ObjectiveTo assess whether secondary prevention, which preemptively treats women with above‐average postpartum bleeding, is non‐inferior to universal prophylaxis.DesignA cluster‐randomised non‐inferiority community trial.SettingHealth sub‐centres and home deliveries in the Bijapur district of Karnataka, India.PopulationWomen with low‐risk pregnancies who were eligible for delivery with an Auxiliary Nurse Midwife at home or sub‐centre and who consented to be part of the study.MethodsAuxiliary Nurse Midwifes were randomised to secondary prevention using 800 mcg sublingual misoprostol administered to women with postpartum blood loss ≥350 ml or to universal prophylaxis using 600 mcg oral misoprostol administered to all women during the third stage of labour.Main outcome measuresPostpartum haemoglobin ≤7.8 g/dl, mean postpartum blood loss and postpartum haemoglobin, postpartum haemorrhage rate, transfer to higher‐level facilities, acceptability and feasibility of the intervention.ResultsMisoprostol was administered to 99.7% of women as primary prevention. In secondary prevention, 92 (4.7%) women had postpartum bleeding ≥350 ml, of which 90 (97.8%) received misoprostol. The proportion of women with postpartum haemoglobin ≤7.8 g/dl was 5.9 and 8.8% in secondary and primary prevention clusters, respectively [difference −2.9%, one‐sided 95% confidence interval (CI) <1.3%]. Postpartum transfer and haemorrhage rates were low (<1%) in both groups. Shivering was more common in primary prevention clusters (P = 0.013).ConclusionSecondary prevention of postpartum haemorrhage with misoprostol is non‐inferior to universal prophylaxis based on the primary outcome of postpartum haemoglobin. Secondary prevention could be a good alternative to universal prophylaxis as it medicates fewer women and is an acceptable and feasible strategy at the community level.Tweetable abstractSecondary prevention of postpartum haemorrhage with misoprostol is non‐inferior to universal prophylaxis.

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Background: With the increasing life expectancy, the population around the world is growing old at a higher rate. Ensuring their quality of life and addressing their health care needs is a major challenge ahead. Elderly women are more vulnerable and there is a dearth for information regarding their health problems in India. Therefore, this study was undertaken focusing on the health problems of rural elderly women. The objective of the study was to assess the morbidity pattern of rural elderly women.Methods: A community based cross-sectional study was conducted in the rural field practice area of Shri B M Patil Medical College, Vijayapura from November 2015 to February 2016. A house-to-house survey was done and 200 women aged ≥60 years were included in the study. They were interviewed using pretested and predesigned questionnaire after obtaining informed consent. Information regarding demographic profile, present or past illness, economic history and physical activity of daily living were collected. Analysis was done using SPSS v.16 and data was represented using proportions and percentages.Results: Majority of the participants were illiterate (96.4%). Most (83.6%) of them were financially dependent. Most common chronic illness was arthritis (73.3%) and visual problem (58.8%).Conclusions: Our study reveals majority of the elderly women are suffering from one or multiple chronic illnesses. As a matter of fact, there is an urgent need to develop better health care services for the elderly women residing in rural areas.

Background: Spirituality has been integral part of medicine and health since ancient age. The extent of spiritual component in medical practice in India is largely unknown. Therefore, the present study was undertaken to assess the extent of knowledge (awareness), attitude and practice among medical professionals regarding the role of spirituality in management of health. Objectives of the study were to study the knowledge, attitude and practices of spirituality in medical practice amongst medical professionals. Methods: A cross-sectional study was conducted in Shri B. M. Patil Medical College Hospital and Research Centre, Vijayapura from November 2015 to December 2015. 150 doctors of all specialties were interviewed using a selfreported multiple choice questionnaire, after obtaining informed consent. Information regarding demographic profile, knowledge, attitude and practices of spirituality in medical practice was collected. Analysis was done using percentages. Results: The response rate was 60% (150/250). More than 80% had a good deal of knowledge of spirituality but were unable to distinguish between spiritual practices and traditional religious rituals. 67% of them felt that spirituality may have resounding effects on psychiatric illnesses in adults. 75% of them practice spirituality in any form of self-health. Majority of the participants agreed that spirituality offers maximum health benefits in chronic diseases. Conclusions: It is evident from this study that there is a wide gap between reality and physician's perception of spirituality. Concepts regarding spirituality and it's application in health is lacking. Hence, redefining the place of spirituality in health and disease by way of conducting collaborative research by qualified and dedicated professionals is the need of the hour.