Journal of the Epidemiology Foundation of India
Journal of the Epidemiology Foundation of India is an official publication of the Epidemiology Foundation of India (EFI). The journal is published in English on quarterly basis and follows double blinded peer review process. Moreover, Journal allows free access (Open Access) to its contents and authors may archive published articles.
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Quantitative-on-Qualitative SWOC Analysis on Solid Waste Management in Urban Slums and Rural Areas of Odisha, India
Background: Solid waste management (SWM) is a crucial environmental health issue in India, particularly in states like Odisha, which encompass urban slums and rural settlements. Despite the implementation of the Solid Waste Management Rules (2016) and the Swachh Bharat Mission, disparities persist in collection systems, segregation practices, and participation. This study aimed to conduct a quantitative-on-qualitative SWOC analysis to assess the status and determinants of SWM in urban and rural contexts of Odisha. Methods: A mixed-method cross-sectional study was conducted among 219 households (110 urban and 109 rural) selected from the areas of a Community Medicine Department. The rules were followed as the sample size was designed for two groups, considering the adjustment factors of 1:1. Data were collected through a questionnaire, observational checklist, and focus group discussions (FGDs) and interviews (IIs). Quantitative data on waste generation, segregation, and disposal were analysed using inferential statistics (Chi-square, t-test, and ANOVA). Qualitative data from FGDs were thematically analysed to derive SWOC components, which were scored and integrated into a SWOC Index. Results: Urban households demonstrated higher use of dustbins (78%) and safer waste disposal, whereas rural households reported open dumping (23%) and burning (19%) as common practices. Statistically significant differences were observed for e-waste and sanitary waste handling (p < 0.01). The integrated SWOC framework revealed Strengths in urban policy implementation, Weaknesses in rural infrastructure and legislative reinforcement, Opportunities in composting and recycling, and Challenges in behavioural and 4R action gaps, which result in Disease transmission dynamics. The computed SWOC index showed a positive potential (+1.9) for urban and a negative potential (–0.6) for rural areas. Conclusion: The quantitative-and-qualitative SWOC approach identified critical gaps and potential strategies to improve SWM across Odisha. Addressing infrastructure inequities and promoting community-driven innovations can strengthen sustainable waste management aligned with SDGs 3, 6, 11, and 12.
EFICON 2025 Abstracts (ACTIVE TILL 28.02.2026)
Copyright (c) 2026 Sonali Kar, Nirmalaya Mohapatra, Vivek Verma, Anagna Ray, Gouri Rath, Krishna Mishra (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Prevalence and Factors Influencing Metabolically Healthy Obesity Among Overweight/Obese School Teachers In Urban Area Of Mysuru
Background and Objectives: Among the obese group of individuals there exists a phenotype of people who do not possess any metabolic abnormalities, they are the metabolically healthy obese (MHO) group of individuals. Although a lot of studies have been conducted on metabolically healthy obesity worldwide, there are not much studies in India. The current study thus aims to estimate the prevalence of metabolically healthy obesity among the school teachers in Mysuru, and identify the influencing factors in order to make healthy lifestyle changes. Methodology: A cross-sectional study was conducted from July to August 2025 among 130 teachers in urban area of JSS schools, selected by simple random sampling. Data were collected using a pretested semi-structured questionnaire covering sociodemographic, lifestyle, and medical history, along with physical measurements and blood investigations, after obtaining written informed consent. Metabolic health was assessed using the NCEP ATP III criteria. Data were entered in Microsoft Excel and analysed using SPSS v28, applying descriptive and inferential statistics. Results: Among the 130 participants, 86 were identified as metabolically healthy overweight/obese, of which 66 were metabolically healthy obese, which accounts to 70.9%. Those categorized as metabolically healthy overweight or obese demonstrated relatively lower waist circumference, triglyceride levels, fasting blood glucose, and blood pressure compared to their metabolically unhealthy counterparts. Regression analysis showed that higher physical activity levels and healthy dietary practices were significant protective factors for metabolic health, while inadequate sleep duration was associated with a higher risk of metabolic abnormalities. Conclusion: About 70.9% of the participants were metabolically healthy obese. Though these individuals are currently metabolically healthy, they are at a larger risk of developing metabolic syndrome in the future. Hence, designing targeted health interventions is essential to prevent future development of metabolic disorders in such individuals. Keywords: Metabolically Healthy Obesity, Overweight, School teachers, Mysuru
Copyright (c) 2026 Dr Deepshika R, Dr Praveen Kulkarni, Dr Ashwathan P (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Impact of m-Health Guided Alternate Nostril Yogic Breathing on Anxiety Levels in Parents of Children with Autism Spectrum Disorder: An Interprofessional Approach
Introduction: A unique stressor has been witnessed in the parents of children who are diagnosed with autism spectrum disorder (ASD) and often suffer from higher levels of stress, anxiety and depression compared to the parents of neurotypical children. Hence, Alternate Nostril Yogic Breathing (ANYB) has been used in the study, commonly known for balancing autonomic nervous system. Recognizing the time constraints faced by parents of children with ASD, the research hypothesizes that a guided 5-minute video on ANYB through mHealth will mitigate anxiety, depression, and stress levels, subsequently protecting parents from associated health risks. The present study aims to evaluate the effectiveness of ANYB administered through mobile (m) -Health on the depression, anxiety, and stress levels of parents of children with ASD. Additionally, it seeks to explore the facilitators and barriers of this intervention. Methods: This mixed-method study including quasi-experimental design and focus group discussion. The study enrolled 74 participants, 30 in the intervention and 44 in the control arm. The Depression Anxiety Stress Scale 21 (DASS21) is the tool used to assess mental health before and after intervention. The intervention group (n=30) received training in ANYB with 5-minute guided m-Health video to practice daily for 2 months, combined with parental training. The control group (n=30) received only parental training. Findings: At pre-intervention phase, the baseline data shows (80.0%) of the subjects were suffering from depression, 100% from anxiety and 43.3% from stress. Post intervention reductions in Depression (63.3%), Anxiety (43.3%) and Stress (0%) among parents of children with ASD in experimental group, while the control group showed no such change. Conclusions: The study emphasizes the importance of m-Health guided ANYB that turns out to be an accessible, acceptable, and impactful solution to reduce stress, anxiety, and depression among parents of children with ASD.
Copyright (c) 2026 Rekha Dutt, Kumari Rina, Sukanto Sarkar, Madhavan C, Ananya Sengupta, Anirban Dasgupta, Nanditha Sujir (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Knowledge and attitude of teachers towards life skills education of school going adolescents.
Introduction: Life skills enable individuals to cope with everyday challenges. Life skills education in schools can influence adolescents’ social and emotional development. Knowledge and attitude of teachers is critical in ensuring effective implementation. Methods: An analytical cross-sectional study was conducted among teachers of senior secondary schools of district Amritsar. An equal number of government and private schools (4 each) were selected from rural and urban areas. At least one teacher each of 9th, 10th, 11th and 12th from each of these 16 schools was included. A self-reporting, validated, structured questionnaire was used to assess their knowledge and attitude towards lifeskills. Results: 73 teachers were included in the study. 41(56.16%) were trained in and 43 (58.90%) had ever taught life skills. Knowledge and attitude scores were calculated and graded. Analysis showed significant positive correlations: age with attitude [rs(71) = .29, p = .012], knowledge with attitude [rs (71) = .30, p = .010], teaching experience with knowledge [rs (71) = .24, p =.041] and teaching experience with attitude [rs (71) = .30, p < .01]. There was no significant correlation between age and knowledge. Teachers who had ever taught life-skills had significantly higher attitude score than those who had not (z = −3.04, p = .002). Knowledge and attitude scores among those trained and not trained were not significantly different. Conclusion: Incorporating life-skills education as regular routine instruction for students is likely to enhance adolescents’ life skills. Keywords: Life skills, Adolescents, Teachers, Knowledge, Attitude, Amritsar
Copyright (c) 2026 Roshanpreet Kaur, Sanjeev Mahajan, Preeti Padda, Adarshjot Kaur Toor (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Assessing social support among patients with non-communicable diseases attending an urban primary health centre at Austin Town, Bengaluru: a mixed method study.
Background: Social support plays a vital role in management of Non Communicable Disease (NCD). This study aimed to assess the level of social support and identify factors influencing it among patients with NCDs. Methodology: A mixed-methods study was conducted over six months at an Urban Primary Health Centre in Bengaluru. A total of 100 adults diagnosed with at least one NCD, selected consecutively were administered a structured questionnaire on sociodemographic, clinical status and the Multidimensional Scale of Perceived Social Support (MSPSS). Key informant interviews (n=3) with community health workers and focus group discussions (n=2) with patients with NCD were conducted. Quantitative data were analysed using descriptive statistics, Chi-square, and logistic regression, while qualitative data underwent thematic analysis. Results: The mean age of the study population was 53.3±10.4 years. Most participants were homemakers (65%), from nuclear families and belonged to Lower Socio-economic Class (n=94). The mean social support score was 4.25±1.46. Social support was moderate for 56%, high for 27% and low for 17%. The mean Hba1c was 6.83±1.21%. About 34% population showed good medication adherence. Well controlled Hba1c levels (p=0.029) were seen among participants with better support. Overall, 30 participants reported that they had nobody when they needed help and 29 participants reported poor family support. Qualitative findings highlighted family and healthcare provider support as key influences. Conclusion: Most patients with NCD reported moderate social support. Family and healthcare provider involvement are crucial in effective disease management. Keywords: Non-communicable diseases (NCDs), Social Support, Mixed-methods study, Hba1c, Medication Adherence, Family.
Copyright (c) 2026 Lasrado Priya Marina Ronald, G Nancy Angeline, Avita Rose Johnson, Farah Naaz Fathima, Pretesh Rohan Kiran, Pooja R Sridhar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Assessment of level of compliance with Tobacco free educational institution guidelines in Educational Institutions of Rishikesh – A Cross-Sectional Study
Introduction: The tobacco-free educational institution (ToFEI) guidelines were introduced by the Ministry of Health and Family Welfare (MoH&FW) in 2008. All Indian educational institutions (EIs) are required to adhere to these standards. In 2009, the Global Youth Tobacco Survey (GYTS) revealed that 14.6% of 13 to 15-year-old school-age youngsters reported using tobacco. Due to the rapidly rising prevalence of tobacco use among school-age adolescents, it is imperative that these standards be strictly followed. Methods: This observational cross-sectional study assessed the level of compliance with ToFEI guidelines among 50 EIs in Rishikesh, selected through universal sampling from the list provided by the State Education Department, Dehradun (14 government, 36 private). The study was conducted over a period of six months (Dec 2024–May 2025). Data were collected through on-site school visits using the 9-criteria evaluation scorecard developed by MoH&FW. Mean, standard deviation, and proportions were calculated to describe the compliance scores. The institutions achieving a compliance score of ≥90/100 were classified as Tobacco-Free EIs. Result: The mean score for adherence was 20.94 (±12.22). The observed score ranged from 9 to 68, with 68 being the highest. These results show that the institutions assessed generally adhered poorly to the ToFEI guidelines, with a broad range of compliance levels. Conclusion: The EIs in Rishikesh need to adhere to the ToFEI recommendations more strictly, tighten their tobacco control policies, and include tobacco control initiatives into their EI-based programs. Keywords: Tobacco free educational institution (ToFEI) guidelines, Tobacco-Free Schools/Educational Institutions, Tobacco Prevalence.
Copyright (c) 2026 Shikha Thakur, Mahendra Singh, Pradeep Aggarwal, Rohit Deoli (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Triangulating Noise Exposure, Aural Hygiene Practices, and Habitat Factors: Determinants of Ear Health among Urban Slum Residents in Bhubaneswar, Odisha
Background: Urban noise is a neglected determinant of aural morbidity, especially in low-income settlements where housing density and poor hygiene amplify exposure risks. Bhubaneswar, a rapidly urbanising city in eastern India, offers a unique setting to examine the interplay between environmental noise, aural hygiene practices, and habitat conditions. Objectives: To assess the relationship between noise exposure levels, aural hygiene behaviors, and residential characteristics with ear health status among adolescents and adults residing in urban slums of Bhubaneswar city, Odisha Methods: A community-based, observational descriptive study was conducted among 384 participants aged 10–50 years, selected by stratified random sampling from six slums representing low, medium, and high noise zones. Data on socio-demographic variables, environmental factors, and hygiene practices were collected using a pre-tested semi-structured questionnaire. Otoscopic and tuning-fork examinations assessed ear morbidity. Data were analysed in SPSS v25 using Chi-square tests and multivariate logistic regression at a 95 % confidence level. Results: Overall prevalence of aural morbidity was 21 %—11 % infections, 3 % hearing loss, and 7 % combined morbidity. The prevalence of deafness increased from 2 % in low-noise, 11 % in medium-noise, to 16 % in high-noise zones (p = 0.001). Use of sharp or metallic objects for ear cleaning (p = 0.017), poor household ventilation (p = 0.016), and shared bathing facilities (p = 0.002) were significantly associated with ear disease. Participants in high-noise areas had 8.5 times higher odds of combined infection and hearing loss (95 % CI 2.9–25.1). Lower socio-economic caste category also increased risk (OR 4.1; 95 % CI 1.14–14.9). Conclusion: Exposure to sustained urban noise, coupled with unsafe aural hygiene and poor housing, significantly impairs ear health among slum residents. Integrating environmental noise control, community awareness, and periodic aural screening within primary health-care services is crucial to reducing preventable hearing morbidity.
Copyright (c) 2026 Angana Ray, Sonali Kar, Vivek Verma, Nirmalaya Mohapatra, Gouri Rath, Prem Panda (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Clinical and Molecular Correlation of Hepatitis B e Antigen Status in HBsAg-Positive Blood Donors: Implications for Disease Staging and Transfusion Safety
Background: Hepatitis B e antigen (HBeAg) is a key serological marker indicative of active viral replication and high infectivity in hepatitis B virus (HBV) infection. Understanding the frequency and clinical implications of HBeAg positivity among HBsAg-positive blood donors is critical for transfusion safety and early disease management. Objective: To evaluate the serological and molecular profiles related to HBeAg status in HBsAg-positive blood donors and to correlate these with biochemical and radiological markers for clinical staging of HBV infection. Methods: A cross-sectional observational study was conducted on 150 HBsAg-positive blood donors at a tertiary care centre of North India between April 2024 and August 2025. Serological markers including HBeAg and anti-HBe were assessed using enzyme-linked fluorescent immunoassay (ELFA). HBV viral load was quantified by real-time PCR (qPCR). Liver function tests (ALT, AST) and transient elastography (FibroScan) were performed wherever feasible. Data were analyzed to assess associations between HBeAg positivity, viral load, liver fibrosis, and biochemical parameters. Results: HBeAg positivity was observed in 15.3% of donors, amongst which 74% showed a very high viral loads (>2×10^7 IU/mL) indicating active replication and high infectivity. Anti-HBe positivity (76.4%) predominated in HBeAg-negative donors, reflecting immune control phases. Older age groups (31-40) had higher HBeAg positivity (43.4%), suggesting cumulative viral activity. No significant correlation was found between HBeAg status and elevated ALT (p=0.418) or liver stiffness(p=0.662), highlighting asymptomatic nature of the infection. Conclusion: HBeAg positivity in HBsAg-positive donors signifies high infectivity driven by active viral replication. This study shows that many such donors with elevated HBV DNA may appear normal on liver enzymes or Fibroscan, leading to missed cases if screening relies only on serology or biochemistry. Integrating HBV DNA testing with serology and clinical evaluation is therefore essential for accurate risk stratification, transfusion safety, and appropriate linkage to care.
Copyright (c) 2026 Emmanuel Jabakumar, Sanjib Gogoi, Sangeeta Pahuja Sindhwani, Amit Kumar Sharma, Manoj B Jais (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Long COVID: Current Status and Future Prospects
Long COVID has emerged as a major chronic health challenge following SARS-CoV-2 infection. It is characterised by persistent or relapsing symptoms that typically develop within months of acute illness and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, exertional intolerance, dyspnea, cognitive dysfunction (“brain fog”), sleep disturbances, autonomic symptoms, pain, and mental health sequelae. It causes reduced quality of life, impaired productivity, and increased healthcare utilisation. Proposed mechanisms include viral persistence or residual viral antigens, immune dysregulation, chronic inflammation, autoimmunity, endothelial dysfunction, dysautonomia, microbiome dysbiosis, and organ-specific damage, often with overlapping symptoms. Management strategies include supportive care and individualised, symptom-targeted pharmacotherapy. Multidisciplinary rehabilitation strategies, along the lines of the Johns Hopkins Model, are also recommended. Future prospects centre on (i) harmonised case definitions to improve prognosis, (ii) harnessing the power of AI for precise diagnosis, (iii) clinical trials for targeted therapeutics, such as antivirals, immunomodulators, anticoagulant/antiplatelet agents, among others. Notably, scalable care models integrating primary care, speciality services, and mental health support are also warranted. Thus, addressing Long COVID will require coordinated research, equitable access to care, and health-system preparedness to manage a growing population with chronic post-infectious disability. These aspects will be discussed in the lecture. Keywords: Long COVID, management, pharmacotherapy, rehabilitation, symptoms
Copyright (c) 2026 Kaushik Bharati (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Emotional Intelligence And Psychological Wellbeing Among Mid Adolescents In Mysuru City
Background: Adolescence is a transformative period marked by rapid physical, emotional, and psychosocial changes. Mid-adolescence (14–17 years) is particularly sensitive as individuals form identity, social connections, and coping mechanisms. Emotional intelligence (EI) the ability to identify, understand, and manage emotions has been recognized as a protective factor for mental health and a determinant of psychological well-being. However, research assessing EI and its correlates among Indian adolescents, especially in Mysuru, remains limited. Objectives: 1. To assess the emotional intelligence among mid-adolescents residing in urban Mysuru. 2. To identify sociodemographic factors associated with emotional intelligence among the study participants. 3. To determine the association between emotional intelligence and psychological well-being among the study participants. Methodology: A school-based cross-sectional study conducted among 2,040 adolescents aged 14–17 years, selected using multistage random sampling from higher secondary schools in Mysuru city. Data were collected using a prevalidated semi-structured questionnaire comprising three parts: sociodemographic details, Schutte Self-Report Emotional Intelligence Questionnaire (33 items), and Ryff’s 18-item Psychological Well-Being Scale. Analysis of data were done using SPSS version 28. Descriptive statistics summarize the findings, while chi-square tests and logistic regression assessed associations and predictors. A p-value <0.05 considered statistically significant. Results: Among 2040 mid-adolescents (mean age 15.15 ± 1.05 years), most belonged to nuclear families and studied in English medium. The mean Psychological Well-Being score was 121.98 ± 17.57, indicating predominantly moderate well-being. The majority demonstrated normal emotional intelligence. Multivariate analysis identified male gender, lower socioeconomic status, poorer perceived health, lower academic performance, and lower psychological well-being as significant predictors of low emotional intelligence (p < 0.05). Conclusion: The present study provided insights into adolescent emotional development, highlighting the need to incorporate EI training into school curricula to promote holistic well-being and resilience. Keywords: Emotional intelligence, Psychological well-being, Adolescents, Mysuru, Schutte scale, Ryff scale
Copyright (c) 2026 Jesymol Joy, Renuka M (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Post Traumatic Growth in Road Traffic Accident Survivors: A Cross Sectional Study from a Tertiary Care Centre in North India
Introduction: Road traffic accidents (RTAs) remain a major public health problem in India, yet most research focuses on psychopathology rather than positive psychological outcomes. Posttraumatic growth (PTG)—positive changes in personal strength, relationships, spirituality, appreciation of life and new possibilities—has been documented after various traumas but rarely among RTA survivors in North India. This study aimed to assess PTG and its correlates among survivors receiving care at a tertiary centre. Method: A cross-sectional study was conducted at Chandan Hospital, Lucknow. Using purposive sampling, 285 RTA survivors aged ≥18 years who had recovered from moderate–severe injuries within the previous 6–24 months were recruited. Data were collected through a socio-demographic questionnaire, the Posttraumatic Growth Inventory (PTGI), Connor-Davidson Resilience Scale (CD-RISC10) and Brief COPE Inventory. Descriptive statistics, Pearson correlations and multiple linear regression were applied using SPSS v25. Results: Participants had a mean age of 34.6 ± 10.2 years; 61.8% were male. The mean PTGI score was 61.4 ± 15.8, indicating moderate–high PTG. PTG correlated positively with resilience (r=0.42) and religious coping (r=0.38). Regression analysis showed resilience (β=0.34, p<0.001), religious coping (β=0.28, p=0.001), female gender (β=0.18, p=0.007), avoidant coping (β=0.19, p=0.013) and longer time since trauma (β=0.12, p=0.028) as significant predictors of PTG. Conclusion: PTG is a salient outcome among Indian RTA survivors and is shaped by resilience, coping styles, gender and time since trauma. Incorporating psychosocial interventions that build resilience, support adaptive coping and respect spiritual frameworks may enhance holistic recovery. Longitudinal studies are warranted to trace PTG trajectories over time. Keywords: Posttraumatic growth, Road traffic accidents, Resilience, Coping strategies, India
Copyright (c) 2026 Rajeev Misra (Author); Divyanshi Singh (Translator); Akanksha Mishra, Rajgopal Reddy (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
A Spatio-Temporal Typology of Infectious Disease Outbreaks in India (2009–2025)
Background: India's diverse ecology drives a complex infectious disease burden, creating distinct regional outbreak patterns. Understanding these zone-specific patterns is therefore critical for effective disease control and prevention. This study analyzes the spatio-temporal patterns of outbreaks across India's biogeographic zones, classifying them to identify national trends, pinpoint hotspots for novel threats, and establish regional risk profiles for targeted public health strategies. Methodology: Weekly Integrated Disease Surveillance Programme (IDSP) outbreak reports (2009–2025) were analyzed. Districts were assigned to biogeographic zones and outbreaks were categorized by transmission mode and emergence status. Spatio-temporal patterns were evaluated using time-series and crosstab analyses in SPSS for spatial concentration, seasonality, and long-term trends. Results: Two dominant, contrasting epidemiological patterns were revealed. Environmentally-mediated diseases (water/vector-borne) concentrated in the Deccan Peninsula and Western Ghats, peaking during the Southwest Monsoon (June-Nov). In contrast, person-to-person diseases concentrated in the densely populated Gangetic Plains, peaking during winter-spring (Jan-Mar). The Western Ghats was a primary hotspot for emerging diseases, while re-emerging diseases showed geographic expansion into frontiers like the Himalayas. A universal reporting dip occurred during the COVID-19 pandemic (2020-2021), followed by a strong resurgence. Conclusion: Environmental transmission peaking with the monsoon in peninsular India contrasts sharply with winter peaks for person-to-person transmission in the northern plains. The emergence and expansion of threats into new territories confirms that a monolithic national strategy is insufficient. Policy must prioritize regionally tailored interventions, including climate-resilient Water, Sanitation, and Hygiene (WASH), targeted vector control, and strengthened One-Health surveillance to mitigate this dynamic burden.
Copyright (c) 2026 Levin Jake Varghese, Amit Kumar Mishra, Gaurav Singh (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Male Engagement and Gender-Transformative Interventions in Maternal and Child Health: A Realist Review & Meta-narrative synthesis.
Introduction: Male engagement is increasingly recognized as a critical strategy for improving maternal and child health (MCH) outcomes and advancing gender equity. Interventions span from gender-accommodating approaches, which work within existing social structures, to gender-transformative ones, which aim to challenge and reshape them. Despite their growing implementation, many remain inconsistently defined and assessed, often focusing narrowly on clinic attendance rather than broader dimensions such as emotional support, decision-making, or shifts in household power dynamics. This review sought to examine what works, for whom, in what circumstances, how, and why male engagement interventions improve MCH outcomes. Methods: This realist review, registered in PROSPERO (CRD420251129477), followed RAMESES guidelines. Evidence was drawn from randomized and non-randomized studies, qualitative research, policy documents, and program evaluations. Data were synthesized using context–mechanism–outcome (CMO) configurations, guided by Pawson’s iterative stages. Searches across MEDLINE, Embase, CINAHL, and Scopus were conducted without date restrictions, limited to English publications. Results: Key mechanisms included enhanced knowledge, equitable attitudes, self-efficacy, and improved couple communication. These were shaped by contextual factors such as patriarchal norms, religious leadership, and health system design. Gender-transformative approaches that fostered critical reflection and collective consciousness demonstrated more sustainable gains in health behaviors and gender-equitable practices compared to gender-accommodating strategies, which often yielded short-term effects. Conclusion: Male engagement is essential for strengthening MCH outcomes, but sustainable change requires gender-transformative strategies that are context-sensitive, multisectoral, and power-aware. Effective programs must be context-sensitive, address structural inequalities, and operate across individual, household, community, and health system levels to sustainably improve both health and gender equity. Keywords: Male engagement, Maternal and child health, Gender-transformative interventions, Realist review
Copyright (c) 2026 Pranav kshtriya, Swati Gohel, Parthasarathi Ganguly, Shweta Mulchandani (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Strategies for reduction in Infant Mortality Rate in India
The number of deaths of children under one year of age per thousand life is defined as infant mortality rate. Presently, the infant mortality rate in India is about 25 per thousand births. The major component of infant mortality is in the age group of 0 to 28 days (Neonatal Period). Neonatal period deaths contributes more than 70% of the total infant mortality. There are important lessons from in Kerala, one of developed states of the country with infant mortality of 4, which has been reported form Developed countries of world. All states can achieve this IMR with multi sectoral interventions. What are major reasons of low IMR in Kerala is i) universal access to the healthcare for antenatal mothers and Neonates ii) strong healthcare delivery system. Iii) Adequate Obstetric care iv) universal Immunization of antenatal mother and Infants v) Nutritional supplementation vi) Low prevalence of anemia among pregnant mothers vii) identification of high risk mothers and timely referral to the higher level of health care services, viii) universal breastfeeding practices ix) nearly 100 percent institutional deliveries by Trained and skilled birth attendants, x) the infection control services xi) development of secondary level health care for the infants and mothers for who are referred particularly Newborns with prematurity / birth Asphyxia /Congenital diseases / neonatal sepsis .xii)implementation of India Newborn Action Plan (INAP) xiii) Improving antenatal care xiv) timely detection of Pneumonia and diarrheal diseases xv) adoption of Kangaroo care for preterm babies xvi) avoiding teen age pregnancy xvii) Ensuring support for Universal institutional deliveries xviii) filling up of all peripheral health workers positions xix) Universal Implementaion of ICDS scheme xx) intensive specific evidence based efforts in districts with high infant mortality
Copyright (c) 2026 Umesh Kapil (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Similarities and Differences Between Clinical Trials of Drugs and Clinical Trials of Vaccines
Background: Clinical trials are central to the development of drugs and vaccines; however, therapeutic, and preventive products differ substantially in objectives, populations, endpoints, and regulatory expectations. Aim & Objectives: To critically compare similarities and differences between drug and vaccine clinical trials, with special reference to the Indian regulatory and public health framework. Methodology: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, WHO IRIS, CDSCO, ICMR, FDA, and EMA sources (2000–2025). Seventy-three eligible publications were included after screening 480 records. Comparative domains included trial phases, endpoints, safety monitoring, ethics, regulatory scrutiny, and post-marketing systems. Results: Both trial types follow phased development, Good Clinical Practice, ethics oversight, and regulatory approval pathways. However, vaccine trials differ in enrolling predominantly healthy populations, emphasizing immunogenicity and population-level effectiveness, requiring larger sample sizes, stricter safety thresholds, and enhanced community engagement. In India, NDCTR-2019, CTRI registration, PvPI, and AEFI frameworks create differentiated yet complementary surveillance mechanisms. Conclusion: While drug and vaccine trials share methodological foundations, vaccines operate within a broader public health governance paradigm. Strengthening integrated surveillance, adaptive regulatory pathways, and ethical harmonization is essential for future therapeutic and preventive innovation.
Copyright (c) 2026 Shankar Prasad Bhattacharya (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Youth Tobacco Use in India: Industry Strategies, Epidemiological Trends, and Policy Gaps
Background: Youth tobacco and nicotine uptake in India persists despite strong legislation, as industry marketing adapts to entertainment media, digital channels, and surrogate promotion. Materials & Methods: This narrative review synthesises surveillance evidence and published reports on youth tobacco/nicotine use in India, alongside policy and implementation literature on tobacco control, industry tactics, and health consequences. Results: GYTS-4 India 2019 (report published 2021) reports that 8% of students aged 13–15 years currently use any tobacco product, and 3% have ever tried an e-cigarette. These figures represent a 42% decline in current use since 2009, indicating progress. However, exposure to tobacco advertisements and related imagery remains high across media platforms: television (44.5%), movies (37.3%), internet videos (33.5%), and online/internet (23.4%) in the past 30 days. The reviewed evidence indicates that flavoured products, surrogate branding, and influencer/digital promotion can sustain youth appeal despite statutory restrictions, while implementation gaps enable continued exposure and access. Early nicotine initiation is associated with dependence risk and adverse respiratory and psychosocial outcomes. Conclusions: India’s gains in reducing youth tobacco use will be sustained only if tobacco control implementation keeps pace with evolving marketing ecosystems, with stronger action on surrogate and digital promotion, media compliance monitoring, and youth-focused prevention and cessation support.
Copyright (c) 2026 Suneela Garg, Anshika Chaudhry, K Madan Gopal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
The Prime Minister’s Clarion Call on Antimicrobial Resistance: From Public Concern to System Action through Diagnostics, Stewardship and One Health
Antimicrobial resistance (AMR) is a major and growing threat to health security. It weakens the treatment of common infections and undermines the safety of routine medical care. In his Mann Ki Baat message of 28 December 2025, the Prime Minister warned that indiscriminate antibiotic use is making common infections such as pneumonia and urinary tract infections harder to treat, and urged citizens not to use antibiotics as a ‘quick fix’. This commentary takes that clarion call as a starting point. It proposes three practical system shifts for India: (i) diagnostic-led stewardship at the point of care, (ii) routine monitoring of antibiotic use and resistance with feedback to facilities, and (iii) operational One Health action at priority human–animal–environment interfaces. The goal is to make the right antibiotic decision the easy decision
Copyright (c) 2026 K Madan Gopal, Suneela Garg (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Making a Case for Provision of Assistive Technology through Healthcare System: Using Evidence to Decision (EtD) Framework Approach
be inclusive, responsive, and equitable, catering to all individuals irrespective of their functional status or disabilities. In this context, the provision of Assistive Technology (AT) — encompassing assistive products, services, and systems that enable individuals with functional impairments to live independently and participate fully in society — is an indispensable component of health system strengthening. However, despite its proven potential to transform lives, assistive technology remains underprioritized in most healthcare systems globally, particularly in low- and middle-income countries (LMICs) such as India. The WHO’s Global Report on Assistive Technology (2022) estimated that more than 2.5 billion people require at least one form of assistive product, yet only one in ten has access. This massive unmet need translates not only into compromised quality of life and increased dependency but also into preventable health complications, reduced productivity, and loss of economic potential. To bridge this gap, there is an urgent need for a robust decision-making framework that integrates evidence with policy action. The Evidence to Decision (EtD) Framework offers such a structured pathway — one that links scientific evidence with context-specific policy choices, ensuring that health systems can make transparent, fair, and evidence-informed decisions about the inclusion and financing of assistive technology.
Copyright (c) 2025 Journal of the Epidemiology Foundation of India
Charting the Course: Telemedicine Trends, Regulatory Frameworks, and Implementation Challenges in India
Background: In low- and middle-income countries like India, telemedicine emerges as an important solution for healthcare delivery as geographical, workforce, and infrastructural disparities limit access to care. Objective: This article explores the evolution of telemedicine in India, with a focus on legal framework, policy shifts, implementation challenges, and comparison with global telemedicine. Methods: The method employed was a qualitative narrative review. Peer-reviewed Google Scholar, PubMed and Scopus-indexed journal articles, World Health Organisation reports, and Indian government telemedicine laws and regulations were among the data sources. Documents published between 2000 and 2024 were evaluated for legislative provisions, implementation hurdles, and relevance, excluding technical or clinical reports without policy analysis or those in regional languages. Results: India has established a foundational regulatory structure for telemedicine through the Telemedicine Practice Guidelines (2020), which is backed by current laws like the Indian Medical Council Regulations (2002) and the Information Technology Act (2000). The COVID-19 epidemic sped up adoption, increased the number of teleconsultation modalities that are acceptable, and revealed structural limitations such as provider preparedness, digital inequality, and data privacy issues. Conclusion: Although India's telemedicine framework is flexible and forward-thinking, its successful implementation necessitates improved digital infrastructure, uniform training, strong data security measures, and ongoing regulatory improvement in line with international best practices.
Copyright (c) 2026 Journal of the Epidemiology Foundation of India https://creativecommons.org/licenses/by-nc-nd/4.0
Addressing Inequity in Assistive Products Through Healthcare Systems in India: A Review
Background: Assistive technologies (AT) are crucial for enhancing individuality, productivity, and quality of life for persons with functional impairments. Despite their proven profits, significant inequities persist in access to assistive products, particularly in low-and middle-income countries like India. Objective: This review scrutinizes the current landscape of assistive technologies establishment in India, evaluates economic and social returns on investment, and categorizes strategies to address inequities through healthcare system integration. Results: Evidence demonstrates substantial returns on investment for assistive products, with wheelchairs increasing economic productivity by 20-40%, spectacles showing benefit-cost ratios of 5:1, and hearing aids yielding ninefold returns per dollar invested. India has established institutional mechanisms including the National Centre for Assistive Health Technology (NCAHT) and the National List of Essential Assistive Products (NLEAP) to address access gaps. However, challenges remain in policy implementation, funding mechanisms, manufacturing capacity, and last-mile delivery. Conclusion: A multi-pronged approach combining strong policy frameworks, increased public funding, indigenous manufacturing, capacity building, and community engagement is essential to achieve equitable access to assistive technologies through India's healthcare system. Integration of AT into Universal Health Coverage represents a strategic pathway toward achieving Sustainable Development Goals 3 and 10.
Acute diarrhoeal disease outbreak in an urban residential complex of Ghaziabad, UP May 2024: Felt needs of community participation
Introduction: An outbreak of acute diarrheal disease in a gated residential complex at Ghaziabad, UP, was reported by the district surveillance team, and study was done to identify exposures of the outbreak. Methods: A Google form circulated among the case for exposure and behavioural details. The water supply and drainage system, purification methods, and cleanliness of tanks were observed. Results: The drinking water source was the society water supply in 198 (98%) cases. The pipeline supplying water to society had a joint, a nearby dirty drain, and maintenance work done a few days back. No chlorine dozer installed, and no records regarding maintenance and chlorination of the water system. Conclusion: There is a need for proactive participation among residents of the complex for ensuring safe drinking water.
Copyright (c) 2026 Rahul Verma, Anurag Dhoundiyal, Shashank Bassi, Sushma Choudhary, Vikasendu Aggarwal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Developing a New Assistive Technology: Parameters, Standards and Compliance Frameworks
Background: Assistive Technology (AT) development in India lacks a unified compliance and regulatory framework. Objective: To provide a framework that guides innovators in developing ATs aligned with regulatory, ethical, and quality standards. Methods: A comprehensive synthesis of national (ICMR, CDSCO, BIS, MoHFW, MeitY, MoSJE) and international (ISO, IEC, FDA, WHO, CE) standards was undertaken to frame a multi-tier compliance pathway. Results: A structured compliance process integrating user-centric design, safety testing, ethical, clinical validation, and digital interoperability was developed. Conclusion: The proposed framework enables developers to design, test, and commercialize ATs safely, ensuring compliance, accessibility, and sustainability across India’s regulatory ecosystem.
Strengthening Ecosystem for Assistive Technology
This report reflects on some of the initiatives undertaken by the International Committee of the Red Cross (ICRC) to contribute to strengthen the ecosystem of assistive technology (AT) by promoting innovation, building partnerships, and prioritizing user-centered approach. The ICRC focused on strengthening national rehabilitation systems, involving end-users in product development, and fostering an environment for sustainable provision of AT. Access to AT has an indispensable role in nurturing a more inclusive society.
Integrating Oral and Maxillofacial Prostheses into India’s RPwD Act, 2016: A Policy Perspective
The Rights of Persons with Disabilities (RPwD) Act, 2016, led to a pivotal moment in India, which initiated the journey towards disability inclusion. This further led to the establishment of a society where all individuals with disabilities, regardless of their abilities, participate fully and with dignity. However, within this broad and inclusive vision lies a silent gap - oral and maxillofacial related disability, rehabilitation for which is still not explicitly recognized as an essential assistive service. For people living with craniofacial defects, prostheses like dentures, obturators, speech aids, and facial prosthetics are often out of reach. These devices are far more than just medical interventions; they restore the ability to speak, eat, and express oneself, restoring not just physical health but also confidence, a sense of belonging, and self-worth. This paper aims to highlight how the formal recognition of Oral and Maxillofacial (OMF) Prostheses could transform India's assistive technology system. These prostheses do much more than just restore function; they help people regain confidence, communicate, and reconnect socially. Backed by growing evidence of their physical, emotional, and social value, this paper calls for a policy change that incorporates OMFP as an essential component of AT, to be included in government-supported rehabilitation programs and promote teamwork among dental professionals, rehabilitation experts, and policymakers. Aligning India's approach with the vision of the RPwD Act (2016) and the WHO's Global Cooperation on Assistive Technology (GATE) initiative would mark a major step toward making oral and maxillofacial rehabilitation not just a legal right, but a lived reality for everyone
Rights of Persons with Disabilities Act (RPwD Act)
Vision Restoration in Degenerative Retinal Diseases Using Stem Cells
Degenerative retinal diseases, such as age-related macular degeneration, retinitis pigmentosa, diabetic retinopathy, and glaucoma, are significant causes of irreversible visual loss worldwide. Current treatments are mostly palliative, treating the secondary obstacle rather than reversing degenerated retinal cells. Stem-cell–based interventions are shifting the treatment landscape for retinal degeneration by targeting multiple biological pathways—replacing lost cells, protecting surviving neurons, regulating immune activity, and supporting new vessel growth. This review brings together current laboratory and clinical findings on four major cell sources: embryonic stem cells, induced pluripotent stem cells, mesenchymal stromal cells, and retinal progenitor cells. Early trials, especially in age-related macular degeneration and retinitis pigmentosa, report good safety outcomes and small but measurable gains in visual function, with transplanted cells surviving in the host retina. However, the major translational hurdles are regulation of the immune response, heterogeneity of long-term integration, surgical complexity, and manufacturing scalability. Advances in engineered delivery systems, immune-evasive pluripotent cells, and biomarker-based patient selection are driving the field toward sustainable therapy. Together, stem cell therapy holds great promise in addressing the unmet needs of degenerative retinal diseases; however, well-designed multicenter trials with well-defined endpoints are essential for determining efficacy and ensuring safe and regulated use in clinical practice.
India’s SDG 2030 Agenda: Progress, Challenges, and the Road Ahead
Background - Given that it is the most populous nation, India will be key to the attainment of the 2030 Agenda for Sustainable Development. Aim - This commentary describes the efforts being made from India to uphold the vision of development for the country, "Sabka Saath, Sabka Vikas," and its integration of the global development agenda. Methodology – This study discusses the work done by the institution headed by NITI Aayog in monitoring and implementing Sustainable Development Goals (SDGs) across the country. Results - India has made substantial advancements, and most of its states are ‘Front-runners’, but specific goals align with major challenges. The remaining goals on Gender Equality, Zero Hunger, and Quality Education are highly concerning. Conclusion - The manuscript states the need for basic framework policies, social entrepreneurship, and global alliances. This is to ensure there are no impediments to India’s progress in sustainable development and inclusivity for its 1.4 billion people.
Copyright (c) 2026 Vrinda Taneja, Neha Kashyap (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Emerging Technologies Transforming Vision Rehabilitation and Eye Care Accessibility
This chapter explores the transformative potential of emerging technologies in vision rehabilitation and eye care accessibility, examining artificial intelligence applications, augmented and virtual reality systems, smartphone-based assistive platforms, 3D printing innovations, and tele-assistive solutions. Through systematic analysis of recent literature spanning 2018-2024, this chapter evaluates the current state of AI-powered wearables, computer vision applications for navigation and object recognition, immersive technologies for therapeutic intervention, and personalized manufacturing approaches. The analysis reveals significant promise in prototype development and research applications, while identifying persistent challenges in commercial translation, affordability, and equitable access, particularly in low- and middle-income countries. The chapter concludes with critical examination of ethical considerations, digital divide implications, and policy recommendations for ensuring that technological advances contribute to rather than exacerbate existing inequities in vision care access.
Global Policy and Frameworks for Assistive Technology in Eye Care
This chapter examines the global policy landscape for assistive technology (AT) in eye care, analyzing frameworks established by the World Health Organization (WHO) and their implementation across diverse healthcare systems. Drawing from recent literature spanning 2018-2024, this analysis explores the WHO Global Report on Assistive Technology (2022), the Global Cooperation on Assistive Technology (GATE) initiative, and their integration with Vision 2020 and the Integrated People-Centered Eye Care (IPEC) framework. The chapter critically examines policy challenges including accessibility, affordability, and equity gaps across low- and middle-income countries (LMICs), regulatory frameworks for emerging digital technologies, and implementation models ranging from community-based delivery to tele-rehabilitation services. Through comparative analysis of case studies from India, The Gambia, and European contexts, this chapter identifies key barriers to AT access and proposes evidence-based policy recommendations for achieving universal health coverage goals in vision care.
Comprehensive Rehabilitation and Assistive Device Intervention in an Untreated Quadrilateral Limb Deformity: a case report
A 14-year-old boy presented to the OPD of the department of physical medicine and rehabilitation with deformities of all the four limbs. He was having transverse deficiency of the right upper limb and longitudinal deficiency of all other limbs. On examination the shoulder joint was bilaterally normal in terms of range of motion and power. On the right side the forearm and hand were absent and on the left there was restriction of pronation and supination at the elbow. In the left wrist there was restriction of ulnar and radial deviation and except for the thumb all other digits were absent [Figure 1]. In the lower limbs, hips were normal, knee on right there was a 20-degree extension deficit and the left knee was fixed around 80 degrees of flexion. Legs were short with a length of eight and four inches respectively with two digits on right and one on left [Figure 2]. There were callosities and hyperpigmentation over both knees and foot due to altered gait pattern [Figure 3]. No deficits in strength were noted in the hip and it was not possible to assess in knee and foot due to deformity.
Assistive Technology (AT) Landscape in India: The Story so far and Road Ahead
The importance of Assistive technology (AT) is gaining serious attention worldwide due to recent technological advancements, an aging population, and the rising prevalence of non-communicable diseases (NCDs) and functional impairments. Global reports on AT reveal that one in every three globally requires at least one AT and this need is further exacerbated by age, region and socioeconomic status, making individuals belonging to LMICs the most vulnerable. The preliminary findings of the ICMR-initiated rATA survey, currently underway across India, reveal a significant gap between AT needs and AT access, with females, older age groups, and individuals from rural and tribal areas being the most vulnerable. Although there have been significant innovations in the field of AT with the advent of Artificial Intelligence (AI) and machine learning (ML), affordability, accessibility and limited customisations as per user needs hinder the wider adoption of AT, especially in India, with a vast population, diverse cultural and geographical landscapes and limited awareness about AT services and products. Indian government initiatives such as the RPwD Act, ADIP and RVY schemes, intended at provisioning AT services for eligible individuals which includes persons with disabilities (PwDs) and individuals above 60 years, have substantially failed to deliver as promised mainly due to inadequate financial allocations, poor distribution and supply chain networks, weak regulatory enforcements and limited awareness of schemes among the targeted beneficiaries. In this regard, this article attempts to provide a comprehensive overview of the current situation of AT in India, focusing on government initiatives and schemes, current demand and scope for AT, barriers in AT adoption and finally recommendations and best practices for a successful AT adoption in India.