Unique challenges posed by complex public health emergencies have often called for institutions, responsible for restoring health, well-being, and order among affected populations, to realign their operating procedures and work in concordance with each other. To ensure optimal health, the growth of the individuals and societies, and development in a greater sense, it is essential to understand the scope of collaboration between law enforcement agencies and public health institutions during emergencies and their aftermath. To foster such partnerships, policy-level advocacy to overcome challenges posed by existing policies and legislation that limit the autonomy of the law enforcement and public health institutions for making informed decisions would be necessary. Human resources working at different levels should be sensitized about the nature and significance of the kind of collaboration, and they should be allowed to express and clarify their doubts about the same. Evidence-based standard operating procedures should be developed for different cadres of professionals, keeping harmony with the operational diversities. Critical issues such as financing the ventures, coordinating and implementing the protocols and projects, following up the cases and suspects, and examining every scenario using evidence-based scientific and legal methodologies would be crucial for the success of such collaborations.

Recommended urine culture is unsuitable for screening pregnant women for asymptomatic bacteriuria due to long turn-around time, unaffordability, and user-unfriendliness. The objective of this review was to evaluate the suitability of various tests for this purpose. A PubMed-based systematic review of published articles irrespective of year and language was done. Search terms included asymptomatic bacteriuria, screening test, urinary tract infection, and diagnostic test. Diagnostic accuracy studies conducted on human populations comparing tests with urine culture were included. One author extracted predefined data fields, including quality indicators, another validated it. Of 78 records, 25 studies describing 15 tests were included. All tests were rapid, seven were valid and two of them were affordable and easy-to-use. No test provided comprehensive identification with antibiotic susceptibility. Despite publication bias, no test was found suitable for screening asymptomatic bacteriuria antenatally and providing evidence-based prescription. Further research is needed to develop tests which suit this purpose.

Context: Change in stunting as the children grow older is rarely found in published literature. Aims: The present paper compares the change in the prevalence of stunting among children as they grow from 0–4 years to 7–11 years. Settings and Design: The present paper is a secondary analysis of India Human Development Survey-I (IHDS-I) (2005) and IHDS-II (2012) data for Kerala. Methods and Materials: In total, 411 children of age 0–4 years and 390 children of age 7–11 years with anthropometric measurements were included in the present study, respectively, from IHDS-I and IHDS-II. Statistical Analysis Used: The statistical analyses were done using SPSS 21.0. The prevalence of stunting was estimated. Bivariate and multivariate analyses were performed using the Pearson Chi-square test. Results: The prevalence of stunting among children has been drastically reduced (50.4% to 20.3%) while growing older from 0–4 years to 7–11 years. Conclusions: More than half of the stunted children below 5 years regained normal growth, as they grow older.

Background: The incidence of postmenopausal osteoporosis continues to rise, as population ages. The morbidity and mortality associated with osteoporotic fractures have a significant negative impact on the economy and quality of life of the affected individual and the community, at large. Objectives: We aimed to study the prevalence of osteoporosis in ambulant rural postmenopausal women, and to look at their dietary calcium intake (DCI) and Vitamin D status. Subjects and Methods: This was a cross-sectional study conducted in 1565 ambulant South Indian rural postmenopausal women. Bone mineral density was estimated by a dual-energy X-ray absorptiometry scan at the femoral neck (FN) and lumbar spine (LS). DCI was calculated by recall for the previous week, and the blood bone biochemical profile was measured. Results: The mean standard deviation (SD) age and body mass index of this population were 60.7 (7.2) years and 26.2 (4.8) kg/m², respectively. The prevalence of osteoporosis was 22% at the FN and 39% at the LS. An increase in the prevalence of osteoporosis was noted at both sites, in successive age categories. Mean (SD) DCI was 420 (282) mg/24 h. Fifty-four percent had Vitamin D deficiency (VDD) (<20 ng/ml) and 6% had severe VDD (<10 ng/ml). Conclusion: A significant proportion of this large cohort of south Indian healthy rural postmenopausal women had osteoporosis at either site with advancing age. Most of them had a suboptimal DCI, and over half of them had VDD.

Background: Vaccines are mostly delivered through routine immunization and catch-up campaigns. Measles-rubella (MR) campaign, one of the largest vaccination campaigns, was launched on February 8, 2017, in five states of India including Karnataka. Objectives: The objective of this study was to compare the association of various sociodemographic factors influencing routine immunization and MR campaign and to identify the reasons for nonvaccination. Materials and Methods: A cross-sectional study was done after the end of MR campaign, by interviewing parents of 147 children aged 9 months to 5 years in urban areas of Mysore. Sociodemographic factors and measles vaccination status by routine immunization and MR campaign were studied. Results: The coverage of measles vaccination by routine immunization and the MR campaign was 93.9% (138/147) and 86.4% (127/147), respectively. While communication with field workers was significantly associated with both routine immunization and the MR campaign, religion and mother's educational status were associated with MR campaign (P < 0.05). The most common reason for not being vaccinated was lack of unawareness about the campaign and the location for vaccination which could have been curbed by health education. Conclusions: The study has shown that there are many factors which can be prevented by the health system that might help in improving immunization coverage.

Introduction: In recent years, there has been an increase in the number of cases of women and men suffering from a sexually transmitted disease. Objective: The objective of this study was to implement an educational intervention on the human papillomavirus (HPV) to increase knowledge about the disease among university students. Materials and Methods: In a preexperimental study with 385 students of both genders, the strategy was designed under the parameters of the PAHO and the Theory of Beliefs in Health. The problem was identified through biological samples of the genitals, and the impact was measured through a questionnaire. The presence of HPV DNA was made with molecular polymerase chain reaction tests; and the answers, through coefficients of variation. Results: Of the participants, 60 were positive: 49 women and 11 men. At the beginning of the application, the knowledge level was medium, between 9.0 and 9.6. After the application, it was between 12.5 and 13, being the level of knowledge average, but very close to the threshold of high. Conclusions: With the results of the tests, it was found that HPV is a real problem among university students. The level of knowledge remained medium, despite the educational intervention.

Background: Complications during pregnancy and childbirth remain a leading cause of illness and death among women of reproductive age in India. In the recent years, the concept of the WHO maternal near miss (MNM) has been adopted by the tertiary level hospitals as it has an added advantage of offering a large number of cases for intervention and for the evaluation of the maternal healthcare being provided by the health-care system. Materials and Methods: In the present study, near miss criterion-based audit of MNM cases and maternal death (MD) cases, based on the WHO near miss approach and MD, was conducted from the record section of the four tertiary level hospitals. In the present study, the WHO MNM approach was adopted to assess the quality of maternal healthcare in tertiary level hospitals. Retrospective secondary data analysis from the records of record section and maternity wards pertaining to June 2015–May 2016, of the hospitals of Ahmedabad city, was conducted from January 2016 to November 2017. Results: The total number of live births of all the four hospitals under surveillance was 21,491. Severe maternal outcome cases were 326, of which 247 (75.8%) were of MNM cases and 79 (24.2%) were of MD. MNM mortality ratio was found to be 3.13:1. Eclampsia (29.45%) followed by preeclampsia (25.46%) and severe postpartum hemorrhage (22.39%) were the leading causes of potentially life-threatening conditions. Conclusion: Above finding suggests the development of a comprehensive framework for the assessment of MNM and further improvement in the quality of maternal health care.

Introduction: Lifetime prevalence of psychiatric disorders in India is about 14%, and the treatment gap is huge necessitating large-scale public health efforts. Manochaitanya programme (MCP), one such innovative program, was launched by the Government of Karnataka in October 2014. MCP entails provision of outpatient psychiatric care in subdistrict (Taluk) hospitals and primary health centers under a public–private (Indian Psychiatric Society-Karnataka chapter) partnership model, at least one Tuesday of every month. Aim: The aim was to do a secondary care level performance audit of MCP of initial 2½ years at all Taluka general hospitals of Karnataka. Methodology: Data on MCP were collected and tabulated from all 31 districts using a specially designed semistructured pro forma. This includes the number of self-reported psychiatric consultations in each Tuesday's clinic, number of psychiatrists, and their visit details. Prospective data were obtained from monthly reports. Results: The district coverage was 100% during initial 2½ years over this period, i.e., MCPs were successfully covered in at least one Taluka hospital in all 31 districts. A total number of estimated consultations under this initiative were 73,663 with an average of 24.1 patients per psychiatrist consultation. One hundred and eleven psychiatrists participated in a total of 3,056 visits across the state. Patient footfall increased consistently over this time period. Conclusions: Psychiatrist-based Manochaitanya programme at secondary care level at Taluk hospitals has noticed substantial benefits to patient care. There is a need for psychiatrist-based secondary care at Talukas (subdistrict) level across the country.

Introduction: Today we all are talking for “Swatch Bharat”, but street workers are the real fighters who are working for this. Street working environment exposes to lot of organic and inorganic dust and chronic inhalation of dust during street sweeping which may increases respiratory health symptoms among them. This study was planned to study the effect of work on health of street workers primarily respiration function. Materials and Methods: A cross sectional study was carried out among muster station of Ahmedabad Municipal corporation area during a period of April 2013 to November 2014. For the study total 762 Safai Kamdar (street sweepers) and 41 administrative staff were included after taking consent. The participants were examined for hypertension, Peak expiratory flow rate (PEFR), lab investigations like hemoglobin and blood glucose. Results: Mean age of Street Sweeper was 39.2 + 10.02 years and admin staff was 38.2 + 6.92 years. Street Sweeper were found to be significantly underweight as compared to admin staff. Hypertension in administrative group (51.1%) was higher but not significant than Street Sweeper (45.03%). only 12.3 % of Safai Kamdar were using any kind of personal protective equipment (PPE). 52.1% of Street Sweeper had low PEFR was as compared to 20% of Administrative group. Conclusion: Street sweeping had a significant impact on health of street sweepers. They should be made aware about use of PPE.

Background: Ministry of Health and Family Welfare has developed National Quality Framework to assess the quality of services for improvement and helps in certification of facilities, while Kayakalp was launched to promote cleanliness and hygiene in public health facilities. Objective: The objective of the study is to assess if Kayakalp implementation within the public health facilities supports quality certification of health facilities. Methods: A retrospective study was designed to gather data for 32 quality-certified district hospitals under National Quality Assurance Standards (NQAS) between May 2015 and April 2018 by reviewing records. Certification criteria and their external assessment checklist under NQAS and Kayakalp program for district hospitals were extracted from their respective states. External assessment score of all district hospitals under study was entered and analyzed using Statistical Package for the Social Sciences version 22 for Pearson's correlation analysis and MS Excel 2016 for statistical analysis. Results: Pearson's correlation coefficient was 0.217, which means that Kayakalp implementation has less significance on the quality certification of public health facilities to NQAS. A scatter chart was plotted which depicts nonlinear relationship between dependent and independent variable. Conclusion: Overall impact of implementation of Kayakalp initiative on quality certification of public health facilities to NQAS was significantly low; however, this could be due to less weightage given to the checkpoints in NQAS as compared to in NQAS.

Background: In India, 60% of the population lack basic medical facilities, so health camps which provide short-term medical interventions for target communities may be beneficial. This study epidemiologically analyzes a health camp event in a rural area of Maharashtra to provide practical insights for organizing, planning, and implementation of health camps. Objectives: 1. Assess the sociodemographic profile and spectrum of morbidity of camp beneficiaries. 2. Assess expectations and satisfaction perceived by community and organizers from health camps. 3. Gain practical insights from the camp event to advocate participation-friendly policies in the community. Materials and Methods: This is a cross-sectional mixed design study. Using qualitative method, a total of four focus group discussions (FGDs) were held with beneficiaries attending the camp and three in-depth interviews (IDIs) were held with camp organizers. A semi-structured questionnaire was used to interview 358 beneficiaries to be studied quantitatively. Results: The camp comprised 52.7% of males and 36.7% of females as beneficiaries. Observed were cases of acute disease (41.6% [n = 149]) and chronic disease (58.7% [n = 209]) with maximum beneficiaries visiting ophthalmology department (25.4%) followed by general medicine (16.70%). FGDs and IDIs revealed two major themes – expectation and satisfaction and several subthemes. Conclusion: The beneficiaries appreciated the event and expressed the requirement of organizing such camps in future again. The camp was need based as revealed by the organizers and beneficiaries. Few strategies in future can result in more participation-friendly health camps.

Background: Any deficiency or inadequate dietary pattern can lead to poor nutrition which can further influence both growth and development throughout from infancy to adolescence. Since adolescents represent the next generation of parents, it is important to monitor their nutritional status at this crucial stage. Thus, this study aimed to explore the factors associated with nutritional status among adolescent girls belonging to these tea gardens. Objective: The objective of this community-based cross-sectional study was to assess the nutritional status of adolescent girls belonging to the tea garden community and the association of the sociodemographic factors with it. Materials and Methods: Anthropometric measurement was taken among adolescent girls in the tea estates of Nazira subdivision of Sivasagar district, Assam. The pattern of dietary intake among adolescents was also studied. The statistical analysis was done using SPSS version 15. Results: The prevalence of thinness and stunting across 265 adolescent girls was 49.4% and 50.6%, respectively. Calorie and protein deficits were found to be 76.60% and 65%, respectively. Majority of the respondents, i.e., 66.80% of the participants, had a poor intake of essential food constituents. Moreover, 76.21% of the respondents were anemic. The association of different sociodemographic factors with thinness, inadequate protein intake, and anemia were found during the study. Conclusion: Thinness and stunting along with protein–energy malnutrition and inadequate intake of important food groups were prevalent in adolescent tea community girls. Overall, the public health burden of malnutrition is still a persisting health problem in the tea gardens of Assam.

Background: Collaborative learning (CL) strategies are grossly underused in medical education. The present study aims to compare the effectiveness of students' preferences for collaborative and traditional learning (TL) strategies. Objectives: The objective of the study is to compare the effectiveness and students' preference for CL and TL methodology for small groups learning's in community medicine. Methodology: This was a crossed over experimental study design with students being taught two separate topics using collaborative and TL methods. Pre- and Post-test scores and students' reflections were recorded. Results: The mean pretest scores of participants were comparable and posttest scores for collaborative method were significantly higher. The effect size for control group was 0.26 and for intervention group was 0.49. Conclusion: Collaborative method was highly effective in improving the performance of participants. Participants' expressed their preference toward collaborative methods over traditional methods of teaching.

Background: Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) are a major public health problem worldwide, affecting the quality of life and causing serious morbidity and mortality. STIs/RTIs have a direct impact on reproductive and child health through infertility, cancers and pregnancy complications, and they have an indirect impact through their role in facilitating the sexual transmission of human immunodeficiency virus. Objectives: (1) To estimate the number/proportion of cases of STI/RTI being treated by health-care providers. (2) To document investigations being prescribed for diagnosis. (3) To document treatment protocols being used by health-care providers for STI/RTI management. Methodology: This was cross-sectional study conducted in Vadodara city. A total of 118 health-care providers were interviewed by using pre-tested semi-structured questionnaire regarding the current status of STIs/RTIs, proportion of STIs/RTIs patients, investigation and managements. Results: Proportion of STI/RTI patients out of all outpatient department patients ranges from 1.03% for general practitioners (GPs), 2.86% for skin and venereal disease (VD), and 15% for obstetricians and gynecologists consultants. Use of investigation for the diagnosis of STI/RTI is minimal among obstetricians and gynecologists specialists (29.41%) and GPs (54.55%). Use of guidelines for the management of STI/RTI is not equal across consultants. Guidelines were followed by 67.50% of skin and VD consultants, 32.35% of obstetricians and gynecologists consultants, and 18.18% of GPs. Conclusion: There is considerable variation in treatment-seeking and the use of standardized treatment protocols for the management of STI/RTI by the government as well as private providers.

Context: India is one of the leading manufacturers of garments with roughly 80% of the workforce dominated by female migrant workers. Lack of education and access to resources in these women contribute to unsafe sexual behaviors, sometimes leading to unwanted pregnancies or sexually transmitted infections (STIs). Awareness raising, and peer education in particular, is extremely effective in addressing reproductive health issues. Aims: This study aims to study the effectiveness of peer health education in improving the awareness on reproductive health among women workers in textile industries. Settings and Design: A health educational interventional study for women in garment and spinning mills using peer education process carried out over a period of 18 months. Subjects and Methods: The process includes orientation to factory management, health needs' assessment, identifying health topics, peer educators' selection, peer educator trainings followed by outreach sessions, and impact measurement. The impact of peer education on reproductive health has been assessed among 597 participants from 9 factories. Statistical Analysis Used: Data were entered in SPSS version 24 and analyzed. Results were expressed as percentages. Chi square test was used where appropriate to find association between categorical variables. Results: The mean age of the workers in both the groups is 25.4 (±9.6) years and 25.1 (±8.3) years. In both the groups, most of the workers were single and more than half of them reside within the factory premises. Significant change in menstrual hygiene practices, knowledge in family planning methods, STIs, and cervical cancer has been observed following peer health education. Conclusions: A well-designed health educational interventional program using peer educators could be a successful approach to create awareness on sensitive topics.

Background: Missed opportunities for immunization (MOI) is considered as the most important preventable reason for underimmunization. Health-care workers stand beyond more than half the children's missed opportunities due to gaps in their knowledge, attitudes, and practices (KAP) regarding immunization. Objectives: This study assessed immunization staff at primary health-care centers in Baghdad/Al-Karkh for KAP that may lead to MOI. Materials and Methods: KAP survey was conducted on field immunization service providers at primary health-care centers in Baghdad/Al-Karkh. Barriers are considered to present whenever scores found <80 in any of KAP. Data were collected using a self-administered structured questionnaire analyzed by SPSS 24. Results: Among 217 respondent health professionals, 69 (31.8%) were physicians and 148 (68.2%) were nurses. The studied sample got mean scores for KAP of 84.7 ± 11.4, 71.1 ± 22.7, and 74.8 ± 20.3, respectively. Physicians had higher mean knowledge score compared to nurses (P < 0.05). Both physicians and nurses got mean scores below 80 for both attitudes and practices. Conclusion: Attitudes and practices in both physicians and nurses need to be improved to avoid MOI.

Context: Metabolic syndrome (MetS) is recognized as a major epidemic of the 21^st century. People with MetS have twice the likelihood of developing and dying from cardiovascular diseases and more than seven times the risk of developing diabetes. Aims: This study was undertaken to determine the prevalence of MetS and its components among adults who were in their first three decades of adulthood. Settings and Design: This was a community-based cross-sectional study among 388 subjects aged 18–49 years selected by multistage random sampling in an area of Kolkata, India. Subjects and Methods: Data collection was done using a structured questionnaire along with anthropometry, blood pressure (BP) measurement, and relevant blood tests. Physical activity was classified by The International Physical Activity Questionnaire-Short Form questionnaire. Statistical Analysis Used: Data were analyzed using the SPSS software version 16.0 and descriptive statistics were calculated as frequency and percentage. Results: The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females) and prevalence of central obesity, elevated fasting plasma glucose, raised triglyceride, raised BP, and reduced high-density lipoprotein cholesterol were 68.6%, 41.5%, 36.1%, 45.1%, and 64.9%, respectively, among the study participants. Conclusions: This research revealed the high prevalence of MetS and its components in the community. Effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been implemented to curtail the epidemic of MetS.

Background: The “Adolescents for Health Action model,” Kishori Panchayat (KP) is an innovative approach for mobilizing and empowering adolescent girls by enhancing their life skills by participating in various community health activities, a platform for interaction with peer-groups, villagers, community leaders, and health-care providers. Aim: The aim of the study is to follow-up the quantitative data regarding the effectiveness of KP in enhancing life skill education among adolescent girls who are members of KP compared to Non-KP girls. Objectives: The main objectives are: (1) to study the knowledge and perceptions regarding life skills among adolescent girls (12–18 years) of KP and non-KP and (2) to identify features of KP and related contextual factors that contributed to the outcome. Methodology: The qualitative study was carried out among 100 KP girls and non-KP girls, respectively (12–18 years), under 20 villages of rural Wardha district over 1-year period after obtaining consent in writing from participants and Institutional Ethics Committee. Focus group discussion was conducted in each village. Key informant interviews of social workers of KPs and school teachers conducted until data saturation. Results: Findings suggest that KP girls had more knowledge and perception regarding life skills and their application compared to non-KP girls. Life skill education program by KP was found to be received positively by adolescent girls. Conclusion: Institutionalization of this can help in building a sustainable model for empowerment of adolescent girls.

Background: Sleep is essential for physical and psychological development of children as well as adolescents. Poor sleep has been noted to lead to poor diet, obesity, stunted growth, mental health issues, and substance abuse. Despite the knowledge regarding the importance of sufficient sleep, the prevalence of insufficient sleep has been noted to increase among children and adolescents. Objective and Aim: The aim of the study was to determine the prevalence of poor sleep quality among adolescents of an urban resettlement colony and to evaluate the association of poor sleep quality with the correlates. Materials and Methods: A community-based cross-sectional study was conducted including 620 adolescents aged 10–19 years, in an Urban Resettlement Colony, Dakshinpuri Extension, New Delhi. A self-reported interview was conducted with the pretested, semi-structured interview schedule. The interview focused on sociodemographic variable, sleep quality using Pittsburgh sleep quality index, Perceived stress scale, screen time, and anthropometric measurements. Results: The mean of Pittsburgh sleep quality index total score was 2.3 (standard deviation = 1.9). Among the adolescents, 7.3% of them were found to be poor sleepers. Poor sleep quality was observed to be higher during school days as compared to vacation (9.3%, 6.5%, respectively). Adolescents of age group equal to and > 15 years have higher odds of having poor sleep quality than those younger than 15 years of age (odds ratio = 4.9; 95% confidence interval: 2.2, 10.8). Conclusion: Significant difference in sleep duration was noted among adolescents of age ≥15 years as compared to the younger group in the present study.

Background: Approaching 100 million in number, India has the second largest population of elderly people after China. India's elderly are growing faster than the general population. By the year 2050, the number of elderly population is expected to increase to 323 million. In the geriatric population, fall is the leading cause of nonfatal injuries and hospital admissions. Falls account for 40% of all injury deaths, and the death rates are the highest among 60 years and above in all the regions of the world. Objectives: The objective of this study is to assess the factors associated with the risk of fall among the elderly of 60 years and older in rural Kattankulathur block. Materials and Methods: The study is a community-based case–control design among the elders in a rural setting. Those who had fallen in the past 12 months were selected as cases, and an equal number of age- and gender-matched controls were selected. Multiple logistic regression was conducted with biological, behavioral, environmental, and socioeconomic variables. Results: Of the 747 elderly contacted for the survey, 140 cases and 140 controls each were selected based on self-reported fall in the previous 12 months. The mean age of the participants was 66 with 95% confidence interval (65–67). Individual risk factors for fall were fear of falling (odds ratio [OR] 6.7) and dizziness (OR 4.9). Conclusions: There is now, more than ever, a need to refocus public health priorities for falls prevention in rapidly aging elders in India. This study provides a much-needed information for further investigation into fall and fall-related injury in developing countries like India.

Context: Undernutrition among adolescents in tribal areas is an area of concern in India. Aims: This study aims to assess nutritional status of adolescent girls and to study their hygienic practices and awareness regarding adolescent programs. Settings and Design: Two blocks (Palghar and Dahanu) in Palghar district of Maharashtra. Subjects and Methods: The present study was a community-based cross-sectional study conducted among 240 unmarried adolescent girls in ten villages of the study area. Results: The mean age of adolescent girls was 14.5 ± 1.62 years. Mean body mass index was 18.13 ± 7.11 kg/m²; 55% of them were wasted and 67% were stunted. Mean hemoglobin was 9.57 ± 1.4 g/dl and 81.6% had moderate anemia. Ninety-two percent reported hand washing with soap after defecation. Only 2.5% had awareness regarding adolescent government programs. Conclusion: The present study indicated very poor nutritional status among tribal adolescent girls. Interventions to reduce the prevalence of malnutrition and anemia in this age group is the need of the hour.

A 30-year-old male working in an abattoir in UAE returned home to Kerala, South India, after getting diagnosed with Crimean–Congo hemorrhagic fever infection. He was admitted to a tertiary care center on the day of arrival and was placed under isolation. Due to the risk of spread of infection among health-care workers, contact-tracing and symptom-monitoring activities were undertaken. As strict standard contact precautions, isolation, contact identification and listing, quarantine, and sensitization of health-care workers were implemented, no secondary cases occurred.