BackgroundCommunity acquired pneumonia is responsible for 16% of under 5 mortality in India, probably due to delayed recognition and qualified care seeking. Therefore these deaths could possibly be averted by creating community awareness and promoting care seeking from qualified physicians in the government system. The objective of study was to assess the effectiveness of facility-based and village-based behavior change communication interventions delivered to community using validated information, education and communication materials, along with infrastructural strengthening of health facilities, for change in care seeking from government system for community acquired pneumonia in rural Lucknow, India.MethodCommunity based open labeled behavioral trial in 2 by 2 factorial design was conducted in eight rural blocks of Lucknow, northern India. Trained community health workers conducted Pneumonia Awareness Sessions once a month for the care givers of children using validated information, education and communication materials either at the villages or at government health facilities. Prior infrastructural strengthening of public health facilities was done to provide optimal care to cases. Pre packed pneumonia drug kits were provided which had amoxicillin, paracetamol and an instruction card on their use as well as pictorial representation of danger signs of pneumonia.ResultsStudy lasted from October 2015 to September 2018. Adherence to conduct of facility-based intervention was 93.0% (279/300) and to village-based intervention was 73.4% (7638/10410). In village-based intervention there was 79.3% (p < 0.0001) increase from a baseline of 3.3% (14/420) and facility-based intervention 68.9% (p = 0.02) increase from a baseline of 5.35% (21/392) in cases of possible pneumonia treated at government health facilities.ConclusionConduct of structured pneumonia awareness session using validated information, education and communication material at village level with infrastructural strengthening resulted in improved qualified care seeking from government facilities for community acquired pneumonia.Trial registrationAEARCTR-0003137, retrospectively registered on 10/July/2018.

Introduction Childhood and adolescence require adequate amount of micronutrients for normal growth and development. The primary objective of study was to assess the prevalence of deficiencies of Vitamins (Vitamin A, 25 Hydroxy Vitamin D, Vitamin B12 and Folate) and minerals (Calcium, Zinc, Selenium and Iron), among urban school going children aged 6–11 and 12–16 years in ten cities of India. Secondary objective was to find the association between micronutrient deficiencies with sociodemographic and anthropometric indicators. Methods A multi-center cross-sectional study was conducted across India. Participants in the age groups of 6 to 11 years (group 1) and 12 to 16 years (group 2) were selected from randomly chosen schools from each center. Data on socio economic status, anthropometric measures was collected. Blood samples were collected for biochemical analysis of micronutrients. Point estimates and 95% confidence intervals was used to assess the prevalence of deficiencies. Associations were observed using chi square, student t test and ANOVA test. Results From April 2019 to February 2020, 2428 participants (1235 in group 1 and 1193 group 2) were recruited from 60 schools across ten cites. The prevalence of calcium and iron deficiency was 59.9% and 49.4% respectively. 25 Hydroxy Vitamin D deficiency was seen in 39.7% and vitamin B12 in 33.4% of subjects. Folate, Selenium and Zinc were deficient in 22.2%, 10.4% and 6.8% of subjects respectively. Vitamin A deficiency least (1.6%). Anemia was prevalent in 17.6% subjects and was more common among females. Conclusion One or more micronutrient deficiencies are found in almost one half of school going children in urban area. Hence efforts must be made to combat these on priority. Trial registration number CTRI/2019/02/017783.

IntroductionChildhood and adolescence are the period of rapid physical and cognitive growth and development, requiring adequate nutrition. Malnutrition in the form of undernutrition or micronutrient deficiency or overweight/obesity affects the health, cognition and educational achievement of this age group. The objective of this study is to assess the prevalence of calcium, iron, zinc, selenium, folate, vitamin A, 25 hydroxy vitamin D and vitamin B12 deficiencies in the serum and haemoglobin, ferritin and lead levels and its association with reported dietary intake and cognitive abilities, in urban school going children aged 6–16 years in 10 cities of India.Methods and analysisA multicentric cross-sectional study will be conducted to recruit 2400 participants (240 per site) across India. Participants will be selected using random sampling and will be categorised into age groups of 6–11 years and 12–16 years, with equal distribution. Data on socioeconomic status, anthropometric measures and 3-day dietary intake and cognitive performance will be collected. Blood samples will be collected for biochemical analysis of micronutrients. Findings will estimate the prevalence of micronutrient deficiencies and their association with dietary habits and cognitive functioning.Ethics and disseminationStudy protocol has been reviewed and approved by institutional ethics committee of all 10 participating sites. Results will be shared and published in a peer-reviewed journal, so that the findings will be helpful for the stakeholders in planning nutritional interventions for targeted groups.Trial registration numberCTRI/2019/02/017783.

Background Micronutrient deficiency (MD) is associated with deficits in cognitive functioning of children. However, no comprehensive multicentric study has been conducted in India to explore the role of multiple MD in cognition of children and adolescents. The present study aimed to explore association of MD with level of general intelligence and specific cognitive functions, in urban school-going children and adolescents across ten cities of India. Method Cross-sectional multicentric study, enrolled participants aged 6–16 years. Blood samples were collected for biochemical analysis of calcium, iron, zinc, selenium, folate, vitamin A, D and B12. Colored Progressive Matrices / Standard Progressive Matrices (CPM/SPM), Coding, Digit Span and Arithmetic tests were used for the assessment of cognitive functions of participants. Height and weight measures were collected along with socio-economic status. Results From April-2019 to February-2020, 2428 participants were recruited from 60 schools. No MD was found in 7.0% (134/1918), any one MD in 23.8% (457/1918) and ≥ 2 MD in 69.2% (1327/1918) participants. In presence of ≥ 2 MD, adjusted odds ratio (OR) for borderline or dull normal in CPM/SPM was 1.63, (95% CI: 1.05–2.52), coding was 1.66 (95% CI: 1.02–2.71), digit span was 1.55 (95% CI: 1.06–2.25) and arithmetic was 1.72 (95% CI: 1.17–2.53), controlling for gender, socioeconomic status and anthropometric indicators. Conclusion Since ≥ 2 MD were found in more than 2/3rd of participants and was associated with impairment in cognitive function, attempts must be made to ameliorate them on priority in school going children in India. Trial registration number CTRI/2019/02/017783.

No abstract

No abstract

Co-participation of Community Advisory Group to develop, execute and disseminate a Covid-19 qualitative research study in India 2 Introduction: WHO has defined community engagement as "a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes". Community engagement is therefore both a process and an outcome. This abstract describes the impact of engaging a community in a qualitative research on Covid-19 in India. This qualitative study aimed to understand the experiences of health-care providers in giving; and Covid-19 patients on receiving health-care in tertiary-care hospitals of India. Purpose of community engagement was to improve the design and methodology of the study and to build trust and transparency among the stakeholders.Methodology: The study team implemented a community engagement technique in the form of a community advisory group (CAG). The group comprised of relevant stakeholders (n=16) including physicians, nurses, policy makers/state health-representatives, Covid-19 patients and their caregivers. Throughout the research duration, CAG met thrice (i) study initiation (ii) progress and (iii) dissemination. The first CAG meeting was to engage members on research question, design and methodology. CAG met again after the data collection to provide different perspectives into the data interpretation. The last CAG meeting was to explore `nontraditional` dissemination techniques to expand reach of research findings and policymaking.Results: We used CAG to engage the community on the following levels of participation: informing community about research; consulting with them on methodology; involving them at every stage of research and collaborating with them to co-design and co-conduct research. Key CAG contributions included: refining the data collection guide to make it culturally-sensitive, helping co-design and refine data collection methodology and recruitment procedure, co-observing project progress and giving recommendations for dissemination. CAG was an essential tool in our research, through which the stakeholders shared lived experience and ensured the work was guided by a robust understanding of the stakeholders involved.Conclusion: CAG can be used as a catalyst for community engagement. It can facilitate the trust-building process and ensure that local priorities/concerns are reflected and prioritized in research goals and processes.