A desperate situation may evoke a fundamental question or suggestion of a radical solution. Hence, let us first examine whether the current situation of maternal anemia in India is really desperate and therefore merits a search for a “magic bullet” as a cure.

Background: Overweight among adolescents has high prevalence on the eastern part of India, especially West Bengal. Objectives: The current study was conducted to estimate and compare the effects of different dietary habits and habits related to physical activity in the development of overweight and obesity among rural schoolgoing adolescents. Methods: A prospective repeated measures study was conducted on 645 schoolgoing adolescents from selected rural government-aided schools from June 2017 to December 2017. Dietary habits of the students and physical activity-related factors were the major predictors. Adjusting for the age and sex of the participants, effect of these factors on the development of overweight and obesity was analyzed by generalized estimating equations for 2 repeated measures, taken 6 months apart. Results: Most of the respondents were aged ≥16 years (56.90%), female (52.87%), Hindu (76.74%), from a nuclear family (76.74%), and studying in the secondary level (57.68%). There was a stark rise in proportion of overweight from 0.93% to 7.44%. The prevalence of unhealthy dietary habits was 68.99% at the baseline, and 66.82% on follow-up. The overall prevalence of inadequate physical activity increased to 48.68% from 47.91%. Female gender and older age group were at higher risk of being overweight or obesity. Overall fast food showed highest risk (3.04, 95% confidence interval [CI]: 1.86–4.95), while among the boys, it was with less vegetable consumption (4.64, 95% CI: 1.84–11.69). Conclusions: Strong evidence was generated of dietary practices being more rigidly related to overweight among the adolescents. Healthy dietary practices coupled with physical activity should be promoted to mitigate the risk of obesity.

Background: Globally, vector-borne diseases account for 17% of infectious disease burden. In India, despite accelerated efforts, both malaria and dengue are major public health concern. Understanding local community perspectives is essential to strengthen ongoing program activities. Objectives: The study aimed to assess the community perceptions and risk reduction practices toward prevention and control of malaria and dengue at slums of Chetla in South Kolkata and to explore the perspectives of relevant local stakeholders in this regard. Methods: This cross-sectional study with mixed-method design was conducted from June to September 2018. Quantitative data were collected in 288 sampled households through face-to-face interview of respondents and environmental checklist, whereas, qualitative exploration was done with five key informant interviews. Quantitative data were analyzed using SPSS version 16 Software. Qualitative data were analyzed thematically using “cut and sort” processing technique. Results: In household survey, majority had unsatisfactory knowledge (68.4%), attitude (64.2%), and practices (62.8%) regarding diseases prevention/control, which was further substantiated by qualitative findings. The use of electric fans (79.5%), mosquito repellents (53.8%) were predominant practices; however, only a few used bed nets regularly (26.0%). Reportedly, “heat” and “poor ventilation” were key reasons behind reluctance to use bed nets. Multivariable regression analysis revealed that increasing age, proximity to a nearby canal, and unsatisfactory knowledge significantly predicted unfavorable attitude, whereas, respondents' gender and unfavorable attitude significantly predicted poor practices. Conclusions: Intensified social behavior change communication with active community participation is the need of the hour to prevent malaria and dengue occurrence and future outbreaks.

Background: The concurrent occurrence of many noncommunicable disease (NCD) risk factors is common, and it can play a synergistic role in occurrence of NCDs. Objectives: This study aimed to identify the magnitude of clustering of NCD risk factors, patterns of risk factors emerged in clustering, and variations in clustering of risk factors based on socioeconomic factors. Methods: A cross-sectional survey was undertaken in an urban area of Puducherry among 2399 adults during 2014–2015. Sociodemographic and behavioral risk factors were assessed through a validated STEPS survey tool. Individuals with three or more risk factors were classified to have clustering of NCD risk factors. Socioeconomic positions in relation to clustering were identified through Chi-square analysis followed by multiple logistic regression where clustering at family and area was adjusted through multilevel modeling techniques. Results: Of the 2399 adults, 1741 (73%) had clustering of NCD risk factors. Inadequate consumption of fruits and vegetables, high salt intake, and high waist circumference are the three predominant risk factors across all subgroups. Adults belonging to Christian religion (adjusted odds ratio [adjOR]: 2.8, 95% confidence interval [CI]: 1.5–5.2), aged 35 years and over (adjOR: 2.0, 95% CI: 1.4–6.0), and illiterates (adjOR: 1.8, 95% CI: 1.1–5.5) are more likely to have clustered NCD risk factors compared to others. Conclusions: Clustering of NCD risk factors is highly prevalent in this region and mainly driven by dietary practices and obesity measures. There is an urgent need to reorient the health system toward integrated approach with mandated inclusion of nutritionist in NCD health service delivery.

Background: An efficient inventory control system would help optimize the use of resources and eventually help improve patient care. Objectives: The study aimed to find out the surgical consumables using always, better, and control (ABC) and vital, essential, and desirable (VED) technique as well as calculating the lead time of specific category A and vital surgical consumables. Methods: This was a descriptive, record-based study conducted from January to March 2016 in the surgical stores of the All India Institute of Medical Sciences, New Delhi. The study comprised all the surgical consumables which were procured during the financial year 2014–2015. Stores ledger containing details of the consumption of the items, supply orders, and procurement files of the items were studied for performing ABC analysis and calculating the lead time. A list of surgical consumables was distributed to the doctors, nursing staff, technical staff, and hospital stores personnel to categorize them into VED categories after explaining them the basis for the classification. Results: ABC analysis revealed that 35 items (14%), 52 items (21%), and 171 items (69%) were categorized into A (70% annual consumption value [ACV]), B (20% ACV), and C (10% ACV) category, respectively. In the current study, vital items comprised the majority of the items, i.e., 73% of the total items and essential (E) category of items comprised 26% of all the items. The average internal, external, and total lead time was 17 days (range 3–30 days), 25 days (range 5–38) and 44 days (range 18–98 days), respectively. Conclusions: Hospitals stores need to implement inventory management techniques to reduce the number of stock-outs and internal lead time.

Background: Iodine deficiency is one of the most prevalent micronutrient deficiencies globally. Women in reproductive age group are vulnerable to develop iodine deficiency as there is an increase in demand for iodine, especially during pregnancy. Objectives: The objective is to assess the prevalence of goiter and its association with iodine status and salt usage practices among the women of reproductive age group. Methods: A community-based cross-sectional study was conducted from August 2015 to July 2017 among 1500 women of reproductive age group in five villages of Udupi Taluk. Stratified sampling design and proportion to population size of the reproductive age women in the study area was used to select the study participants. A pretested semi-structured questionnaire was used for data collection. Goiter was assessed clinically and graded as per the recommended criteria of the WHO. Salt samples from every household were collected for iodine estimation. Blood and urine samples were collected from subsample to estimate thyroid-stimulating hormone levels and urinary iodine excretion levels, respectively. Results: The overall prevalence of goiter was 13% with 11.5% being Grade 1 and 1.5% being Grade 2. No significant association of goiter with urinary iodine, salt iodine levels, and salt usage practices was found. Conclusions: Median urinary iodine among the women with goiter indicates iodine sufficiency and no significant difference observed in urinary iodine levels between women with and without goiter.

Background: Research on different measures of food security and their interrelation in order to identify vulnerable households are scarce in India. Objectives: The objective was to assess household food security (HHFS), nutrient adequacy, dietary diversity, and nutritional status of under-five children along with their interrelation in the slums of Bankura Municipality, West Bengal. Methods: A cross-sectional study was conducted during 2016–2017 among 240 households using two-stage 30-cluster random sampling. Information regarding socioeconomic characteristics, availability, and utilization of different poverty alleviation schemes was collected. HHFS was assessed by a validated HHFS scale-short form in Bengali and nutrient adequacy with 24-h recall method. The eldest under-five child in the family was measured for anthropometry using standard procedure and for dietary diversity with the Individual Dietary Diversity Score. Results: Overall, 74 (29.1%) households had “food security,” whereas 102 (44.3%) and 64 (26.6%) had, respectively, low and very low food security. Among 190 under-five children, 63 (35.3%) had single and 50 (25.5%) had multiple anthropometric failures. Overall, 89 (36.1%) households were deficient for both energy and protein and 111 (47.6%) had deficiency of either of these two. Indicators on the utilization of different poverty alleviation schemes were associated with low/very low food security. A “Composite Index of Food Scarcity” comprising of HHFS, nutrient adequacy, and dietary diversity was proposed which was found to have dose–response relationship with grades of anthropometric failure of under-five children. Conclusions: An index comprising of three indicators might help identify the vulnerable households in relation to food security more effectively than a single indicator.

Background: Pregnancy is a state, which is often associated with extreme joy and happiness. Women undergo a number of physiological and psychological changes during pregnancy, which are often stressful if aligned with other adverse life events, compromising their health and well-being. However, there exists no comprehensive psychological instruments for measuring this stress. Objectives: The study was conducted to develop a multidimensional scale to assess prenatal maternal stress (PNMS) comprehensively. Methods: The initial phase of the study focuses on developing items and assessing the content validity of these items. The second phase focuses on pilot-testing and field-testing the newly developed perceived PNMS scale (PPNMSS) among 356 pregnant women belonging to different parity and trimester from November 2015 to October 2016. Results: The underlying factor structure of the 28-item PPNMSS had explored using exploratory factor analysis. The final scale is retained with 15 items having considerable item loading under four major factors as follows: perceived social support, pregnancy-specific concerns, intimate partner relations, and financial concerns. Reliability of each of these dimensions was assessed using Cronbach's alpha. Convergent and divergent validity of the scale was assessed by correlating the scores with perceived stress scale and the World Health Organization (five) well-being index (1998 version). Conclusions: As a comprehensive scale, PPNMSS is efficient to measure PNMS, which facilitates an early detection of stress and depression among pregnant women and timely intervention by health care professionals.

Background: With the rapid rolling out of the information highway, an increasing number of patients are accessing the Internet for medical information. Against this background, the present study was undertaken. Objectives: To ascertain patients' use and opinion on impact of Internet on doctor–patient relationship. Methods: A cross-sectional study was done. A total of 709 patients was interviewed, 307 from urban and 402 from rural field practice areas. Institutional ethical approval was obtained before data collection. Categorical data were summarized by percentages with 95% confidence intervals (CIs). Quantitative data were summarized by mean and standard deviation. Associations were explored using odds ratio (OR) with 95% CI for categorical data and two sample t-test for quantitative data. Results: Internet for medical information was used by 50.35% of the patients (95% CI = 46.68, 54.02). More urban patients, i.e., 79.48% used Internet compared to rural patients, i.e., 28.11%. This difference was significant, OR = 9.9 (95% CI = 6.9, 14.0; P < 0.0001). Users of Internet had about 4 years more schooling than nonusers. This was significant, P < 0.0001. More users believed that this trend will improve the doctor–patient relations (51.26%), compared to nonusers (17.05%). This difference was significant, OR = 5.11, 95% CI = 3.61, 7.22, P < 0.0001. Conclusions: A large proportion of patients used Internet to get medical information, significantly more urban patients compared to rural patients. The implication of this is that doctors in times to come will be dealing with patients empowered by online health information.

Background: Whole-grain consumption is associated with several health benefits. Little is known, however, about whole-grain consumption patterns in medical students in Malaysia. Objectives: The study was conducted to assess whole-grain intake pattern and factors influencing intake among Malaysian medical students. Methods: A cross-sectional study investigating whole-grain intake among 151 medical students in a private medical university in Malaysia was conducted from January to June 2018. A self-administered questionnaire was used to assess sociodemographic variables, the whole-grain intake pattern and the knowledge and attitudes toward whole-grain intake. Data were analyzed using IBM SPSS software. Chi-square test and multivariable logistic regression were used. Results: The prevalence of reported whole-grain intake in the past 3 months was 51%. Chinese ethnicity, readiness to adhere to Malaysian food pyramid, and self-preparation of food, and eating at home were significantly associated with whole-grain consumption. However, the primary determinants of food choice such as education, knowledge, and affordability did not seem to influence whole-grain consumption. Whole-grain consumption is relatively low among Malaysian medical students. Cultural background and self-belief influence this practice despite being from the medical fraternity. Conclusions: Efforts are needed to bridge the knowledge–practice gap by assessing the barriers to whole-grain consumption to design effective initiatives to promote an increase in whole-grain consumption.

Background: The study on self-perceived uselessness may help health-care workers to provide opportunities for intervention for increased quality of health and greater survival rate in elderly. Objectives: To find the prevalence of self-perceived uselessness and its determinants among the elderly residents of old age homes of North Bengaluru. Methods: A cross-sectional descriptive study was undertaken on 129 elderly aged 60 years and above in the old age homes of North Bengaluru. Self-perceived uselessness, sociodemographic variables, morbidity status, functional status, financial status, and personal habits were assessed using a semi-structured questionnaire. Proportions, percentages, and Chi-square test were used for analysis. Results: Nearly half (45%) of the elderly had agreed that they had perceived themselves as useless as they age. Majority of those who perceived uselessness had one or >1 chronic morbidities and were functionally dependent (81.2%). Significant association was seen between self-perceived uselessness and functional dependency, gender, education, and having some form of activities during their leisure time. Conclusions: It can be concluded that self-perceived uselessness is quite prevalent in nearly one-half of the elderly in the old age homes in North Bengaluru having significant association with variables such as gender, education, leisure activities, and functional status.

Background: Alcohol dependence has become a major public health problem with many implications on the lives of dependents and their families. Objectives: The objectives of this study is to ascertain the enabling factors to seek medical help and continue behavior change among alcohol dependents and to assess the perceptions of health-care providers regarding treatment-seeking behavior of alcohol dependents. Methods: The present study deployed the transtheoretical model (TTM) as a theoretical framework for analyzing the enabling factors to seek medical help and continue behavior change among alcohol dependents and to understand the perceptions of health-care providers dealing with alcohol dependents at a tertiary care psychiatry hospital in Guntur of Andhra Pradesh. In-depth interviews and desk review of hospital records were done. Respondents included treatment-seeking individuals for alcohol detoxification (action phase), patients attending follow-ups (maintenance phase), and mental health professionals at the study site. The study was conducted during August and September 2017. Qualitative analysis using thematic framework and MS EXCEL for quantitative data was used. Results: Themes and subthemes emerging out of analysis were fitted in stages of TTM of behavior change. In the process of behavior change, there were key supportive elements such as problem awareness (precontemplation), availability and accessibility of services (contemplation), appropriate treatment modality (action), and alcohol anonymous groups (maintenance), which sustained the progress of change and yielded effective outcomes. Conclusions: Alcoholism needs to be addressed holistically rather than focusing only on biological treatment.

Background: Adolescence is a vulnerable period of growth and development. This is the time when habits are inculcated which will carry forward to adult life. Sleeping patterns among adolescents have an impact on their overall health. Early substance use initiation is a serious concern because it is associated with significantly increased risks for developing substance use disorders. In general, aggressive behaviors progress from less to more severe over the course of adolescent development. Objectives: The objectives of this study are to determine the lifestyle behaviors of young adolescents focusing on sleep pattern, aggressive behavior, and substance use. Methods: A cross-sectional study was conducted among 739 students of Class VII and VIII in both government and private schools in Imphal West and Kangpokpi districts of Manipur between August 27 and September 25, 2017. A pretested, structured questionnaire was used, which included the modified version of Buss and Perry Aggression Questionnaire. The data were analyzed using the IBM SPSS software (IBM SPSS for Windows, Version 21.0. Armonk, NY, USA). Results: Only 56.2% of the students had adequate sleep. The proportion of adolescents using alcohol, tobacco, cigarettes, and Ganja was 4.6%, 9.5%, 5.7%, and 1.6%, respectively. Aggressive behavior was shown by 35.3%. Male students were getting more sleep (60.7%), were more aggressive (38.8%), and were using tobacco and cigarettes (82.4%) more than female students. Conclusions: Around two-fifth of the adolescents were not getting enough sleep. The association between aggressive behavior and substance use was found but needs further investigation for its temporal relationship.

Rotavirus is a leading cause of severe pediatric diarrhea worldwide, with about 199,000 childhood deaths in 2015, of which 90% in low-income countries. India alone accounts for 22% of the global rotavirus gastroenteritis (RVGE)-related deaths among children below 5 years of age. The World Health Organization recommends introducing rotavirus vaccines (RVVs) as a priority in developing countries where high rates of RVGE are observed. To have the desired impact, RVV should be administered the earliest possible, ideally before the first episode of RVGE. In India, four RVVs are available for use in infants ≥6 weeks of age: the single-strain, two-dose, live-attenuated human RVV Rotarix; the five-strain, three-dose, human-bovine reassortant RVV Rotateq; the single-strain, three-dose, naturally reassortant human-bovine RVV Rotavac; and the five-strain, three-dose, human-bovine RVV Rotasiil; all of them proven to be efficacious and well tolerated. Whereas Rotarix and Rotateq have shown high efficacy/effectiveness against severe RVGE in developed countries (≥90%), they have been observed to be lower in developing countries (~40%–70%). Rotavac and Rotasiil have shown similar efficacy in low-income settings, but further studies are needed to assess their effectiveness. Rotarix and Rotateq have not shown increased intussusception (IS) risk in clinical trials. Postmarketing surveillances were able to show a very tiny increased risk of IS after the first dose of vaccine, but the extensive benefits of rotavirus vaccination far outweigh the low-level risk of IS. In India, where the disease is a major problem and occurs in very early months of life, RVVs should have high coverage and vaccination schedule should be completed as early as possible (≥6 weeks of age) to maximize the vaccine impact.

North East Region in India is showing a peculiar type of cancer incidence pattern. This is an attempt to get a clear picture of cancer in NE India, the gaps in providing cancer care, and a way forward for a healthier NE. For this purpose, a desk review was undertaken along with secondary data analysis in 2018. In NE, the survival rate is comparatively very low, with higher proportion of distant metastasis cases at diagnosis. Even worse, the NE region lacks required infrastructure with respect to specialized treatment facilities, human resources, etc., In view of high burden of the disease with very limited resources, a multidisciplinary, multidimensional, and multilevel approach are needed to protect this vibrant region from becoming the cancer hub.

The present study aimed to find out the effect of disease-related impairments on functional status in individuals with spinal muscular atrophy and identify perceived barriers to undergo physiotherapy. The cross-sectional observational study was conducted on 90 participants from January to March 2018 using validated patient-reported questionnaire via electronic mail, along with Fatigue Severity Scale and ACTIVLIM. Results revealed that difficulty in sitting was due to scoliosis (36%) and muscle weakness (23%), the latter also contributing toward difficulty in standing and walking (59%). Inverse relationship exists between ACTIVLIM measures and fatigue severity scores (r = −0.338, P < 0.05), body mass index (r = −0.225, P < 0.05), age (r = −0.258, P < 0.05), and duration of illness (r = −0.257, P < 0.05). Economic constraints (27%), difficulty in traveling (17%), and lack of family support and mobility (14%) are perceived barriers to undergo physiotherapy. Functional impairments and identified barriers must be addressed as part of rehabilitation.

Exposure to biomass fuel smoke has detrimental health effects causing chronic diseases. This study investigated the relationship between biomass fuel smoke exposure and hypertension among the rural Bangladeshi women. A total of 410 women aged 19–60 years were enrolled in this study during April–May 2017 who regularly cooked with biomass fuel in traditional cook stove for the past ≥1 year. Self-reported daily cooking hours and lifetime cooking experience of the participants were recorded, and their blood pressure was measured. Participants' age ≥40 years, parental history of hypertension, body mass index ≥25 kg/m², and cumulative exposure to biomass smoke were found to be the significant risk factors of hypertension. Every 1 year increase in cumulative exposure to biomass smoke eventually exacerbated the risk of hypertension by 61% (adjusted odds ratio 1.61, 95% confidence interval: 1.16–2.22; P < 0.01). This study provides evidence that long-term exposure to biomass fuel smoke is associated with hypertension.

Asia Pacific region has been witnessing numerous public health emergencies in recent years with the Nipah outbreak in North Kerala (2018), India, needs special mention. Threats posed and experiences gained have compelled health systems to draft frameworks nationally and internationally for preparedness, outbreak response, and recovery. Our failure to obtain comprehensive guiding frameworks for application in the Indian context for Ebola, Severe Acute Respiratory Syndrome, Influenza A (H1N1), and Nipah outbreaks led us to the search outside India for frameworks that have worked in the past. A thorough review of the WHO, Centers for Disease Control and Prevention, and Malaysian framework was done to identify explicit components and replicable objectives to the national context. In the absence of a specific framework, Nipah recovery and response experience that worked in Kerala outbreak (2018) was compared against novel H1N1 (2015) guidelines at national level. This article provides the groundwork and insights as a value addition toward an India-specific framework of action for response and recovery for Nipah outbreaks in future.