Integrated multisectoral strategy to improve girls' and women's nutrition before conception, during pregnancy and after birth in India (Swabhimaan): protocol for a prospective, non-randomised controlled evaluation

INTRODUCTION: Swabhimaan is a community-based programme to improve adolescent girls’ and women’s nutrition in the rural areas of three Indian states—Bihar, Chhattisgarh and Odisha with high prevalence of undernutrition. METHODS AND ANALYSIS: Swabhimaan has a nested prospective, non-randomised controlled evaluation. Since 2017, five intervention sites receive community-led interventions through national government’s livelihood mission supported women’s self-help group federations and five control sites will initiate these activities 36 months later, in 2020. Community-led activities aim to improve coverage of 18 interventions including adequacy of food consumed, prevention of micronutrient deficiencies, access to basic health services and special care of nutritionally ‘at risk’ girls and women, improving hygiene and access to water and sanitation services and access to family planning services. The evaluation includes baseline (2016–2017), midline (2018–2019) and endline (2020–2021) surveys covering 6638 adolescent girls, 2992 pregnant women and 8755 mothers of children under 2. The final impact analysis will be by intention to treat, comparing primary and secondary outcomes in five intervention areas and five control areas. The primary outcomes are: (1) a 15% reduction in the proportion of adolescent girls with a body mass index (BMI) <18.5 kg/m2; (2) a 15% reduction in the proportion of mothers of children under two with a BMI <18.5 kg/m2 and (3) and a 0.4 cm improvement in mean mid-upper arm circumference among pregnant women. ETHICS AND DISSEMINATION: All procedures involving human subjects were approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences, Bihar, Chhattisgarh and Odisha and in compliance with guidelines laid down in the Declaration of Helsinki. Evidence will inform maternal and preconception nutrition policy at national and state level. TRIAL REGISTRATION NUMBER: 58261b2f46876 and CTRI/2016/11/007482; Pre-results

Lessons for TB from the COVID-19 response: qualitative data from Brazil, India and South Africa

BACKGROUND: Brazil, India and South Africa are among the top 30 high TB burden countries globally and experienced high rates of SARS-CoV-2 infection and mortality. The COVID-19 response in each country was unprecedented and complex, informed by distinct political, economic, social and health systems contexts. While COVID-19 responses have set back TB control efforts, they also hold lessons to inform future TB programming and services. METHODS: This was a qualitative exploratory study involving interviews with TB stakeholders (n = 76) in Brazil, India and South Africa 2 years into the COVID-19 pandemic. Interview transcripts were analysed using an inductive coding strategy. RESULTS: Political will – whether national or subnational – enabled implementation of widespread prevention measures during the COVID-19 response in each country and stimulated mobile and telehealth service delivery innovations. Participants in all three countries emphasised the importance of mobilising and engaging communities in public health responses and noted limited health education and information as barriers to implementing TB control efforts at the community level. CONCLUSIONS: Building political will and social mobilisation must become more central to TB programming. COVID-19 has shown this is possible. A similar level of investment and collaborative effort, if not greater, as that seen during the COVID-19 pandemic is needed for TB through multi-sectoral partnerships

Measuring the health of the Indian elderly: evidence from National Sample Survey data

<p>Abstract</p> <p>Background</p> <p>Comparable health measures across different sets of populations are essential for describing the distribution of health outcomes and assessing the impact of interventions on these outcomes. Self-reported health (SRH) is a commonly used indicator of health in household surveys and has been shown to be predictive of future mortality. However, the susceptibility of SRH to influence by individuals' expectations complicates its interpretation and undermines its usefulness.</p> <p>Methods</p> <p>This paper applies the empirical methodology of Lindeboom and van Doorslaer (2004) to investigate elderly health in India using data from the 52^ndround of the National Sample Survey conducted in 1995-96 that includes both an SRH variable as well as a range of objective indicators of disability and ill health. The empirical testing was conducted on stratified homogeneous groups, based on four factors: gender, education, rural-urban residence, and region.</p> <p>Results</p> <p>We find that region generally has a significant impact on how women perceive their health. Reporting heterogeneity can arise not only from cut-point shifts, but also from differences in health effects by objective health measures. In contrast, we find little evidence of reporting heterogeneity due to differences in gender or educational status within regions. Rural-urban residence does matter in some cases. The findings are robust with different specifications of objective health indicators.</p> <p>Conclusions</p> <p>Our exercise supports the thesis that the region of residence is associated with different cut-points and reporting behavior on health surveys. We believe this is the first paper that applies the Lindeboom-van Doorslaer methodology to data on the elderly in a developing country, showing the feasibility of applying this methodology to data from many existing cross-sectional health surveys.</p

Prevalence of pulmonary tuberculosis among the tribal populations in India

IMPORTANCE: There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity. OBJECTIVE: To estimate the prevalence of TB among the tribal populations in India. DESIGN, PARTICIPANTS, SETTING: A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old. MAIN OUTCOME AND MEASURES: Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening. RESULTS: A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496–754] in the central zone and least 153 [95% CI: 24–281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504–1101] and Jammu and Kashmir the lowest 127 [95% CI: 0–310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m(2), h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever. CONCLUSION AND RELEVANCE: The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs

Choice of point of Care diagnostic device in anemia prevalence surveys: policy-level Implications in monitoring progress and guiding further action.

Anemia is highly prevalent disease of global concern. Childhood anemia can result in irreversible damage to brain and affect cognitive, intellectual, and pyscho-motor development. In pregnant women, it is a significant contributor to adverse maternal outcome (1–4). In 2011, alone it was responsible for loss of 42 million Disability adjusted life years and among the top three causes of disability worldwide (5). In an attempt to address this huge public health problem, guidelines have been issued by various leading international organizations and targets have been set to monitor progress towards its control. One such indicator is 50% reduction of anemia in women in reproductive age group (WRA) between 2011 and 2025 (6). This makes it necessary to carry out huge population-based anemia prevalence surveys repeatedly, to measure the progress and guide policy makers in carrying out specific interventions needed to reduce its prevalence

Effect of nigella sativa on bone mass density (BMD) in albino rats

Abstract Background: Osteoporosis may be diagnosed in postmenopausal women and in men aged 50 years and older if the measurement of bone mineral density in the lumbar spine, total hip or femoral neck is at least 2.5 standard deviations below that of a young control (T score –2.5 or less). Based on current guidelines, a diagnosis of osteoporosis relies on a history of fragility fracture or the result of bone mineral density (BMD) evaluation. Nigella sativa seeds (NS) has been used traditionally for various illnesses. The most abundant and active component of NS is thymoquinone (TQ). However paucity of data is available in this regard especially in animal model mimicking postmenopausal osteoporosis. Materials &amp; Methods: A total 42 female rats were selected and divided in to seven groups of six in each. Pregnant rats excluded, only non-pregnant rats were used (confirmed by the Veterinary Surgeon attached to the Department). Firstly, the rats were immobilized using ether anaesthesia at a minimal dose following which, a freshly prepared suspension of thiopentone sodium i.v. was given through the dorsal tail vein cannulation at a dose of 10mg/kg. The left hind legs of all the rats were immobilized using plaster casts so as to promote the process of osteoporosis. Results: It is evident from measurement of dry bone weight that there is significant bone loss in the ovariectomised rats in comparison to sham rats. Treatment with Nigella sativa extract significantly improved the bone weight, though there is no dose related improvement. There is a significant change in raloxifene treated as well as in combination treated groups in comparison to all the doses of test drug showing the better effectiveness of raloxifene. Conclusion: The histopathological studies as well as radiographic finding of bone showing high osteoblastic activity and minimum osteoclastic activity indicating bone formation, also supports its anti-osteoporotic activity. Based upon the results of the present study in animal model, it is quite justified that this indigenous drug may be tried as an adjunct therapy in the treatment as well as prevention of osteoporosis. Keywords: Osteoporosis, Nigella sativa (NS), raloxifene, albino rats, bone mineral density (BMD), anti-osteoporotic activity, histopathology, radiological change

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Uptake of HIV testing and HIV positivity among presumptive tuberculosis patients at Puducherry, South India.

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