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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Qualitative method to re-evaluate cases of acute and accelerated silicosis from West Bengal
Background: A marginal farmer’s income is inadequate to sustain a decent living. Hence, they work in brick fields or similar jobs during the lean season, which generates respirable dust containing silica. Lungs are sensitised. Lung already sensitised to crystalline silica, and the lack of use of personal protection equipment during this work worsen the symptoms. Objectives: Evaluate the actual cumulative period of exposure in brick fields and ramming mass industry. Combine the Direct Acyclic Graph and Bradford Hill Graph to identify the causal pathway. To find out the epidemiological pathway, follow a characteristic pathway. Results: Twenty-five workers are affected by Silicosis; two medical officers of the local hospital and one interviewee have been interviewed in depth. Thematic content analysis using open, axial, and selective has been used for coding. Interviews have been coded as explained, and reached saturation. Objectives has been achieved by eight interviews. Data Triangulated with ILO/WHO radiographic grade (mostly 1/2/3), health camp data, and DAG modelling of confounders such as chronic malnutrition. Worked in the brickfield for some years, not recorded, the only record is of the brickfield lung already affected by respirable crystalline silica only worsens even for a short time. . ILO ratings indicated moderate to severe profusion; all Bradford Hill requirements were satisfied, affirming cumulative RCS as the causative factor inside migratory chains from farms to kilns through intermediaries. Conclusion: Gradual improvement in the social and economic context and advocacy for active community nutrition, promotion of personal protective equipment and screening may prevent silicosis.
Copyright (c) 2025 Pinaki Sensarma, Soumya Sarkar, Ujjwala Gupta, Jitumoni Rajkonwar, Sabrina Khan https://creativecommons.org/licenses/by-nc-nd/4.0
Demographic Characteristics and Burden of Transfusion‑Transmissible Co‑Infections in HBsAg‑Positive Blood Donors at a Tertiary Care Hospital in North India.
Introduction: Chronic hepatitis B infection remains a major public health issue in India, and asymptomatic blood donors can constitute an important reservoir for silent transmission. Epidemiological profiling of HBsAg‑positive donors helps in identifying high‑yield groups for enhanced screening and targeted preventive interventions within blood transfusion services. Methods: This cross-sectional observational study was conducted on 150 HBsAg-positive blood donors between April 2024 and August 2025. Sociodemographic data, donor type and donation frequency, ABO/Rh blood group, and serological status for HIV and syphilis were extracted and summarized. Results: All 150 HBsAg‑positive donors were male, predominantly aged 21–40 years (92.0%), with most residing in rural areas (57.0%) and educated up to higher secondary level (92.0%). B blood group (34.9%) and O blood group (26.8%) were most frequent, and nearly two‑thirds (62.0%) were first‑time donors, with only 4.6% having more than five lifetime donations. Co‑infection with HIV was detected in 6.7% and syphilis in 2.7%, including 2.7% with combined HIV–syphilis infection, while the vast majority were negative for other TTIs. Conclusion: Although overall TTI co‑infection prevalence was modest, the presence of HIV and syphilis among these donors underlines the importance of strict pre‑donation screening, universal serological testing, and post‑test linkage to care for infected individuals.
Copyright (c) 2026 mmanuel Jabakumar, Sanjib Gogoi, Sangeeta Pahuja Sindhwani, Amit Kumar Sharma, Manoj B Jais https://creativecommons.org/licenses/by-nc-nd/4.0
Reprogramming Bacteriophage Therapy with Artificial Intelligence: The Next Leap in AMR Combat
Antibiotics are extensively utilized as therapeutic agents, ranging from initial treatment to last-resort medications. Microorganisms have acquired antimicrobial resistance (AMR) as a result of their growing use and abuse. The ability of microorganisms, such as bacteria, fungi, viruses, and parasites, to withstand the effects of antimicrobial medications that were once efficient in treating infections is known as antimicrobial resistance (AMR). A major public health concern marked by higher treatment failures and mortality rates is caused by this phenomenon, which is made worse by variables including the overuse and inappropriate use of antibiotics. An estimated 700,000 fatalities worldwide are due to AMR each year (1) , a surge in resistant infections that is substantial, with resistance rates three to four times greater in low- and middle-income nations than in high-income ones (2). India confronts major issues with AMR, with large economic expenditures connected with it, totalling to $2.5 billion yearly, according to an examination of AMR in five countries: the USA, India, China, the United Kingdom, and Pakistan(3). Additionally, according to the Global One Health Index (GOHI), Brazil and India exhibit significant shortcomings in their AMR laboratory networks and coordination capabilities, which worsens the AMR problem(4). According to estimations, bacterial AMR caused 4.95 million deaths globally in 2019, and by 2050, it might be the cause of 10 million deaths yearly(5). The crucial link between antimicrobial consumption and resistance is further highlighted by the WHO's Global Antimicrobial Resistance and Use Surveillance System (GLASS), with India's high rates of antimicrobial consumption contributing significantly to the global AMR burden(6).
Copyright (c) 2026 Neeraj Ranakoti, Khusboo Bisht, Deo Mani Tripathi https://creativecommons.org/licenses/by-nc-nd/4.0
Post-Wedding Depression: The Silent Struggle of the Self-Reliant Woman
Marriage is often portrayed as the beginning of a beautiful chapter in a woman’s life. However, behind the celebratory ceremonies, glamorous wedding photos, and social expectations lies a silent crisis: Post-wedding depression, especially prevalent among today’s self-dependent working women. While postpartum depression has been widely discussed, Post wedding depression remains largely ignored despite its growing psychological footprint in modern society
Copyright (c) 2026 Anshita Misha, Suneela Garg 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 https://creativecommons.org/licenses/by-nc-nd/4.0
When Returning, Register Foreign Qualifications As Additional Qualifications Unless Foreign Medical Specialist/Super-Specialist Examinations Evolve
This is a plea to the emigrant physicians returning from United States/United Kingdom/Canada/Australia/New Zealand as specialists and/or super-specialists to remember registering their foreign qualifications with National Medical Commission as additional qualifications with a concurrent plea to National Medical Commission and National Board of Examinations in Medical Sciences to consider evolving Foreign Medical Specialist/Super-Specialist Examinations for the emigrant physicians returning as specialists and/or super-specialists from the rest of the world.
Copyright (c) 2026 Annapoorna Chakrabarty, Sampreet Dhaliwal, Amit Jain, Deepak Gupta https://creativecommons.org/licenses/by-nc-nd/4.0
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 https://creativecommons.org/licenses/by-nc-nd/4.0
Assessment and Predictors of Sleep Quality among Elderly Population in Jodhpur: A cross-sectional study
Background: Sleep quality tends to deteriorate with age, impacting both physical and mental well-being in older adults. While numerous factors can influence sleep patterns, limited evidence exists from urban settings in Rajasthan, particularly Jodhpur. Objectives: This study aimed to assess the sleep quality among the elderly population in urban Jodhpur and to examine the association between various predictors and sleep quality within this population. Methods: A community-based cross-sectional study was conducted among 215 elderly individuals (aged 60 years and above) from urban Jodhpur. The Geriatric Depression Scale-15 (GDS-15) was used to measure depression symptoms, while the Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. In order to evaluate the variables that can influence the quality of sleep, a structured questionnaire was also utilized. Binary logistic regression and descriptive statistics were used to find factors that predicted poor sleep quality. Results: Among the 215 participants, 116 (53.9%) were found to have poor sleep quality (PSQI >5). In adjusted analysis, taking one medication (AOR: 2.43; 95% CI: 1.11–5.31; p = 0.014) and frequent night-time awakenings due to health or environmental factors (AOR: 2.76; 95% CI: 1.30–5.87; p = 0.005) were significantly associated with poor sleep quality. No significant associations were found with age, gender, BMI, education, depressive symptoms, alcohol use, or physical activity. Conclusion: More than half of the elderly population in urban Jodhpur reported poor sleep quality, with significant associations identified with health-related and behavioral factors. Integrating routine sleep assessments into geriatric care and implementing community-based interventions could significantly improve the well-being of this population. Keywords: Sleep quality, elderly, Pittsburgh Sleep Quality Index, geriatric health, depression, urban Jodhpur, behavioral factors.
Copyright (c) 2025 Sweta Sharma, Prem Prakash Sharma, Naveen Dutt, Naveen K.H., Manoj Kumar Gupta, Srikanth Srinivasan (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
National One Health Mission: An Integrated Ecosystem for Augmenting India’s Pandemic Preparedness
Over the past two decades, outbreaks such as Nipah virus infection, Severe acute respiratory syndrome, Avian influenza, Middle East respiratory syndrome, Zika virus disease, COVID-19 and Monkeypox have highlighted the growing threat of zoonotic spillovers and the need for proactive pandemic preparedness through a One Health approach integrating human, animal, and environmental health. In India, the National One Health Mission (NOHM), launched under the aegis of the Principal Scientific Adviser to Government of India, provides an integrated framework involving 16 Ministries and Departments for coordinated pandemic preparedness and response. NOHM is anchored on six strategic pillars: intersectoral R&D, integrated surveillance & multisectoral outbreak response, 23 BSL-3 laboratories, medical countermeasure development, data integration and capacity building. Key initiatives include sentinel syndromic surveillance for acute febrile, respiratory, encephalitic, and diarrhoeal illnesses, integrated surveillance at high-risk animal–human interfaces (slaughterhouses, bird sanctuaries, wetlands, and zoos) to strengthen early zoonotic spillover detection, genomic and metagenomic surveillance, support pathogen sequencing, variant tracking, and preparedness for “Disease X”. Wastewater surveillance serves a population-level early warning system for priority pathogens. The National Joint Outbreak Response Team (NJORT) and national mock drills operationalize multisectoral rapid response. The proposed integration of Integrated Disease Surveillance Program (IDSP), National Digital Livestock Mission (NDLM), Department of Animal Husbandry & Dairying (DAHD), and Ministry of Environment, Forest & Climate Change (MoEFCC) data platforms will enable real-time intelligence sharing. Together with accelerated vaccine, therapeutic, and monoclonal antibody platforms aligned to the 100 Days Mission, and strong global collaborations, NOHM is building a resilient, future-ready pandemic preparedness ecosystem for India.
Copyright (c) 2026 Nivedita Gupta, Sangeeta Agarwal, Anoop Velayudhan, Pragya Yadav (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
One Health Governance in India: Scientific Perspectives on the National Model Framework for States and Union Territories
Emerging zoonoses, antimicrobial resistance, and climate-linked health threats demand countermeasures that transcend geopolitical boundaries. India's unique ecological and administrative structure makes One Health operationalization both urgent and structurally complex. However, translating One Health from concept to practice has proven difficult, largely due to fragmented governance and weak intersectoral co-ordination. The Government of India’s governance framework model - Strengthening One Health Governance in States and Union Territories under the National One Health Mission, needs broader scientific dissemination, which will be essential to generate field evidence, catalyse peer learning across States and Union Territories, and strengthen its execution.
Copyright (c) 2026 Kamran Zaman, Abhranil Gangopadhayya, Ankita Saha, Jyothi Bhat (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Leptospirosis in Children: A Systematic Review of Clinical and Laboratory Manifestations
Background: Leptospirosis is a bacterial infection causing health risks in tropical and subtropical regions. It presents in children with varying clinical symptoms, from flu-like to severe multi-organ involvement. Early diagnosis is crucial for effective management, but is challenging due to non-specific symptoms and laboratory findings. Methods: An effective literature search was conducted across various electronic databases (e.g., PubMed, Scopus, ScienceDirect) for studies published up to 2024. Studies were selected based on predefined inclusion criteria focusing on pediatric cases of leptospirosis and their clinical and laboratory features. Results: A total of 9 studies met the inclusion criteria. Across studies, males were predominantly affected, particularly from rural or peri-urban areas with significant environmental exposure, such as contact with contaminated water or infected animals. The most common clinical features included fever, fatigue, myalgia, and gastrointestinal symptoms (nausea, vomiting, abdominal pain), with conjunctival suffusion being a hallmark in specific cases. Laboratory abnormalities often included elevated C-reactive protein (CRP), leukocytosis, thrombocytopenia, and markers of kidney injury such as increased BUN and creatinine. Conclusion: Leptospirosis remains an important pediatric health issue. The disease presents with nonspecific symptoms, making early diagnosis challenging. Renal involvement is common complication Severe cases with neurological or hematological manifestations require urgent attention.
Copyright (c) 2026 Manisha Verma, Rajeev Verma (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Zoo-WIN: Bridging Surveillance, Supply Chains, and One Health for Zoonotic Disease Control in India
Background: Zoonotic diseases account for approximately one billion illness episodes annually worldwide. In India, rabies and snakebite envenomation remain leading but preventable causes of mortality, significantly worsened by supply-chain failures in anti-rabies vaccine (ARV), anti-rabies serum (ARS), and anti-snake venom (ASV). Aims and Objectives: To review the epidemiological imperative for Zoo-WIN, describe its design and objectives, analyse its alignment with national and global One Health frameworks, and identify key operational challenges and future directions. Methodology: A narrative review of published literature, government policy documents, surveillance programme data (IDSP 2018–2023), and grey literature on Zoo-WIN, rabies, snakebite envenomation, and One Health in India. Results: Zoo-WIN, launched in March 2025 by NCDC with UNDP support, leverages the eVIN architecture for real-time ARV/ARS/ASV stock monitoring and beneficiary follow-up across five pilot states. It aligns with NAPRE (2021), NAPSE (2023), and NOHP-PCZ, and supports the WHO “Zero by 30” goal. Conclusion: Zoo-WIN represents a landmark digital intervention for zoonotic disease control in India. Its scale-up depends on addressing connectivity gaps, healthcare worker training, intersectoral data integration, and sustained funding.
Copyright (c) 2026 Kamal Tyagi, Kashish Grover, Rohit Katre, Pallavi Singh (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
A brief overview of the GRADE approach for rating strength of evidence and practice recommendations
The medical fraternity is faced with an avalanche of medical literature. While it is desirable that the current best evidence inform practice guidelines and recommendations, it is true that much of the evidence is not of optimal quality, and recommendations based on poor quality evidence may result in undesirable outcomes. Moreover, many context specific considerations, such as costs and patient preferences may be key concerns in formulating recommendations. These issues call for a systematic framework to rate the quality of evidence and strength of recommendations. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) offers such a framework for any given clinical question, and offers advantages over traditional approaches to guideline development. Crucial elements for ensuring the trustworthiness of the guideline development process, such as recruiting an appropriate panel, excluding conflicts of interest, systematically reviewing the best evidence, rating certainty in evidence, and incorporating patient values and preferences, are rendered due importance in the process.
Epidemiological Methods and application of Biostatistics
Copyright (c) 2023 Manya Prasad, Pradeep Aggarwal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Strengthening Laboratory Systems for Emerging and Re emerging Zoonotic Diseases: A One Health Approach
Emerging and re‑emerging zoonotic diseases (ERZDs) continue to threaten public health, economic stability, and national security worldwide. A resilient and coordinated laboratory system is central to their surveillance, detection, and control. The One Health approach recognizes the interconnectedness of human, animal, and environmental health and provides a transdisciplinary framework to strengthen laboratory networks across sectors. In India, institutions such as the Integrated Disease Surveillance Programme (IDSP), the Virus Research and Diagnostic Laboratory (VRDL) network, and the National Centre for Disease Control (NCDC) anchor zoonotic disease surveillance. However, gaps persist in laboratory capacity, biosafety, intersectoral coordination, and genomic integration. This review explores global and national experiences in strengthening laboratory systems for ERZDs using a One Health paradigm, with emphasis on integration, capacity building, quality assurance, and policy frameworks necessary for sustainable response systems.
Copyright (c) 2026 Palak Pumma, Rahul Kumar, Arti Nareda (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Role of Central Health Education Bureau in One Health: National & Global Perspectives
The One Health approach, that integrates human, animal, and environmental health, is crucial for strengthening national and global health security. Highlights some of the key initiatives undertaken in India in this domain and explores the opportunities for future action. Further, it underscores the importance of information, education and communication materials, training programs for diverse stakeholders, and community outreach activities, in enhancing knowledge, attitude and practices among the public. The manuscript also examines potential areas to which the Central Health Education Bureau can support and contribute to the One Health approach through targeted interventions, interdisciplinary collaboration, and evidence-based research. Additionally, it emphasizes the importance of effective risk communication and community engagement in managing health risks and improving preparedness.
Copyright (c) 2026 Gowri Nambiar Sengupta, Deepa Anil Kumar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Climate Change, Emerging Infections and One Health: A Review of Climate-Resilient Epidemiological Surveillance in India
Climate change is reshaping infectious disease risks through rising temperatures, extreme rainfall, flooding, drought, shifting vector ecology, water and food insecurity, ecosystem disruption and changing human-animal-environment interactions. These risks are highly relevant for India because of its climatic diversity, monsoon dependence, dense settlements, large livestock interface, forest-fringe populations, coastal vulnerability and uneven local health-system resilience. One Health provides an appropriate framework because climate-sensitive surveillance cannot depend only on human case reporting. It must integrate animal, environmental, entomological, laboratory and climate intelligence. India already has important institutional assets, including the National Programme on Climate Change and Human Health, IDSP/IHIP, zoonoses surveillance platforms, the National One Health Mission, the VRDL network and field epidemiology training systems. However, these platforms remain only partly linked for routine climate-informed surveillance and response. This review discusses major climate-infection pathways, examines India’s current preparedness architecture, identifies implementation gaps, and proposes a practical agenda for building climate-resilient epidemiological surveillance through interoperable data systems, district risk profiling, joint risk assessment, sentinel surveillance, resilient laboratories and a climate-ready workforce.
Copyright (c) 2026 K Madan Gopal, Suneela Garg (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Kyasanur Forest Disease: Clinical profile, diagnostic approaches, and management protocol
Background: Kyasanur Forest Disease (KFD) is an emerging tick-borne flavivirus first identified in 1957 in Karnataka, India. Since 2012, the disease has expanded to four other states, posing an increasing public health threat. This study aims to develop a comprehensive, standardized protocol for clinical characterization, diagnostic approaches, and management of KFD to assist clinicians and public health specialists in navigating its expanding geographical footprint and reducing associated mortality. Methods: With the involvement of multiple experts and their experiential learnings in managing the KFD cases, this comprehensive protocol was developed emphasizing on clinical presentation and management. Results: KFD poses a significant public health challenge with a mortality rate ranging from 2% to 10%, and reported higher fatality in non-endemic regions. The disease typically presents with an abrupt onset of fever, severe headache, myalgia, and prostration, progressing to a biphasic course in 10-18% cases. Haemorrhagic and neurological complications, including altered sensorium, seizures, and meningitis, can occur and are associated with increased mortality with multi-organ dysfunction syndrome (MODS). Diagnosis relies on molecular methods (RT-PCR, real-time RT-PCR) and serological assays (IgM/IgG ELISA). Currently, no specific antiviral treatment is available, and management is primarily supportive, focusing on symptom control, fluid balance, and addressing complications. Conclusion: The current manuscript consolidates current knowledge on the epidemiology, clinical characteristics, differential diagnosis, laboratory investigations, and management strategies for KFD primarily for the clinician and public health specialist. This also highlights the critical need for early diagnosis, robust surveillance, and improved supportive care to reduce morbidity and mortality.
Copyright (c) 2026 Rima R. Sahay, Deepak Y Patil, Tushar Chiplunkar, Jagdish Patil, Anita M Shete, Manoj Murhekar, Nivedita Gupta, Kavitha Saravu, Pragya Yadav (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Reframing India's Approach to Snakebite Envenomation Through a One Health Approach
Snakebite envenomation remains a neglected public health challenge in India. More than 1,000,000 snakebites occur annually, causing approximately 58,000 deaths,[2] and disability in nearly four times as many people.[1] The World Health Organization (WHO) has set a target of reducing snakebite-related deaths by 50% by 2030.[3] India has aligned its national response through the launch of the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in 2024.[4] Achieving this goal, however, requires moving beyond a predominantly biomedical response to adopting a one-health framework which consider human, animal and environmental aspects of the problem together to find comprehensive solutions.
Copyright (c) 2026 Kinshuk Gupta, Rajesh Kumar (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Capacity Building Efforts on Viral Hepatitis under National Viral Hepatitis Control Program
The “National Viral Hepatitis Control Program” (NVHCP) was launched in India as a stepping stone towards combating viral hepatitis as a public health threat. The program was launched on the occasion of world hepatitis day 2018 with the target of eliminating viral hepatitis by the year 2030. The program has provisions for developing infrastructure, nominating human resources, and building their capacity for successful service delivery. A time-bound cascade of training approaches is being adopted by the program to orient the designated healthcare workers on the standard operating protocols. The training is being conducted following a top-to-bottom approach, where master trainers are first identified and sensitized at the national level under the mentorship of the National Center for Disease Control (NCDC), the master trainers then sensitize the designated healthcare workers at the state level in collaboration with the state National Health Mission (NHM). Here is an outline of the Capacity-building efforts on Viral Hepatitis under NVHCP in Uttarakhand State.
National Viral Hepatitis Control Program
Copyright (c) 2023 Pragya Pandey, Ajeet Singh Bhadoria (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
Serum Magnesium level and severity of Schizophrenia, Depression, Obsessive Compulsive Disorder: A cross Sectional and Hospital Based Study in a Tertiary Care Hospital in Eastern India
Magnesium is a vital macronutrient that plays an essential role in brain function, particularly in intracellular transmission, neuronal myelination, synapse formation, and neurotransmission. It is crucial for maintaining neuronal health and supporting higher cortical functions of the central nervous system (CNS). Several studies have reported that reduced serum magnesium levels are associated with psychiatric disorders such as schizophrenia, depression, obsessive–compulsive disorder (OCD), and other major psychiatric conditions. The aim of this study is to evaluate serum magnesium levels in patients with major psychiatric disorders in order to determine its potential role as a contributing factor in disease association, treatment outcomes, and remission of major psychiatric disorders. Methodology: A cross-sectional study was conducted on patients diagnosed with schizophrenia, depression, and obsessive-compulsive disorder (OCD), attending both outpatient and inpatient departments of the Institute of Psychiatry (IOP) over a period of three months. A total of ninety subjects were included in the study, comprising sixty cases and thirty matched controls. Serum magnesium levels were estimated from blood samples collected from all participants, and the analysis was carried out at the Biochemistry Laboratory of the Institute of Psychiatry-COE, Kolkata. Discussion: A significant decrease in serum magnesium levels was observed in patients with psychiatric disorders as compared to healthy controls. It was also found that the serum magnesium levels were also associated with the severity or progression of psychiatric illnesses. Conclusion: Serum magnesium levels were found to be significantly lower in patients with schizophrenia, depression, and obsessive–compulsive disorder compared to healthy controls, and these reductions correlated with illness severity. Magnesium may therefore serve as a potential biomarker and an adjunctive therapeutic target in psychiatric disorders.
Copyright (c) 2025 Riyal Das (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
The One Health approach has gained increasing prominence as a framework that recognizes the interdependence of human, animal, and environmental health. It is an integrated, unifying approach to balance and optimize the health of people, animals, plants and ecosystems. It uses the close, interdependent links between these fields to create new surveillance and disease control methods. In India, where biodiversity hotspots coexist with dense human and livestock populations, successful implementation of One Health requires active engagement with communities that live at the human- animal-ecosystem interface. Among these, the Van Gujjars, a semi-nomadic pastoralist community inhabiting the forests of the Shivalik region across Uttarakhand and adjoining states represent an underrecognized yet strategically important stakeholder.
Copyright (c) 2026 Pradeep Aggarwal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Tribal Health: A Comprehensive Review of Challenges, Interventions, and Future Directions
Tribal populations worldwide face numerous health challenges due to factors such as socio-economic disparity, geographic isolation, cultural differences, and limited access to healthcare. This article explores the health status of tribal communities, focusing on the prevalence of infectious and non-communicable diseases, barriers to healthcare access, and the role of traditional medicine. The review also highlights the impact of government health interventions, the significance of cultural competence in healthcare, and potential strategies for improving health outcomes in tribal populations. The findings emphasize the need for culturally sensitive healthcare delivery, sustainable policy interventions, and innovative solutions such as telemedicine and mobile health.
Copyright (c) 2025 Rutuja Khobragade, Arun Tandon Samir Tandon (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
The Zika Virus: An Overview of Epidemiology, Pathogenesis, and Prevention
Zika virus (ZIKV), a member of the Flaviviridae family, has emerged as a significant public health concern due to its rapid spread and association with severe neurological complications, including microcephaly in new-borns and Guillain-Barre syndrome in adults. This review aims to provide a comprehensive overview of the Zika virus, covering its epidemiology, pathogenesis, clinical manifestations, and strategies for prevention and control. By synthesizing current research and data, we highlight the need for on-going vigilance and research to mitigate the impact of this virus on global health.
Copyright (c) 2024 RE Ugandar, A Sai Keshava Reddy (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
A Pilot study on "Assessment of Knowledge and Attitude of disposing the used napkin of HIV infected women visiting in HIV specific Clinic in King George's Medical University, Lucknow
Background: Human immunodeficiency virus (HIV) continues to be a major global health concern according to the World Health Organization (WHO).Rapid population growth, extensive urbanization, and cultural diversity all contribute to this problem in the nation. Menstrual hygiene products, especially disposable sanitary napkins, are a major waste management concern. Aims & Objectives: This study aimed to assess the knowledge, attitudes, and practices of HIV-infected women regarding the disposal of used sanitary napkins, with a focus on their awareness of health and environmental risks and the influence of education on hygienic practices. Methodology-We conducted a cross-sectional study among 61 females. We used a pre-tested self-administered questionnaire to assess HIV-infected women's knowledge and attitude towards disposing of used napkins. Results: The results show that there was a strong link between education and knowing that bad hygiene during menstruation can lead to infections (p=0.0001), between education and practicing good hygiene (p=0.0026), between education and using menstrual products (p=0.000), and between education and how often changing menstrual products (p=0.0009). Conclusion: Addressing menstrual hygiene through education, healthcare, and sanitation reduces health risks and environmental harm. Proper disposal of biomedical waste, including HIV-contaminated materials, vital for preventing infections and ensuring sustainability.
Copyright (c) 2025 Rajeev Misra, Sandeep Tiwari, Akanksha Mishra, Prachi Milani , Divyanshi Singh (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
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 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
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