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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Latent Tuberculosis Infection Diagnostics: Comparative Performance of TST, IGRAs, and Cy-Tb
Background: Traditional methods such as Tuberculin Skin Test (TST) demonstrates reduced specificity due to BCG vaccination and environmental mycobacteria cross-reactivity. Interferon-Gamma Release Assays (IGRAs) improve specificity but require complex laboratory infrastructure. The Cy-Tb skin test has emerged as an affordable, and field-friendly diagnostic alternative. Objective: This review synthesizes current evidence comparing LTBI diagnostics, focusing on procedures, diagnostic accuracy, safety, and programmatic relevance of Cy-Tb relative to TST and IGRA, with emphasis on high TB burden settings. Methods: Comprehensive searches were conducted in Medline and Scopus databases using terms such as “latent tuberculosis infection,” “Cy-Tb skin test,” “tuberculin skin test,” “interferon-gamma release assay,” and “diagnostic accuracy.” 35 studies published between 2015-2025 were included. Results: Sensitivity for Cy-Tb ranged from 70% to 80%, and specificity ranged from 98% to 99% (Ruhwald M et al., South Africa and Muniyandi M et al., India). TST sensitivity ranged from 60% to 77%, while specificity from 55% to 65% in BCG vaccinated populations. (Chandrasekaran P et al., India). For IGRAs, sensitivity ranged from 75% to 85%, and specificity from 95% to 98%. (Chandrasekaran P et al., India and Pai M et al., Canada) The concordance between Cy-Tb and IGRA exceeds 90%, demonstrating strong diagnostic agreement (Aggerbeck H et al., 2018). Cy-Tb is associated mainly with mild, transient local injection site. TST can cause local skin reactions and rare systemic hypersensitivity, while IGRAs carry minimal risk (Hamada et al., China). Conclusion: Cy-Tb offer improved specificity and comparable sensitivity to IGRAs with simplicity and cost-effectiveness suitable for large-scale implementation in high-burden settings. Scalable and accessible LTBI diagnostics with favourable safety profiles, like Cy-Tb, are critical to accelerating TB elimination efforts globally. Keywords: latent tuberculosis infection, Cy-Tb test, tuberculin skin test, interferon-gamma release assay, TB preventive therapy, cost-effectiveness, high-burden settings.
Copyright (c) 2025 Smilee Choudhary, Suman Saurabh, Manoj Kumar Gupta, Rozaline Lenka, Priyanka Sidholi, Sanjana Jaiswal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Violence as a Public Health Issue: A Narrative Review
Background: Despite significant economic growth, India confronts an endemic crisis of violence. This paper argues for a paradigm shift, reframing violence from a purely criminal-legal issue to a multifaceted public health epidemic that requires a prevention-oriented approach. Methods: The analysis adopts a public health lens, employing the Four-Step Scientific Methodology and the Social-Ecological Model as foundational frameworks. It synthesizes and examines national data from key surveillance systems, including the National Family Health Survey (NFHS) and the National Crime Records Bureau (NCRB), to define the problem and identify its structural determinants. Results: The epidemiological findings reveal a crisis of staggering proportions. Nearly one-third of married women (29.3%) experience spousal violence (NFHS-5), and the nation's suicide rate reached an unprecedented high of 12.4 per 100,000 population in 2022 (NCRB). Deep-rooted determinants, including patriarchy, caste hierarchies, and socioeconomic deprivation, were identified as primary drivers. The appraisal of systemic responses revealed significant implementation gaps in progressive laws like the PWDVA (2005) and an underutilization of the healthcare system as a frontline for intervention. Conclusion: Violence in India is a preventable public health epidemic. A comprehensive, multi-pronged strategy is essential, operating across primary, secondary, and tertiary prevention levels. This includes sustained public awareness campaigns, strengthening the healthcare response, and providing integrated, long-term support for survivors to foster a safer and more just society. Keywords: Violence, Public Health, India, Structural Determinants, Prevention
Copyright (c) 2025 Sanjana Jaiswal, Simlee Choudhary, Priyanka Sidholi, Rozaline Lenka (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Impact of Educational Program on Nursing Officers’ Knowledge of Emerging & Re-emerging Diseases in Punjab, India
Introduction: Emerging and re-emerging diseases, such as tuberculosis, dengue, malaria, and influenza, remain major global health challenges. Nursing officers are vital in detection and management, yet knowledge gaps persist. This study aimed to assess the effectiveness of an educational intervention to improve their knowledge in selected institutions of Punjab, India. Methodology: A one group pre and post-test research design was adopted to conduct study among 30 nursing officers working in selected institutions of Punjab selected through convenience sampling. Structured questionnaire was used to collect the data from participants. Descriptive and inferential statistics was done with SPSS version 24. Results: Mean knowledge scores improved significantly across most domains. Scores for emerging and re-emerging conditions increased from 11.4±2.88 to 16.5±1.99 (p<0.05). Knowledge about tuberculosis, vector-borne diseases, and rabies improved from 10.9±3.72 to 17.6±1.77 (p<0.05); HIV, hepatitis, and diarrhoeal diseases from 11.8±3.34 to 17.5±1.57 (p<0.05); cardiovascular diseases, diabetes, and stroke from 9.96±3.22 to 13.8±2.22 (p<0.05); prevention and management of NAFLD and COPD from 11.6±2.49 to 16.4±3.14 (p<0.05); and mental well-being from 13.3±2.52 to 17.6±2.61 respectively. Only cancer prevention and management showed a modest, statistically non-significant change 9.20±2.51 to 11.55±1.86 (p=0.76). Conclusion: Structured educational intervention significantly improved nursing officers’ knowledge across multiple domains of emerging and re-emerging communicable diseases. Integrating such targeted training into routine professional development programs can strengthen the capacity of healthcare systems to detect, prevent, and control communicable disease outbreaks which can contribute to improved public health outcomes in Punjab and beyond.
Copyright (c) 2025 Kamlesh K Sharma, Simarjeet Kaur, Atul Sharma (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Prescription Audit in outpatient department of a district level government hospital in northern Kashmir: an observational study
Background: An ‘audit’ is defined as ‘the review and the evaluation of the health care procedures and documentation for the purpose of comparing the quality of care which is provided, with the accepted standards’. Studying the prescription audit is that part of the audit which seeks to monitor, evaluate and if necessary, suggest modifications in the prescribing practices of medical practitioners. Aims and objectives: In this study, we aimed to study the prescription pattern and assess the quality of prescription, with the standard prescription norms in Out Patient department of various specialities of a Government District Hospital. Methodology: This observational study was conducted on the patients receiving medication during treatment in the outpatient departments of various specialities of the District Hospital, over a period of one month and the calculated sample size was 95 (according to the guidelines of prescription audit by MoHFW). An additional sample of 5 was included in the study, making the total sample size 100. Results: A total of 20 parameters were assessed using a checklist. It was found that out of 100 study participants, brief history was mentioned in 51% prescriptions; dosage, duration and frequency was mentioned in 72% prescriptions, sign and stamp of the treating doctor was present on 37% prescriptions; medications were written in capital letters in 70% prescriptions, but were written in generic form in only 17% prescriptions. 78% of the medication orders were clear and readable; route of administration was not mentioned in 65% prescriptions. Vitamins, tonics or enzymes were prescribed in only 10% prescriptions, while antibiotics were prescribed in 44% prescriptions. Conclusion: This study provides insights into prescription patterns and quality. By addressing the identified limitations and incorporating recommendations, healthcare providers can enhance the quality of prescriptions, leading to improved patient care and treatment outcomes in the outpatient setting.
Copyright (c) 2025 Numan Farooq Kawa, Rohul Jabeen Shah, Anjum Fazili, Hanna Zahoor Hamdani (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Assessment of Emotional and Behavioral Problems Among Adolescent Girls in a Government School, Delhi
Background: Adolescence is a critical developmental period characterized by significant emotional and behavioral changes. In India, adolescents constitute about one-fifth of the population, yet mental health problems in this group remain under-documented. This study aimed to assess the prevalence and pattern of emotional and behavioral problems among adolescent girls in a government senior secondary school in Delhi using a validated screening tool. Methodology: A cross-sectional study was conducted over four months among 433 adolescent girls from classes 9 to 12 at Government Girls Senior Secondary School No.1, Najafgarh. Participants were selected via stratified random selection based on course groups and probability proportional to size. Data were collected using a socio-demographic profile and the self-administered Strengths and Difficulties Questionnaire (SDQ), which assesses five subscales: Emotional, Conduct, Hyperactivity, Peer, and Prosocial behavior. Results: The mean age of participants was 15.5 ± 1.24 years. Analysis of socio-demographic data revealed that 31% of participants were from Class 12, 30% from Class 11, 20% from Class 9, and 19% from Class 10. A vast majority (93%) identified as Hindu, 68% lived in nuclear families, and 54% had two or fewer siblings. Findings indicated a substantial mental health burden, as nearly 60% of students demonstrated borderline or abnormal total SDQ scores. Specifically, abnormal behaviors were most prevalent in hyperactivity (34%) and peer difficulties (24.9%), while 16.4% showed abnormal emotional difficulties. Significant associations were found between hyperactivity and nuclear family structures (p=0.04), while conduct problems were significantly more frequent in younger students £ 15 years (p=0.001). Emotional difficulties were also significantly associated with the presence of siblings (p=0.04). Conclusion: A significant mental health burden exists among adolescent girls, with 60% showing emotional or behavioral difficulties. Factors such as age, family type, and sibling presence significantly influence these outcomes. Strengthening school-based mental health programs through the effective implementation of "Manodarpan" is essential for early detection, counseling, and enhancing emotional resilience.
Copyright (c) 2025 Ghurumourthy Dhandapani, Anubha Gupta, Geeta Yadav, Shveta Lukhmana, Sahadev Santra (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Nutritional Adequacy Beyond Macronutrients: Dietary Diversity and its Determinants Among PLHIV In Northern India
Introduction: Dietary diversity is a critical component of nutritional adequacy and overall health. In people living with HIV (PLHIV), suboptimal dietary diversity can worsen nutritional deficiencies and compromise immune recovery. Limited evidence exists regarding dietary diversity patterns and influencing factors among PLHIV in North India. Objectives: To assess the level of dietary diversity and determine its socio-demographic and clinical correlates among PLHIV attending a tertiary care hospital. Methods: A cross-sectional study was conducted among 400 adults enrolled at an ART Centre in Western Uttar Pradesh. Data on socio-demographic and HIV-related characteristics were collected using a structured proforma. Dietary diversity was assessed by 24-hour recall using the FAO 10-food group method. Dietary Diversity Score (DDS) ranged from 0–10 and was categorized as low (0–3), medium (4–6), and high (7–10). Descriptive statistics were applied; association analysis with selected variables is ongoing. Results: The mean age of participants was 41.1 ± 10.8 years, and 52.5% were male. Most were rural residents (74.8%) and unemployed (46%). The mean DDS was 4.06 ± 1.40, with over half (52.3%) having low dietary diversity, 39.2% moderate, and only 8.5% high diversity. The distribution was right-skewed, reflecting limited consumption of diverse food groups. Conclusion: Dietary diversity was found to be suboptimal among PLHIV, suggesting inadequate diet quality and potential nutritional vulnerability. Further statistical analysis to identify socio-demographic and clinical factors associated with dietary diversity is underway and will be presented at the conference. Keywords: Nutrition, PLHIV, Dietary diversity
Copyright (c) 2025 Syed Sohaib Hashmi, Mohammad Athar Ansari, Ali Jafar Abedi, Salman Khalil (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Assessment of Mental Health of School-Going Adolescents in Rural Areas of Ghaziabad
Background: India has one of the largest adolescent populations globally. Mental health problems during adolescence can significantly affect growth, academic performance, and future well-being. Despite its importance, adolescent mental health remains underexplored, particularly in rural areas. Aims & Objectives: To assess the mental health status of school-going adolescents studying in classes 6 to 10 in rural schools of Ghaziabad and to determine its association with selected sociodemographic factors. Methodology: A community-based cross-sectional study was conducted among 357 adolescents aged 12–17 years studying in rural schools of Ghaziabad. Data were collected using a predesigned semi-structured questionnaire covering sociodemographic details and mental health assessment. Responses were recorded on a Likert scale and total scores were categorized as Poor (<13), Satisfactory (13–26), and Good (>26). Institutional permission was obtained, and consent was taken from school authorities. Data were analysed using Statistical Package for the Social Sciences version 26. Results: More than half of the adolescents (54.3%) had poor mental health status, while 43.2% had satisfactory and 2.5% had good mental health. Younger adolescents (12–13 years) showed poorer mental health compared to older groups. Significant associations were observed between mental health status and age, family income, and living with parents. Common psychological concerns included feeling low, difficulty concentrating, sleep disturbances, and thoughts of self-harm. Findings were consistent with studies conducted in Bangladesh and rural Tamil Nadu showing high levels of adolescent psychological distress. Conclusion: A considerable proportion of rural adolescents demonstrated poor mental health. Strengthening school-based counselling services, enhancing parental engagement, and implementing community awareness programmes are essential to improve adolescent mental well-being in rural Ghaziabad.
Copyright (c) 2025 Mehak Pal Kaur, Deepika Agrawal, Syed Hasan Nawaz Zaidi, Neha Jetli (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Link Between Subclinical Eating Disorder And Mental Health Among Female Students Of Panjab University Chandigarh
Background: Subclinical eating disorders refer to disordered eating attitudes and behaviors that do not meet full diagnostic criteria but still cause significant psychological distress and functional impairment. Young women transitioning to university life are particularly vulnerable due to social comparison, lifestyle changes, altered eating habits, academic pressure, and increased independence. These factors may contribute to anxiety, stress, depression, and body image concerns. Early identification is important to prevent progression to clinical eating disorders. Aim: To determine the association between subclinical eating disorders and mental health among female students of Panjab University. OBJECTIVES: 1. To assess the prevalence of subclinical eating disorders. 2. To investigate the association between subclinical eating disorders and mental health status. 3. To examine the relationship between Body Mass Index (BMI) and subclinical eating disorders. METHODOLOGY: A cross-sectional study was conducted among 229 female students aged 18–35 years at Panjab University using purposive sampling. Data were collected using the Eating Attitudes Test (EAT-26) and Depression Anxiety Stress Scale (DASS-21). Statistical analysis was performed using SPSS version 31. Descriptive statistics and Chi-square tests were applied to determine associations. RESULTS: Among participants, 34.5% (n=79) scored ≥20 on EAT-26, indicating risk of subclinical eating disorders. Significant associations were observed between elevated EAT-26 scores and depression (p=0.006), anxiety (p=0.035), and stress (p=0.001). A statistically significant relationship was also found between BMI and eating disorder risk (p=0.007), with higher prevalence among overweight participants. CONCLUSION: Subclinical eating disorder risk is prevalent among female university students and is significantly associated with psychological distress and BMI. Early screening, mental health support, and body image interventions within university settings are recommended to prevent progression to clinical disorders.
Copyright (c) 2025 Harnoor Kaur, Garima, Paravreet Kaur, Manoj Kumar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
The intersection of Artificial Intelligence (AI) and Maternal Health
Artificial Intelligence (AI) algorithms identify patterns and risk factors for potential complications by analyzing large datasets, thereby enabling early detection, monitoring and intervention. By supporting clinical decision-making and reducing diagnostic errors, AI can predict complications such as preeclampsia, gestational diabetes and preterm labour. AI-powered risk stratification tools categorize expectant mothers according to their risk levels and design personalized care plans tailored to individual needs. Wearables and remote monitoring technologies allow continuous tracking of maternal and fetal health parameters. Mobile health apps linked with AI-enabled wearables collect real-time data which is analyzed by AI-based platforms, enabling continuous care. This is helpful for pre- and post-natal monitoring, sending reminders for appointments or medication and issuing alerts for deviations from normal parameters. AI Chatbots provide virtual prenatal consultations and 24/7 AI-based support, improving access in remote, underserved areas and reducing dependency on in-person consultations for basic queries. AI algorithms help in identifying early signs of postpartum depression and can provide virtual cognitive behavioural therapy. Natural Language Processing tools can analyze speech and text for emotional distress during online consultations. Advanced image analysis by AI algorithms can detect abnormalities the human eye may overlook, reducing diagnostic errors. AI based genomic analysis can screen for foetal genetic conditions. Early detection of genetic disorders leads to better planning and maternal health outcomes. Real-time translation of healthcare information and consultations by AI-translation services, overcomes language barriers in multicultural or migrant communities. Developing AI-driven solutions and comprehensive maternal health monitoring systems will be crucial as the global community works towards achieving the Sustainable Development Goals related to maternal and child health. Integrating AI into global maternal health programs can significantly enhance their reach and impact, leading to improved maternal health outcomes. Governments and technology developers must collaborate to ensure accessible and effective AI solutions.
Copyright (c) 2025 Niket Verma (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Effectiveness of community-based nutritional intervention on growth & nutritional indicators among malnourished children aged 13–60 months in rural Jhajjar, Haryana
Introduction: At the global level malnutrition among under-five children has been given immense priority. Child growth failure measured as stunting (height for age), wasting (weight for height) and underweight (weight for age). This study aimed to assess the effectiveness of community-based intervention on nutritional indicators and ICDS growth chart zones shift in 13-60 months malnourished children in rural area of district Jhajjar, Haryana. Methods: The study was a community-based cluster randomised experimental study. Out of 177 AWCs in the selected area, 80 children selected from 10 AWCs in the rural field practice area of Pt B D Sharma Postgraduate Institute of Medical Sciences, Rohtak and randomly allocated into 2 groups (5 in each): Intervention and Control group. First, the nutrition educational intervention module (a booklet) was designed for mothers of malnourished children. Second, the intervention was implemented on the intervention group and evaluated in terms of shift in zones as per colour coded ICDS growth charts, nutritional status, calorie and protein intake before and after intervention. Results: The proportion of children who were in yellow zone decreased from 82.5% to 27.5% (i.e. 55%) in intervention group and 85.0% to 57.5% (i.e. 27.5%) in the control group. The proportion of children who were in red zone decreased from 17.5% to 2.5% (i.e. 15%) in intervention group and 15.0% to 10.0% (i.e.05%) in the control group. This was statistically significant in absolute percentage change. Conclusion : Child health and nutrition programmes based on health education initiatives promote mother’s nutritional knowledge, child care practices and specific behavioral changes in caregivers which would improve the malnutrition status of children. 37.5% more overall improvement in malnourished children among intervention group occurred relatively as compared to control group. Keywords: community based intervention, malnourished children, mothers, nutritional educational intervention
Copyright (c) 2025 Varun Kumar Arora, Hement Kumar Sharma, Srishti Singh, Neha Grewal, Anjali Gupta, Trushna Parida (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Ensuring Dignity at Birth: Bridging Gaps in Respectful Maternity Care in India and Beyond
Introduction: Respectful maternity care (RMC) is a human-rights-based approach ensuring dignity, privacy, confidentiality, informed consent, effective communication, non-discrimination, emotional support, pain relief, choice of birthing position, and companionship during labour. These components are essential for improving maternal satisfaction, reducing mistreatment, and encouraging facility-based childbirth. Four studies were analyzed: tertiary care hospitals in Bhopal (n≈150) and Odisha (n=246), a community-based study in Northern India (n=485), and a global scoping review (10 studies). Results Gandhi Medical College, Bhopal, Madhya Pradesh – Tertiary Care (Shwetha et al., 2023): Patient satisfaction scores in labour rooms and OT ranged 4.55–4.59/5, indicating generally positive experiences. All India Institute of Medical Sciences, Bhubaneswar Odisha–Tertiary care (Yadav et al., 2023 n=246): 35% reported good RMC; dignified care (82%) and non-discrimination (79%) were strong; consent (48%) and confidentiality (52%) were weak. Barriers: staff shortage, workload. All India Institute of Medical Sciences, New Delhi, northern India rural villages – Community-based (Kaur et al., 2023, n=485): 88.7% experienced RMC; communication and autonomy scored 62.9%. Gaps: poor communication, no choice of birthing position, inadequate pain relief, absence of companion. Global Review – Multi-country (Mira-Catalá et al., 2024, 10 studies, Africa, Mexico, USA): Interventions like provider training, maternity open days, checklists, and continuous user feedback improved RMC. Reductions were noted in physical abuse (4%→2%), non-consented care (83%→65%), and verbal abuse (18%→11%), while women’s reports of respectful care increased from 12% to 64%. Conclusion: Although RMC practices are improving in India, significant gaps remain, particularly in consent, communication, autonomy, and emotional support. Prioritizing continuous provider training, patient-centered policies, monitoring mechanisms, and empowerment of women during childbirth is essential to ensure universally dignified, equitable, and high-quality maternity care. Keywords: Pregnancy, Privacy, Respect, Physical abuse, Patient Centered Care
Copyright (c) 2025 Rozaline Lenka, Srikanth Srinivasan, Yogesh Jain, Dr. Gautam Mohanan, Priyanka Sidholi, Sanjana Jaiswal, Smilee Choudhary (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Designing an interventional training program for infection prevention and control among medical undergraduates
Introduction: Infection prevention and control (IPC) practices are the cornerstone for control of Healthcare Associated Infections (HAIs) which are a significant global burden. There exists a gap in the knowledge, attitude and practice (KAP) among healthcare providers of various categories as well as intra-category knowledge-practice gaps. Methods: A desk review was conducted with the aim of designing an interventional training program for the medical undergraduates in our tertiary teaching institution. Various databases were searched and relevant articles were shortlisted. Information related to IPC practices applicable to work ethic of doctors was extracted and compiled. Results: The studies varied with respect to the study population, mode of intervention, time of assessment post-intervention and research methods used. Studies among medical students were few. Consistent knowledge practice gaps of 20-40% and improvement with interactive methods was seen. Most studies (65%) assessed knowledge change post-intervention at 1 month, change in attitude is demonstrable post 3 months. Use of qualitative research methods was low in studies among Indian medical undergraduates. A mixed method interventional KAP study among medical undergraduates with educational interventions was designed as a mixed-method research which included Focus Group Discussions. The KAP questionnaire was validated and tested for internal consistency (Crohnbach alpha for knowledge 0.8, attitude 0.8 and practice 0.7). Conclusion: The structured training program will be based on insights from the study which will also guide appropriate suggestions for concerned administrative authorities. Keywords: Infection Prevention and Control, Medical Undergraduates, Training Program Development
Copyright (c) 2025 Arushi Arora, Adarshjot Kaur Toor, Sanjeev Mahajan, Loveena Oberoi (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
From Mine to Makeup: Occupational Hazards of Mica Mining and Ethical Implications for India’s Cosmetic Industry
Introduction: Mica, a naturally occurring mineral, is widely used in India’s cosmetic industry for lipsticks, eye-shadows, nail polish, and powders. Despite its commercial importance, mica mining in states such as Jharkhand and Bihar is largely informal and unregulated, exposing workers, including children, to serious occupational hazards. These include respiratory diseases, musculoskeletal injuries, and psychosocial stress, compounded by unsafe working conditions and environmental degradation. Evidence synthesis on the occupational, environmental, and social consequences of mica mining in India is limited. Methodology: A scoping review was conducted using PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and grey literature, including NGO and investigative reports. Studies reporting occupational health outcomes, child labour, environmental exposure, or supply chain issues were included. Data were extracted on exposure, population, outcomes, and policy relevance, and findings were synthesized descriptively. Result: The review identified substantial evidence of occupational and environmental hazards, including chronic respiratory illness, musculoskeletal injuries, and widespread child labour. Environmental assessments highlighted soil and water contamination near mining sites. Reports confirm mica’s extensive use in the cosmetic industry and underline ethical concerns related to its sourcing. Existing policy initiatives, such as the Responsible Mica Initiative, show progress but enforcement remains limited. Conclusion: Mica mining in India poses significant occupational and environmental challenges. The cosmetic industry’s reliance on mica underscores an ethical imperative for responsible sourcing or safer alternatives. Strengthened regulations, elimination of child labour, and sustainable supply chain practices are critical to protect worker health and uphold industry ethics Keywords: Mica mining, Occupational health, Child labour, Environmental contamination, Cosmetic industry, India, Ethical sourcing, Public health
Copyright (c) 2025 Kunal Vats, Alan Lyander War, Ambreshwar Ghule, Yogesh Kumar Jain, Manoj Kumar Gupta (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Assessment of Opium Use Disorder and Opioid-Induced Bowel Dysfunction in a Rural Village of Western Rajasthan: A Cross-Sectional Study
Introduction: Opioid Use Disorder (OUD) affects 2.1% of India’s population. In western Rajasthan, opium use is culturally rooted and socially accepted. Opioid-Induced Bowel Dysfunction (OIBD) and Opioid Enteropathy (OE) are complications often overlooked in community settings, requiring population-level evidence. This study determines the prevalence of OUD in a rural village and assesses OIBD in those who had OUD, identifies individuals at high risk for OE, and characterizes the associated symptom profile in high-risk participants. Methodology: A community-based study was conducted in Khejarli, Jodhpur, using a 2-phase design. In Phase I, a universal sampling strategy was adopted, wherein eligible individuals were screened for OUD using the DSM-5 diagnostic criteria. In Phase II, OUD patients were assessed for OIBD using the Hindi-translated GSRS scale. High-risk OE was defined based on the presence of more than two Alarm symptoms with moderate to severe anaemia. Data were analysed using SPSS v23, applying descriptive and inferential statistics. Results: Out of 882 individuals screened, 136 (15.4%) were diagnosed with OUD (mean age: 49±14.2 years, 98.5% males). OIBD was in 113(83.1%), and 76(55.9%) of these individuals were identified as high-risk for OE, which was significantly associated with older age, lower educational status, longer duration, and greater severity of opioid use, higher morphine-equivalent consumption, financial debt due to opioid use, and presence of other substance use (p < 0.05). Conclusion: This study shows that a considerable burden of gastrointestinal complications exists among opioid users in rural communities. These findings recommend the need for early community-level screening and integrated public health interventions that address both opioid dependence and gastrointestinal health, particularly in resource-limited rural areas. Keywords: Opioid enteropathy, Opioid-induced bowel dysfunction, Opioid use disorder, Rural Population.
Copyright (c) 2025 Ateeq Ur Rehman Mullah, Ashish Agarwal, Pankaj Bhardwaj, Manoj Kumar Gupta, Chhagan Lal Birda, Prem Prakash Sharma, Manavi Vikram, Vaibhavi Minotra (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Gynaecological morbidities among women attending a cancer screening centre in rural Karnataka, India
Background: Reproductive illness is a common yet underreported issue among women in developing countries, including India, having a great impact on the health and quality of their lives. Studies have shown that despite this high prevalence, women in developing countries rarely approach health facilities. Methods: This was a cross-sectional study carried out among women attending a community cancer screening facility covering rural and semi-urban population of coastal Karnataka in Southern India. Participants’ demographic characteristics and reproductive history was assessed, and they were clinically screened for gynaecological morbidity. Study participants were subjected to per speculum examination and Pap smears followed by Visual Inspection with Acetic Acid (VIA) Results: Of the 599 women who consented to participate nearly 68% were in the age group of 30- 50 years. The Pap smear test diagnosed 36.9%of women with infection. Gynaecologic morbidity was found to be more (54.5%) among women less than 30 years of age and least (24.6%) in women more than 50 years of age. Predictably older women (>50 years of age) were observed to present with prolapse and this association was significant (p < 0.005). Around 51.3% of OCP users had infection on Pap smear versus 35.5% of non-users (p=0.048)., out of the 67 women positive for VIA, 3 women were found to have a positive Pap smear result, indicating presence of cervical cancer. Conclusion: The study underscores the urgent public health need to strengthen routine gynaecological screening, integrate reproductive health care into primary services, and promote community awareness. Early detection and timely management can prevent chronic complications and enhance women’s health and dignity across the life course.
Copyright (c) 2025 Zari Anjum, Suma Nair, Vibha Swaroop (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Behind the Glitter: Occupational, Environmental, and Public Health Impacts of India’s Mica Supply Chain
Introduction: Mica, a naturally reflective mineral, gives shimmer and glow to many cosmetic products such as lipsticks, eyeshadows, and highlighters. India remains one of the largest global producers of mica, particularly in Jharkhand and Bihar, where extraction is largely informal. This unregulated nature of mica mining exposes workers—including women and children—to unsafe occupational conditions, resulting in respiratory diseases, musculoskeletal disorders, and psychological stress. Beyond human health, the mining process contributes to environmental degradation and contamination of local ecosystems. Despite its economic significance, the broader public health and environmental implications of mica’s supply chain remain underexplored in India. Methodology: A scoping review was undertaken across PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar, supplemented with NGO and investigative reports. Studies and reports focusing on occupational hazards, environmental exposure, and community health outcomes related to mica mining and processing were included. Data were extracted on exposure type, affected populations, outcomes, and policy relevance, and were synthesized descriptively. Results: Evidence highlights serious occupational and environmental health challenges, including chronic respiratory illness, ergonomic strain, and child labour. Environmental assessments show heavy metal contamination of soil and water around mining regions. Broader community-level effects include malnutrition, poor sanitation, and limited healthcare access, contributing to an ongoing public health burden. Conclusion: India’s mica supply chain presents intertwined occupational, environmental, and ethical challenges. Addressing these requires stricter enforcement of safety standards, sustainable sourcing policies, and public health interventions to safeguard workers and mining-affected communities.
Copyright (c) 2025 Ambreshwar Ghule, Lyander Alan War, Kunal Vats, Yogesh Jain, Manoj Kumar Gupta (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Designing a BPACR Scoring System for a Tertiary Teaching Hospital.
Introduction: Birth Preparedness and Complication Readiness (BPACR) is a comprehensive strategy to promote timely utilization of skilled maternal, intranatal and neonatal care. Standardising the assessment of BPACR is of utmost importance to monitor effective implementation of related strategies and initiatives. Methods: A desk review was conducted with the aim of framing a locally relevant BPACR assessment tool. Various databases were searched and relevant articles were shortlisted and examined to study the items used in their respective BPACR scoring system. A contextually appropriate measurement tool for use in our tertiary teaching hospital was framed. Results: The reviewed studies demonstrated variation in BPACR assessment approaches. The number of items used ranged from 6 to 21 across various domains. Based on this review a scoring system was framed. Conclusion: A BPACR scoring system with 25 items, for use among post-partum women delivered at our tertiary teaching hospital was framed. Validity was ensured by group of experts from the departments of Community Medicine and Obstetrics and Gynaecology. Internal consistency was tested by Cronbach’s alpha (0.73). Each item will be given a score of 1 and grading done based on Bloom’s criteria as the items relate to knowledge, attitude and practice. As the institution is catering to mothers of different areas, our scoring system assesses individual preparedness. Keywords: Birth preparedness and complication readiness, BPACR Score, Tertiary teaching hospital.
Copyright (c) 2025 Kamini Raj, Sanjeev Mahajan, Adarshjot Kaur Toor, Suparna Grover (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
The Human Cost of Beauty: Occupational Risks and Public Health Burdens of Mica Mining in India
Introduction: Mica, a naturally shimmering mineral, forms the foundation of several cosmetic products, including eye shadows, highlighters, and nail polishes. In India, major mica deposits are found in Jharkhand and Bihar, where extraction remains largely informal and unregulated. Workers, including women and children, often mine under unsafe conditions with minimal protective equipment. Such practices expose them to a range of occupational hazards—respiratory illnesses, musculoskeletal disorders, injuries, and psychosocial stress—while also creating broader environmental and community health challenges. Despite the mineral’s economic value, research on the public health consequences of mica mining remains limited. Methodology: A scoping review was conducted using PubMed, Scopus, Web of Science, ScienceDirect, Google Scholar, and grey literature, including NGO and investigative reports. Studies focusing on occupational health outcomes, environmental exposure, or social determinants linked to mica mining were included. Data were extracted on exposure type, population, outcomes, and policy relevance, and synthesized descriptively. Results: Findings reveal significant evidence of occupational risks, particularly chronic respiratory disorders, ergonomic strain, and high rates of child labour. Environmental assessments report heavy metal contamination in soil and water near mining areas. Community-level effects include poor nutrition, limited healthcare access, and psychosocial strain among miners’ families. Conclusion: Mica mining poses a serious occupational and public health concern in India. Strengthening occupational safety standards, regulating informal mining, and promoting ethical, sustainable sourcing are critical to protect worker health and community well-being. Keywords: Mica mining, Occupational health, Public health, Child labour, Environmental contamination, India, Ethical sourcing.
Copyright (c) 2025 Lyander Alan War, Ambreshwar Ghule, Kunal Vats Vats, Yogesh Jain, Manoj Kumar Gupta (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Double Burden: Maternal Non-Communicable Diseases and Perinatal Outcomes in India
Introduction: The increasing prevalence of NCDs such as diabetes, hypertension, and obesity among women of reproductive age can lead serious and lasting impacts on the health of both mother and child. The objective of this narrative review is to understand the association between maternal NCDs and adverse perinatal outcomes. Methodology: PubMed, Scopus, and Google Scholar databases were searched for studies using keywords like "maternal non-communicable diseases", "perinatal outcomes", "gestational diabetes", "hypertension in pregnancy", "maternal obesity". Articles exploring the link between pre-existing or gestationally-developed NCDs and specific perinatal outcomes were selected and reviewed. Results: Evidence shows a strong, consistent link between maternal NCDs and adverse perinatal outcomes. Hypertensive disorders complicated an estimated 7–10% of pregnancies and according to one prospective cohort study, severe pre-eclampsia was associated with a more than eightfold higher risk of perinatal death (Risk Ratio 8.60). Some Indian studies report gestational diabetes mellitus (GDM) prevalence as high as 14%; findings from a study showed GDM is a strong predictor for macrosomia and neonatal hypoglycaemia. Findings from a key Indian analysis showed that obese pregnant women had substantially higher odds of developing GDM (OR 4.85) and hypertensive disorders (OR 3.83). Conclusion: The increasing prevalence of NCDs among pregnant women in India poses a serious threat to achieving national and global maternal and child health goals. The findings of this review show an urgent need to transition from a purely infection-focused antenatal model to an integrated one that includes routine screening, early diagnosis, and effective management of NCDs. Keywords: Pregnancy, Gestational, Perinatal Death, Noncommunicable Diseases, Obesity.
Copyright (c) 2025 Shuchita Solanki, Muskan Thakur, Lyander Alan War, Hrudyashwari Kishor Khadse, Nikita Singh, Yogesh Jain, Manoj Kumar Gupta (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Risk perception and influencing factors for substance abuse in college going adolescents in Rohtak city: A qualitative study
Substance use among young people is no longer an unfamiliar concern- it has slowly made its way into college campuses. Adolescents often experiment with tobacco, alcohol, or drugs out of curiosity, peer influence, or emotional stress, without fully understanding the long-term harm.2023 UNODC reports shows overall drug use increase by 23% over the last decade. Risk perception is shaped not only by individual choices but also by family values, social pressure, and media exposure. This study explores how college going students in Rohtak perceive the risks of substance use and what factors influence them. This qualitative study was carried out in five colleges of Rohtak city. Data were collected through focused group discussions with students selected by purposive sampling and In-Depth interviews were conducted with students willing to discuss more about the subject using a pre-designed semi-structured interview schedule. Data were recorded, transcribed and analyzed using inductive thematic analysis. Six broad themes emerged from the study. Many students considered substances like cigarettes and alcohol as normal or social habits. Peer pressure and college environment played a major role. Family and cultural factors also contributed, especially where substance use was normalized at home. Media and social platforms often glamorized such behaviors, further shaping attitudes. Although students recognized the health risks, many believed they were personally immune. Students stressed upon the importance of counseling, awareness programs, and stricter campus monitoring to prevent substance use. Substance use among adolescents is not just an individual decision, it is a reflection of society, cultural values, emotional issues and accessibility. Students, although, understand the risks, they often underestimate the consequences. To tackle this a multipronged strategy needs to be applied like strengthening preventive education program and teacher-student interaction, policy implementation and institutional support, parental and family engagement initiatives, community involvement and awareness campaigns.
Copyright (c) 2025 Narender Kumar, Varun Kumar Arora, Srishti Singh, Neha Grewal, Trushna Parida, Dr Anjali Gupta (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Proportion of Non-Alcoholic Fatty Liver Disease (NAFLD) and Its Risk Factors Among Diabetic Patients Attending a Diabetic Clinic at a Tertiary Care Centre in Rishikesh, Uttarakhand: A Cross-Sectional Study
Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common chronic liver disease worldwide and is closely linked with Type 2 Diabetes Mellitus (T2DM). Individuals with diabetes are at increased risk of hepatic steatosis, fibrosis, cirrhosis, and hepatocellular carcinoma. Despite the rising burden of metabolic diseases in India, region-specific data from Uttarakhand remain limited, particularly using non-invasive diagnostic modalities such as FibroScan with Controlled Attenuation Parameter (CAP). Aim: To estimate the proportion and determine the risk factors of NAFLD among diabetic patients attending a tertiary care centre in Rishikesh, Uttarakhand. Methods: A hospital-based cross-sectional study was conducted from December 2024 to May 2025 at All India Institute of Medical Sciences, Rishikesh. A total of 330 T2DM patients aged ≥30 years were enrolled using consecutive sampling. Data were collected through structured interviews, anthropometric assessment, biochemical investigations, and FibroScan. NAFLD was defined as CAP >238 dB/m, and liver fibrosis as liver stiffness measurement (LSM) >7.0 kPa. Statistical analysis was performed using SPSS version 25. Descriptive and inferential statistics, including independent t-test, Mann–Whitney U test, and Chi-square test, were applied. A p-value <0.05 was considered statistically significant. Results: The proportion of NAFLD among diabetic patients was 60% (198/330). Participants with NAFLD had significantly higher mean body weight (p=0.001), body mass index (p<0.001), and waist circumference (p<0.001). Lower per capita income (p=0.035), reduced platelet count (p=0.003) were also significantly associated with NAFLD. No significant associations were observed with age, sex, occupation, physical activity, glycaemic control, lipid profile, liver enzyme levels. Conclusion: NAFLD is highly prevalent among T2DM patients in this tertiary care setting in Uttarakhand. Obesity, central adiposity, and socioeconomic factors are key determinants. Routine screening using non-invasive tools and early lifestyle interventions are essential to prevent disease progression and related complications. Keywords: NAFLD, Type 2 Diabetes Mellitus, FibroScan, CAP, Risk Factors.
Copyright (c) 2025 Rohit Deoli, Ajeet Singh Bhadoria, Ravikant, Rohit Gupta, Shikha Thakur, Ravi Kumar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Perception and Experience of Indian Medical Students Regarding the Family Adoption Program in Delhi NCR
Introduction: The National Medical Commission introduced the Family Adoption Program (FAP) in 2022 under Competency Based Medical Education (CBME) offering Indian Medical Graduates opportunity to engaging with rural community, developing clinical skills, understanding importance of community engagement and cultivating a deeper understanding of social determinants of health. Methods: A cross-sectional study was conducted among MBBS students (1st year, 2nd year and 3rd year) from Santosh Medical College, Ghaziabad. Taking the proportion of students having good perception as 50%, the sample size was calculated to be 384. Convenient sampling was used to recruit participants for the study and a total of 416 participants were recruited from all three years of MBBS. Data was collected using pretested, semi-structured questionnaire covering socio-demographic details, rapport-building, identifying local communicable, non-communicable, vector-borne diseases and self-perceived skill enhancement. Data was entered in MS Excel and analysed using Stata MP-17 and and chi-square tests were applied to determine associations. Results: Out of 416 participants, 57.9% were females. Almost 91.8% students reported developing good rapport with their adopted families initially and 95.7% continued to have good rapport on subsequent visits. Most common NCDs, identified were Hypertension (47.6%), Diabetes (41.3%) and communicable diseases such as Typhoid (37.5%), URTI (28.1%) and LRTI (24.3%) were most common. Most common vector-borne disease was Dengue (31.3%). Superstitious beliefs regarding diseases and treatment were identified among 55.3% families. Previously undiagnosed medical conditions were identified in 14.2% families. The program improved communication, clinical skills and holistic understanding of community health with positive perception, partially positive and poor perception in 86.5%, 12.7% and 0.7% students respectively calculated through Likert scale. Conclusion: The FAP provided valuable community exposure and enhanced student competency in communication and clinical practice. It offers a holistic platform and links medical education with community health needs.
Copyright (c) 2025 Jyoti Shukla, Neha Jetli, Deepika Agrawal, Syed Hasan Nawaz Zaidi, Amod Kumar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Estimating the High-risk population of Hereditary Breast and Ovarian Cancer (HBOC) based on personal and family history in Jodhpur
Background: Breast cancer is the most common cancer among women worldwide and a leading cause of cancer-related deaths. In India, it accounts for over 14% of female cancers, with a rising incidence among younger women. Hereditary Breast and Ovarian Cancer (HBOC), primarily linked to BRCA1/2 mutations, significantly contributes to early-onset disease. Aim: This study aimed to estimate the lifetime risk of breast cancer among women in Jodhpur, Rajasthan, using the CanRisk tool, and to examine its associations with hereditary, reproductive, lifestyle, and sociodemographic factors. Methodology: A community-based cross-sectional study among 211 women (18–60 years) in Jodhpur used convenience sampling and a structured questionnaire. Lifetime breast cancer risk was estimated using the CanRisk tool, and data were analyzed with SPSS 23.0 using descriptive and inferential statistics. Results: Overall, 80.1% of women had a lifetime breast cancer risk ≥3.4% (national average). Higher risk was seen in younger (≤30 years), premenopausal, nulliparous, and single women, as well as those with early menarche, higher BMI, PCOD, diabetes, or a family history of cancer. Age at first childbirth and menopause showed no significant association. Conclusion: The study shows a high prevalence of elevated breast cancer risk among women in Jodhpur. Integrating hereditary, reproductive, and metabolic factors through models like CanRisk can enhance early detection and prevention. Further studies should refine risk assessment and explore additional factors. Keywords: Breast cancer, Hereditary Breast and Ovarian Cancer (HBOC), CanRisk tool, Risk assessment, Family History
Copyright (c) 2025 Manavi Vikram, Puneet Pareek, Manoj Kumar Gupta, Pankaj Bhardwaj, Vaibhavi Minotra, Ateeq Ur Rehman (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Prevalence of behavioural risk factors of non-communicable diseases among undergraduate medical students in Raipur city
Introduction: In 2021, non-communicable diseases (NCDs) caused 43 million deaths worldwide, including 18 million premature deaths, mostly in low- and middle-income countries. Studies in India show high prevalence of NCD risk factors among young adults. Medical students, despite their role in promoting health, are prone to unhealthy lifestyles. This makes their risk factor assessment essential to guide interventions for the well-being of the future healthcare workforce. Methodology: A cross-sectional study was conducted among 384 undergraduate medical students in Raipur City during the period of 2024-25, who were selected by simple random sampling. A self-administered questionnaire adapted from the WHO-STEPS instrument was used to assess risk factors. Results: Out of 384 students, 54.9% were males and 45.1% were females. The mean age of study participants was 21.23±1.96 years. The majority of students (65.4%) followed a mixed diet. Only 3.4% of students met the WHO recommendation of intake of ≥5 servings of fruits and vegetables/day. Frequent intake (≥3 days/week) of sugary drinks, fast food, and sweets/chocolates was reported by 20.3%, 33.3%, and 31.5%, respectively. Almost 15% of students reported regular consumption of extra salt. Around 69.5% of students engaged in adequate physical activity (≥150 minutes/week). Ever use of tobacco and alcohol was reported by 10.2% and 16.1% of students, respectively. More than half (54.16%) of the participants had one risk factor. Conclusion: There is a high prevalence of behavioural risk factors for NCDs among undergraduate medical students in Raipur city. These findings highlight the need for regular screening and targeted lifestyle counselling among college students. Keywords: Non-communicable diseases, risk factors, medical students
Copyright (c) 2025 Sanooja Sherin Chakkalakkunnan, Gouri Kumari Padhy (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Assessment of Night Eating Syndrome and its relationship with sleep, circadian rhythm and mood among college going students in Western Rajasthan: A Cross-sectional study
Introduction: Night Eating Syndrome is an eating disorder characterized by excessive evening or nighttime food intake, often accompanied by poor sleep, delayed circadian rhythms, and low mood. First described by Stunkard et al., now classified under DSM-5 as “other specified feeding or eating disorder.” Globally, prevalence ranges from 3-15%,while Indian studies show higher rates 54% in Punjab and 37.3% in Tamil Nadu. This study aimed to assess NES prevalence among college students in Jodhpur and its association with sleep,circadian rhythm,and mood, also identifying predictors. Methodology: A cross-sectional study was conducted among 673 college students from seven colleges under Jai Narain Vyas University, selected through multistage sampling. Data were collected using a semi-structured questionnaire comprising the Night Eating Questionnaire and SCRAM scale. Statistical analyses in SPSS v23 included chi-square, Mann–Whitney U, Spearman’s correlation, and logistic regression. Results: NES prevalence was 15.9%. Significant associations were seen with academic stream (p = 0.015), with higher rates among Commerce and Arts students. NES correlated with poor sleep quality, lower morningness, and higher depressive mood (all p < 0.001). Logistic regression revealed that poor sleep (AOR = 0.947, p = 0.035), lower morningness (AOR = 0.927, p = 0.008), and elevated depressive mood (AOR = 1.074, p = 0.004) were significant predictors of NES. Conclusion: NES was prevalent among college students in Jodhpur and linked to poor sleep and low mood, highlighting the need for awareness, mental health support, and sleep-friendly academic schedules. Keywords: Circadian rhythm, College students, Night Eating Syndrome, Prevalence, Sleep disturbance.
Copyright (c) 2025 Vaibhavi Minotra, Mamta Nebhinani, Manoj Kumar Gupta, Pankaj Bhardwaj, Manavi Vikram, Ateeq Ur Rehman Mullah (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Social Support and its Association with Socio-demographic Factors among Elderly in District Ghaziabad
Introduction: Elderly individuals often experience physical decline, loneliness, and dependence, making social support an essential determinant of their quality of life. With changing family structures in India, it is important to understand the level of social support available to the elderly and how it varies with socio-demographic factors. This study was conducted to assess level of social support among the elderly population in district Ghaziabad and to examine its association with socio-demographic factors. Methodology: A community-based cross-sectional study was carried out among 630 participants who were aged 60 years and above in rural areas of district Ghaziabad. Participants were selected by multistage random sampling. Data were collected using a predesigned semi-structured questionnaire, which included socio-demographic details and the Multidimensional Scale of Perceived Social Support (MSPSS). The data were analyzed using SPSS and chi-square tests were applied to determine associations. Results: Out of 630 elderly, 42.1% were aged 60–69 years, and 73.8% were males. The majority were Hindus (83.0%) and 52.7% were married. 31.9% were illiterate, 64.1% were not working and 48.6% financially dependent. Perceived social support was moderate in 65.2%, high in 17.9%, and low in 16.8%. Family provided the highest support (mean score 4.12 ± 1.26). Significant associations were found between social support and age, religion, caste, marital status, education, occupation, financial dependency, socio-economic status, and family type (p<0.001). Conclusion: Most elderly reported moderate social support, mainly from family. Socio-demographic factors significantly influenced support, highlighting the need to strengthen family and community networks.
Copyright (c) 2025 Nidhi Arora, Gajendra Kumar Gupta, Deepika Agrawal, Rahul Kumar, Syed Hasan Nawaz Zaidi, Amod Kumar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Flexible Flat Foot Among Adults: Prevalence, Footwear Influence, and Implications for Fall Risk — A Narrative Review
Introduction: Flexible flat foot (FFF) is a common postural variation in which the foot's medial arch collapses during weight-bearing. It is influenced by various factors, including long-standing hours, footwear, trauma, BMI, and sex. This review explores the prevalence of flexible flat feet in adults; the effects of footwear, particularly improper or inadequate arch support, on balance and fall risk; and their association with balance and fall risk. Methodology: A narrative review was conducted by searching the PubMed, Scopus, Google Scholar, and ScienceDirect databases for studies published between 2015 and 2025. Keywords included “flat foot", “flexible flat foot", “pes planus", "footwear", "balance", and “fall risk". Studies on adults (18–35 years) assessing FFF or flat foot prevalence, the impact of footwear on flat foot and foot posture, and/or balance and falls were included in this review. Results: Available studies report variable prevalence of flat feet, ranging from 11% to 26%, and of flexible flat feet, around 13% to 15%, in adults. Footwear emerged as a key modifying factor, as studies suggest that footwear choices and prolonged use can contribute to a higher prevalence of flat feet, particularly when wearing low-arch-support shoes. Footwear has also been linked to altered balance in adults with flat feet, potentially increasing the risk of falls and injuries. Conclusion: Flexible flatfoot is a common yet under-researched musculoskeletal condition with notable functional and postural effects in adults. There is a need to raise awareness among adults about supportive footwear choices for daily use and to implement institutional-occupational reforms regarding footwear restrictions, as evidence suggests the prevalence of FFF among adults is increasing, predisposing individuals to increased fall risk. Keywords: Adult, Flatfoot, Accidental Falls, Shoes, Prevalence, Footwear, Balance.
Copyright (c) 2025 Muskan Thakur, Nikita Singh, Hrudyashwari Kishor Khadse, Shuchita Solanki, Yogesh Kumar Jain, Manoj Kumar Gupta (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Harnessing Digital Technologies for Enhanced Healthcare Delivery and Patient Outcomes: Evaluating IPHS Compliance in Tamil Nadu
Background: The Indian Public Health Standards (IPHS) 2022 provide uniform benchmarks for healthcare facilities across India. Ensuring compliance with IPHS is vital to improve service delivery and patient outcomes nationwide. Tamil Nadu, a high-performing state in health with a track record of innovation has implemented digital IPHS assessment toolkit using Open Data Kit (ODK) for real-time monitoring This study evaluates IPHS compliance across public health facilities in Tamil Nadu and explores patient perspectives on care quality. Methods: We conducted a mixed-methods evaluation. Quantitative data on IPHS compliance were collected via ODK-based checklists covering six domains (Infrastructure, Human Resources, Diagnostics, Drugs, Service Delivery, Governance) across facilities (DHs, SDH, CHCs, PHCs, and AAMs). As of October 2025, state-level domain compliance scores were analysed and categorized into performance bands (<25%, 25–50%, 50–69%, 70–79%, >80%). Qualitative insights were obtained from 14 patient interviews at a 2 District Hospitals and 1 UPHC in Chennai region coded to identify key themes. Results: Tamil Nadu’s facilities showed high overall compliance: 68% of facilities scored >80% in Service Delivery and Governance domains. Over 80% of facilities achieved at least 50% compliance in all domains except Diagnostics (~64%). As per interview most patients reported prompt and comprehensive diagnostic services (93% endorsement) and attentive, continuous medical care (86%). Universal access to free care and medicines was praised (93%), and care quality was perceived as high and patient-centric (79%), fostering trust and continuity (71% had repeat visits). However, 36% of patients faced financial burden for advanced diagnostics not available on-site. Conclusion: Tamil Nadu’s IPHS compliance exceeds national trends. The ODK-based digital assessments and dashboard have enabled gap identification and data driven governance, correlating with positive patient experiences. Policy recommendations include targeted investments in weaker domains, leveraging digital monitoring for continuous quality improvement, and expanding essential diagnostic services.
Copyright (c) 2025 Arpita Aggarwal, Ayushi Rai, Swarnika Pal, K Madan Gopal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
Prevalence, Risk Factors and Perinatal Outcomes of Gestational Diabetes Mellitus Among High-Risk Pregnant Women in West Bengal
Background: Gestational Diabetes Mellitus (GDM), characterized by insulin resistance and hyperglycemia (≥140 mg/dl) during pregnancy, increases the risk of adverse outcomes. Data on GDM from hard-to-reach regions of West Bengal remain limited. The Child in Need Institute (CINI) implements the “CINI Method,” integrating case management, community mobilization, and system strengthening approach to improve health outcomes. Aims & objectives: This study aims to explore the GDM prevalence, associated factors, and perinatal outcomes among pregnant women from northern and southern districts of state. Methodology: From September 2023 to July 2025, a prospective cohort study was conducted among high-risk pregnant women (N=3026) in remote blocks: Gosaba (n=1419) in South 24 Parganas (south), two blocks in Kalimpong (n=1105) and one (n=502) in Darjeeling district (north). The intervention included system strengthening, community mobilization, behaviour change, early risk prevention, nutritional counselling, IFA supplementation, gestational weight tracking and birth preparedness. Blood sugars levels were extracted from Mother and Child Protection Card. Results: Overweight and obesity (body mass index ≥25kg/m2) was observed in 25% of women, predominantly from northern districts (75%) and in those aged ≥20 years (91.3%). GDM prevalence was 17% (421/2452), higher in northern districts (56%) and Hindus (68.4%). GDM was associated with higher median maternal age (26 vs. 24 years, p<0.001), higher BMI (30% vs. 23.5%; Odds Ratio 1.4; 95% CI: 1.12-1.78, p=0.004) and multiparity, (>2 deliveries, 13.3% vs. 6.8%, p<0.001), but not education, caste or income. GDM increased the risk of premature births (OR 1.41; 1.11-1.78, p=0.004) and caesarean deliveries (57.7% vs 51.9%, p=0.038). Nutritional counselling reduced junk food intake (49%→9.4%, p<0.001) and improved dietary diversity (87%→99.4%, p<0.001) between 3rd to 9th months. Conclusion: High GDM prevalence especially among older and overweight women from northern districts of West Bengal, was linked to adverse perinatal outcomes, highlighting the need of strengthened community-based screening and management.
Copyright (c) 2025 Tila Khan, Ipsita Bhattacharjee, Shishir Biswas, Sreeparna Ghosh Mukherjee (Author) https://creativecommons.org/licenses/by-nc-nd/4.0/
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.
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/