Background: Primary infertility is a serious health issue that has profound socioeconomic and health implications on both the individual and society. Despite the important consequences of infertility, estimation of its prevalence is limited. Objective: The objective of the study is (1) to estimate the prevalence of primary infertility among women of reproductive age group in urban population of Central India and (2) to study its associated risk factors. Material and Methods: In a community-based cross-sectional study, all married women between 15 and 49 years of age in urban field practice area were included. The data were collected by face-to-face interview with the help of predesigned and pretested questionnaire. Results: The majority of the women (39.3%) belonged to 25–29 years of age group. The overall prevalence of primary infertility among reproductive age group women was 8.9% (51/570). Sociodemographic factors that had statistically significant association with infertility were age at marriage more than 25 years (P < 0.05), nuclear family (P < 0.05), higher education level (P = 0.04), employed women (P < 0.05), high socioeconomic status (P = 0.01), and family history of infertility (P < 0.05). Physiological factors that had statistically significant association with infertility were obesity (P = 0.03), age at menarche more than 14 years (P < 0.05) and irregular menstruation pattern (P < 0.05). Depression (P = 0.01) and stress (P < 0.05) were the psychological factors significantly associated with infertility. Conclusion: The prevalence rate of primary infertility in urban population of Central India was lower than reported trends of infertility from developing countries. Sound knowledge about various factors related to infertility can help health-care providers and policymakers to design and implement various policies.

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Context: Domestic violence in Indian setting has five major components: emotional abuse; physical violence; sexual violence; honor killing; dowry-related abuse; and death. Aims: The aim of the study was to estimate the prevalence of domestic violence and 3 of its components – emotional abuse, physical violence, and sexual violence among women in the age group of 15–49 years in Kaniyambadi block, rural Vellore, Tamil Nadu and to determine the risk factors of domestic violence. Settings and Design: A community-based cross-sectional study among women between the ages 15 and 49 years at the rural setting of Kaniyambadi block, Tamil Nadu. Results: Prevalence of all forms of domestic violence among women was 77.5%, and forty percent women were classified as having ever been subjected to severe domestic violence. Prevalence of physical violence was 65.8%, sexual abuse was 17.5%, and emotional abuse was 54.2%. Alcohol consumption by husband (adjusted odds ratio [AOR] 4.37; 1.35, 14.18), controlling behavior by family member (AOR 8.07; 2.47, 26.37), and woman's employment (AOR 4.33; 1.27, 14.77) were statistically significant determinants of domestic violence. Three-fourth (73.1%) of the women felt that being subjected to domestic violence has affected their physical and mental health. Conclusions: The high prevalence of domestic violence in our community needs to be addressed as it has tacit implications on socioeconomic well-being, physical and mental health of a woman, her family, and thereby, society as a whole.

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Background: An outbreak of the rare and highly pathogenic Nipah virus infection occurred in Kozhikode, Kerala, India, during May 2018. Methodology: Outbreak control activities included laboratory case confirmation and isolation. Contact surveillance was initiated and close contacts were home quarantined for the maximum incubation period of the disease. Field visits and verbal autopsy of the deaths were done to elicit the details of exposure. Results: Of the 18 confirmed cases, 16 succumbed (case fatality rate, 88.8%). The mean incubation period was 9 days. The transmission was person to person wherein the primary case served as a point source for 15 other cases including 2 health-care workers. The mean age of the affected cases was 41 years with male preponderance. More than 2600 contacts were under surveillance. The outbreak was contained within 3 weeks and declared closed by July the same year. Conclusion: Early detection of the outbreak and prompt isolation of cases along with strengthening of infection control practices and barrier nursing helped in containing the outbreak.

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Hearing is the key to learning spoken language, performing academically, and engaging socially for children. Degree of hearing loss quantifies the hearing ability from mild to profound, based on the audiometric findings for an individual across certain frequencies or pitches. Early identification and appropriate intervention is the prime need. A probable strategy is to ensure that every newborn is screened for possible hearing loss at the birth in the hospital. In India, hearing screening facility is mostly available to newborns brought into tertiary hospitals. Some of the key issues in the implementation of the program identified are lack of human resources, inadequate infrastructure, equipment-related shortcomings, and low priority for hearing impairment (HI) prevention. The Government of India initiated efforts toward prevention and control of HI, i.e., National Program for Prevention and Control of deafness and Rashtriya Bal Swasthya Karyakram which are significant milestones in the implementation of systematic nationwide hearing screening programs.

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Background: Anxiety disorders are the most frequent mental disorders encountered in childhood and adolescent years. The number of epidemiological studies done in this area within India is limited. Objectives: We determined the prevalence of anxiety disorders among adolescents in a rural community of Ballabgarh block, district Faridabad, Haryana. Secondarily, we also assessed sociodemographic and other factors associated with anxiety disorders among adolescents. Materials and Methods: This community-based cross-sectional study was conducted among 729 adolescents (10–19 years). Screen for Child Anxiety-Related Emotional Disorders tool was used for assessing prevalence and type of anxiety disorders. Sociodemographic and personal factors were included in the logistic regression multivariable model to establish associations. Adjusted odds ratios (AOR) along with 95% confidence intervals (CI) are computed. Results: The prevalence of anxiety disorders among adolescents was (22.7%; 95% CI: 19.7–26.0). Girls (27.6%) had higher prevalence than boys (18.3%) (P < 0.01). Social anxiety disorder (14.3%; 95% CI: 11.7–16.9) was the most common form of anxiety disorder. Female sex (AOR 1.8; 95% CI 1.2–2.6; P < 0.01), lower-middle socioeconomic status (AOR 1.96; 95% CI 1.2–3.1; P < 0.01), and presence of stressful event within the past 1-year (AOR 2.48; 95% CI: 1.12–5.06; P = 0.01) were found to be associated with the presence of anxiety disorders. Conclusions: Anxiety disorders are common among adolescents in rural settings of India. Tackling them will require appropriate health systems response. Adequate interventions should be incorporated at primary care level to address the mental health concerns of adolescents.

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Background: The major focus of studies related to health among tribes in India has been on malnutrition. The world is in the stage of epidemiological transition, and noncommunicable diseases are overtaking the communicable diseases not only in general but also among the tribal population. Objectives: A cross-sectional study was conducted to find out the prevalence of diabetes and hypertension among the tribal population. Methodology: A house-to-house survey using a semi-structured questionnaire was conducted in three randomly selected tribal villages. Participants aged 18 and above from both genders were included. Blood pressure was recorded and random blood sugar was estimated for all the participants. Chi-square test was used to study association for categorical variables and one-way ANOVA and Student's t-test were used to study association for continuous variables. A P < 0.05 was considered significant. Results: A total of 952 tribal people were interviewed. About 40.2% were males and 59.8% were females. About 82.2% were Illiterate. 18.9% were underweight compared to 8.8% who were overweight or obese. The prevalence of diabetes was 3.8% (36 participants) of which 77.8% was newly detected. Increasing age was associated with diabetes. Overall, prevalence of hypertension was 16.7% (159 participants) of which 62.9% were newly detected. Age, gender, body mass index, and literacy status were associated with the presence of hypertension. Only eight participants had both diabetes and hypertension. Conclusion: Noncommunicable diseases burden in tribal population is as high as in the general population. Effective strategies to prevent this have to be devised.

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Background: Professional swimmers face a hidden occupational hazard due to improper maintenance of pool. Ill maintained pools can lead to erosive effects on dental health and thus needs to be evaluated. Methodology: Fifty-six competitive swimmers from two training centers were contacted and surveyed for swimming exposure and oral health. A visual analog scale was used to rate the tooth sensitivity. Dental erosion and dental caries were recorded according to WHO oral health assessment criteria (2013). The dentinal hypersensitivity experience was assessed using the dentine hypersensitivity experience questionnaire - 15 (DHEQ-15). Data were analyzed using Chi-square test and multivariate analysis. Results: The prevalence of dentinal hypersensitivity and dental erosion was found to be 69.6% and 48.2%, respectively. The common surfaces affected by dental erosion were palatal surfaces of maxillary anterior, followed by lingual surfaces of mandibular anterior. There was a direct association between duration of the stay in pool and dental erosion. The DHEQ-15 questionnaire revealed that more than 80% of the participants never felt these sensations had any serious long-term effects on oral health. Conclusions: Oral health professional must understand dental erosion among competitive swimmers as an occupational oral health hazard and provide early counseling and necessary invasive and noninvasive care.

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Background: Most adolescents lack access to age- and sex-appropriate health information which is vital for young people to make informed decisions about their reproductive sexual health. Objectives: The study objective was to study the effectiveness of the interventional reproductive and sexual health education on knowledge, attitude, and menstrual practices of school-going adolescent girls. Materials and Methods: It was an interventional study consisting of a pretest, intervention session, and posttest conducted among 400 school-going adolescent girls in a rural area of Maharashtra. Results: There was a statistically significant increase in knowledge, attitude, and practice median scores following intervention (P < 0.05). Conclusions: Age- and sex-appropriate health education programs can facilitate the development of healthy reproductive and sexual behavior patterns among adolescents through the enhancement of knowledge and development of right attitude.

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Introduction: Depression and cognitive function are said to be the foes of the nutritional status of the older adults. Depression is the most common psychological problem in old age, while deterioration of cognitive function is also observed in this age group. Objectives: The main objective of the study is to find out the association of nutritional status with depression and cognitive function of older women. Materials and Methods: A cross-sectional study was done among 196 older women, residing in old-age homes of Kolkata. Nutritional status of the participants was assessed by the long version of Mini Nutritional Assessment tool (MNA^®). Level of depression was assessed by Geriatric Depression Scale (GDS 30). Cognitive function was checked by using the Folstein Mini-Mental State Examination (MMSE). Chi-square, Kruskal–Wallis test, and Spearman's rho correlation coefficient was calculated using SPSS software. Results: About 38.3% and 14.8% participants were suffering from mild and severe depression. 13.2% and 9.2% older women were found with borderline impairment and impairment in cognitive function, respectively. Significant correlation of nutritional status was found with both depression and cognitive function (P < 0.05), and this was supported by multinominal logistic regression model. Conclusions: Both depression and impairment in cognitive function can cause malnutrition or vice versa among older women.

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Introduction: Burnout syndrome refers to a combination of physical fatigue and emotional exhaustion, which, in turn, affects the working efficiency of a person. In India, factors such as extensive working hours, poor facilities, and physical and emotional abuse of doctors by patients and seniors lead to the high prevalence of occupational burnout among medical practitioners. Materials and Methods: The sample consisted of 300 resident doctors working in public sector hospitals across Mumbai. The “Copenhagen Burnout Inventory” questionnaire was utilized to assess the prevalence of burnout. Questionnaires were made available personally or electronically. Burnout was recorded on three parameters, personal burnout, work-related burnout, and client-related burnout. Results: The average working hours recorded was 88 h/week. About 56.66% (n = 170) showed scores that indicate burnout. About 66.67% of respondents showed personal burnout, 57.14% had work-related burnout, and 16.67 had client-related burnout. Conclusion: The high prevalence of burnout syndrome among resident doctors in public sector hospitals is alarming as it not only takes a toll on the physical and mental health of the medical practitioners but also reduces their working efficiency and motivation. Stress management strategies should be propagated in hospitals to encourage work and personal life balance.

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Chronic cough is one of the most common symptoms for patients-seeking consultation in an outpatient clinic. It is associated with substantial psychological, physical, and social burdens and impaired quality of life. This review highlights some of the major diagnostic and management challenges confronted in the field of cough with a special focus on the Indian perspective. Heterogeneity in definitions and classifications and challenges associated with over-the-counter drug use and irrational drug use are some of the major controversies. Streamlined diagnostic approach involving a combination of subjective and objective tools, evidence-based amendments in clinical practice, and stringent implementation of regulatory guidelines are mandatory to address controversies in cough management in developing countries.

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Context: Alcohol consumption is the third largest risk factor for disease and disability in developing countries. Globally, 4% of all deaths are related to alcohol consumption every year. De-addiction measures and rehabilitation strategies can sometimes be challenging in rural population as there is a potential for a higher rate of relapse due to socio-cultural barriers such as unemployment, limited entrainment activities, and peer pressure during social events. Methodology: A cross-sectional study was conducted to determine the factors contributing to relapse in Bengaluru rural district. A total of 112 participants were interviewed, after attending de-addiction camp, using a semi-structured questionnaire containing instruments such as Penn Alcohol Craving Scale, self-efficacy scale, interpersonal support evaluation list, and presumptive stressful life events scale. Bivariate and multivariate logistic regression was done to determine the factors associated with relapse. Results: The relapse rate was 55.4% among the study participants. Education, self-efficacy, social support, and craving were associated with relapse in the bivariate analysis (P < 0.05). In multiple logistic regression model, craving (odds ratio [OR] – 1.8, confidence interval [CI]: 1.2–2.5), good interpersonal tangible support (OR – 0.09, CI: 0.01–0.5), and desirable life events (OR – 0.03, CI: 0.02–0.6) in the past were associated with relapse. Conclusion: Relapse rate was 55.4% among the study participants which is comparable to the findings of the other long-term studies. Increased craving, low-self-efficacy, and poor social support were associated with relapse hence need to be addressed in follow-up counseling sessions.

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Background: This study was carried out to assess the reach of medico-social and economic programs to the silicosis victims in Karauli. The district is infamous for large-scale unregulated sandstone mining, a pulmonary hazard, causing silicosis, a debilitating occupational disease compensable under Indian laws. Methodology: A sample of 250 silicosis cases from 38 villages were randomly recruited and interviewed from four different sites. Results: The study reports that 99% of sandstone miners came from marginalized poor communities, had large families, and lived in mud houses. Victims' linkage to their entitlements and welfare programs was poor (51%). Victims (43%) continue to work as casual laborers including in mining sector due to economic compulsions. Greater than 68% of the laborers were wrongly treated for tuberculosis (TB) prior to their diagnosis, >50% go out of the state or cities for better treatment, and 60% of cases had not received their compensation from the government. Among those who received compensation, only 4% spent money for productive purposes and 44% victims were not in a position to work due to health difficulties. Conclusions: Silicosis has affected the poorest of the poor; victims are wrongly diagnosed and treated for TB. The district is not equipped to deal with the health problems of the victims, forcing them to seek treatment in other states and cities. In conclusion, the impact of rehabilitation programs in the district is ineffective and inadequate and has limited reach. Findings of the study will have far-reaching implications for informed policymaking on the rehabilitation of silicosis victims in the state.

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Context: In India, people residing in slum are not able to get safe food, drinking water, and shelter. Special vulnerable group such as women and children are at higher risk for infectious- and nutritional-related problems. Because of the dual responsibility of working women for her family and job, chances are always higher that the reproductive and child health (RCH) of such families are compromised. Aims: The aim of this study is to assess RCH profile of working women residing in slums. Subjects and Methods: A community-based cross-sectional observational study was carried out among slums of Rajkot city. With the usage of simple random sampling technique and informed verbal consent for the study, a total of 480 working and nonworking women were enrolled in this study. Semi-closed prestandardized questionnaire was used to capture their sociodemographic, reproductive health, and child health parameters. The World Health Organization growth standard was used to categorize the nutritional status of their children. Results: Age of marriage and first conception were significantly delayed among working women. Only 37.8%working women had adequate birth spacing between two children. About 33.3% had received adequate antenatal care (ANC) services during pregnancy. Higher prevalence of malnutrition (65.2%) and lower prevalence of full immunization (39.4%) were found among children of working women. Conclusions: Low birth spacing, lower utilization of ANC care services, higher malnutrition, and poor immunization coverage among working women had indicated underutilization of RCH services by working women of slum.

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Background: In India, social issues such as stigma and discrimination are still experienced by many women living with HIV (WLHIV) at various levels such as family, community, or health care settings even after a decline trend in HIV prevalence. Objectives: To assess stigma, discrimination, and domestic violence among WLHIV attending an antiretroviral therapy (ART) center and its association with unsafe sexual practices. Materials and Methods: This cross-sectional study was carried out among WLHIV attending an ART center of a tertiary care hospital after obtaining approval from the institutional ethics committee. An interview schedule was used to collect data from WLHIV selected by systematic random sampling method on the day of interview. Data were collected after taking their written informed consent using a semistructured validated study instrument. Stigma and discrimination was assessed by a set of 7 and 11 closed-ended dichotomous–response questions, respectively. We measured self-reported occurrence of domestic violence and unsafe sexual practice. Results: A total of 135 WLHIV were enrolled in this study. As high as 81% perceived stigma in their daily life while 41% reported to be discriminated. Domestic violence was experienced by 50.3% of the respondents. Majority of them (three-fourths) reported the type of violence to be physical as opposed to a quarter reporting sexual violence. Stigma, discrimination, and domestic violence were significantly associated with unsafe sexual practices. Conclusion: Social evils in the form of stigma, discrimination, and domestic violence are still faced by a remarkable proportion of WLHIV, and it has been found to be associated with unsafe sexual practices.

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Background: India has the third largest human immunodeficiency virus (HIV) epidemic in the world, with 15,000 newborns infected every year. Prevention of mother-to-child transmission (PMTCT) services can eliminate new HIV infections. Nondisclosure of positive HIV status and nonoptimal uptake of PMTCT are related. Therefore, understanding different aspects of HIV disclosure are necessary for program managers and careproviders for prevention and support. Objective: The present research explores HIV disclosure narratives, the family's perspective, and theoretical framework in the context of PMTCT. Methods: A qualitative study was conducted among 31 (16 mothers and 15 fathers) utilizers of PMTCT at an urban antiretroviral therapy center. A semi-structured in-depth interview guide based on disclosure process model (DPM) was used to explore HIV disclosure goals and outcomes by both members of parental dyad. The recorded interviews were transcribed verbatim, translated into English, and analyzed with Atlas.ti software. Directed content analysis was used to code data according to “a priori” and emerging themes. Demographic data were analyzed using descriptive statistics. Results: Limited disclosure is a necessity for pregnant women and their male partners for approach coping with HIV diagnosis and pursuing positive support for PMTCT adherence. Interpersonal, society, and community contextual outcomes affect the care uptake and future likelihood of disclosure. Conclusions: DPM suggestions from the present study can be used to facilitate a goal-directed process that allows parents/PLWHA to selectively disclose their HIV status to family members and acquaintances for obtaining maximum support to eliminate newborn HIV infections while minimizing distress, stigma, and discrimination.

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Background: Hospitals generate variety of waste which is hazardous to patients, health workers, community, and environment. Proper health-care waste management (HCWM) requires infrastructure, trained workforce, law and supervision. More than 80% of the population of Tripura depends on the public health-care system but the knowledge and practice of health-care workers regarding HCWM in the public sector of Tripura is not clear. Objectives: The objective was to assess the knowledge and practice of health-care workers regarding HCWM and to take an account of the existing HCWM facilities in the public sector of Tripura. Study Design: This was a facility-based, cross-sectional study. Materials and Methods: This study was conducted during 1^st November 2015 to 16^th October 2017 among 544 health-care workers working in thirty health institutions chosen by stratified random sampling. Data entry and analysis was performed using SPSS software version 15.0. Results: Overall, 37.68% of the respondents had fair knowledge regarding HCWM, 8.27% received in-service training on HCWM, 66.17% were immunized against hepatitis B and > 90% of the respondents knew about segregation of waste at source but knowledge regarding the use of colored bins for this purpose varied widely across different categories of participants. Housekeeping staff were ignorant about most of these issues. The importance of disinfecting the waste before disposal was known to 83.63% of the workers. Proper HCWM was practiced by 39.15% and segregation of waste at source into colored bins was followed by 23.3% of the respondents. The study revealed both waste management facilities and display of waste management policy as poor. Technical qualification and in-service training were identified as the statistically significant determinants of knowledge and practice of HCWM (P < 0.05). Conclusion: HCWM scenario including knowledge of health-care workers in Tripura is lacking. Installing proper waste management facilities, raising technical qualification at recruitment and in-service training may improve the situation.

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Background: In India, cardiovascular disease (CVD) is the largest cause of mortality and morbidity in all regions of the country. Now, to reduce the burden of CVD in our country, we first need to assess cardiovascular health status of the adult population. Objective: The aim of this study is to assess cardiovascular health status among adults and to find the influence of sociodemographic factors on it. Methodology: In a cross-sectional study, cardiovascular health status of 100 sampled adult population of urban area of Teliamura Municipality area, Tripura, was assessed using a pre-designed and pre-tested semi-structured schedule from July 2017 to August 2017. Samples were taken from the adult population by simple random sampling. Collected data were compiled and analyzed using the Statistical Package for the Social Sciences (SPSS 16.0.). The Chi-square and Fisher's exact test were applied to find association. Results: The mean age of the study participants was 44.89 (±13.76) years, comprised 52.0% males and 48% females. Hypertension was seen among 58% of the study population and 77% had ideal (<100 mg/dl) level of fasting blood sugar (FBS). The present study showed obesity, hypertension, high level of total cholesterol, high level of FBS was mostly prevalent among 42–61 years age group. Married people were more obese, hypertensive compared to unmarried. Conclusion: Middle age group population were worst affected by high blood pressure, high blood sugar, poor body mass index, and poor level of cholesterol. Healthy lifestyle measures might reduce the burden of CVD which could be evaluated in future research.

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Context: In Ashram schools, scheduled tribes (ST) children from age 6 to 17 years belonging to various ethnic groups stay under common living and dietary provisions. However, there are scant reports on ethnotribal height differences. Aims: The aims of the study are to(a) estimate height differences between schoolchildren of three major local STs, (b) compare heights and average skinfold thickness (SFT) of ST with non-ST and urban schoolchildren, and (c) compare median heights and weights of ST and non-ST schoolchildren with the Indian Academy of Pediatrics standards. Settings and Design: Four Ashram schools and one urban school in Northwest Maharashtra. Subjects and Methods: All children from age 6 to 17 years were included for height, weight, and mid-arm circumference (n = 2106). Data were processed with Excel and Epi info software for quantitative comparisons. Statistical Analysis Used: Quantitative methods including ANOVA were used for statistical comparison of heights. Results: There were no differences among heights between ST students (ANOVA P > 0.05). However, there were significant differences between heights of boys and girls between ST and non-ST students across age groups (ANOVA P < 0.0001). ST boys and girls were mostly below 3^rd or 10^th percentile of IAP height and weight charts while non-ST children were between 25^th and 50^th percentiles. The average SFT values for prepubertal age groups were significantly lower in ST schoolchildren. Conclusions: ST students showed a significant growth disadvantage against general and other backward classes categories, although no intertribal anthropometry differences were observed.

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