Background: High sodium intake is a major public health concern. Sodium consumption pattern of West Indian population has never been reported before. Objectives: The cross-sectional study assessed sodium intake pattern by considering all possible dietary sources and spot urine sodium estimation among sedentary healthy adults of productive age group (35–55 years). Materials and Methods: Twenty-four-h dietary recall (3 alternative days in a week), food frequency assessment, weighing of table, and cooking salt (n = 218) were performed. Spot urine samples were collected for subset (n = 33) to quantify sodium excretion. Flame photometer “CL 361” was used for food sodium quantification. Results: Men had higher sodium intake than women (3.9 ± 0.4 vs. 3.8 ± 0.4 g/day). Significantly higher sodium intake among men was from processed ready to eat foods (0.8 ± 0.3 vs. 0.6 ± 0.1, P < 0.05) and among women was from cooking and table salt (2.6 ± 0.3 vs. 2.8 ± 0.3, P < 0.001). Lowest quartile (<25^th percentile) intake of oral sodium consumption (2.4 ± 0.5 g/day) was higher than WHO safe recommendation level of <2 g/day. Late afternoon spot urine sodium content was used to predict 24-h sodium excretion (6.1 ± 0.5 g/day), in turn population level sodium intake estimation. Analyzed sodium content of most frequently consumed all ready to eat foods was found to be higher than the reported values. Conclusion: There is a strong need of evidence-based guidelines and policy formulation for national salt reduction program in India.

Context: Medication nonadherence is common among diabetics and it is one of the leading public health challenges. Aims: The aims of this study were to find the prevalence of nonadherence to diabetic medication and to identify various factors associated with it. Settings and Design: This study was conducted in 34 villages of the field practicing areas of rural health training center. This was a mixed method study design. Subjects and Methods: It was conducted among 328 type 2 diabetic patients. The quantitative data were collected from diabetic patients and qualitative data from health-care providers to identify their perceived barriers for patient's nonadherence. Statistical Analysis Used: Collected data were entered in Epi Info (3.5.3) and analyzed using SPSS version 24 software. Results: The prevalence of low adherence to diabetic medication was 45.4% among the study population. Bivariate analysis shows significant association with the patients who are literate (odds ratio [OR] = 0.6, confidence interval [CI] = 0.38–0.95), hypertensive (OR = 1.6, CI = 1.04–2.5), taking treatment from private facility (OR = 0.54, CI = 0.34–0.87), perceived lack of satisfaction with doctor–patient relationship (OR = 3.3, CI = 1.3–8.3), and perceived lack of knowledge about diabetes (OR = 2.03, CI = 1.29–3.1) with low adherence to medication. Conclusions: The prevalence of nonadherence to medications is common among diabetics in rural areas, and there is a need to strengthen the primary health-care system in addressing barriers to achieve better health outcomes.

Background: Several competing priorities with health and development sector currently deter research, and as a result of which evidence does not drive policy- or decision-making. There is limited operational research (OR) within the India's National Tobacco Control Programme, as it is in other middle- and low-income countries, primarily due to limited capacity and skills in undertaking OR and lack of dedicated funding. Few models of OR have been developed to meet the needs of different settings; however, they were found to be costly and time-consuming. Objective: To elucidate a cost-effective and less resource arduous training model for building capacity in OR focused on tobacco control. Materials and Methods: This 5½-day partly funded course enrolled 15 participants across the country and nine facilitators. The facilitator-participants interactions were initiated 2 weeks before the course, which enabled them to develop possible research questions and a plan for data analysis. Results: This article presents the new OR model along with experiences of the participants which will provide useful insights on lessons learned for planning similar courses in the future. While we faced several challenges in the process and the outputs were modest, several lessons were learned which will be instrumental in the future courses that we are planning to conduct. Conclusion: This low cost and less time intensive model can be applied in similar settings across range of public health issues.

Context: School-going children are documenting the increasing incidence of high blood pressure (BP). Compared to adults, the prevalence of hypertension (HT) is low among children, but high BP among them can lead to HT in their adult life. Aim: The aim of was to study the risk factors and correlates of high BP among school-going children. Materials and Methods: A cross-sectional study was carried out for 1½ years among 892 randomly selected school children of 6^th–10^th class. Measurements such as height, weight, and BP were recorded and classified as per the standard guidelines for given age and sex. Statistical Analysis: Correlation and linear regression analysis were done for continuous variables. For dichotomous variables, mean and standard deviation were calculated and t-test was used in this study. Results: Higher age group, being male, and obesity were found to be significantly associated with elevated systolic BP (SBP) and elevated diastolic BP (DBP). Family history of diabetes and HT was significantly associated with elevated DBP. On linear regression analysis, the studied factors explained 30% variation in SBP and only 12% variation in DBP. Weight and body mass index explained the maximum variation in both SBP and DBP. Conclusion: Overweight or obesity, being male, family history of HT, and increasing age were important risk factors of elevated BP.

Background: It is possible to prevent deaths due to cervical cancer through screening and treatment. Cervical cytology which is a standard screening tool in developed countries fails as a screening method in low-resource countries due to financial and technical constraints. Objective: To determine the prevalence of pre-malignant lesions of the cervix by VIA and Pap smear test among rural married women and to find out association of socio demographic factors with positive screening test results. Method: A community based cross-sectional study was carried out among rural married women in the field practice area of a tertiary health care center. A pre-designed questionnaire was administered to collect information on socio-demographic characteristics from 550 women. They were tested for the presence of pre-malignant lesions of the cervix using VIA and Pap smear as screening tools. Results: Out of 550 study participants, total 37 patients were found positive, out of which 7, 17 & 13 patients were found positive by Pap smear alone, VIA test alone, and by both these tests respectively. Moderate agreement (k=0.498) was found between these two tests by applying Kappa statistics at 95% confidence interval. The VIA and Pap smear tests were positive among 5.5% and 3.6% study subjects respectively. The positivity rate was found to be more in the age group of >50 years, Hindu, SC/ST caste, joint family, professional and, upper class. Conclusion: The prevalence of pre-malignant lesions of the cervix by VIA test was 5.5% while 3.6% pre-malignant lesion was detected by Pap smear method. VIA and Pap smear positivity rates among rural married women.

Background: Neonatal death remains a global challenge contributing to 45% of underfive deaths. With rising institutional delivery, to accelerate decline in neonatal mortality rate (NMR) improvement in the quality of perinatal care requires attention. Objectives: This implementation research targeted improving service delivery readiness for quality of newborn care at public health facilities in three districts of Uttar Pradesh, India, with high NMR. Materials and Methods: This before-after study assessed the facility readiness and quality of newborn services at 42 health facilities. The changes in 26 signal functions for routine and emergency obstetric and newborn care were tracked. Results: There was marked improvement in newborn service availability: skilled birth attendants (51%), resuscitation (30%), and kangaroo mother care (27%) at these facilities. A multifold rise in newborn resuscitation efforts and documentation (n = 4431 vs. n = 144 in preintervention period) with high success rate (98.6%) was observed. There was also improvement in obstetric care services including partograph use (31%) and active management of third stage of labor (46%). However, several infrastructural indicators (electricity, water supply, toilets, and sanitation) remained unchanged. Conclusion: Overall improvements were observed in the majority of the signal functions for perinatal care and newborn resuscitation efforts. There was a limited impact on the infrastructural and supervision components.

Context: The state of Gujarat had introduced Extruded Fortified Blended Food, Balbhog, as take-home ration for children 6–35 months of age. The study aimed to understand awareness, availability, and consumption pattern of Balbhog and gain insights on factors influencing its regular use. Aims: This study aims to understand coverage and feeding practices of micronutrient fortified blended food (Balbhog) and determine factors for its regular use. Subjects and Methods: A cross-sectional survey of 1623 households with children of 6–35 months of age registered in Anganwadi centers was conducted in the four districts of Gujarat. Household and dietary survey were conducted to understand child care and feeding practices at household level. Results: The results showed high awareness about Balbhog (88.6%) among caregivers, with majority reporting using it (81.7%) before. Regular Balbhog consumption (42.2%), however, declined considerably across all population characteristics. Monthly distribution of adequate Balbhog packets, taste of Balbhog preparations, meal frequency of children, and caregivers' participation in the monthly Integrated Child Development Services (ICDS) event emerged as strong predictors of regular Balbhog consumption. No disparity in consumption was observed across socioeconomic characteristics of the population. Conclusion: Household feeding practices and ICDS program factors mediated regular use of Balbhog among children. Improving availability of entitled Balbhog packets, raising awareness about Balbhog preparations, and improving child feeding practices could help in increasing Balbhog consumption in the community.

Background: Urbanization and water scarcity are placing pressure on urban food security. Globally, wastewater irrigation is a common feature of urban agriculture; however, high pathogen densities of wastewater pose disease risk for farming households. Objectives: (a) Compare Escherichia coli concentrations of groundwater, surface, and wastewater. (b) Estimate the household diarrheal disease risk between the irrigation sources. Materials and Methods: This 12-month case-cohort study was undertaken in 187 households from four communities, selected purposively based on the irrigation water type, in urban Ahmedabad. The study included two communities utilizing surface water and one each using groundwater and wastewater. Households were visited bimonthly during each visit self-report health information was collected by health diary method. Water samples were analyzed for E. coli using the most probable number method. Results: Average E. coli concentrations, per 100 mL, in all the three water sources, were exceeding the international irrigation water standard and measured 3.04 × 10⁴, 9.28 × 10⁵, and 4.02 × 10⁹ for groundwater, surface, and wastewater, respectively. The incidence of diarrhea in the groundwater area was 7.92 episodes/1,000 person-weeks, while the wastewater and surface water group had incidences of 13.1 and 13.4 episodes/1,000 person-weeks. A positive correlation between irrigation water quality and incidence of diarrhea was documented. The average treatment effect of wastewater quality obtained was 2.73. Conclusion: Large proportions of Ahmedabad's farming population rely on water unsuitable for irrigation, inducing significant adverse health effects for farming households. This warrants an urgent need of introducing the concept of urban agriculture to the local civic authorities.

Objectives: In India, integrated biological and behavioral surveillance was carried out in 2014–2015 among high-risk key population as a part of second-generation HIV surveillance system. Computer-assisted personal interviewing and integrated information management system were used for the first time in this large national field based survey. We evaluated the strengths and weaknesses of technology use in this survey. Methods: Mixed methods comprising of the key informant's interviews and structured data collected from field interviewers were used to do the strengths, weaknesses, opportunities, and threats analysis with defined attributes. Results: Despite the challenges, the technology use in this survey was a huge success with respect to data coverage, response rates, real-time data, and acceptance by respondents. However, such techniques require more focus on the competency of human resource, training, and concurrent evaluation systems to get better data quality, time adherence, and effective use of technology. Conclusion: The recommendations resulted from this analysis will help for strategic management while designing such systems in field-based community surveys.

Context: The world is aging rapidly through “demographic transition.” The aging leads to CI Refers as Cognitive Impairment (CI) – a risk factor for dementia. A community-based cross-sectional study was conducted among the elderly aged ≥50 years. Objectives: The objective of the study is to estimate the prevalence of cognitive dysfunction among the elderly and to identify the associated sociodemographic variables. Settings and Design: This was a community-based cross-sectional study in rural and urban field areas of a medical college. Subjects and Methods: Participants aged ≥50 years were interviewed using a structured questionnaire and screened for cognitive dysfunction using Gujarati version of Mini-Mental Status Examination. A score of 23 out of 30 was taken as the cutoff. Written informed consent was obtained from participants. Statistical Analysis Used: Univariate and multivariate analyses were done using SPSS version 17 and Epi Info version 6 to identify significant variables. Results: Of 560 participants, 140 (25%) had CI. Rural (27.6%) and female (29.8%) prevalence was higher than urban (18.5%) and male (19.1%) prevalence. On multivariate analysis, age ≥60 years (odds ratio [OR]: 2.98) and illiteracy (OR: 39.8) had significant positive association with outcome; being employed (OR: 0.18), living with spouse (OR: 0.07), and living with spouse and children (OR: 0.08) had significant negative association with outcome. Conclusions: CI – a precursor of dementia – has serious clinical and public health consequences. Awareness generation and capacity building of primary health-care workers and family caregivers are core control strategies.

Objectives: To know the sputum smear and culture conversion among multidrug resistance tuberculosis (MDR-TB) patients. Materials and Methods: The longitudinal cohort study was conducted for 142 MDR-TB patients registered in 2010 under Revised National Tuberculosis Control Programme of Vadodara region. Three follow-ups were taken for sputum and culture examination, at completion of 6, 12, and 24 months of treatment. Individuals were interviewed to know the reasons for missed dose and default. Results: The sputum smear and culture conversion rate was 43.4%, 47.7%, and 57% at 6 months, 12 months, and 24 months of follow-up, respectively. Treatment default rate was highest (15.2%) within initial 6 months of therapy. The mean time to sputum smear and culture conversion was 120.27 days and 125.02 days, respectively. Conclusions: Most of patients who were culture positive at 6 months remained so even after 12 months. There was not much difference in the time taken for culture and sputum conversion.