Traditionally, qualitative studies are founded on interpretative and constructive epistemology. The process of data collection in these studies is longer and intensive. This helps to build a strong rapport with the community, hence enabling to capture the field as naturally as possible. These characteristics provide an ample scope to take care of quality and validity of data. However, in applied situations, data collection is often a truncated activity. This robs away a number of taken-for-granted strengths of traditional qualitative research methods: No time is spent on rapport building; holism is left behind, instead we engage in selection; we focus narrowly on specific phenomenon of concern, divorced from its context; analysis does not evolve out of an iterative process. In this paper, we aim to discuss some of the issues related to rigor and quality of such studies and strategies available to address them.

In order to respond to the changing paradigm of public health challenges, India needs adequately trained public health professionals. Public health education is a tool to create public health professionals. Public health education in India is at cross-roads on several fronts. Traditionally, public health education in India was offered through medical schools and was open for medical graduates only. However, recently the country has witnessed an emergence of institutions offering public health programs to nonmedical background graduates. An examination of the history and current status of public health education can provide us with an insight into the evolution of the discipline in the country. This is important as in order to respond to the public health education challenges in the present time, we need to understand the historical directions taken by the discipline in the past. This review captures how the public health education efforts in the country have been aided by concerted actions within the discipline and by an enabling environment and a positive intent at the national level, whereby we can better understand the context for the recent developments in Indian public health.

Rotavirus is currently by far the most common cause of severe diarrhea in infants and young children worldwide and of diarrheal deaths in developing countries. Worldwide Rotavirus is responsible for 611,000 childhood deaths out of which more than 80% occur in low-income countries. The resistance of rotavirus to commonly used disinfectants and ineffectiveness of oral rehydration therapy due to severe vomiting indicates that if an effective vaccine is the preferred option. WHO has recommended inclusion of rotavirus vaccine in the National Schedules where under 5 mortality due to diarrheal diseases is ≥ 10%. Currently two vaccines are available against rotavirus. Rotarix (GlaxoSmithKline) is a monovalent vaccine recommended to be orally administered in two doses at 6-12 weeks. Rota Teq (Merck) is a pentavalent vaccine recommended to be orally administered in three doses starting at 6-12 weeks of age. Serodiversity of rotavirus in India and its regional variation favor either a monovalent vaccine that can induce heterotypic immunity or a polyvalent vaccine incorporating majority of serotypes prevalent in the country. However, the efficacy of available rotavirus vaccines is less in low-income countries. Both the candidate vaccines when coadministered with OPV, immune response to first dose of these vaccines is reduced. However, immune responses to subsequent rotavirus vaccine doses are not affected. In view of this, WHO recommends three doses of either vaccine to be given to children in developing countries to produce the optimum response. Indigenous vaccine, 116E (Bharat Biotech) based on human rotavirus of serotype G9P [11] is still under Phase 2 trials. Another multivalent vaccine is being developed by Shantha Biotechnics in India. The cost effectiveness of the three dose schedule of the available and the rsults of the field trials of the indigenous vaccines should be assessed before inclusion of rotavirus vaccine in the National Immunization Schedule.

This paper analyzes the present processes, products and needs of post-graduate public health education for the health programming, implementation and oversight responsibilities at field level and suggests some solutions for the institutes to adopt or adapt for improving the quality of their scholars. Large number of institutions has cropped up in India in the recent years to meet the growing demand of public health specialists/practitioners in various national health projects, international development partners, national and international NGOs. Throwing open MPH courses to multi-disciplinary graduate's is a new phenomenon in India and may be a two edged sword. On one hand it is advantageous to produce multi-faceted Public health postgraduates to meet the multi tasking required, on the other hand getting all of them to a common basic understanding, demystifying technical teaching and churning out products that are acceptable to the traditional health system. These Institutions can and must influence public health in the country through producing professionals of MPH/ MD degree with right attitude and skill-mix. Engaging learners in experimentation, experience sharing projects, stepping into health professionals' roles and similar activities lead to development of relatively clear and permanent neural traces in the brain. The MPH institutes may not have all efficient faculties, for which they should try to achieve this by inviting veterans in public health and professionals from corporate health industry for interface with students on a regular basis. The corporate and public health stalwarts have the capacities to transmit the winning skills and knowledge and also inspire them to adopt or adapt in order to achieve the desired goals.

Background: Domestic violence has serious impact on women's health and well-being. A nationwide survey conducted in India observed that 37.2% of women experienced violence after marriage. Objectives: To assess the prevalence of domestic violence among the ever married women in reproductive age group and to find out the types of domestic violence and factors associated with it. Materials and Methods: The study was a community based cross-sectional study, conducted in a slum area of Kolkata. Results and Conclusion: Overall prevalence of domestic violence was 54%, of which 41.9% suffered from both current and lifetime physical and psychological violence. Presence of property, higher per capita income and social support were protective factors against domestic violence, whereas alcohol addiction and multiple sex partners were the important contributory factors for it. The study recommended more social support, awareness and income generation for women in the slum areas.

Background: Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. Objectives: To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. Materials and Methods: Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. Results: The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. Conclusion: The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.

Cardiovascular diseases including hypertension are increasing in developing countries especially among high-risk group people like bank employees. A cross-sectional study of 1493 bank employees of Surat city was conducted during August, 2004 to September, 2005 to study the prevalence of hypertension among bank employees and the effects of socio-demographic factors on prevalence of hypertension. Data were analyzed using epi 6 software. The χ^[2] -test was applied as a nonparametric test of statistical significance. Prevalence of hypertension was 30.4% and prehypertension was 34.5%. Out of 455 found as hypertensive, 258 (56.70%) were not having any symptoms at the time of examination. Prevalence was high among persons with age 50 years and above (48.5%); among male (32.5%) as compared to female (23.1%); among employees having small family size; among separated/divorcee person (40.0%). Prevalence of hypertension increased with seniority of the official position of bank employee with highest prevalence among managers (45.9%). Prevalence of hypertension was noted highest among the higher socioeconomic group; SEC I (35.0%) followed by class II (20.4%). Effects of different risk factors of hypertension were observed here. This study may help in identifying the common profile of hypertensive or persons at risk, which may further help in identifying the risk group and planning the group specific IEC interventions.

A cross sectional study was conducted from February - May 2009 with the objectives to find out profile of injuries among municipal primary school children in Siliguri, West Bengal and to identify the related factor associated with injury. 20% of total primary schools under municipal corporation of the town were selected and a pre-designed, pre-tested schedule was used to assess the profile of injury and associated factors. The Chi square test was usedto determine statistical significance at the 0.05 significance level. Out of 956 participants, a significantly higher injury was observed among males (68%). Open wound injuries were commonest (59.6%) occurring mainly at the extremities. Falls were mainly responsible for overall injuries. Injury at home (41.8%) was also found to be more. Mother education, number of siblings and presence of caregiver were significant related factors to injury.

A cross-sectional study was conducted on Lucknow highway in Bareilly district of Uttar Pradesh to study the knowledge of truck drivers about HIV transmission and prevention and to study the sexual behaviour of these drivers with reference to HIV/AIDS. Age, marital status, education, income, drinking alcohol, length of stay away from home, knowledge about transmission and prevention of HIV, and HIV-prone behavior of truck drivers were studied. Chi-square, mean, and SD were calculated. In all, 289 (97.6%) drivers had heard about HIV/AIDS. Only 242 (81.8%) were aware of HIV transmission by heterosexual route. Misconceptions such as HIV transmission by mosquito bites, living in same room, shaking hands, and sharing food were found. Out of 174 (58.8%) who visited Commercial Sex Workers (CSW), 146 (83.9%) used a condom. 38 (12.8%) visited more than 5 CSW in the last 3 months. Time away from home on the road, marital status, alcohol use, and income class were associated with visiting CSW. High-risk behavior was established in the study population. Safe sex and use of condoms need to be promoted among the truck drivers and better condom availability needs to be assured on highways.

Oral cancer is one of the most common life threatening diseases in India. Tobacco and alcohol are considered to be the most risk factors for oral cancer. This study was conducted to investigate the association of tobacco and poly-ingredient oral dip products with oral cancer. A case-control study of 350 cases and 350 controls, over a period of 19 months, between February 2005 and September 2006 was carried out in Pune, India. The self-reported information about the consumption of tobacco, poly-ingredient oral dip products, alcohol, dietary habits and demographic status were collected by a researcher made questionnaire. Univariate and multivariate analysis were used to identify the risk of substances abuse. The frequency of smoking, smokeless and oral dip products in cases were significantly higher than controls (P < 0.0001). Among smoking types, bidi (P < 0.0001, OR = 4.1 95% CI = 2.4 - 6.9), of smokeless types, chewing tobacco (P < 0.0001, OR = 8.3, 95% CI = 5.4 - 13.0) and mishiri (P < 0.0001, OR = 3.3, 95% CI =2.1 - 5.4), and of oral dip products, consumption of gutkha (P < 0.0001, OR = 12.8, 95% CI =7.0 - 23.7) and supari (P < 0.0001, OR = 6.6, 95% CI =3.0 - 14.8) indicated strong association with oral cancer upon adjustment. This study provides strong evidence that gutkha, supari -areca nut- chewing tobacco (tobacco flakes), bidi smoking and mishiri (tobacco powder, which applied as a tooth and gum cleaner) are independent risk for oral cancer.

Pictorial warnings are effective in promoting smoking cessation as shown by research in the developed countries. This study aims to determine perceptions of Indians about the effectiveness of pictorial health warnings on tobacco packs which existed from May 31, 2009, to December 1, 2011. A cross-sectional survey was undertaken in five states of India with 1897 participants (56% males; 54% tobacco users). More tobacco users expressed that the pictorial warnings are inadequate to convey the health impact of tobacco use when compared with nonusers (71.50% vs. 62.75%; P < 0.001). More illiterates when compared with literates expressed their concern that the current pictorial warnings will not motivate them to quit (61.17% vs. 51.01%; P < 0.001). The new warnings implemented from December 1, 2011, in India are also not field-tested. Field testing and assessment of effectiveness of health warnings should be a mandatory requirement for Parties reporting on Article 11 of Framework Convention on Tobacco Control (FCTC).

Community based study on health expenditure is a rarity in India. A Rural Community based longitudinal study was undertaken in Jaulgaon village of Maharashtra, with objectives of finding out the health expenditure contributed by direct treatment, related travel and relevant loss of wages with certain pertinent associated factors. 50% of the village population was studied (N = 256) by pre-designed, pre-tested schedule following WHO guidelines. A monthly house to house interview was conducted over 12 months. During study period, 78% study subjects suffered some illness with mean illness episode 1.74/person and 6.37/family without any sex difference. The annual health expenditure of the community was Rs 1,576/family, 4,31/person and 2,42/episode, which was about 4.3% of their income. The major part of the expenditure (82%) was for direct treatment cost, followed by loss of wages (12%) and travel related cost (6%). Expenditure was seen to be significantly associated with family income (P = 0.000) and education (P = 0.006).

'Janani Suraksha Yojana (JSY)' was implemented in India to promote institutional deliveries among the poorer section of the society. A cross-sectional study was conducted in Bankura district among 324 women who delivered in last 12 months selected through 40 cluster technique to find out institutional delivery rate, utilization of JSY during antenatal period and relation between cash benefit under JSY during antenatal period and institutional delivery. Overall institutional delivery rate was 73.1% and utilization of JSY among eligible women was 50.5%. Institutional delivery (84.0%), consumption of 100 iron-folic acid tablets (46.0%) and three or more antenatal check-ups (91.0%) were better in women who received financial assistance from JSY during antenatal period than other women. After adjustment for socio-demographic factors, JSY utilization came out to be significantly (P=0.031) associated with institutional deliveries. The study showed that cash incentive under JSY in antenatal period had positive association on institutional deliveries.

Background: Milk and dairy products from animal sources (cow's milk or buffalo's milk) are an important part of Indian diet and its consumption starts at an early age. Objective: The purpose of this study is to understand the processing, storage and modifications carried out before bovine milk is fed to the infants and compare it with recommendations by Health Care Professionals (HCPs). Materials and Methods: The study involved assessments involving HCPs and mothers of children below 1 year of age through both qualitative and quantitative methods. Feeding recommendations by HCPs were assessed through a quantitative method. Results: The children are commonly initiated on bovine milk post 3 months of age. The milk is not covered while boiling in 70% cases and boiled at suboptimal temperature (moderate: 62% or low: 31%). Half of the families store milk outside refrigerators openly in the kitchen or rooms. The milk is modified in the majority of cases (81%) before being fed. Modification of the milk was often done with sugar (85%), followed by water (49%), biscuits, fennel seeds, cardamom or infant cereals before feeding the baby. Addition of water was more prevalent among mothers of infants between 3 and 6 months. HCPs do not advise consumption of bovine milk by infants unless there is no other option available. Conclusion: A clear gap exists between recommended and actual practices for infant feeding in India. There is a huge opportunity to educate mothers on importance of breast feeding and benefits of implementing appropriate processing, storage, and consumption practices of bovine milk.

Background: It is a common practice to process milk before consumption. Processing generally involves boiling, addition of sugar and/or condiments, dilution with water, etc. The boiled milk is stored for subsequent use either at room temperature or under refrigerated conditions. Objective: The purpose of this study was to see the effect of household practices on the nutritional profile of milk. Materials and Methods: Different types of pasteurized milk samples: standardized, double toned, full cream, and unpasteurized milk were analyzed. The effect of household practices on the nutritional profile of all these milk samples was studied using National/International methods. Results: Boiling of milk increased the concentration of most of the components and minerals except for vitamins A, B ₃ , B ₅ , and B ₁₂ where the decrease observed was 21%, 13%, 3%, and 21%, respectively. Addition of water decreased the concentration of minerals and vitamins. Addition of sugar increased the energy and condiments increased total solids, carbohydrate and minerals content but led to a decrease in the vitamin content. Storage of milk led to a decrease in total solids by 19% and vitamins A, B ₃ , B ₅ , and B ₁₂ by 26%, 17-19%, 23%, and 18-26%, respectively. The pH was not influenced by any of the household practices. Conclusion: Every step during household practices in the handling of milk reduces its nutritional profile and significantly affects the quality. Vitamins play a very important role in health and loss during household processing becomes an interesting attribute that requires further research in detail.

Background: Milk is susceptible to contamination by many microorganisms including microbial pathogens responsible for causing diseases. Various processes including pasteurization, boiling or storage under refrigerated conditions are undertaken to minimize the microbial contamination of milk. Objective: This study was undertaken with an objective to evaluate the effect of household practices on the microbiological profile of milk. Materials and Methods: Milk samples of pasteurized, ultra heat treated (UHT) as well as unpasteurized milk (Vendor's milk) were collected. The effect of different storage practices and treatments on the microbiological profile (standard plate count (SPC), coliform, E. coli, Salmonella, Shigella, Staphylococcus aureus, yeast and moulds, anaerobic spore count, and Listeria monocytogenes) of milk was studied using National/ International Standard Test Methods. Results: Average SPC in vendor's milk was found very high as compared to pasteurized milk. Coliform, yeast and moulds, E. coli, and Staphylococcus aureus were detected in the samples of vendor's as well as pasteurized milk. Boiling the milk reduces SPC and kills the other microorganisms. Storage of boiled milk under room temperature or refrigerated condition resulted in a similar increase in SPC at the end of 24 h, but storage of un-boiled milk even under refrigerated conditions increased SPC manifold after 24 h. Conclusion: The pasteurization process and hygienic conditions at the milk processing units along with cold chain of milk from suppliers to end users needs improvement. Currently, even pasteurized milk does not match the microbiological standards. It is recommended that milk should be boiled before consumption and refrigerated for storage to improve its shelf life/keeping quality.

Background: The major contaminants usually encountered in milk and milk products include pesticide residues, heavy metals, and aflatoxin M1 (AFM1). Primarily, milk get contaminated before milching, from the cattle feed, from sources/materials used during the processing of milk as well as improper handling of the milk during the pre- and postprocessing period. Objective: The purpose of this study was to evaluate the effect of household practices on milk contaminants. Materials and Methods: Samples of pasteurized as well as unpasteurized milk (Vendor's milk) were analyzed for AFM1, pesticide residues, and heavy metals. Simulating the household practices, the impact of boiling on these contaminants was assessed. Results: The contaminant Aflatoxin M1 (AFM1) was detected at a concentration ranging from 0.071-0.075 ppb in unpasteurized as well as pasteurized milk samples analyzed during the course of study. Moreover, boiling had no impact on the quantity of AFM1 present in the milk. Pesticides and heavy metal contents were found to be within acceptable limits in all the milk samples tested. Conclusion: Mycotoxins especially aflatoxins in cattle feed and their consequential presence in milk and milk products is a serious concern world over as they are reported carcinogens. These fungal toxins are resistant to high temperatures and may lead to various health hazards. Preventive steps must be taken at each stage to ensure good quality of milk and milk products free from these contaminants. Awareness programs and education for the dairy farmers and milk processors may be helpful in this regard.