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Introduction Food adequacy and dietary quality in the lactation period are fundamental for maternal and child health. Lactating mothers are vulnerable to malnutrition because of increased physiological demand, monotonous diet, lactogenesis process, and increased nutrient requirements. The micronutrient adequacy especially among women is not ensured in Indian diet. The dual course of gender bias and poverty, along with lack of knowledge about diet quality are significant impediments in maintaining minimum dietary diversity among Indian women. The study aimed to assess the prevalence of minimum dietary diversity and associated factors among lactating women. Methodology A community-based cross-sectional study was conducted among 1236 lactating women through a multistage sampling procedure in Haryana state, India. Data were collected in Computer-assisted personal interviewing (CAPI) using a pretested structured interview schedule. Minimum Dietary Diversity for Women by Food and Agriculture Organization (FAO) was used to calculate the minimum dietary diversity. Results The mean dietary diversity score among lactating women from the ten food groups was 6.35 ± 2.57 and the prevalence of minimum dietary diversity was 77.1%. The complete model revealed that both individual and household factors can explain the variation in dietary diversity intake. Furthermore, the result of model 2 explained that women aged 31 to 35 years (AOR 5.92,95% (1.87–18.77), graduation and above qualified women (AOR 1.98, 95% (0.96–4.09) and lactating women with high knowledge on nutrition (AOR 2.00, 95% (1.34–4.57) were the significant factors promoting minimum dietary diversity. Conclusion Three-fourths of the lactating women reached adequate minimum dietary diversity. Younger age, low educational level, and poor nutritional knowledge were significant constraints to achieving minimum dietary diversity. Further improvement in the minimum dietary diversity among lactating women is very much required. It is also advised that exiting platforms dispersing awareness on nutrition should be supported and strengthened.

Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions-(1) counseling and (2) SMS text messaging and phone calls-to improve the follow-up rates. This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534. RR2-10.2196/31578.

Background: The follow-up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Hiralal Santudevi Pradhan Institute of Ophthalmic Science (Bharatpur Eye Hospital [BEH]) noticed that the follow-up rate was only 22% among its pediatric patients. Several factors like lack of awareness and forgetfulness among patients may contribute to a lower number of follow-up visits. Therefore, BEH decided to find if counseling and reminders through SMS text messaging and phone calls would improve the follow-up rates. Objective: This study aims to evaluate the impact of interventions like counseling and reminder SMS text messaging and phone calls in improving the follow-up rate of pediatric patients. Methods: This is a public health intervention study being conducted using quantitative analysis. All children (0-16 years) with ocular conditions requiring at least 3 follow-up visits in the study period will be included. In all, 264 participants will be allocated to 3 groups: routine standard care, counseling, and reminders with SMS text messaging and phone calls. In counseling, patients will take part in 20-minute counseling sessions with trained counselors at each visit, and information leaflets will be provided to them. In the reminder SMS text messaging and phone call group, patients will receive an SMS text message 3 days prior and a phone call 1 day prior to their scheduled visits. Patients attending within 2 days of the scheduled date will be considered compliant to follow-up. The proportion of patients completing all the follow-up visits in each group will be assessed. Informed consent will be taken from parents and children. Univariate and multivariate analyses will be conducted. Results: The ethical approval for this study has been obtained from the Ethical Review Board (ERB) of Nepal Health Research Council (ERB protocol registration #761/2020 P). The data collection was initiated on January, 24, 2021, but due to the COVID-19 pandemic, as of September 2021, we have only been able to enroll 154 of the planned 264 participants (58.3% of the sample size). Conclusions: This study will reliably document not only the factors associated with follow-up rate through an intervention package (counseling and reminders through SMS text messaging and phone calls) but also the cost effectiveness of the intervention package, which can be applied in all the departments of the hospital. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): DERR1-10.2196/31578

Children's undernourishment remains a severe public health concern and is one of the main causes of illness and early mortality among children of under-five. The analysis in focus was intent to measure the prevalence of and factors associated with nutritional status of under-five children by using the Composite Index of Anthropometric Failure (CIAF). Current cross-sectional study was conducted with a total of 749 children which were selected through cluster sampling methodology. Field staff has been trained in all aspects of data collection including taking consent and measurements. Assessment of the nutritional status of the children was computed through CIAF. Multivariable logistic regression analysis was applied to analyze the leading factors associated with undernutrition. The overall prevalence of undernutrition was 54.5% among under five children according to CIAF while 9.6% experienced wasting only, 8.8% were classified as both wasting and underweight, 7.2% as wasting underweight and stunting, 11.9% stunting and underweight, 8.0% stunting only and 8.9% underweight only. Most of the mothers were educated to secondary and above level, 55% working mothers, around 40% mothers have age at the time of delivery was 26 years and above. It was observed that female children were more likely to suffer from undernutrition than male children. Children age (13 – 24 Months): [aOR:1.48, CI: 1.10-1.86]; female child: [aOR:2.88, CI: 1.65-4.97]; family monthly income of up to INR 15,000 [aOR: 2.46, CI: 1.77-4.82], underweight mother: [aOR: 2.01, CI: 1.18-3.21]; mother’s education above secondary level: [aOR: 2.68, CI: 1.29-3.01], working mother: [aOR: 1.95, CI: 1.57-2.89], and age of introducing complementary food: [aOR: 1.88, CI: 1.62-2.36] were significantly associated with anthropometric failure among children. Most of the children under five experience anthropometric failure. CIAF is a helpful resource that offers a comprehensive image of the prevalence of undernutrition. However, more evidence is required in similar settings to confirm its usefulness.

Extreme heat and heat waves have been established as disasters which can lead to a great loss of life. Several studies over the years, both within and outside of India, have shown how extreme heat events lead to an overall increase in mortality. However, the impact of extreme heat, similar to other disasters, depends upon the vulnerability of the population. This study aims to assess the extreme heat vulnerability of the population of four cities with different characteristics across India. This cross-sectional study included 500 households from each city across the urban localities (both slum and non-slum) of Ongole in Andhra Pradesh, Karimnagar in Telangana, Kolkata in West Bengal and Angul in Odisha. Twenty-one indicators were used to construct a household vulnerability index to understand the vulnerability of the cities. The results have shown that the majority of the households fell under moderate to high vulnerability level across all the cities. Angul and Kolkata were found to be more highly vulnerable as compared to Ongole and Karimnagar. Further analysis also revealed that household vulnerability is more significantly related to adaptive capacity than sensitivity and exposure. Heat Vulnerability Index can help in identifying the vulnerable population and scaling up adaptive practices.

High ambient temperature is a key public health problem, as it is linked to high heat-related morbidity and mortality. We intended to recognize the characteristics connected to heat vulnerability and the coping practices among Indian urbanites of Angul and Kolkata. In 2020, a cross-sectional design was applied to 500 households (HHs) each in Angul and Kolkata. Information was gathered on various characteristics including sociodemographics, household, exposure, sensitivity, and coping practices regarding heat and summer heat illness history, and these characteristics led to the computation of a heat vulnerability index (HVI). Bivariate and multivariable logistic regression analyses were used with HVI as the outcome variable to identify the determinants of high vulnerability to heat. The results show that some common and some different factors are responsible for determining the heat vulnerability of a household across different cities. For Angul, the factors that influence vulnerability are a greater number of rooms in houses, the use of cooling methods such as air conditioning, having comorbid conditions, the gender of the household head, and distance from nearby a primary health centre (PHC). For Kolkata, the factors are unemployment, income, the number of rooms, sleeping patterns, avoidance of nonvegetarian food, sources of water, comorbidities, and distance from a PHC. The study shows that every city has a different set of variables that influences vulnerability, and each factor should be considered in design plans to mitigate vulnerability to extreme heat.

Background Computer-coded verbal autopsy (CCVA) methods to assign causes of death (CODs) for medically unattended deaths have been proposed as an alternative to physician-certified verbal autopsy (PCVA). We conducted a systematic review of 19 published comparison studies (from 684 evaluated), most of which used hospital-based deaths as the reference standard. We assessed the performance of PCVA and five CCVA methods: Random Forest, Tariff, InterVA, King-Lu, and Simplified Symptom Pattern. Methods The reviewed studies assessed methods’ performance through various metrics: sensitivity, specificity, and chance-corrected concordance for coding individual deaths, and cause-specific mortality fraction (CSMF) error and CSMF accuracy at the population level. These results were summarized into means, medians, and ranges. Results The 19 studies ranged from 200 to 50,000 deaths per study (total over 116,000 deaths). Sensitivity of PCVA versus hospital-assigned COD varied widely by cause, but showed consistently high specificity. PCVA and CCVA methods had an overall chance-corrected concordance of about 50% or lower, across all ages and CODs. At the population level, the relative CSMF error between PCVA and hospital-based deaths indicated good performance for most CODs. Random Forest had the best CSMF accuracy performance, followed closely by PCVA and the other CCVA methods, but with lower values for InterVA-3. Conclusions There is no single best-performing coding method for verbal autopsies across various studies and metrics. There is little current justification for CCVA to replace PCVA, particularly as physician diagnosis remains the worldwide standard for clinical diagnosis on live patients. Further assessments and large accessible datasets on which to train and test combinations of methods are required, particularly for rural deaths without medical attention.

Adolescents and young adult comprise a significant proportion of India’s population. Although, this group of the population faces serious challenges to their health and well-being. To promote their health and well-being, Centre of Excellence (CoE) at King George’s Medical University, Lucknow, India, serves as an advanced care facility for 10–24-year-old adolescents and young adult women. This paper reports the socio-demographic characteristics of, and health services availed to adolescents and young adults who are visiting the CoE in Lucknow, India. A total of 6038 beneficiaries received clinical services during June 2018–March 2022. Out of total clinical services, 38.37% counselling and 37.53% referral services were utilised. Menstruation (46.29%), sexual and reproductive (28.19%), nutrition (5.91%), and mental health (1.67%) related problems were highly reported. The age of beneficiaries is classified into three categories, i.e., 10–14, 15–19, and 20–24 years. Prevalence of overweight was highest among adolescents aged 20–24 years compared to other age groups. Other than nutrition, late-adolescent girls (15–19) faced more health problems than their counterparts. The percentage of beneficiaries decreased significantly during and post the COVID-19 period (<0.001). Therefore, age-specific programs are currently needed, and interventions need to be designed accordingly.

Background Verbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical attention or certification. We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India’s ongoing, nationally-representative Indian Million Death Study (MDS). Methods Performance criteria include a low ill-defined proportion of deaths before old age; reproducibility, including consistency of COD distributions with independent resampling; differences in COD distribution of hospital, home, urban or rural deaths; age-, sex- and time-specific plausibility of specific diseases; stability and repeatability of dual physician coding; and the ability of the mortality classification system to capture a wide range of conditions. Results The introduction of the MDS in India reduced the proportion of ill-defined deaths before age 70 years from 13% to 4%. The cause-specific mortality fractions (CSMFs) at ages 5 to 69 years for independently resampled deaths and the MDS were very similar across 19 disease categories. By contrast, CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths. Thus, reliance mostly on urban or hospital data can distort national estimates of CODs. Age-, sex- and time-specific patterns for various diseases were plausible. Initial physician agreement on COD occurred about two-thirds of the time. The MDS COD classification system was able to capture more eligible records than alternative classification systems. By these metrics, the Indian MDS performs well for deaths prior to age 70 years. The key implication for low- and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths, use simple but high-quality field work with built-in resampling, and use electronic rather than paper systems to expedite field work and coding. Conclusions Simple criteria can evaluate the performance of VA-based COD systems. Despite the misclassification of VA, the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available.

A wealth of information is available on extreme heat and humidity associated with mortality for cities of the developed world, but there is a dearth in the literature for coastal cities of the developing world. The aim of the present study was to assess the effect of ambient heat on all-cause mortality on the urban population of Surat, a coastal city in India. Retrospective analysis of all cause mortality data with temperature and humidity was performed for the summer months (March–May) for the period 2001–12. Student's t-test and correlation coefficient were used to study the relationship between ambient heat and mortality. A total of 36,167 deaths for 961 summer days (2001–12) were analysed. Mean daily mortality was estimated at 37.6 ± 9.4 for the study period. There is an increase of 11% mortality when the temperature crosses 40°C. However, there is an increase of 3 (9%) deaths per day during danger-level heat-risk days and 6 (18%) deaths per day during high-risk heat days (extreme danger) respectively. Mortality seems to be well correlated with the high temperature (P < 0.001) and high heat index (HI) values (P < 0.001). The effect of extreme heat on mortality is at a peak on day-2 of the maximum temperature. The study concludes that the impact of ambient heat in the increase of all cause mortality is clearly evident and HI is more important than maximum temperature (18% deaths/day versus 11% deaths/day). Therefore, emphasis should be given to develop measures of adaptation towards ambient heat. This analysis may fulfil the needs of policy makers and apply strategies like integrated coastal zone management. Extreme heat-related mortality merits further analysis in order to reduce harmful health effects among Surat's most vulnerable urban population.