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Abstract National surveillance data were collected to study the outbreak trends of infectious diseases/syndromes before and during the COVID-19 pandemic period, spanning from 2018 to 2022. The study found that out of 4208 outbreaks, 2972 occurred before the COVID-19 period, affecting 147,425 people, while 1236 outbreaks affected 52,324 people during the pandemic. The number of outbreaks for diseases such as acute flaccid paralysis, fever with rashes, leptospirosis, rabies, and scrub typhus increased during the pandemic. The geographic distribution of outbreaks remained similar for some reemerging diseases in both periods. The trends for dengue, Japanese encephalitis, and cholera remained consistent with peaks mostly from July to September in both periods. We observed a considerable reduction in morbidity and mortality due to outbreaks in India during the pandemic. Despite similar distributional patterns, the study indicates a strong suspicion of persistent outbreak-initiating factors, necessitating an efficient and vigilant surveillance system in the country.

Caesarean section (CS) is considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial susceptibility pattern of the culture positive isolates. To estimate the incidence of surgical site infections (SSI's) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for caesarean section at a tertiary care teaching hospital in Medchal, India. A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity. The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n = 1,274, 63.2%) and underwent emergency caesarean delivery (n = 1,232, 61.1%). Ninety two participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (a RR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; power 100%) among women aged 25 years or younger. Microbial growth in culture was observed from 55 (75.8%) out of total 66 samples. The most common organisms identified were Staphylococcus aureus (n = 7(12.3%)23, 46.0%), Klebsiella sp. (n = 13, 26.0%), and Escherichia coli (n = 12, 24.0%). The rate of SSI following caesarean deliveries subjected to single dose antibiotic prophylaxis was low. Young women and obese women were at high risk of developing SSI.

Background Diabetic Retinopathy (DR) is an emerging public health issue, leading to severe visual impairment or blindness. Early identification and prompt treatment play a key role in achieving good visual outcomes. The objective of the study was to estimate the effectiveness of SCREEN package on improving referral compliance from peripheral centres to a tertiary eye centre in Nepal. Methods In this facility-based cluster-randomized trial, ten out of 19 referring centres of the tertiary eye care centre in Lumbini zone, Nepal were randomized into intervention and control groups. A SCREEN packagewereprovided as intervention for DR patients who require advanced treatment in the tertiary centres and was compared with the current practice of the control arm, where structured counselling and follow-up mechanism are absent. Compliance was estimated by a weekly follow-up between the referring centre and the referred hospital. Results We recruited 302 participantsof whom 153 were in the intervention arm. The mean age of the participants was 57.8 years (Standard deviation [SD]±11.7 years). With implementation of SCREEN package71.2% ( n =109) in the intervention group and 42.9% ( n =64) in the control group were compliant till three months of follow-up (Difference 28.3%, 95% CI: 17.6- 39.0, p <0.05). Compliance was 43% ( n =66) with counselling alone, and 66% ( n =103) with first telephonic follow-up in the intervention arm. The mean duration to reach the referral centre was 14.7 days (SD± 9.4 days) and 18.2 days (SD± 9.1 days) in the intervention and the control arm, respectively (Difference 3.5 days, 95% CI: 0.7 to 6.4 days). Conclusions Counselling& follow-up to patients is the key factor to improve the utilization of the health services by patients with DR. Health systems must be strengthened by optimizing the existing referral structure in Nepal. Trial registration ClinicalTrials.gov Protocol Registration and Results System, ClinicalTrials.gov Identifier: NCT04834648 , 08/04/2021.

Background Diabetic Retinopathy (DR) is an important public health issue in Nepal. Despite the availability of retinal services, people may not access them because of the lack of knowledge about DR and poor referral systems. DR screening uptake was low at Reiyukai Eiko Masunaga Eye Hospital(REMEH) since retina services were started. Scheer Memorial Hospital is a multispeciality hospital near to REMEH. It has no eye department but has been running a regular diabetic clinic. This was a site for referring diabetic patients for DR screening. Improving DR awareness among general physicians has the potential to address these challenges. Methods The aim of our study was to investigate the effectiveness of providing health education to selected health personnel and establish a referral pathway on the attendance of diabetic patients for retinal screening at REMEH. This was a non-randomized, pre-post intervention study design. Total of three health education sessions were provided to the health care professionals of Scheer on diabetic retinopathy using Power Point presentations, posters, pamphlets and videos. The study period was 16 months (2020 June –2021 September) and divided into 8 months pre-intervention(baseline data collection) and 8 months post intervention period. The proportional increase in number of diabetes attendance pre and post intervention was calculated by Z test. The change in knowledge of health care personnels pre and post intervention was scored and evaluated through a questionnaire and calculated by paired- t test. Data was analyzed using Excel and Epi Info 7.The Protocol was published on August 21, 2021, in JMIR Publications. Results The proportional increase in number of referrals of diabetes attendance post intervention increased from 50 to 95% and was statistically significant ( p  < 0.001, 95% CI: 0.214–0.688). The mean score of knowledge gained by physicians on DR awareness was more at post intervention (8.8 ± 1.32) than pre intervention (6.4 ± 1.51). It was statistically significant ( p  < 0.001). Conclusion This study shows that a well-planned health education intervention changes the knowledge in physicians about DR. There is an increase in the number of referrals and attendance of patients for DR screening with the change in knowledge and referral mechanism. Trial Registration Clinical Trials.gov NCT04829084; https://clinicaltrials.gov/ct2/show/NCT04829084 :02/04/2021.

We present a methodically devised protocol for conducting a systematic review and meta-analysis aimed at ascertaining the prevalence of BReast CAncer gene (BRCA) mutations in breast and ovarian cancer (BOC) among women in India. The review will include cross-sectional, cohort, case-series, and registry-based studies focusing on females clinically diagnosed with any stage of BOC, tested for BRCA germline mutation and undergone any form of treatment. A Cochrane literature search will be carried out to identify all the published and unpublished articles available in English from 2010 till date across various electronic databases including PubMed, Psych Info, SCI, Cochrane Central, Embase, Scopus, IND Med and Google Scholar. A step-by-step process will be followed to select all the relevant studies for final inclusion using Rayyan software. The selection process of the review will be reported based on Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) checklist. The protocol has been registered in PROSPERO (ID: CRD42023463452). Joanna Briggs Institute Critical Appraisal Checklist will be used to evaluate the methodological quality of the included studies. The outcome measure will be the prevalence of BRCA1/2 gene mutation in this population. Meta-analysis will be performed to report the pooled prevalence along with 95% confidence interval. The results of this review study will provide valuable insights for clinicians, and policy makers, enabling them to formulate guidelines that underscore the importance of screening for BRCA mutations in cases of BOC.

Accurate measles data is crucial for effective disease surveillance, outbreak response, and vaccination strategy formulation in India. However, data collection and analysis face significant challenges due to limitations in primary data sources, including the Health Management Information System (HMIS), the Integrated Disease Surveillance Programme (IDSP), National Family Health Survey (NFHS), World Health Organization (WHO) surveillance data and the private healthcare system. However, these sources have their own demerits leading to substantially incomplete epidemiological information on epidemiological data on measles. Besides, current data predominantly focus on children under five, limiting the understanding of measles transmission among older age groups. To sustain measles elimination efforts, establishing a robust and mandatory reporting system, similar to the COVID-19 reporting framework, is essential for improving measles and other infectious disease surveillance.

Introduction Diabetes mellitus is a chronic condition that requires consistent self-management to prevent complications and maintain quality of life. This meta-analysis estimated the pooled prevalence of various self-care components in Indian populations with diabetes and their regional distribution. Methods A literature search was conducted for studies published between January 2014 and November 2024 in PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. Studies reporting prevalence of various self-care practices among diabetic populations in India were included. Data was extracted based on study details, demographics, setting, and self-care practices. Study quality and bias risk were assessed using the Newcastle-Ottawa Scale. Statistical analysis was done in Stata version 18. A mixed method model was used to estimate the pooled prevalence. Heterogeneity was explored through sub-group analysis, sensitivity analysis and meta-regression. Results A total of 29 articles were included in this review with 7863 populations. Most studies belonged to southern India ( n  = 19, 65.5%), and community settings ( n  = 15, 51.7%). The pooled prevalence of drug adherence was highest (71%, 95% CI: 63–79). This was followed by glucose monitoring (60, 50–70), dietary compliance (51, 42–59), healthy coping (43, 22–63), physical activity (41, 34–47), risk reduction (28, 20–36), and problem solving (22, 12–33). Meta-regression showed that the prevalence of physical activity is notably higher in the West (1.02, 95% CI: 0.57–1.48), East (0.77, 0.36–1.18), North (0.78, 0.36–1.18), and South (0.65, 0.31–1.0) regions compared to Central region. Glucose monitoring was significantly higher in East (0.7, 0.2–1.2) and South (0.57, 0.15–1.0) regions compared to Central region. Conclusion Self-care practices among diabetic populations in India remain suboptimal, with considerable variation across regions. These findings underscore the urgent need for context-specific, scalable interventions and strengthened health system support to promote comprehensive diabetes self-management across the country.

Background Operational Research (OR), as part of a quality assurance program, has become a standard feature of most health institutions in most high-income countries. In contrast, in low-income settings, operational research is less common, and almost no one has asssed operational research capacity building (ORCB) as a tool to improve efficacy, efficiency and quality in these settings. This study evaluated the impact of an ORCB program on participants’ research competencies and the extent to which research findings were implemented in practice. Materials and methods This study combined quantitative and qualitative data to evaluate an ORCB intervention in eye hospitals in Nepal (3 sites) and northern India (1 site) from 2019 to 2022. A self-reported questionnaire was administered at the end of the study period, and formal interviews were conducted. The questionnaire covered knowledge improvement, practice implementation, and motivating and challenging factors. Statistical analysis included paired t-tests to compare pre- and post-training scores. Qualitative data were gathered through interviews and observations and analysed thematically. Results The program demonstrated significant improvements in participants’ research knowledge gain. Quantitative analysis revealed substantial gains in knowledge ( p -values < 0.05 for all domains). Post-training, 66.7% developed study protocols, and 60% trained other staff or students. Qualitative feedback indicated overall positive impacts, including enhanced research and operational activities. However, reported challenges such as inconsistent mentorship quality, poor internet connectivity during online sessions, and difficulty in balancing clinical work with research. Despite these challenges, there was notable improvement in research practice and internal training within hospitals, and the program’s approach was appreciated for its effectiveness. Conclusion The study highlights the need for standardized training modules, consistent mentorship, and stronger institutional support. Building operational research capacity in resource-poor settings with limited administrative staff and weak data infrastructure improves individual staff knowledge and skills. Participants learned about scientific principles of reliability and validity and their importance to efforts to improve service equity, efficiency, and effectiveness.

Equity in health research is more than an ideal; it is essential to ensure that research addresses real-world needs. In India, however, deep and long-standing disparities affect how research is shaped: who is studied, who gets to lead, and which health concerns are prioritised. These exclusions are rarely captured through conventional academic research alone. To address this gap, a narrative approach was adopted, allowing for the inclusion of grey literature and underdocumented sources essential for examining structural research inequities that are often underrepresented in academic databases. Drawing from a real-world case of a measles outbreak in Mumbai’s Govandi slum, the review highlights the dangers of research neglect in marginalised communities. It also examines the challenges faced by researchers from underserved regions, institutions, and communities who often lack access to funding, infrastructure, and leadership opportunities. These dual exclusions of participants and researchers stem from structural biases that influence which communities are studied and whose voices are heard. The review is grounded in an equity-informed perspective and draws on purposively selected academic, institutional, and grey literature published between 2000 and 2025. Sources were identified through targeted searches and selected based on their relevance to health research disparities, representational gaps, and policy implications in the Indian context.The review concludes with actionable solutions to democratise research, including decentralised funding, equity-sensitive ethics review, inclusive research leadership, and a national equity-monitoring framework. To serve all populations, Indian health research must not only expand its evidence base, but also diversify the experiences and expertise it includes.

In this article, we develop Bayesian estimation procedure for estimating the stress strength reliability R = P [ X > Y ] when X (strength) and Y (stress) are the inverse Chen random variables. First, we study some statistical properties of the inverse Chen distribution such as quantiles, mode, stochastic ordering, entropy measure, order statistics and stress strength reliability. Then, we estimate the stress strength parameters and R using maximum likelihood and Bayesian estimations. A symmetric (squared error loss) and an asymmetric (entropy loss) loss functions are considered for Bayesian estimation under the assumption of gamma prior. Since, joint posterior distribution of the model parameters and R involve multiple integrations and have complex form. So, we do not get analytical solution without using any numerical techniques. Therefore, we propose to use Lindley’s approximation and Markov chain Monte Carlo techniques for Bayesian computation. A simulation study is carried out for the proposed Bayes estimators of unknown parameters and compared with the maximum likelihood estimator on the basis of mean squared error. Finally, an empirical illustration based on failure time data is presented to demonstrate the applicability of inverse Chen stress strength model.