Rural households in India rely extensively on informal biomedical providers, who lack valid medical qualifications. Their numbers far exceed those of formal providers. Our study reports on the education, knowledge, practices and relationships of informal providers (IPs) in two very different districts: Tehri Garhwal in Uttarakhand (north) and Guntur in Andhra Pradesh (south). We mapped and interviewed IPs in all nine blocks of Tehri and in nine out of 57 blocks in Guntur, and then interviewed a smaller sample in depth (90 IPs in Tehri, 100 in Guntur) about market practices, relationships with the formal sector, and their knowledge of protocol-based management of fever, diarrhoea and respiratory conditions. We evaluated IPs’ performance by observing their interactions with three patients per condition; nine patients per provider. IPs in the two districts had very different educational backgrounds—more years of schooling followed by various informal diplomas in Tehri and more apprenticeships in Guntur, yet their knowledge of management of the three conditions was similar and reasonably high (71% Tehri and 73% Guntur). IPs in Tehri were mostly clinic-based and dispensed a blend of allopathic and indigenous drugs. IPs in Guntur mostly provided door-to-door services and prescribed and dispensed mainly allopathic drugs. In Guntur, formal private doctors were important referral providers (with commissions) and source of new knowledge for IPs. At both sites, IPs prescribed inappropriate drugs, but the use of injections and antibiotics was higher in Guntur. Guntur IPs were well organized in state and block level associations that had successfully lobbied for a state government registration and training for themselves. We find that IPs are firmly established in rural India but their role has grown and evolved differently in different market settings. Interventions need to be tailored differently keeping in view these unique features.

Introduction Coronavirus disease 2019 (COVID-19) was declared as pandemic and measures adopted for its control included quarantine of at-risk, isolation of infected along with other measures such as lockdown, restrictions on movement, and social interactions. Both the pandemic and these measures have the potential to cause mental health problems among individuals. Objective The present study aimed to investigate and estimate the prevalence of psychological well-being, particularly from an Indian perspective using systematic review and meta-analysis of existing literature. Methods We searched in the PubMed database, starting from the onset of the current pandemic and until 10th October 2020 to synthesize evidence on mental health outcomes from India. DerSimonian and Laird method of the random-effects meta-analysis was employed and heterogeneity between studies was assessed using the Chi-square based Cochran's Q statistic and I-squared (I 2 ) statistics. Results The pooled prevalence of stress in nine studies was 60.7% (95% CI: 42.3%–77.7%), depression in eight studies was 32.7% (95% CI: 24.6%–41.3%), anxiety in six studies was 34.1% (95% CI: 26.3%–42.3%) and sleep disturbances in six studies was 26.7% (95% CI: 13.9%–41.8%). As expected, high heterogeneity was observed in the above-mentioned outcomes. Sub-group analysis showed that Health Care Workers (HCWs) had a higher prevalence of stress, anxiety, depression & psychological distress in comparison to the general population. Conclusion A significant impact on psychological well-being during COVID-19 was observed in India as common adverse outcomes were stress (61%), psychological distress (43%), anxiety (34%), depression (33%), and sleep disturbances (27%). Thus the COVID-19 pandemic represents an unprecedented threat to mental health, which should become a priority for public health strategies.

The main aim of this paper was to identify job stressors, gender responses and association of psychosocial work stressors with prevalence of work related musculoskeletal disorders (MSDs) among foundry workers. The data were obtained with ergonomics checklist using Likert scale. The results of this study showed a high prevalence of MSDs among workers. The male workers were more prone to pain in neck while the female workers were more prone to MSDs in upper back and shoulders. Correlation analysis showed significant relationship of dimensions of work aspects with pain and discomfort. It proved that the work-related MSDs are the results of interaction of multiple stressors associated with work and work environment, and other personal factors. ANOVA indicated that the perception of work aspects as stressors differed significantly between male and female workers.

Background: A considerable proportion of the population remain unvaccinated due to multiple reasons including vaccine hesitancy. To study the factors responsible for the incomplete immunization of under-5 children from the perspectives of the communities, a vaccine hesitancy survey was done in two districts of Odisha. In addition, the survey aimed to elucidate the reasons for differential vaccine hesitancy. Methods: This community-based cross-sectional study was conducted in the rural areas of Balangir and Nuapada districts in Odisha. We adapted the vaccine hesitancy survey questionnaire (core closed questions) developed by SAGE working group. We used this questionnaire in a sample of 260 households, selected from 30 clusters. The questions were categorized into three main dimensions, namely, awareness about vaccine efficacy, accessibility to obtain vaccine, and acceptability of the vaccines at the individual and community level. We used bivariate and multivariate regression analysis to determine the predictors for refusal or hesitancy of the vaccine. Results: Long distances and time are the two prime factors of accessibility linked with the refusal or hesitancy of the vaccine. We found that there is a high level of acceptance of vaccines at the level of parents and more than three-fourths took their children for vaccination despite hearing negative information about them. Pentavalent and measles were more commonly refused or hesitated vaccines by the parents compared to BCG or polio. Conclusion: In the current scenario of increasing immunization coverage in India, vaccine hesitancy acts as a missing link in action for the policymakers to achieve cent percent target.

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Corneal problems cause a significant proportion of blindness in India. Once corneal opacity is established, restoration of their vision is possible only through transplantation of cornea from donated eyes. Eye donations are dependent on people willing to pledge their eyes. PURPOSE: To determine "awareness of eye donation" and knowledge regarding eye donation and factors affecting in an adult population of northern India. METHODS: 550 Subjects who accompanied patients attending four ophthalmic clinics were interviewed using structured questionnaire. The information was collected about socio demographic profile, awareness of eye donation, knowledge about its various aspects and pledge to donate eye, reasons for donating or not donating eyes and sources of information. Data analyzed using SPSS software, Chi square test was used to test significance across category and p value <0.05 was considered statistically significant. RESULTS: Out 550 subjects 44.2% were in 18-35 years and 55.8 % were >35 yrs old. Majority was Hindu (76.73%) and males (71.64%). 78% subjects were aware of eye donation. The major source of awareness was AV aids (89%). Awareness was found to be high as age and education increases, in males, and in urban population. Significant difference (p<.05) was found between awareness and various variables except religion. 27% knew that relative can make pledge, only cornea is transplanted is known to 25.2%, 44.7% were aware about ideal time of eye removal and only 12 (2.8%) had pledged their eyes. 250(58.3%) subjects were aware but not willing to pledge their eyes or relatives eyes. Need more information to decide (79.2%), perceived objection by family members (52%) and religious reason (38.8%) were cited as major factors for not willing to pledge eyes. Nobility (76%) and pleasure (17.9%) was the main motivational force stated for willingness to donate eyes. CONCLUSION: There is good level of awareness in urban population still very less subjects is willing to pledge eyes major factor being insufficient knowledge. Targeting on aspects in which knowledge was found to be low might help to increase eye donation.

Introduction: Millions of adolescents are facing the burden of malnutrition in India, and the sociocultural context of nutrition poses challenges while addressing this burden. This study aimed to assess: (a) the determinants of knowledge, attitude, and self-efficacy scores and (b) the relationships between nutrition-related knowledge, attitude, and self-efficacy scores among adolescents in India. Methods: The community-based study was conducted among adolescents across three rural and three urban districts in India. This observational study employed a self-administered structured questionnaire containing information on demography, nutrition-related knowledge, attitude, and dietary self-efficacy. Differences in knowledge, attitude, and self-efficacy scores between sociodemographic variables were assessed using the t -test. Regression analysis was used to determine relationships between knowledge, attitude, and self-efficacy scores. Results: A total of 985 adolescents (44.5%) from rural areas and 1225 (55.5%) from urban slums participated. There were significant differences in knowledge, and self-efficacy scores between rural, urban inhabitants ( P < 0.001), and adolescents with different grades of education ( P < 0.001 for knowledge and P = 0.01 for self-efficacy). There were significant differences in knowledge and attitude scores among adolescents from non-backward and backward classes ( P < 0.001 for knowledge and P = 0.02 for attitude) and those who were vegetarians and non-vegetarians ( P = 0.002 for knowledge and P < 0.001 for attitude). The study demonstrated significant relationships between knowledge, attitude, and self-efficacy scores ( P < 0.001). Conclusion: Nutrition-related knowledge, attitude, and self-efficacy scores are determinants of dietary behavior and are inter-related. Community-based interventions targeting to improve the nutritional status of adolescents should focus on improving self-efficacy besides the other two determinants.

Health education materials such as flipbooks enhance learning and deliver key messages in a captivating mode. Validation of such materials is crucial to ensuring implementation fidelity. We conducted a study to achieve two objectives: (a) to develop two flipbooks, one each for adolescents and young married women (YMW); (b) to validate the flipbooks using five parameters, namely, content validity, construct validity, concurrent validity, relevance, and face validity. The study was a part of a community-based peer-led intervention on health, nutrition, and hygiene. The content validity and relevance were assessed by interviewing outreach workers (ORWs, n = 42) using self-administered five-point Likert scale-based tools. A pre- and post-intervention assessment of knowledge among adolescents (n = 100) and YMW (n = 50) across six out of 13 intervention sites was done to evaluate the construct validity. The two flipbooks contained 12 structured sessions with five key messages per session, in addition to illustrations, discussion points, and theme-based stories at the end of each session. The content and relevancy indices were ranked above 80% by ORW. There was a statistically significant increase in the knowledge scores of adolescents (p < 0.001) and YMW (p < 0.001) post intervention. The validation process helps in assessing the relevance and appropriateness of the education content for greater acceptance and responsiveness by the users.