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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India’s HPV vaccine rollout: from a welcome launch to an elimination strategy
India’s recent nationwide rollout of human papillomavirus (HPV) vaccination marks an important moment in cancer prevention. The national campaign, launched in February 2026, offers a single dose of quadrivalent HPV vaccine to eligible 14-year-old girls free of cost through government health facilities, with plans to continue vaccine availability through routine immunisation sessions after the initial campaign phase (1,2). Prophylactic HPV vaccines are most effective when administered before exposure to infection, making early adolescent vaccination central to prevention. In its 2022 position paper, the World Health Organization (WHO) recommended a one- or two-dose schedule for girls aged 9–14 years, with HPV vaccination positioned as a foundational pillar of the global strategy to eliminate cervical cancer as a public health problem (3). Importantly, India has contributed directly to the evidence supporting a single-dose approach. A multicentre prospective cohort study from India reported that a single dose of quadrivalent HPV vaccine provided high protection against persistent HPV 16/18 infection at 10 years, with efficacy comparable to two- and three-dose schedules (4).
Copyright (c) 2026 Manya Prasad, Umesh Kapil, Pradeep Aggarwal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Feasibility of a Multi-Stakeholder Engagement Model for Community-Based Management of Malnutrition
Introduction: Childhood undernutrition remains a major public health challenge in India, with stunting at 35.5%, wasting at 19.3%, and underweight at 32.1% among children under five, disproportionately affecting rural areas. Gaps in early identification, treatment access, and caregiver knowledge limit the effectiveness of conventional programs. Community-based Management of Malnutrition (CMM) integrates local interventions with system convergence and caregiver empowerment to ensure sustained gains. This study aimed to develop a feasible village-level CMM delivery model focusing on stakeholder engagement, caregiver empowerment, and implementation fidelity. Methods: A multistakeholder team was formed through systematic mapping of village actors, including Sarpanch, Medical Officers, health workers, ASHAs, Anganwadi Workers (AWWs), and supervisors. Consultative discussions finalized camp plans, roles, and logistics. Caregivers of malnourished children were mobilized via ASHAs and AWWs. Process indicators - attendance, stakeholder participation, fidelity to planned activities, and operational feasibility, were documented. Growth outcomes were assessed after 3 months. Results: The SHINE Model: Stakeholder and Health-system Integration for Nutritional Empowerment model comprised five stations: anthropometry; anemia screening; demonstration of calorie-dense recipes using local foods and scheme awareness; health talks on balanced diet, weaning, and danger signs; and symptom-based treatment and referral. A total of 33 caregiver–child pairs (71.7% invited) attended. The 4-hour camp maintained fidelity to the planned activities, with consistent adherence to stakeholder roles and minimal additional costs, demonstrating operational feasibility. At 3 months, median (IQR) weight gain was 0.7 (0.3–1.0) kg and height gain was 1.0 (0–1.5) cm. Weight gain exceeded expected growth velocity in 61.3% (19/31) of children, while 16.1% (5/31) exceeded expected height gain as per WHO standards. Conclusions: This village-level CMM model demonstrated feasible, high-fidelity implementation without additional resources. By empowering caregivers and strengthening convergence between health and nutrition services, it supports early identification and community-based management of malnutrition. Integration with Village Health and Nutrition Days (VHNDs) offers a scalable framework for rural settings.
Copyright (c) 2025 Surabhi Puri, Harshal Ramesh Salve (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Relationship of Vitamin D status with obesity amongst children residing in Himachal Pradesh, India
Background Vitamin D deficiency and obesity have been recognized as significant health burden among children globally. Aims & Objectives We investigated the relationship between Vitamin D status and obesity in apparently healthy school children residing in Himachal Pradesh, India. Methodology A total of 800 school children (386 boys and 414 girls) aged 6-18y were enrolled from two high altitude regions (>1000 meters) of Himachal Pradesh, India. Fasting blood samples were collected for the estimation of serum 25-hydroxyvitamin D (25-OHD), using automated autoanalyzer (chemiluminescent immunoassay). The data was collected on age, gender, height, and weight using the standard equipments and procedure. The body mass index (BMI) was calculated for the determination of overweight and obesity. The association between serum 25-OHD and BMI was assessed using statistical methods carried out on STATA (version 14) software. Results A total of 573(71.6%) children were found with normal adiposity followed by underweight (214, 26.8%) and overweight (13, 1.6%). No significant difference was observed in the distribution of children in different categories of BMI and Vitamin D (p=0.580), neither in boys (p=0.449) nor in girls (p=0.330). Further, the correlation analysis also demonstrated a lack of correlation (r=0.04, p= 0.227) between serum 25-OHD and BMI. Conclusions Body adiposity was not associated with Vitamin D status of children in the present study. Key words Vitamin D, children, obesity
Copyright (c) 2025 Dr. Gajendra Singh, Prof. Umesh Kapil (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Early postnatal care and full immunization: district-level evidence from National Family Health Survey (NFHS-5), India
Introduction Full immunization (12–23 months) remains uneven across Indian districts. Early postnatal care (PNC ≤2 days) may strengthen contact with the health system and improve vaccine completion. We examined whether districts with higher early PNC coverage also have higher full-immunization coverage. Methods Cross-sectional ecological analysis using NFHS-5 (2019–21) district factsheets (≈708 districts). Exposure: PNC within 2 days (%). Outcome: full immunization at 12–23 months (%). Using a simple DAG, we prespecified a minimal adjustment set: ANC ≥4, institutional births, women’s education (≥10 years) and literacy, improved drinking water, improved sanitation, clean fuel, adolescent motherhood, third-or-higher-order births, and sex ratio at birth. We also included state fixed effects. Primary analysis: OLS with state-clustered robust SEs. Effects are percentage points(pp) change in full immunization per +10-pp higher PNC. Robustness is checked using spline for non-linearity, influence trimming, leave-one-state-out. Results We will present adjusted associations of Change in full immunization per 10 percentage points (pp) in PNC with 95% CIs, diagnostics, and sensitivity results. Preliminary checks supported linearity, with estimates stable to influence trimming and leave-one-state-out. Conclusions A DAG-guided minimal adjustment with state fixed effects yields transparent, policy-relevant estimates from routine survey indicators. If a positive association is confirmed, strengthening early PNC, alongside ANC and institutional delivery, could help improve vaccine completion. This shows how to move beyond “adjust for everything” toward defensible models for MCH program analytics.
Copyright (c) 2025 Karthik Balajee Laksham, Rizwan Suliankatchi Abdulkader (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence of Adverse Events Following Immunization (AEFI) among Children (0–16 Years) Receiving Routine Vaccines under the National Immunization Schedule: A Cross-Sectional Study in a Tertiary Hospital, June September 2025
Introduction: India’s National Immunization Schedule (NIS) ensures universal access to vaccines against vaccine-preventable diseases 2. Although vaccines are safe, no vaccine is entirely without risk, and adverse reactions will occasionally occur following immunization 3. Adverse Events Following Immunization (AEFI) require robust monitoring to maintain public confidence and safety surveillance Objectives: To estimate the prevalence of AEFI among children (0–16 years) receiving routine vaccines under NIS and to identify sociodemographic and vaccine-related factors associated with AEFI occurrence in a tertiary care setting Methodology: A cross-sectional study was conducted from June to September 2025 at the Immunization Clinic of a tertiary hospital in West Bengal. A total of 286 children (0–16 years) and their caregivers were recruited. Data were collected using a pre-tested structured questionnaire capturing: Sociodemographic profile, Vaccine type, dose, and site, Occurrence and type of AEFI within 7 days post-vaccination. Descriptive statistics were used to estimate prevalence, and the Chi-square test assessed associations between independent variables and AEFI occurrence, with p < 0.05 considered significant Results: The overall prevalence of AEFI was 25.9% (n=74). The most common AEFI was fever (82.4%), followed by local swelling at the injection site (28.4%). Most AEFIs appeared within 24 hours of vaccination, with fever subsiding by day 3, while 5.4% of swelling cases persisted up to day 7. A majority of AEFIs (63.5%) occurred in the 1 to below 9 month age group, followed by 16–24 months (16.2) Conclusion: The study highlights that while most AEFIs are minor and self-limiting. Strengthening AEFI surveillance systems, and ensuring timely management and reporting are crucial to sustaining trust in India’s Universal Immunization Programme
Adverse Events Following Immunization, National Immunization Schedule, Universal Immunization Program, Vaccine Safety, Children, India
Copyright (c) 2025 Dr Haritha H P, Dr Gitismita Naik, Dr Sunil Dash (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Need based training of Community Health Volunteers for Cervical Cancer in Delhi – A before and after study
Background: Cervical cancer, accounts for 6%–29% of all cancers among women, is the 2nd most common cause of cancer among females in India after cancer of breast. Nearly 20%–25% of the cervical cancer related death globally occurs in India. Key to reduce burden of cervical cancer is early detection with timely treatment. Under National Health Mission, community health platforms are functioning and its members play key role in generating awareness related to health, hygiene, nutrition, water, sanitation and social determinants in community. The present study identified gaps in awareness about cervical cancer among community health volunteers (CHV) and addressed through need- based training. Materials &Methods: A before and after study was conducted among 135 CHV from January-December,2023 in Delhi, using 100% sampling technique. They were interviewed using pre-tested structured questionnaire and training was provided addressing gaps identified in pretest. Data analysis was done by Microsoft excel, SPSS Result: The mean pretest score 8.47(SD=4.76) improved to 18.29(SD=2.92) post test score. The knowledge score of CHV showed statistically significant improvement (P<.0001). There was significant improvement in scores of all areas of cervical cancer except participation in health education programme , at the end of 6 months. Conclusion: The need-based assessment proved effective in identifying gaps in knowledge about various aspects of cervical cancer among CHV which is critical for uptake of any screening program in a developing country. Thus, need based capacity building of health workforce is essential to achieve the goal of universal health coverage.
Cervical Cancer, need based training, community health volunteers.
Copyright (c) 2025 Dr Sudipta Basa, Dr Nandini Sharma, Dr Madhulekha Bhattacharya (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Sociodemographic, clinical and dietary determinants of Gestational diabetes mellitus: A Case-control Study.
Title: Sociodemographic, clinical and dietary determinants of Gestational diabetes mellitus: A Case-control Study. Introduction: Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy contributing to adverse maternal and neonatal outcomes. Its growing prevalence in India is linked to rising maternal age, overweight, and changing dietary habits. Identifying modifiable determinants, especially nutritional factors, is essential for prevention and early intervention. Methods: A case-control study was conducted among 100 pregnant women (50 newly diagnosed GDM cases and 50 controls) attending the antenatal clinic of Department of Obstetrics and Gynecology, JNMCH, AMU, Aligarh. Sociodemographic data was collected. Dietary intake and dietary diversity score (DDS) were assessed using 24-hour recall. Chi-square, independent t-test, and Fisher’s exact tests were applied using IBM SPSS version 20. Results: Socio-demographic factors were not found to be associated with GDM. Mean pre-pregnancy BMI was significantly higher among GDM cases than controls (26.07 ± 3.86 kg/m² vs 23.21 ± 3.35 kg/m²; p < 0.001). Poor dietary diversity (DDS<5) was higher in GDM cases than controls (40% vs 24%, p=0.06) though not statistically significant. Previous history of GDM was found in 12% cases vs 2% controls. Mean calorie, fat, carbohydrate and dietary fibers intakes were higher, and protein intake was lower among cases than controls although differences were not statistically significant. Conclusion: Higher pre-pregnancy BMI is a key modifiable risk factor for GDM. Promoting optimal weight attainment before planning pregnancy, taking fiber-rich diets, and improved dietary diversity among women of reproductive age women can reduce metabolic susceptibility and mitigate GDM risk.
Gestational Diabetes Mellitus, Determinants, Pre-pregnancy BMI
Copyright (c) 2025 Shafia Shafiq Shafia (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Effect of School Eye Health Education Program on Eye Health Knowledge and Practice Among School Students in Rural Aligarh: An Interventional Study
Background: Vision impairment in children remains a significant public health concern, with undiagnosed refractive errors adversely affecting academic performance and quality of life. Prolonged exposure to digital devices and near-distance activities has escalated the risk of myopia among school-age children. Rural populations are especially vulnerable due to limited awareness and restricted access to eye care services. Despite the recognized role of school-based health education in shaping early health behaviours, few Indian studies have evaluated structured interventions targeting ocular health literacy in rural settings. Objectives: To assess baseline knowledge, attitudes, and practices (KAP) regarding eye health among rural school students and to evaluate the effectiveness of a targeted health education intervention in improving these parameters. Methods: A single-arm quasi-experimental study was conducted in Jawan Block, Aligarh district, Uttar Pradesh. A total of 175 students from Classes VI–VIII across two randomly selected junior high schools participated. A validated KAP questionnaire (Cronbach's α = 0.83) was administered at baseline and at three-month follow-up. The intervention comprised eye health education using IEC charts and posters developed from the AIIMS Primary Eye Care booklet, supplemented by visual acuity testing and referrals. Results: Significant improvements were observed across all three domains. Knowledge of ocular symptoms rose from 65.3% to 88.2% (p<0.001), awareness of myopia from 25.3% to 66.0% (p<0.001), and awareness of eye donation from 24.0% to 83.3% (p<0.001). Attitudinally, spectacle-related stigma declined significantly (25.3% to 10.4%, p<0.001), while support for peers wearing glasses increased from 60.7% to 91.7% (p<0.001). In practice, regular outdoor activity improved (70.0% to 84.7%, p=0.002), use of unprescribed eye drops fell (34.0% to 20.8%, p=0.011), and eye clinic attendance rose from 40.0% to 56.9% (p=0.004). Conclusion: A structured, contextually appropriate eye health education intervention produced significant improvements in ocular health KAP among rural school children. Integration of eye health education into school curricula, with active participation of teachers, parents, and local health workers, is recommended to sustain these gains and reduce avoidable childhood visual impairment.
Copyright (c) 2025 Mohd Yasir Zubair Yasir, Absar Ahmad, Shubham Upadhyay, Saira Mehnaz, Uzma Eram (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
To investigate the prevalence of leukorrhea among women attending Gauhati Medical College & Hospital and to accurately identify associated pathogenic microorganisms through conventional and molecular (16S rRNA sequencing) analyses.
Introduction: Leukorrhea, a non-bloody vaginal discharge, can be physiological or pathological. Pathological leukorrhea is commonly caused by microbial infections and presents symptoms like itching, burning, and pain. Early and accurate microbial identification is essential for effective treatment and management. Methods: A total of 50 vaginal swab samples were collected from women experiencing leukorrhea at a tertiary care hospital in Guwahati. The samples were subjected to morphological (colony characteristics), biochemical (Gram staining, catalase, citrate, indole), and molecular (16S rRNA gene sequencing) analyses. Fungal identification was done using LPCB staining and chromogenic media. Results: Biochemical and morphological methods identified common pathogens such as E. coli, Klebsiella spp., Staphylococcus spp., and Candida albicans. However, molecular analysis revealed the presence of Staphylococcus cohnii and Stutzerimonas stutzeri, highlighting discrepancies in traditional identification techniques. This underscores that species-level confirmation is only achievable through molecular sequencing methods, especially for atypical or non-culturable organisms. Discussion: The highest prevalence of leukorrhea was observed among women aged 30–35. Traditional methods were insufficient for definitive species-level identification, proving the critical need for sequencing technologies in microbial diagnostics. Conclusion: Accurate detection of pathogenic microbes causing leukorrhea requires integrating molecular sequencing techniques with classical methods. Sole reliance on morphological and biochemical tests can lead to misidentification and suboptimal treatment. This study emphasizes the need for molecular diagnostics to inform precise clinical interventions.
Leukorrhea, Pathogenic microbes, 16S rRNA sequencing, Molecular identification, Reproductive tract infections (RTIs)
Copyright (c) 2025 Syeda Tamanna (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
The prevalence of sleep disorders in adults: a descriptive population-based study in Western Uttar Pradesh
Background Sleep-related disorders are increasingly recognized as important contributors to non-communicable diseases, particularly cardiovascular conditions. Disorders such as obstructive sleep apnea (OSA), insomnia, and poor sleep quality are linked with hypertension, diabetes, obesity, and physical inactivity. Despite their growing significance, community-based data from India, especially Western Uttar Pradesh, are limited. Early detection through simple screening tools like the STOP-BANG questionnaire can facilitate timely intervention and reduce disease burden. Aims & Objectives Aim: To assess the prevalence of sleep-related disorders and their association with cardiovascular risk factors. Objectives: (1) To estimate the prevalence of sleep-related disorders; (2) To determine the prevalence of cardiovascular risk factors; (3) To assess their association Methodology A community-based cross-sectional study was conducted among 1600 adults aged 30–70 years in four districts of Western Uttar Pradesh using multistage random sampling. Data were collected using validated tools including the Global Sleep Assessment Questionnaire, Pittsburgh Sleep Quality Index, STOP-BANG questionnaire, Epworth Sleepiness Scale, and Global Physical Activity Questionnaire. Anthropometric and clinical measurements were recorded. Results Sleep-related breathing disorders and insomnia were observed in 37% and 36% of participants, respectively. Poor sleep quality was reported by 23.9%, and 11% had daytime dysfunction. OSA prevalence (STOP-BANG ≥3) was 11.8%, significantly higher among males (p<0.001). Overweight/obesity (34.3%), hypertension (19.3%), and diabetes (12.3%) were common. Significant associations were found between sleep disorders and cardiovascular risk factors. Conclusion Sleep-related disorders are highly prevalent and strongly associated with cardiovascular risk factors. Health practitioners should be aware of this high prevalence, as early identification and treatment can improve quality of life and may reduce later morbidity and mortality.
sleep-related disorders, obstructive sleep apnea, cardiovascular risk factors,
Copyright (c) 2025 Rambha Pathak, Dr.Rashmi Upadhyay, Dr. Saurabh Srivastava, Dr.Kiran Jakhar, Dr Abhishek Bharti, Dr Kriti Singh (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence of Workplace Violence Against Doctors in a Tertiary Care Hospital of Delhi
Background: Workplace violence has emerged as a serious occupational hazard among healthcare professionals globally, affecting both developed and developing nations. In India, nearly three-fourths of doctors have faced some form of workplace violence, adversely impacting their safety, morale, and quality of patient care. This study aimed to assess the prevalence, associated factors, and consequences of workplace violence against doctors in a tertiary care hospital in Delhi. Aim: To study the prevalence of workplace violence against doctors in a tertiary care hospital of Delhi. Objectives: To determine the prevalence of Workplace violence against doctors at a tertiary care hospital of Delhi. Methods: A cross-sectional study was conducted among 420 doctors, including interns, junior residents, senior residents, and consultants from 14 departments of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Participants were selected using probability proportionate to size and simple random sampling. Data were collected using a pre-validated questionnaire on socio-demographic details, experiences of violence, and reporting practices. Analysis was done using SPSS version 21. Ethical clearance was obtained. Results: Workplace violence was reported by 63.6% (95% CI: 58.9%–68.2%) of doctors, primarily verbal abuse (63.6%; 95% CI: 59.0%–68.2%) and verbal threats (55.5%; 95% CI: 50.8%–60.1%). Incidents occurred mostly in clinical departments and during night shifts, with patients’ attendants (71%) as the main perpetrators. Only 33.3% had received formal communication-skill training, and half of the participants were aware of workplace violence laws. Although reporting procedures existed for 62.8%, only 34.0% were aware of the actual mechanism, and just 49.4% reported the incident. Violence led to emotional distress (74%), work-life imbalance (62%), and changes in patient management (58%). Conclusion: Workplace violence negatively affects doctors’ mental health and clinical performance. Strengthening hospital security, enforcing legal safeguards, and enhancing communication skills training are to promote a safe and supportive healthcare environment.
Workplace violence, Doctors, Verbal abuse
Copyright (c) 2025 MOHIT JAIN, ANITA KHOKHAR (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
To Study impact of Anaemia on fungus growth in anaemic patients.
Introduction: This study has been conducted in semi-urban area of Muktsar District, Punjab. A big section of people suffer from fungal infection due to poor hygiene, bad food habits and untreated anaemia. Objectives: 1. To examine impact of anemia on fungus growth in anaemic patients. Materials and Methods: For purpose of study, applied clinical research was done on 32 patients in a randomized controlled trial method in 2024. Patients were divided in 2 groups , 16 each in experimental and non experimental methods. For Data collection and experiments, 2 lab technicians and a pharmacist helped. To achieve the objectives of the study, primary data was collected from 32 patients selected from Sri Muktsar Sahib District of Punjab. SPSS, version 16 was used for Chi square test, Mean value and Standard Deviation for data of Haemoglobin, Blood sugar and Blood pH was taken Results: The study revealed that on giving regular iron supplements with antifungal treatment improvement was 1.8 times more than antifungal treatment alone. Relapse rate of fungus infection in non-experimental group was 2.3 times more than experimental group. Percentage of fungus cure increased upto 71.2 percent after giving iron supplements along with antifungal treatment. In non- experimental group it was only 28.7 percent. Interestingly, on comparison of both the groups, the percentage of patients with complete cure was 42.5 percent more than the non- experimental group.
Copyright (c) 2025 Seema Goyal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Comparative Evaluation of Residual Diagnostic Measures for Outlier Detection in Linear Regression: An Empirical Study Using Heart Rate Data
Outliers in medical datasets can substantially distort regression models, leading to biased estimates and unreliable clinical inferences. This study evaluated residual-based diagnostic methods-including standardized residuals, Cook's Distance, DFFITS, DFBETAS, Covariance Ratio, and standardized scores-for detecting influential observations in a simple linear regression model. Using age as the predictor and heart rate as the outcome, data from 30 individuals were analyzed. The initial model (R² = 0.22) revealed one highly influential outlier (heart rate = 290 at age 42), consistently identified across multiple diagnostics. Removal of this case improved model adequacy, yielding a more stable regression (R² = 0.10) with no further significant outliers detected. Findings highlight that even a single outlier can markedly distort regression-based conclusions, underscoring the importance of employing complementary diagnostic tools to ensure valid statistical inference in medical research.
Outlier detection linear regression residual diagnostics
Copyright (c) 2025 Dr Shashank Kirti (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence of Low Bone Mineral Density and Assessment of Screening Tools in a Rural Area of Delhi
Introduction Osteoporosis poses a disproportionate burden on postmenopausal women, yet access to DXA-based bone mineral density (BMD) measurement remains severely limited in rural India, with only 700–800 scanners serving over 140 million postmenopausal women. This study aimed to determine the prevalence of osteoporosis and osteopenia in a rural Delhi cohort, examine associations with lifestyle and menopausal symptom burden, and compare the diagnostic performance of five validated screening tools—OSTA, SCORE, ABONE, ORAI, and OSIRIS—against DXA-measured BMD. Methodology This community-based cross-sectional study enrolled 94 women aged 40 years and above at the Rural Health Training Centre, Najafgarh, under the SNSP Abhiyan. BMD was assessed via portable peripheral DEXA at the right calcaneus and classified per WHO T-score criteria. Participants completed a sociodemographic and lifestyle questionnaire and the validated 11-item Menopause Rating Scale (MRS). Diagnostic performance of five risk scores was evaluated using sensitivity, specificity, PPV, NPV, and ROC curve analysis. Results Mean age was 52.5 ± 8.8 years and mean age of menopause was 44.8 ± 9.9 years. BMD was abnormal in 93.7% of participants—51.1% osteopenic and 42.6% osteoporotic. Lower educational status was significantly associated with abnormal BMD (p = 0.028). Multivariate regression identified age (p = 0.038) and somatic menopausal symptom severity (p = 0.026) as independent predictors of reduced BMD. OSTA demonstrated the highest sensitivity (85.7%) and NPV (98.1%) with an AUC of 0.73. SCORE had the highest PPV (85%) but poor sensitivity (42.5%) and an AUC of 0.50. ABONE, ORAI, and OSIRIS showed moderate performance with AUCs of 0.53–0.57. Conclusion This study reveals a high burden of low BMD among rural women in Delhi. OSTA emerged as the most effective primary screening tool, supporting targeted DXA referrals in resource-constrained settings. Age and somatic menopausal symptom severity were significant predictors of reduced BMD, highlighting the skeletal consequences of estrogen deficiency. Integration of OSTA into rural primary care protocols, alongside development of population-specific screening questionnaires, is strongly recommended.
Copyright (c) 2025 Anubha gupta, Ghurumourthy D., Geeta Yadav (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Health Problems and Healthcare Utilization among Urban Slum Residents of Ghaziabad: A Cross-Sectional Study
Abstract Title: Health Problems and Healthcare utilization among Urban Slum Residents of Ghaziabad: A Cross-Sectional Study. Introduction: Urban slums face overcrowding, poor sanitation, and limited healthcare access, leading to a high burden of disease. Respiratory infections and chronic illnesses like hypertension are common health issues in these settings. Healthcare utilization is shaped by cost, availability, and awareness, often limiting timely care. This study explores health problems and healthcare utilization patterns among urban slum residents of Ghaziabad. Methodology: A community-based cross-sectional study was conducted among 384 residents from four randomly selected urban slums of Ghaziabad. Participants were interviewed using a pre-tested, semi-structured questionnaire covering socio-demographic details, commonly reported illnesses, and health-seeking practices. Data were entered in MS Excel and analyzed using appropriate software, with a p value <0.05 considered significant. Results: The study revealed that respiratory problems were the most prevalent health issue, affecting 191 participants (49.7%), followed by skin infections (23.4%), gastrointestinal problems (14.1%), and musculoskeletal disorders (9.6%). Among chronic illnesses, hypertension (19.5%) and diabetes (12.2%) were the most common. Regarding health-seeking behavior, 64.8% of respondents preferred government hospitals for primary treatment, while 23.4% sought care from pharmacies or drug stores, and only 8.3% utilized private hospitals. The severity of symptoms (44%) and high cost of treatment (38.3%) were the major determinants influencing healthcare-seeking, whereas cultural belief was reported by only 2.3% of participants. Conclusion: The findings highlight a dual burden of communicable and non-communicable diseases among slum residents, with respiratory illnesses and hypertension being the most common. Strengthening affordable healthcare services and implementing preventive interventions tailored to vulnerable urban slum populations.
Copyright (c) 2025 Dr Rahul Sanskritayan Roy (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Assessment of stress, anxiety, and depression among medical students at a medical college in North India
Abstract: Introduction – Medical students are more vulnerable to stress, anxiety, and depression than students in other courses. Mental health issues can adversely affect academic performance, professional development, and the delivery of quality patient care. The aim of this study was to estimate the prevalence of stress, anxiety, and depression among medical students at a medical college in North India. Material and methods – A cross-sectional study conducted from August to October 2024 at JNMCH, AMU, among undergraduate medical students. The sample size calculated was 258. All medical students willing to participate were included, and students with diagnosed psychiatric illnesses receiving treatment were excluded. PSS SCALE, GAD-7, and PHQ-9 were used. The questionnaires were administered through the Google link on WhatsApp groups. Data analysed and appropriate tests used. Results – The mean age of participants was 20.81 ± 1.44 years. Males (64.6%) were more than females (35.4%). The majority live in a hostel (72.6%). Approximately 3/4th of the students (75.80%) had moderate to severe perceived stress. 15.0% had moderate to severe anxiety, and 11.0% had severe depression. Conclusion – Early identification and intervention are crucial to support student well-being and academic performance. Regular conduction of mental health screening programs for medical students to identify those at risk early, and provide accessible counseling and psychological support services within the college.
Stress, Anxiety, Depression, Medical students, North India.
Copyright (c) 2025 Absar Ahmad, Subhash Kumar, Dr. Mohd Yasir Zubair, Sameena Ahmad, Uzma Eram, Saira Mehnaz (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence and risk factors of stroke in North India
Title: Prevalence and risk factors of stroke in North India Swati Sharma*, Dhananjay Gupta, Gagandeep Singh Background: The World Health Organization (WHO) defines Stroke as "rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin." The burden of Stroke is ever-increasing in India, and it is the fourth leading cause of mortality and fifth leading cause of disability in the country. Methods: This prospective survey was done in the Stroke unit of the Department of Neurology in a leading medical college institute of North India. All stroke patients admitted between June 2023 and June 2025 were enrolled in the study. Data was collected in a structured questionnaire and analyzed using MS-EXCEL and SPSS software. Results: A total of 345 patients were included, and the average age of stroke patients in our cohort was (77.41%), which is significantly lower than the global average. More than 30% patients were younger than 65 years, and about 13% younger than 50 years. Gender distribution showed a male preponderance, with (70%) patients being male. The major risk factors reported were Hypertension (72.8%), Diabetes Mellitus (61.3%), Atrial fibrillation (56.8%), Smoking (18%), Alcohol (35.4%), and sedentary lifestyle (22%). The major stroke type was Ischemic stroke (82%). Conclusion: The increasing risk of stroke amongst the younger population, especially those with hypertension and diabetes, highlights the urgent need for targeted preventive strategies in high-risk groups. Public health interventions focusing on early detection, community awareness of stroke symptoms, and management of modifiable risk factors could significantly reduce stroke-related morbidity and mortality in the North West population.
Copyright (c) 2025 Swati Sharma (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Correlation of Nutritional Status and Cognitive Function with Oral Health Related Quality of Life among Elderly with Edentulism in a Tertiary Care Dental Setting, Jodhpur
Introduction: Oral health is a crucial determinant of overall well-being in elderly. Edentulism can adversely affect nutrition and cognition, which in turn may influence oral health-related quality of life (OHRQoL). This study assessed nutritional status and cognitive function among elderly with edentulism and examined their correlation with OHRQoL. Methodology: A hospital based cross-sectional study was conducted among 290 elderly individuals (≥60 years) with complete or partial tooth loss attending the dental OPD of a tertiary care centre in Jodhpur from January to March 2025. Validated Hindi versions of the Mini Nutritional Assessment–Short Form, Indian Elderly Dietary Index, Mini-Cog, and Geriatric Oral Health Assessment Index were used, along with a 24-hour dietary recall questionnaire. Proportions and Spearman’s rank correlation were applied for analysis. Results: Majority (85.5%) had partial tooth loss, and 57.6% reported poor OHRQoL. Nutritional assessment showed 13% malnourished and 34.5% at risk, with deficiencies in calories (>60%), protein (>80%), calcium (>80%), and vitamin C (99%). Less than half (43%) had a “healthy diet” score. Cognitive impairment was high in 36.2% of participants. OHRQoL correlated positively with nutritional status (ρ = 0.371, p < 0.001) and cognitive function (ρ = 0.307, p < 0.001). Moderate positive correlations were observed with calorie and vitamin C intake, as well as diet quality. Conclusion: Poor OHRQoL among elderly with edentulism is significantly influenced by nutritional status and cognitive function, highlighting the need for integrated oral, nutritional, and cognitive health interventions.
Copyright (c) 2025 Dr. Tanmayee Sarkar, Dr. Gomathi Arumugam, Dr. Ankita Chugh, Dr. Srikanth Srinivasan, Dr. Suresh Kumar Sharma (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Assessment of Psychological Distress among adult Population Attending Health Centers of Mysuru Using K-10 Scale
Background: Psychological distress is a growing public health concern, often underrecognized in primary care settings which is the first point of care. It is the early indicator of common mental disorders like anxiety, depression, bipolar disorder. Large proportion of individuals with CMD’s go undiagnosed and untreated. The Kessler Psychological Distress Scale (K-10) is a validated screening tool for detecting symptoms of anxiety and depression. Aims & Objectives: 1. To assess the level of psychological distress among adult PHC attendees in Mysuru 2. To determine the association between level of psychological distress and sociodemographic factors Methodology: A cross-sectional study was conducted among 202 adult patients attending both rural and urban health centres affiliated with a medical college in Mysuru. Data were collected using a structured questionnaire comprising sociodemographic details, behavioural factors, and the K-10 scale. Statistical analysis was performed using SPSS version 28. Descriptive statistics were used to summarize the data, and chi-square tests were applied to assess associations between categorical variables. Results: Among the 202 participants, 61.8% were male and 38.2% female, with a mean age of 35.32 ± 15.28 years. While 43.6% were likely to be well, 56.4% exhibited varying levels of psychological distress. Significant associations were observed between psychological distress and residence (p = 0.000), marital status (p = 0.017), smoking (p = 0.005), and alcohol consumption (p = 0.011). A positive correlation was also found between K-10 scores and the number of working hours per day, indicating occupational strain as a contributing factor. Conclusion: More than half of the study population experienced psychological distress, influenced by both social and behavioural determinants. These findings highlight the importance of integrating routine mental health screening into primary care and tailoring interventions to address contextual risk factors.
Copyright (c) 2026 Kodeeswaran M, Dr. Sunil Kumar D (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Reproductive and sexual health seeking behaviour and autonomy among women residing in the urban practice area of a teaching hospital in a North-Eastern state in India.
Background: Governments come up with different strategies to meet the unmet needs of family planning along with other services for reproductive and sexual health. Yet, the awareness and utilization of these services are often poor, especially in developing countries. Hence, a cross sectional study was conducted to assess the reproductive and sexual health seeking behaviour and autonomy among women residing in the urban practice area of a teaching hospital in a North-eastern state in India. Methodology: Interview was conducted for 117 consenting women for the study using a pre-designed and a pre-tested questionnaire. Data was entered in Microsoft Excel spreadsheet and analysed using the software Epi Info version 7. Results: Majority of the participants (64%) were married out of whom 10.7% were married before the legal age of 18. Fifty nine percentage had already undergone pregnancy with 4% of them conceiving before the age of 18. Regarding sexual health, 77% of the study population had sexual experience out of whom, 9% were below 18 years during their experience. Only 43% of the participants had used contraceptives during their first sexual exposure. Health seeking behaviour regarding sexual and reproductive health was also poor among majority of the study participants (92.3%). Autonomy was found to be high in 68.7%, moderate in 22.5% and poor in 8.8% of the study participants. No significant association was found between socio-demographic parameters and reproductive and sexual autonomy. Conclusion: Health seeking behaviour was poor among study population, however, sexual and reproductive autonomy was found to be high among majority of the study population. This could be due to the high literacy rate and attainment of high degree of education found among the study participants. The cultural and social variation in status of women in the society could also contribute to this.
Copyright (c) 2026 Dr. Jayden lhamu bhutia, Dr. Shraddha Deokota, Dr. Priyadarshini Moirangthem (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Comparative Study of Nutritional Status among Populations of Umarwada (Urban Area) and Olpad (Rural Area): A Community-Based Cross-Sectional Study in Surat.
Background: Nutrition is a fundamental determinant of health, growth, and productivity. Rapid urbanization has resulted in dietary transitions and lifestyle-related health issues, while rural populations continue to face challenges of undernutrition. Understanding the nutritional differences between urban and rural populations is essential to address the double burden of malnutrition in India. Objectives: To assess the nutritional status of individuals in Umarwada (urban) and Olpad (rural) areas. To compare the prevalence of undernutrition and overnutrition between the two populations. To identify socio-demographic factors associated with nutritional outcomes. Methods: A community-based cross-sectional study will be conducted among [sample size, e.g., 200] participants each from Umarwada (urban) and Olpad (rural) areas of Surat district. Nutritional status will be assessed using anthropometric indicators (BMI, MUAC), dietary recall, and clinical examination. Socio-demographic data will be collected through a pre-tested structured questionnaire. Statistical analysis will include chi-square test and logistic regression to identify predictors of nutritional status. Expected Results: It is anticipated that undernutrition (stunting, thinness, anemia) will be more prevalent in the Olpad (rural) population, while overnutrition (overweight, obesity, and lifestyle-related NCD risks) will be higher among Umarwada (urban) participants. Socio-economic status, dietary diversity, and physical activity are expected to show significant associations with nutritional outcomes. Conclusion: The study will highlight contrasting nutritional challenges in Umarwada (urban) and Olpad (rural) communities, emphasizing the need for context-specific interventions—strengthening undernutrition programs in rural areas and addressing lifestyle-related overnutrition in urban settings. The findings can provide evidence for policymakers to design integrated nutrition and public health strategies.
Nutrition, Umarwada, Olpad, Urban, Rural, Malnutrition, Community Medicine
Copyright (c) 2025 Dr.Manishkumar Bhoi, Dr. Bipin Vasava (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Treatment-Seeking Behaviour among the young adults(15-24 years) residing in Palam area, Delhi.
Background: Treatment-seeking behaviour, defined as the process through which individuals recognise symptoms, interpret their significance, and decide on appropriate care, is inherently complex and influenced by multiple factors, including cultural beliefs, socioeconomic status, service accessibility, and interpersonal networks. Young adults' behaviour is influenced by perceived invulnerability, peer influence, limited familiarity with formal healthcare systems, and a growing reliance on unverified digital sources of health information. Aims and Objectives: To assess the adequacy of treatment-seeking behaviour among young people residing in the Palam area of Delhi. To find out the association of socio-demographic factors and treatment-seeking behaviour among the young adults. Methodology It was a community-based study of young adults (15-24 years) residing in the Palam area of Delhi. The study was conducted in the time period from April 2024 to August 2025 Statistical Analysis: Adequacy of treatment-seeking behaviour among young adults. Statistical association between socio-demographic factors and treatment-seeking behaviour was done using the chi-square. Result: More than half (66.6%) of the study participants had an adequate level of treatment-seeking behaviour.Adequate TSB is consistently higher across all morbidity types, particularly for Injuries(82.6%), Respiratory(71%), Gastrointestinal(69.7%) Conclusion: Understanding the treatment-seeking behaviour of young adults and the factors influencing it can pave the way for the planning and implementation of targeted health services for both prevention and treatment, thereby enhancing efficiency and ensuring cost-effectiveness for the healthcare system.
Copyright (c) 2026 B.T Tejeswi, Dr. Manish Goel, Dr. Nazish Rasheed (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
The Historical Architecture of Intellectual Dominance: From Colonial Extraction to Knowledge Hegemony and the Vision of Atmanirbhar Bharat
The contemporary global landscape is defined by a rigid, often invisible hierarchy of intellectual labor that traces its lineage back to the era of physical colonialism. Historically, the dominance of developed nations over Low- and Middle-Income Countries (LMICs) was established through the extraction of raw materials and the exploitation of physical labor.<!-- [if supportFields]> ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"sA5T4Lpr","properties":{"formattedCitation":"(1)","plainCitation":"(1)","noteIndex":0},"citationItems":[{"id":88,"uris":["http://zotero.org/users/local/ybigpvE3/items/HYJRPUVK"],"itemData":{"id":88,"type":"article-journal","abstract":"Despite taking on several forms throughout history such as colonial medicine, tropical medicine, and international health, the field of global health continues to uphold colonialist structures. History demonstrates that acts of colonialism ...","container-title":"Global Health Action","DOI":"10.1080/16549716.2023.2186575","issue":"1","language":"en","note":"PMID: 36940174","page":"2186575","source":"pmc.ncbi.nlm.nih.gov","title":"Colonization and decolonization of global health: which way forward?","title-short":"Colonization and decolonization of global health","volume":"16","author":[{"family":"Hussain","given":"Maysoon"},{"family":"Sadigh","given":"Mitra"},{"family":"Sadigh","given":"Majid"},{"family":"Rastegar","given":"Asghar"},{"family":"Sewankambo","given":"Nelson"}],"issued":{"date-parts":[["2023",3,20]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} <![endif]-->(1)<!-- [if supportFields]><![endif]--> In the modern era, this has evolved into a sophisticated form of "intellectual hegemonism." <!-- [if supportFields]> ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"iHzhXBGv","properties":{"formattedCitation":"(2)","plainCitation":"(2)","noteIndex":0},"citationItems":[{"id":91,"uris":["http://zotero.org/users/local/ybigpvE3/items/UGQXBF9L"],"itemData":{"id":91,"type":"article-journal","abstract":"The present study aspires to catch a glimpse of a peculiar phenomenon in the history of religions, namely, the competitive character of early Christian apologetic literature in its attempt to confront head-on the non-Christian ideological life-world and, for that matter, to persuade the latter’s adherents to convert to the new hierophanic message. More specifically, in this study I look into the hierophanic/religious/spiritual market of the first three centuries CE, focusing on its creating, perpetuating and promoting of intellectual hegemony interactions, while at the same time I explore the conversion discourse used by all parties concerned in order to win over the Other. Apart from other religions, early Christian ‘Apologists’ faced predominantly Middle Platonism, Stoicism, Neopythagoreanism and, last but not least, Neoplatonism. In doing so they adopted a number of rhetoric and social strategies at hand; strategies that, although intended to turn the Other into the Same—which they did achieve, albeit gradually—ended up turning the Same into the Other as well.","container-title":"Religions","DOI":"10.3390/rel12090782","ISSN":"2077-1444","issue":"9","language":"en","license":"http://creativecommons.org/licenses/by/3.0/","note":"publisher: Multidisciplinary Digital Publishing Institute","page":"782","source":"www.mdpi.com","title":"Intellectual Hegemony, Conversion Discourse and Early Christian Apologetic Literature","volume":"12","author":[{"family":"Adrahtas","given":"Vassilios"}],"issued":{"date-parts":[["2021",9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} <![endif]-->(2)<!-- [if supportFields]><![endif]-->Developed nations have strategically positioned themselves as the "think tanks" of the world, monopolizing the high-value, creative phases of innovation while relegating LMICs to the status of executors and assemblers. This systemic division of labor is not merely an economic byproduct but a deliberate structural design that maintains the Global North's technological and scientific superiority.<!-- [if supportFields]> ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"siAee98a","properties":{"formattedCitation":"(3)","plainCitation":"(3)","noteIndex":0},"citationItems":[{"id":93,"uris":["http://zotero.org/users/local/ybigpvE3/items/J34387W9"],"itemData":{"id":93,"type":"webpage","title":"AI Empire: Unraveling the interlocking systems of oppression in generative AI's global order - Jasmina Tacheva, Srividya Ramasubramanian, 2023","URL":"https://journals.sagepub.com/doi/10.1177/20539517231219241","accessed":{"date-parts":[["2026",4,3]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} <![endif]-->(3)<!-- [if supportFields]><![endif]--> By controlling the intellectual "source code" of industries, developed nations ensure that LMICs remain in a state of perpetual dependency, performing the repetitive, middle-class tasks that sustain the global economy without ever owning the means of innovation.<!-- [if supportFields]> ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"am0nDO8Y","properties":{"formattedCitation":"(4)","plainCitation":"(4)","noteIndex":0},"citationItems":[{"id":94,"uris":["http://zotero.org/users/local/ybigpvE3/items/75IXDWTZ"],"itemData":{"id":94,"type":"webpage","abstract":"World Development Report 2024: The Middle-Income Trap identifies pathways for emerging market economies to avoid what has become known and feared as the “middle-income trap.”","container-title":"World Bank","genre":"Text/HTML","language":"en","title":"World Development Report 2024: The Middle-Income Trap","title-short":"World Development Report 2024","URL":"https://www.worldbank.org/en/publication/wdr2024","accessed":{"date-parts":[["2026",4,3]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} <![endif]-->(4)<!-- [if supportFields]><![endif]-->
Copyright (c) 2026 Sudip Bhattacharya, Amarjeet Singh (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Editorial on Iron supplementation and anaemia in India: necessary, but no longer sufficient
With reference to the Editorial published in the Journal of EFI (Prasad M, Kapil U. Iron supplementation and anaemia in India: necessary, but no longer sufficient. Journal of the Epidemiology Foundation of India. 2025; 3(3): 229-230. DOI: https://doi.org/10.56450/JEFI.2025.v3i03.001 ), I would like to make following comments :- The Editorial comprehensively brings out most of the measures for Anaemia control being implemented at present. The Operational Guidelines under Anaemia Mukt Bharat (AMB) strategy launched by the Ministry of Health & Family Welfare (MoHFW), Govt. of India in April,2018 focus on SIX Interventions including Addressing Non-Nutritional causes of Anemia, with special focus on Malaria, Haemoglobinopathies and Fluorosis. While the above Editorial does mention about the first two Non- Nutritional causes, equal emphasis needs to be given to Prevention and Control of Fluorosis in endemic areas.
Copyright (c) 2026 Pradeep Saxena (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
The Association between passenger overloading, spinal posture changes, and work-related musculoskeletal disorders among three-wheeler drivers in Chandigarh
Background: Three-wheelers are a vital mode of transport in Chandigarh, with approximately 7,440 drivers facing occupational health risks including prolonged sitting and poor ergonomics. A significant, under-observed factor is passenger overloading, which alters vehicle balance and compels drivers to adopt strained or unnatural postures. Over time, these postural deviations may increase the risk of work-related musculoskeletal disorders (WMSDs), particularly in the back and neck. Aims & Objectives: This study aims to investigate the association between habitual postural changes induced by passenger overloading of driving seat only and the prevalence of WMSDs among three-wheeler drivers in Chandigarh. To determine the prevalence and location of WMSDs among the study population using the Nordic Musculoskeletal Questionnaire. To assess and categorize the drivers' work habits and specific spinal posture changes associated with varying passenger loads using a standardized observation checklist and interview. To identify the socio-demographic, work duration, and overloading factors correlated with the incidence of WMSDs. Methodology: A cross-sectional study is being conducted among approximately 200 auto-rickshaw drivers in Chandigarh using convenience sampling. WMSD prevalence is assessed via the internationally validated Nordic Musculoskeletal Questionnaire (NMQ), while the primary exposure—passenger overloading (defined as habitually carrying >3 passengers)—is assessed via self-report. Results & Conclusion: Data collection and analysis are currently underway as part of an ongoing dissertation. Findings are expected to inform targeted ergonomic interventions and relevant public health policies for this occupational group to mitigate the specific postural deviations, such as hunched back or twisted spine, hypothesized to correlate with higher incidences of low back and neck pain.
Copyright (c) 2025 Shivani Shivani, Manoj Kumar, Paravreet Kaur (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
An Analysis of the Nexus Between Government Health Expenditure and Key Health Indicators in India: A Longitudinal Study from 2013-14 to 2021-22
Background: India has a complex health finance system comprising public and private financing. Despite the presence of a public healthcare system, the private sector is the major contributor to the healthcare services in India. Analyzing the relationship between government health expenditure and public health outcome is crucial, witnessing a shift in public health spending in recent years. This study helps understand how health expenditure trends align with major health indicators. Aim: This paper analyzes the correlation between Government of India’s health expenditure - measured across GDP (Gross Domestic Product), THE (Total Health Expenditure) - and the critical health indicators - neonatal, infant, child and maternal mortality rates and life expectancy at birth, over the study period 2013-14 to 2021-22. Methods: A longitudinal trend analysis was conducted for the period 2013-2021 using secondary published data. Health expenditure data were sourced from National Health Accounts (NHA) - India, and key health indicators were obtained from United Nations Inter-Agency Group for Child Mortality Estimation (UN-IGME) and the World Bank. Results: The Pearson correlational model demonstrated a significant inverse relationship between public health financing and mortality. GHE as a percentage of THE shows near-perfect negative correlation with NMR (r = -0.95), IMR (r = -0.96) and U5MR (r = -0.95%). Contrariwise, OOPE as a percentage of THE showed a strong near-positive relationship against NMR (r = 0.96), IMR (r = 0.97) and U5MR (r = 0.97). Moreover, sustained rise in per capita GHE is associated with reduced MMR. Conclusion: The study is evident of a positive association between increased public health expenditure and improved public health indicators in India. The findings demonstrate a transition from private and OOPE spending towards increased public health investment, which strongly correlates with positive public health indicators. Keywords: Government Health Expenditure (GHE); Out-of-Pocket-Expenditure (OOPE); Child Mortality; Maternal Mortality
Copyright (c) 2025 AMOS ALLAN SUBBA, Abuk, Naveditta, Gopal, SS Tiwari, Varsha (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Factors Affecting Health-Seeking Behaviour among High-Risk Pregnant Women in Rural Haryana: A Mixed-Methods Study
Background: High-risk pregnancy (HRP) constitutes 20–30% of all pregnancies in India and contributes to 75% of perinatal morbidity and mortality. Despite national programmes such as the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), only 14% of pregnancies are currently classified as high-risk on national platforms. Sub-centres represent the most peripheral public health unit, yet their readiness to manage HRP remains understudied, particularly in rural Haryana. Objectives: To assess infrastructure and service readiness of rural sub-centres for maternal healthcare and to explore healthcare provider perspectives on barriers in the management of high-risk pregnancies. Methods: A community-based, cross-sectional, convergent parallel mixed-methods study was conducted across 10 randomly selected sub-centres under CHC Dighal and CHC Dubaldhan, Jhajjar district, Haryana. Quantitative data were collected using a validated sub-centre checklist. Qualitative data were obtained through in-depth interviews (IDIs) with 12 healthcare workers (4 LMOs, 4 ANMs, 4 ASHAs) and analysed using inductive thematic analysis. Ethical clearance was obtained from the IEC, Pt. B. D. Sharma PGIMS, Rohtak. Results: Most sub-centres had adequate basic infrastructure — 90% had electricity, water supply (80%), and essential diagnostic equipment. However, 30% lacked examination tables and blood glucose measurement was absent in 30% of facilities. All sub-centres referred identified HRP cases (100%). Five barrier themes emerged from IDIs: challenges in client engagement, inadequate infrastructure and care provision, barriers to timely ANC registration, limited community acceptance and support, and gaps in access to comprehensive maternal healthcare. Key barriers included communication difficulties, transportation deficits, healthcare worker knowledge deficiencies across all cadres, cultural misconceptions about pregnancy and inadequate family involvement. Conclusion: While basic sub-centre infrastructure is largely in place, functional gaps and multi-level barriers significantly impede HRP management in rural Haryana. Targeted frontline worker training, referral system reform, community engagement addressing cultural barriers, and policy-level resource investment are essential. These findings have direct implications for strengthening PMSMA implementation and achieving equitable maternal health outcomes in rural India especially for High-risk pregnancy.
Copyright (c) 2025 Srishti Singh, Varun Arora, Anik Chakraborty, Narender Bhukkal, Amandeep Kaur, Trushna Parida (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Development of a composite malaria burden index using principal component analysis for comparative assessment of tribal and non-tribal districts in Chhattisgarh
Background: Malaria remains a significant public health problem globally and in India. Despite accounting for only 2.29% of India’s population, Chhattisgarh contributes a disproportionately high share of malaria cases and deaths in the country. Traditional surveillance indicators often provide fragmented information on disease burden. A composite index integrating multiple indicators may provide a more comprehensive assessment of malaria burden and help identify high-risk areas for targeted interventions. Objectives: To develop a composite Malaria Burden Index (MBI) using Principal Component Analysis (PCA) and to compare the malaria burden between tribal and non-tribal districts of Chhattisgarh. Methods: A secondary data analysis was conducted using district-level malaria surveillance data for 2024 obtained from the National Vector-Borne Disease Control Programme (NVBDCP) database. Five key malaria indicators were included: Annual Parasite Incidence (API), Annual Blood Examination Rate (ABER), Slide Positivity Rate (SPR), Annual Falciparum Incidence (AFI), and Slide Falciparum Rate (SFR). Districts were categorized as tribal or non-tribal according to the Ministry of Tribal Affairs classification. PCA was performed using IBM SPSS Statistics (version 25) to construct the composite MBI based on the correlation matrix. The first principal component (PC1) was retained as the MBI. Results: The first principal component (PC1) had an eigenvalue of 4.739 and explained 94.78% of the total variance and was retained as the Composite Malaria Burden Index. Based on these scores, districts were categorized into low, moderate, and high malaria burden groups. High MBI scores are concentrated in the southern tribal districts, particularly Bijapur, Narayanpur, and Dakshin Bastar. Most non-tribal districts fall into the low or moderate burden categories. Conclusion: The Composite Malaria Burden Index provides an integrated measure for assessing malaria burden at the district level. The findings highlight a disproportionately higher burden in tribal districts of Chhattisgarh, emphasizing the need for intensified malaria control interventions in these high-risk areas.
Copyright (c) 2025 Sanooja Sherin Chakkalakkunnan (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Exploring the impact of Yoga on Postpartum Depression: Implications for Maternal Mental Health- A Narrative Review
Background: Postpartum depression (PPD) is affecting 19% of women within the first year after childbirth globally. PPD significantly impacts a mother’s emotional well-being, underscoring the need for early identification and intervention. Pharmacological treatments, though effective, may be limited by breastfeeding safety concerns. Consequently, non-pharmacological approaches such as yoga have gained attention as accessible strategies to enhance maternal well-being. Objective: This narrative review synthesizes current evidence on the effectiveness of yoga-based interventions in alleviating postpartum depressive symptoms and improving maternal mental health. Methods: This comprehensive review analyzed data from twelve research papers and reviews published between 2012- 2025. Studies involving postpartum women (≤12 months after delivery) receiving yoga interventions were included. Data on study design, intervention characteristics, and mental-health outcomes were narratively synthesized. Results: Anxiety and depression were assessed with different scales, reported a statistical diminution of anxiety when applying the interventions: yoga during pregnancy (p < 0.001) and in postpartum (p < 0.05). Visual Reality enhanced mindfulness and yoga intervention’s therapeutic effects offers a powerful, scalable approach to treating postpartum depression and anxiety immediate changes in EPDS scores were strongly correlated with changes in GAD-7 scores (r = 0.68, P < 0.001), and moderately correlated with changes in salivary cortisol levels (r = 0.53, P < 0.01). Laughter Yoga (LY) significantly reduced postpartum depression symptoms (t (102) = -14.007; p = 0.000 < 0.05). Yoga was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, −0.73 [95% CI, −1.84 to −0.43], P < 0.001). However, most studies had small sample sizes and limited follow-up, restricting generalizability. Conclusion: Evidence indicates that yoga is a feasible, low-risk adjunct to conventional care for postpartum depression, promoting maternal well-being. Further large-scale, standardized trials are needed to establish efficacy and integration into maternal health services. Keywords: postpartum depression, yoga, maternal mental health, non-pharmacological therapy, Mind-body intervention
Copyright (c) 2025 Priyanka Sidholi, Naveen KH, Manoj Kumar Gupta, Srikanth Srinivasan, Naresh Nebhinani (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
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