Radiofrequency waves generated from mobile phones cause potential public health problems. Short-term effects like changes in sleep, heart rate, and blood pressure, and long-term effects like carcinoma are well documented. The Government of India's efforts in laying down regulations regarding the safety limits, manufacture, marketing, and mobile use are still in nascent stage. The need for stringent enforcement of laws for prevention of phone usage while driving and guidelines of medical regulatory bodies regarding rules and regulations of phone usage while at class or attending patients is of utmost importance. This should be supplemented by mass media to raise awareness among people regarding the possible health effects of radiofrequency emissions from mobile phones and the guidelines to minimize its exposure. It is the need of the hour to teach young people to be structured, to know when to have the cell phone on, and to avoid becoming the slave of technology instead of its mastery.

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Modified BG Prasad socioeconomic scale is widely used to determine the socioeconomic status of study subjects in health studies in India. It is an income-based scale and, therefore, has to be constantly updated to take inflation and depreciation of rupee into account. The Consumer Price Index (CPI) for industrial workers (IW) is used to calculate updated income categories for January 2014. Details of the calculations involved will enable young researchers to calculate specific income categories for their research work. State-specific CPI values are also available on the Department of Labour website and should be used to determine more accurate income categories for the study area.

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Tobacco use is a major public health challenge in India with 275 million adults consuming different tobacco products. Government of India has taken various initiatives for tobacco control in the country. Besides enacting comprehensive tobacco control legislation (COTPA, 2003), India was among the first few countries to ratify WHO the Framework Convention on Tobacco Control (WHO FCTC) in 2004. The National Tobacco Control Programme was piloted during the 11 ^th Five Year Plan which is under implementation in 42 districts of 21 states in the country. The advocacy for tobacco control by the civil society and community led initiatives has acted in synergy with tobacco control policies of the Government. Although different levels of success have been achieved by the states, non prioritization of tobacco control at the sub national level still exists and effective implementation of tobacco control policies remains largely a challenge.

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Health is determined not only by medical care but also by determinants outside the medical sector. Public health approach is to deal with all these determinants of health which requires multi sectoral collaboration and inter-disciplinary coordination. Although there have been major improvements in public health since 1950s, India is passing through demographic and environmental transition which is adding to burden of diseases. There is triple burden of diseases, viz. communicable, non-communicable and emerging infectious diseases. This high burden of disease, disability and death can only be addressed through an effective public health system. However, the growth of public health in India has been very slow due to low public expenditure on health, very few public health institutes in India and inadequate national standards for public health education. Recent years have seen efforts towards strengthening public health in India in the form of launch of NRHM, upgradation of health care infrastructure as per IPHS, initiation of more public health courses in some medical colleges and public health institutions and strengthening of public health functional capacity of states and districts under IDSP.

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The human body is a wonderful machine. The future of child birth in the form of test tube babies, surrogate motherhood through new reproductive and cloning technology will introduce undreamt of possibilities in the sexual arena. Surrogacy is a method of assisted reproduction whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. In some jurisdictions the possibility of surrogacy has been allowed and the intended parents may be recognized as the legal parents from birth. Commercial surrogacy, or "Womb for rent", is a growing business in India. In our rapidly globalizing world, the growth of reproductive tourism is a fairly recent phenomenon. Surrogacy business is exploiting poor women in country like India already having with an alarmingly high maternal death rate. This paper talks about paternity issues and women's right to health in context of surrogacy. Government must seriously consider enacting a law to regulate surrogacy in India in order to protect and guide couples going in for such an option. Without a foolproof legal framework, patients will invariably be misled and the surrogates exploited.

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Hydroxychloroquine (HCQ), an antimalarial has been proposed as possible treatment for coronavirus disease-2019 (COVID-19). India has approved the use of HCQ for prophylaxis of asymptomatic health workers treating suspected or confirmed COVID-19 cases, and asymptomatic household contacts of confirmed patients. The U.S. Food and Drug Administration has issued Emergency Use Authorization for the use of HCQ to treat COVID-19 in adolescents and adults. In this review, we go over the available evidence for and against HCQ's use as prophylaxis or treatment for COVID-19, especially in the Indian context.

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Context: Birth and immediate postpartum period pose many challenges for the newborn. The neonatal mortality rates are high in India, whereas the breastfeeding rates are still low. Hence, need exists for a simple and easily applicable intervention, which may counter these challenges. Aims: The present study was undertaken to evaluate the effects of very early skin-to-skin contact (SSC), in term babies with their mothers, on success of breastfeeding and neonatal well-being. Settings and Design: Randomized control trial conducted over 2 years' period in a tertiary care hospital. Materials and Methods: Healthy babies delivered normally were included. Very early SSC between mothers and their newborns was initiated in the study group. We studied effective suckling (using modified infant breastfeeding assessment tool [IBFAT]), breastfeeding status at 6 weeks, maternal satisfaction, thermal regulation, baby's weight and morbidity. Statistical Analysis: T-test, Pearson Chi-square test and non-parametric Mann-Whitney test were used through relevant Windows SPSS software version 16.0. Results: We observed that SSC contributed to better suckling competence as measured by IBFAT score (P < 0.0001). More babies in the SSC group were exclusively breastfed at first follow-up visit (P = 0.002) and at 6 weeks (P < 0.0001). SSC led to higher maternal satisfaction rates, better temperature gain in immediate post-partum period, lesser weight loss was at discharge and at first follow-up (all P < 0.0001) and lesser morbidity than the study group (P = 0.006). Conclusion: Very early SSC is an effective intervention that improves baby's suckling competence, maternal satisfaction, breastfeeding rates and temperature control and weight patterns.

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Background: The Internet is a widely used tool known to foster addictive behavior, and Internet addiction threatens to develop into a major public health issue in the near future in a rapidly developing country like India. Objective: This cross-sectional study intends to estimate prevalence, understand patterns, and evaluate risk factors for Internet addiction among college students in the city of Bengaluru, India. Materials and Methods: Out of a total of 554 data samples from eight colleges selected through multistage cluster sampling, 515 samples were analyzed. Young's 20-item Internet Addiction Test (IAT), an inventory including demographic factors and patterns of internet use, was administered. Results: This study of college students aged 16-26 years (mean ± SD 19.2 ± 2.4 years), with marginally high female representation (56%), identified 34% [95% confidence interval (CI) 29.91-38.09%] and 8% (95%, CI 5.97-10.63%) as students with mild and moderate Internet addiction respectively. Binary logistic regression found Internet addiction to be associated with male gender [adjusted odds ratio (AOR) 1.69, 95% CI, 1.081- 2.65, P = 0.021], continuous availability online (AOR 1.724, 95% CI, 1.018-2.923, P = 0.042), using the Internet less for coursework/assignments (AOR 0.415, 95% CI, 0.263-0.655, P < 0.001), making new friendships online (AOR 1.721, 95% CI, 1.785-2.849, P = 0.034), getting into relationships online (AOR 2.283, 95% CI, 1.424-3.663, P = 0.001). Conclusion: The results highlight the vulnerability of college students to Internet addiction. The findings provide explanations on the addictive behavior of the internet users, support the inclusion of "Internet Addiction" in the DSM-VI, and open up new paths for further research.

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This article presents information on the medical equipment industry in India-on production, procurement and utilization related activities of key players in the sector, in light of the current policies of liberalization and growth of a "health-care industry" in India. Policy approaches to medical equipment have been discussed elsewhere.

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Background: Breast and cervical cancers are two major cancers among Indian women. Analysis of trends would help in planning and organization of programs for control of these cancers. Objective: The objective of the following study is to compute risk of breast and cervical cancers using updated data from different cancer registries of India and study of its trends. Materials and Methods: Data on incidence rates of breast and cervical cancers were obtained from six major cancer registries of India for the years 1982-2008 and from the recently initiated cancer registries, North Eastern Registries of India with a total of 21 registries. Annual percent change in incidence and risk in terms of one in number of women likely to develop cancer was estimated for both the cancers in various registries. Results: The annual percentage change in incidence ranged from 0.46 to 2.56 and −1.14 to −3.4 for breast and cervical cancers respectively. Trends were significant for both cancers in the registries of Chennai, Bangalore, Mumbai and Delhi except Barshi and Bhopal. North East region showed decrease in risk for breast and cervical cancers whereas increasing trend was observed in Imphal (West) and for cervical cancer in Silchar. Conclusion: North Eastern region recorded decline in the incidence of breast cancer which is contrary to the observation in other registries, which showed increase in breast cancer and decline in cervical cancer incidences.

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Public health informatics is emerging as a new and distinct specialty area in the global scenario within the broader discipline of health informatics. The potential role of informatics in reducing health disparities in underserved populations has been identified by a number of reports from all over the world. The article discusses the scope, the limitations, and future perspective of this novice discipline in context to India. It also highlights information and technology related tools namely Geographical Information Systems, Telemedicine and Electronic Medical Record/Electronic Health Record. India needs to leverage its "technology" oriented growth until now (e.g., few satellite-based telemedicine projects, etc.) simultaneously toward development of "information"-based public health informatics systems in future. Under the rapidly evolving scenario of global public health, the future of the public health governance and population health in India would depend upon building and integrating the comprehensive and responsive domain of public health informatics.

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Background: Hepatitis B vaccine was introduced in the Universal Immunization Program (UIP) of 10 states of India in the year 2007-08. This assessment was planned and conducted to ascertain the reasons for low reported coverage of Hepatitis B (Hep B) vaccine in comparison of similarly timed diphtheria, pertussis, and tetanus (DPT) vaccine; to identify operational and programmatic challenges in new vaccine introductions, and to derive lessons for further scale up of Hep B vaccination (or for introduction of any new vaccine) in UIP of India. Materials and Methods: Purposive sampling with both quantitative and qualitative data collection. Two districts each were purposively selected from 5 of the 10 states, which introduced Hep B vaccine, in the year 2007-08. A protocol was devised and data was collected through desk review, in-depth interviews and on-site observation at state, districts and facility levels. The assessment was completed in December 2009. Results: Coverage with three doses of Hep B vaccine was lower than similarly timed three doses of DPT vaccine. Poor stock management ("stock outs or nil stocks" at various levels), incomplete recording and reporting, perceived high cost & related fear of wastage of vaccine in 10 dose vial, and incomplete knowledge amongst health functionaries about vaccination schedule were the main reasons cited for reported lower coverage. Hep B vaccine birth dose was introduced in only 3 of 5 states evaluated. The additional reasons for low Hep B birth dose coverage were lack of knowledge amongst Health Workers about birth dose administration, no mechanism for recording birth dose, and insufficient trainings, official communications, and coordination at various levels. Conclusions: This assessment documents challenges faced in the introduction of hepatitis B vaccine in UIP in India and summarizes the lessons learnt. It is concluded that for successful introduction and scale up of any new vaccine in national or state immunization program; clear and timely central level instructions and oversight and improved stock management is required. At state and district levels; quality trainings, effective supervision and monitoring, improving data recording and reporting are key factor for success. The additional focus on Hep B birth dose administration may help in improving coverage. The lessons from this assessment can possibly be utilized for future introduction and scale up of any new vaccine (or other similar interventions) in India or in any other developing country setting.

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Undernutrition among tribal children is a major public health problem in India. Our study attempted to evaluate the prevalence of malnutrition among Lodha children of Paschim Medinipur, West Bengal. A cross sectional study was conducted among 165 children aged 1-14 years in a village of Paschim Medinipur district during January to March 2008. Children were considered underweight, stunting and wasting following the NCHS standards. Overall the prevalence of underweight, stunting and wasting was 33.9%, 26.1% and 19.4 %, respectively. Of these, 9.1%, 9.7% and 3.6% children were found to be severely underweight, stunted and wasted. Moreover, the prevalence of underweight and stunting was significantly higher in pre-school children compared to school going children. There is an urgent need for appropriate steps to be taken to improve nutritional status of children in this ethnic group.

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During the past 60 years, a number of infectious diseases have been targeted for eradication or elimination, with mixed results. While smallpox is the only one successfully eradicated so far, campaigns on yaws and malaria brought about a dramatic reduction in the incidence in the beginning of the campaign but ultimately could not achieve the desired goal. There is again a renewed interest in disease eradication. The World Health assembly in May 2010 passed a resolution calling for eradication of measles by 2015; the target of polio eradication still remains elusive. In view of these developments, it is appropriate time to revisit the concept of disease eradication and elimination, the achievements and failures of past eradication programmes and reasons thereof, and possibly apply these lessons while planning for the future activities. This paper based on the Dr. A.L.Saha Memorial Oration describes various infectious diseases that have been targeted for eradication or elimination since 1950s, the potential direct and indirect benefits from disease eradication, and the issues and opportunities for the future.

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Background: Indian census 2011 has detected declined child sex ratio in the West and South districts of Tripura State. Objectives: To find out the sex ratio at birth and to identify the factors affecting child sex ratio in west and south districts of Tripura. Methods: This community-based cross-sectional study combined with a qualitative component was conducted among 3438 couples chosen by multistage sampling. Quantitative data were collected by a structured interview schedule. Data were analyzed by computer using SPSS version 15.0. Chi-square test was applied for testing the significance of study findings and P < 0.05 was considered statistically significant. Qualitative data were collected by Focus Group Discussions and analyzed by qualitative free listing and pile sorting considering Smith's S value. Results: Sex ratio at birth in West and South Tripura districts during 2013 was found to be 972 and 829 respectively. Son preference was higher among couples irrespective of their literacy, residence, occupation, family type and religion except Christianity. Expenditure at marriage, lesser contribution to parent's family and fears of adverse situations at in law's house after marriage etc. were causes for lesser daughter preference. Very few pregnant women underwent ultrasonography for sex determination of fetus. Girls had differential or delayed medical care and higher death rate. The desire for children was found to be limited after male births. Conclusions: Low daughter preference was mostly due to economic reasons and prolonged contraception following male birth. Literacy, occupation and residence of study subjects did not modify prevalent higher male preference.

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Clinical governance and better human resource management practices are important planks in the current health policies emphasizing quality of patient care. There are numerous reasons why it is important to improve quality of healthcare, including enhancing the accountability of health practitioners and managers, resource efficiency, identifying, and minimizing medical errors while maximizing the use of effective care and improving outcomes, and aligning care to what users/patients want in addition to what they need. "Quality in health is doing the right things for the right people at the right time, and doing them right first time and every time." Quality can also refer to the technical quality of care, to nontechnical aspects of service delivery such as clients' waiting time and staff's attitudes, and to programmatic elements such as policies, infrastructure, access, and management. In this oration/article quality initiatives like Reproductive and Child Health (RCH) and National Rural Health Mission (NRHM) of Government of India (GOI), which concentrate on improving the quality of infrastructure of vast rural health facilities including sub-center, primary health center, and community health center has been taken into account with focus on improving quality of health services also. United Nation Population Fund (UNFPA) in collaboration with the GOI has proposed introducing quality assurance program for accessing and improving the quality of services at public sector health facilities. It is felt that improving the quality of health services in public sector will attract the client belonging to low economic strata, and surely will help in achieving the goal of the NRHM, that is, "Reaching the enriched with quality of health services."

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Multisectoral approach (MSA) refers to deliberate collaboration among various stakeholder groups (e.g., government, civil society, and private sector) and sectors (e.g., health, environment, and economy) to jointly achieve a policy outcome. By engaging multiple sectors, partners can leverage knowledge, expertise, reach, and resources, benefiting from their combined and varied strengths as they work toward the shared goal of producing better health outcomes. Improving public health (PH) is challenging because of the size of its population and wide variation in geography. MSA help in addressing identified health issues in focused way as it helps in pooling the resources and formulating the common objectives. One of the major advantages is optimization of usage of resources by avoiding duplication of inputs and activities which tremendously improve program effectiveness and efficiency. Willingness at the leadership and mandate at the policy level are necessary to plan and execute the successful multisectoral coordination. All the major stakeholders require to share the common vision and perspective. Developing institutional mechanism is utmost requirement as it will standardize the processes of intersectoral coordination (ISC). Creation of PH cadre is strategic move to meet the major health challenges being faced by the health system, and it would be anchor of establishing systematic ISC. There are many national and international examples of MSA applications such as for malaria elimination, tobacco control, HIV/AIDS prevention, Finland's community-based cardiovascular disease prevention project (North Karelia Project), and Singapore's Health Promotion Board. Promotion of MSA within the health system and with other ministries is seen as an important measure for effective implementation and improving efficiency.

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Background: There is paucity of evidence on the effectiveness of facemask use in COVID-19 in community settings. Objectives: We aimed to estimate the effectiveness of facemask use alone or along with hand hygiene in community settings in reducing the transmission of viral respiratory illness. Methods: We searched PubMed and Embase for randomized controlled trials on facemask use in community settings to prevent viral respiratory illnesses published up to April 25, 2020. Two independent reviewers were involved in synthesis of data. Data extraction and risk-of-bias assessment were done in a standard format from the selected studies. Outcome data for clinically diagnosed or self-reported influenza-like illness (ILI) was recorded from individual studies. Pooled effect size was estimated by random-effects model for “facemask only versus control” and “facemask plus hand hygiene versus control.” Results: Of the 465 studies from PubMed and 437 studies from Embase identified from our search, 9 studies were included in qualitative synthesis and 8 studies in quantitative synthesis. Risk of bias was assessed as low (n = 4), medium (n = 3), or high (n = 1) risk. Interventions included using a triple-layered mask alone or in combination with hand hygiene. Publication bias was not significant. There was no significant reduction in ILI either with facemask alone (n = 5, pooled effect size: −0.17; 95% confidence interval [CI]: −0.43–0.10; P = 0.23; I² = 10.9%) or facemask with handwash (n = 6, pooled effect size: (n=6, pooled effect size: −0.09; 95% CI: -0.58 to 0.40; P = 0.71, I² = 69.4%). Conclusion: Existing data pooled from randomized controlled trials do not reveal a reduction in occurrence of ILI with the use of facemask alone in community settings.

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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.

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The Rajiv Aarogyasri Community Health Insurance (RACHI) in Andhra Pradesh (AP) has been very popular social insurance scheme with a private public partnership model to deal with the problems of catastrophic medical expenditures at tertiary level care for the poor households. A brief analysis of the RACHI scheme based on officially available data and media reports has been undertaken from a public health perspective to understand the nature and financing of partnership and the lessons it provides. The analysis of the annual budget spent on the surgeries in private hospitals compared to tertiary public hospitals shows that the current scheme is not sustainable and pose huge burden on the state exchequers. The private hospital association's in AP, further acts as pressure groups to increase the budget or threaten to withdraw services. Thus, profits are privatized and losses are socialized.

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Background: Multidrug - resistant TB (MDR - TB) has emerged as a major threat to global TB control efforts in recent years. Facilities for its diagnosis and treatment are limited in many high - burden countries, including India. In hyper - endemic areas like Mumbai, screening for newly diagnosed cases at a higher risk of acquiring MDR - TB is necessary, for initiating appropriate and timely treatment, to prevent its further spread. Objective: To assess risk factors associated with MDR - TB among Category I, new sputum smear-positive cases, at the onset of therapy. Materials and Methods: The study applied an unmatched case - control design for 514 patients (106 cases with MDR - TB strains and 408 controls with non - MDR - TB strains). The patients were registered with the Revised National Tuberculosis Control Program (RNTCP) in four selected wards of Mumbai during April 2004 - January 2007. Data were collected through semi - structured interviews and drug susceptibility test results. Results: Multivariate analysis indicated that infection with the Beijing strain (OR = 3.06; 95% C.I. = 1.12 - 8.38; P = 0.029) and female gender (OR = 1.68; 95% C.I. = 1.02 - 2.87; P = 0.042) were significant predictors of MDR-TB at the onset of therapy. Conclusion: The study provides a starting point to further examine the usefulness of these risk factors as screening tools in identifying individuals with MDR-TB, in settings where diagnostic and treatment facilities for MDR-TB are limited.

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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.

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