registry network are diverse in functionalities and practices. The characteristics of online registers vary in content and features and to achieve coordinated level of data quality, across all the different registries and to keep a balance in standards of the data collected and validation of that data, the registries are adhering to the minimum data set items laid down by ICTRP. Conclusion: The very process of registering the clinical studies helps in promoting the research methods and also raising the standards of research, especially among young researchers. It also helps in reducing the duplicity of research.

Background & objectives: Worldwide variations in human growth and its genetic and environmental factors have been described. In this study, an attempt was made to assess the morphological differences and similarities among under 5 year children of rural areas of Uttar Pradesh State in India, and to determine differences or similarities of body size among children living in diverse regions. Methods: For this purpose, a cross-sectional district nutrition profile study conducted during 2002-2003 was used. The data on 10,096 children drawn from 1080 villages in 54 districts were part of the district level Diet and Nutrition Assessment survey. The mean values for height and weight for 54 districts were taken as the input data for subsequent analysis. The data were first normalized by means of principal component analysis (PCA) and then K-means clustering was performed. Results: The PCA and cluster analysis yielded four distinguishable clusters or patterns in the anthropometric data of children. These clusters were ordered according to the average body size (weight and height) of children. The mean stature and body weight of these children in cluster I were 3.2 cm and 1.4 kg higher than those of cluster IV indicating differences between clusters. Also, the variations between clusters in their social, demographic, health and nutrition parameters were compared. Interpretation & conclusions: The use of PCA and cluster analysis methods and their merits in studying the Uttar Pradesh preschool children growth variations are discussed. These results helped in identifying the districts with higher prevalence of undernutrition and the contributing factors.

A community-based, cross-sectional study was carried out in five regions of India by adopting a multistage random sampling procedure. Information was collected from the participants about socio-demographic particulars such as age, sex, occupation, education, etc. Anthropometric measurements such as height, weight and waist and hip circumferences were measured and three measurements of blood pressure were obtained. Fasting blood sugar was assessed using a Glucometer. Data analysis was done using descriptive statistics, χ2 test for association and logistic regression analysis. A total of 7531 subjects were covered for anthropometry and blood pressure. The overall prevalence of overweight/obesity and abdominal obesity was 29 and 21 %, respectively, and was higher in the Southern region (40 % each) as compared with other regions. The prevalence of hypertension was 18 and 16 % and diabetes was 9·5 % each among men and women, respectively. The risk of hypertension and diabetes was significantly higher among adults from the Southern and Western regions, the among elderly, among overweight/obese individuals and those with abdominal obesity. In conclusion, the prevalence of overweight/obesity and hypertension was higher in the Southern region, whereas diabetes was higher in the Southern and Western regions. Factors such as increasing age, male sex, overweight/obesity, and abdominal obesity were important risk factors for hypertension and diabetes. Appropriate health and nutrition education should be given to the community to control these problems.

The LC-MS/MS with Quick, Easy, Cheap, Effective, Rugged and safe method was used for analysis of eighteen pesticides in fruit samples. This method was found to be accurate (≥99%), as it possessed limits of detection in the 0.002–0.087 ranges respectively. The coefficients of variations (≥0.9999) were less than 2% at the low ng g−1 concentration. Mean recoveries ranged between 97 and 101%, and % RSD were below 5%. The imidacloprid mean concentrations of red grapes (125.124 ng g−1) and green grapes (702.030 ng g−1) differed significantly (p

In this study, we assessed the exposure of urban populations to different classes of organophosphate pesticides due to the consumption of different types of vegetables. Liquid chromatography–mass spectrometry was used for quantification, while the quick, easy, cheap, effective, rugged and safe extraction method was used to isolate eighteen organophosphate pesticides found in vegetable samples (eggplant, ladyfinger, cauliflower, cabbage, tomato and chili) at concentration of μg/kg. This method was accurate (≥ 99.5%) and possessed a limit of detection and quantification in the range of 0.002–0.099 and 0.009–0.337 μg/kg respectively. The coefficients of variation (≥ 0.9999) were less than 2% at the low end of the linear range of the method. The mean recovery ranged between 94 and 103%, and the % relative standard deviation (RSD) was generally below 10%. These results demonstrate that the methodology is both highly efficient and robust. The proposed method was successfully applied to the analysis of vegetable samples collected from different government farmer markets and street shops in urban areas. The mean concentration of chlorpyrifos in eggplant (24.02 μg/kg), cabbage (10.55 μg/kg), cauliflower (2.85 μg/kg), tomato (178.87 μg/kg) and ladyfinger (2.49 μg/kg) differed significantly (p

A sensitive method for the quantification of eight organophosphate pesticides in water samples at the ng L−1 concentration level has been developed. These organophosphates include pesticides, insecticides and herbicides used in agricultural applications. A lyophilization with simple solvent extraction followed by selective analysis using a liquid chromatography–mass spectrometry method was used. This method was accurate (≥98.9%), as it possessed limits of detection and quantification in the 4.9–51 and 16.5–171 ng L−1 ranges, respectively. Furthermore, the coefficients of variations (≥0.999) were less than 8.2% at the low ng L−1 end of the linear range of the method. In addition, the percentage recovery of all pesticides at the 0.1 μg L−1 levels ranged from 96% to 103%. This method was then used for the quantification of organophosphates in drinking and bore water samples collected from different parts of urban areas. We subsequently found detectable levels of monocrotofos, imedacloprid, triazofos, atrazine, propanil, quinolfos and metribuzin in more than 23% of the water samples analyzed.

Background: As cesarean birth rates continue to rise, more women are faced with the choice of planning a vaginal delivery or a repeat cesarean section after a previous cesarean section. The objective of this prospective study was to study the morbidities and mortality of women attempting a trial of labor after cesarean (TOLAC) versus elective repeat cesarean section (El-RCS).Methods: Prospective data was recorded on management practices, associated complications and morbidity & mortality for a period of 8 months on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/ teaching hospitals for delivery.Results: A trial of labor was planned in 25.8% (4035) women and 34.5% (5399) women underwent elective repeat cesarean section and rest had emergency repeat cesarean section. Overall maternal morbidity due to any cause was 20.7% among El-RCS as compared to 14.2% in TOLAC which was statistically significant (OR: 1.57, CI: 1.41-1.76, P=0.00). Blood loss of more than 1000ml was around 8.0% among TOLAC where as in El-RCS it was 8.8% (OR: 0.89, CI: 0.77-1.94, p=0.14 not statistically significant). Blood transfusion was given in 3.7% in TOLAC where as in El-RCS it was given in 6.5% (OR: 0.56, CI: 0.45-0.68, p=0.00 highly significant). Complication like dehiscence of scar was similar in both groups. Post-operative complication were seen in 2.8% cases in TOLAC where as in El-RCS it was 5.8% (OR: 0.47, CI: 0.38-0.59, p=0.00 highly significant). Uterine rupture was 0.3% in TOLAC where as in El-RCS it was 0.7% (OR: 0.43, CI: 0.21-0.87, p=0.009 statistically significant). Maternal mortality was reported in 0.2% cases of TOLAC as compared to 0.1% cases in El-RCS (p=0.17) which was not statistically significant.Conclusions: Maternal morbidity was found to be more in elective repeat cesarean section than trial of labor after cesarean section.

Background: Cesarean section is one of the most performed surgical procedures all over the world, but unfortunately cesarean sections are associated with a great deal of maternal morbidity and mortality. In the past the rate of cesarean section has increased for many avoidable and unavoidable indications both in developed and developing countries. The objective of this study was to compare maternal morbidity and mortality in elective repeat cesarean section (El-RCS) and emergency repeat cesarean section Em-RCS.Methods: Prospective data was recorded on management practices, associated complications and morbidity and mortality on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/teaching hospitals for delivery.Results: Of the 15664 women with a previous cesarean section, 5399 (34.5%) women underwent elective repeat cesarean section, 7752 (49.5%) women who underwent emergency repeat cesarean section and 2513 (16.0%) had successful trial of labor (S-TOL). There was failed trial of labor (F-TOL) in 1522 cases and requiring an emergency cesarean section for delivery of baby. Therefore, total no. of 7752 women had an emergency cesarean section. The overall maternal morbidity was 22.5%, 20.7% in Em-RCS and El-RCS respectively. Blood loss was more than 1000ml in 7.2% of Em-RCS where as in El-RCS it was 8.8%, blood transfusion was 7.5% in Em-RCS where as it was 6.5% in El-RCS, dehiscence of scar in Em-RCS was 4.7% as compared to 2.2% in El-RCS, uterine rupture was 1.2% in Em-RCS as compared to 0.7 % in El-RCS found statistically significant. Post-operative complication was 5.9% cases in Em-RCS where as in El-RCS was 5.8% (p=0.79 non-significant). Maternal mortality was reported in 12 (0.2%) cases of Em-RCS as compared to 5 (0.1%) cases in El-RCS (p=0.37) which was not statistically significant. Conclusions: Maternal morbidity was found more in emergency repeat cesarean section than in elective repeat cesarean section. Complications and referral of women who are likely to undergo cesarean section should be diagnosed at an early stage so that the maternal morbidity and mortality can be prevented.

Correction for ‘Analysis of dialkyl urine metabolites of organophosphate pesticides by a liquid chromatography mass spectrometry technique’ by Sukesh Narayan Sinha et al., Anal. Methods, 2014, 6, 1825–1834.

Foodborne diseases are an important reason for diarrhoeal deaths among Indian children (

PurposeTo assess knowledge, perceptions and practices of grassroots‐level food safety regulators.Design/methodology/approachKnowledge, attitude and practices (KAP) study using quantitative and qualitative methods for data collection. Quantitative data was collected using a pre‐tested knowledge assessment questionnaire. Qualitative data was collected by conducting a focus group discussion (FGD) and six in‐depth interviews among food safety regulators from all 23 districts of the South Indian state of Andhra Pradesh. Quantitative data were analysed using SPSS package (version 14.5). The FGD and in‐depth interviews' recordings were transcribed verbatim and translated into English before compiling them into individual reports. These reports were read independently by a group of researchers before inferences were drawn.FindingsThe respondents' knowledge on basic food microbiology was limited. They attributed their inability to monitor all cases of food poisoning/adulteration to delay in receiving information and lack of laboratory facilities. They had sound knowledge of conventional adulterations, but were not equipped to check newer adulterations. Their knowledge on health/nutrition claims on food labels is almost nil. Orientation towards food safety issues other than adulteration is the need of the hour.Originality/valueThe results of the study can serve as the basis for developing an in‐service training module for food safety regulators.

The antioxidant properties of sesame lignans (sesamol, sesamin and sesamolin) were evaluated in comparison to tocols (alpha- and gamma-tocopherols and alpha-tocotrienol) and butylated hydroxytoluene (BHT) using the following in vitro lipid peroxidation systems: (i) rat liver microsomes and cumene hydroperoxide (CumOOH)/Fe2+-ADP-NADPH (enzymatic) or (ii) rat liver mitochondria and Fe2+-ascorbate (nonenzymatic) systems. Sesamol containing a free phenolic group inhibited lipid peroxidation in both the systems whereas sesamin and sesamolin having methylenedioxy groups were effective only in the microsomal system. Since detoxifying enzymes are localized in microsomes, the inhibitory effects of sesamin and sesamolin observed in the microsomal system may be attributed to their metabolites. However, the inhibitory effects of lignans were lower than tocols and BHT. Combination of individual lignans and tocopherols (alpha, gamma) or alpha-tocotrienol showed higher inhibitory effects than the sum of individual inhibitions in CumOOH and Fe2+-ascorbate systems suggesting synergistic interactions. The time course of CumOOH-mediated lipid peroxidation showed a lag period and a decreased rate of thiobarbituric acid reactive product formation in the presence of individual lignans in combination with alpha-tocopherol suggesting recycling of alpha-tocopherol.

ObjectiveTo combine evidence from randomized controlled trials to assess the effect of Fe-fortified foods on mean Hb concentration in children (DesignWe conducted a meta-analysis of randomized, controlled, Fe-fortified feeding trials that evaluated Hb concentration. The weighted mean difference was calculated for net changes in Hb by using random-effects models. Meta-regression and covariate analyses were performed to explore the influence of confounders on the net pooled effect.SettingTrials were identified through a systematic search of PubMed, the Cochrane Library and secondary references.SubjectsEighteen studies covering 5142 participants were identified. The duration of feeding of fortified foods ranged from 6 to 12 months in these studies.ResultsEighteen studies were included and evaluated in the meta-analysis. The overall pooled estimate of Hb concentration showed a significant increase in the fortification group compared with the control group (weighted mean difference = 5·09 g/l; 95 % CI 3·23, 6·95 g/l;I2= 90 %,τ2= 18·37,P< 0·0001). Meta-regression analysis indicated that duration of feeding was positively related to the effect size (regression coefficient = 0·368; 95 % CI 0·005, 0·731;P< 0·05). The net pooled effect size after removing the confounders was 4·74 (95 % CI 3·08, 6·40) g/l.ConclusionsWe observed an association between intake of Fe-fortified foods and Hb concentration in children aged

A Quick Easy Cheap Effective Rugged and Safe (QuEchERS) extraction was developed and followed by selective analysis using a liquid chromatography-mass spectrometry method for the quantification of eighteen pesticides in vegetable samples. This method was accurate (⩾99.5%), and it exhibited limits of detection and quantification values in the 0.006-0.091 and 0.020-0.314μgkg-1 ranges, respectively. Furthermore, the coefficients of variations (⩾0.9999) were less than 1% at the low μgkg-1 end of the method. Mean recoveries ranged between 94% and 102%, and relative standard deviations were below 10%. Based on these results, the methodology was proven to be highly efficient, robust, and suitable for monitoring the maximum residue limits (MRL) compliance of a wide range of commodity/pesticide combination. This method was successfully applied to the analysis of vegetable samples that were collected from different government farmers' markets and street shops in urban areas. The presence of target pesticides was found in the range of 0.016 and 50.85μgkg-1.

Despite a vast network of primary health centres and sub-centres, health care outreach in rural parts of India is poor. The Dangoria Charitable Trust (DCT), Hyderabad, has developed a model of health care outreach through trained Village Health and Nutrition Entrepreneur and Mobilisers (HNEMs) in five villages of Medak district in Andhra Pradesh, not serviced by the Integrated Child Development Scheme (ICDS) of the Government of India. Impact of such a link worker on perinatal/ neonatal mortality has been positive. The present study attempts to examine the association of maternal nutrition and related factors with perinatal, and neonatal mortality in these villages.Women from five selected villages who had delivered between June 1998 and September 2003, were identified. Those who had lost a child before one month (28 days), including stillbirths, (group 1- mortality group), who could be contacted and were willing to participate, were compared with those who had not lost a child (group II- no mortality), through a structured questionnaire and physical examination for anthropometric status and signs and symptoms of nutritional deficiency. Categorical data were analysed using Pearson chi square analysis. Continuous data were analysed using Student's t test.Mortality during perinatal, neonatal period was 8.2 per cent of all births. Malnutrition was rampant. Over 90 per cent women had 3 or more antenatal check-ups, had taken tetanus injections and had complied with regular consumption of iron-folic acid tablets. Higher percentage of women in group I (mortality group) tended to have height less than 145 cm (high risk) and signs and symptoms of micronutrient deficiencies. However, differences between groups I and II were not statistically significant. Pre-term delivery, difficult labour (use of forceps), first parity, birth asphyxia (no cry at birth) and day of initiating breastfeeding showed significant association with mortality.Significant association between signs and symptoms of malnutrition with perinatal, neonatal deaths may have been masked by high prevalence of malnutrition in the mothers of both the groups and the small study sample size. However, maternal malnutrition, may contribute indirectly through its effects on other pregnancy-related as well as delivery-related complications leading to adverse outcome of pregnancy. The HNEM experience of DCT suggests that a properly trained and supported village level worker can contribute to reduction in perinatal and neonatal mortality.