Background: Kerala is recognised for its strong maternal and newborn health outcomes, characterised by low maternal and neonatal mortality rates and high coverage of antenatal care. However, recent trends suggest persistent challenges related to delivery practices, including rising caesarean section rates and home births. While existing studies examine these emerging trends at a broader level, there is limited evidence at the district level over the years. Objective: This study analyses district-level patterns in home births and caesarean deliveries across Kerala between 2019 and 2024. Method: The study used annual administrative data reported by Kerala’s Directorate of Health Services. The indicators included the number of home deliveries and caesarean sections. Descriptive analysis and district-wise visualisations were employed to highlight patterns. Results: The findings consistently show high rates of caesarean sections in most districts, with Malappuram recording over 25,000 caesarean deliveries annually from 2019 to 2024. Other districts such as Kozhikode, Kollam, and Ernakulam also reported higher figures, each exceeding 10,000 in most years. In comparison, Idukki and Wayanad reported lower figures in the state; however, they still account for a significant number, with over 3,000 in most years. Although home deliveries remained low overall, districts like Malappuram and Wayanad showed relatively higher figures, with Malappuram reporting notable numbers ranging from 198 in 2019–20 to 252 in 2023–24. Conclusion: The findings highlight persistently high caesarean section rates. Home births remained relatively low across most districts in the state, except for a few. Improving maternal health delivery services by promoting safe, evidence-based practices and monitoring the use of unnecessary medical interventions is essential for enhancing maternal outcomes throughout the state.
Introduction:Bipolar Affective Disorder (BPAD) is a serious and long-lasting mental illness marked by episodes of mania and depression. Even when patients are in remission, depressive symptoms often persist and can greatly reduce their quality of life (QOL). Understanding this relationship is important for improving overall patient care and outcomes. Materials and Methods:This cross-sectional study was conducted in the Psychiatry Department of MCH, Kolkata, from April to December 2024. A total of 180 BPAD patients aged 18–65 years, all in remission, were selected through simple random sampling technique. Data were collected using a socio-demographic questionnaire, WHOQOL-BREF (26 items), and Hamilton Depression Rating Scale (17 items). Analysis was performed using SPSS (2016 version). Results:Residual depression was common: 51% of patients had mild depression, 47.7% moderate, and 1.11% severe. Quality of life scores showed 16.11% with poor QOL, 81.11% with average QOL, and only 2.77% with good QOL. A moderate negative correlation was found between depression and QOL, indicating that greater depression was linked to poorer life quality. Religion, residence, occupation, and medication discontinuation were significantly associated with depression, while age, gender, and occupation influenced QOL. Conclusion:Even during remission, many BPAD patients experience depression that impacts daily living and overall well-being. Addressing socio-demographic factors and ensuring treatment adherence are crucial for improving their quality of life.
Background: Seborrheic Keratosis (SK) is most common benign epidermal tumor with distinctive “stuck on” appearance. It appears on the sun-exposed sites with equal sex distribution in middle- and old-aged individuals. Head, neck and trunk are the common sites. They often range in size from a few millimetres to a few centimetres.They are usually slow growing, however, clinical changes such as sudden increase in size, color change and ulceration may indicate malignant change.Case Presentation:The purpose of this review is to report a case of an unusually large, seborrheic keratosis on the face, highlighting its clinical and histopathological features.The manifestations pointed towards malignancy and the patient underwent biopsy and complete excision with a favorable outcome. Investigation: Even though they are clinically diagnosed, SK mimickers are well known, with melanoma being the most worrisome. Dermoscopy is used to help with diagnosis when uncertainty arises, as various benign and malignant conditions must be considered in the differential diagnosis due to their morphological diversity.Management: Treatment options include surgical therapy,laser therapy, electrocautery, cryosurgery, shave excisions and laser-assisted removal. Conclusion:Giant SK, an atypical SK is uncommon and can manifest in an unusual way, and histopathological analysis is warranted to look for concomitant malignancy.
Background: Tuberculosis is a highly infectious disease responsible for millions of deaths each year, with a disproportionately high incidence in developing countries like India. Comorbidities associated with tuberculosis can complicate treatment and increase mortality risk. This study aims to assess the prevalence of comorbidities among pulmonary tuberculosis patients, which could provide insights for improving patient management and reducing mortality. Methods: This is a cross-sectional study among 400 diagnosed pulmonary tuberculosis patients.The study was conducted after approval from the Institutional Ethics Committee (IEC) of SKNMCGH. Their demographic data and comorbidities were recorded on Excel spreadsheets, which was then analysed using open-Epi software and the Chi-Square test. Results: Out of the 400 pulmonary tuberculosis patients studied, 158 (39.5%) were found to have one or more comorbidities. The incidence of comorbidities increased with age. The most common comorbidity was found to be diabetes affecting 84 (21%) of patients, followed by hypertension, asthma and malnutrition, affecting 17.25%, 14.50% and 11% of patients respectively. There were also various other comorbidities, but none of them affected more than 2% of the patients. Conclusion: A large proportion of tuberculosis patients have comorbidities, which can lead to unsuccessful treatment and an increase in their mortality. Therefore, it is very important to detect and diagnose these comorbidities and control their progression.
Agricultural workers are susceptible to a range of chemicals, such as pesticides, fertilizers, and other agrochemicals, which pose significant risks to their health. Understanding the epidemiology of exposure to these chemical hazards is crucial for developing effective preventive strategies and improving occupational health standards among agricultural workers. The review aims to synthesize existing research on the prevalence, types, and health effects of chemical exposures among agricultural workers. The prevalence of chemical exposures was high, with significant regional variations. Health effects ranged from acute symptoms like skin irritation and respiratory issues to chronic conditions such as cancer, neurotoxicity, and reproductive problems. Several studies highlighted the increased vulnerability of certain subgroups, including women, children, and migrant workers. Additionally, the review found that chemical hazards not only impact human health but also pose serious threats to environmental safety, leading to soil degradation, water contamination, and biodiversity loss. There is a critical need for enhanced regulatory measures, improved safety practices, and targeted interventions to mitigate these risks. Furthermore, the environmental impact of these chemicals underscores the necessity for sustainable agricultural methods that protect both human well-being and the ecosystem. Future research must assess combined chemical exposures and preventive strategies across agricultural settings.
Background: A qualitative study was carried out among doctors in Karnataka to understand their perceptions about breast cancer, its rapid rise and control measures. Methods:67 doctors from allopathic as well as AYUSH fields answered a qualitative questionnaire related to screening policy in breast cancer, uptake, control measures, treatment costs and health insurance cover. The questionnaires were sent as links to Google Forms. About 300 doctors were contacted but only about 67 doctors answered the questions. Answers were recorded from Google Forms into Excel sheets and subjected to statistical analysis by SPSS program. Results:Among all the participating doctors, 66% of participants suggested making screening of breast cancer a mandatory procedure in the form of clinical breast exams (CBE), self-breast exams (SBE) and mammography. Conclusion: Most doctors feel that screening policies could be made mandatory.They recommend breast cancer to be treated as a public health emergency.
Background:Dementia is an emerging public health priority due to rapid population ageing, particularly in low- and middle-income countries (LMICs), where over 60% of affected individuals reside. In India, national estimates overlook substantial regional and rural–urban variation, and community-based evidence remains limited. Objective:To review evidence on the prevalence, risk factors, methodological approaches, screening tools, and public health response to dementia, with emphasis on community-based studies from LMICs, especially India. Methods:A narrative review of literature published between January 2000 and June 2024 was conducted using PubMed, Scopus, and Google Scholar. Community-based epidemiological studies, relevant reviews, and policy documents were included. Hospital-based studies and those focusing exclusively on pharmacological or molecular aspects were excluded. Thirty-seven articles were synthesized thematically. Results:Global dementia prevalence is projected to increase from about 57 million in 2019 to over 150 million by 2050, with the fastest rise in LMICs. In India, prevalence among adults aged ≥60 years ranges from 4.5% to 11% across states, with higher burden influenced by education, lifestyle, and healthcare access. Nearly 45% of dementia cases are attributable to modifiable life-course risk factors. Community-based studies using culturally appropriate screening tools provide more accurate estimates, though methodological challenges persist. Conclusion:Addressing dementia as a public health priority requires strengthening community-based research and integrating prevention, early detection, and care into existing health systems in LMICs.
Background: Chrono-nutrition explores the role of meal timing, frequency, and regularity in shaping metabolic health through circadian mechanisms. Evidence indicates that glucose metabolism, insulin secretion, and appetite regulation follow circadian rhythms and are influenced by the temporal distribution of energy intake. Late or evening-skewed eating patterns and circadian misalignment, common in modern lifestyles, are associated with poorer metabolic outcomes. This study examined the association between meal timing, percent body fat, blood glucose, and insulin levels in adolescents and young adults (16-25 years old). Methods: Of 1,313 apparently adolescents and young adults screened, complete data were available for 1,015 participants after applying predefined exclusion criteria. Body composition was assessed using bioelectrical impedance, while fasting and 2-hour post-glucose blood samples were analysed for plasma glucose, insulin, and HbA1c using standard methods. Meal timing was recorded based on the last meal consumed the previous night, and data were analysed using SPSS 27 with p<0.05 considered statistically significant. Results: Among the 1,015 participants, 42.6% were males and 57.4% females, with 41.2% aged 16–18 years and 58.8% aged 19–25 years. The mean time of the last meal was 20.57 ± 1.10 h, ranging from 17:00 to 23:30 h. Later meal timing was associated with significantly higher percent body fat, while muscle mass was significantly greater among those who consumed their last meal earlier. Participants in the earliest meal-timing quintile had significantly lower stimulated glucose, fasting and post-glucose insulin levels, and HOMA-IR compared with later quintiles. Time of last meal showed positive correlations with percent body fat, glucose and insulin indices, and a negative correlation with muscle mass. Conclusion: Late timing of the last meal was associated with higher insulin levels, increased adiposity, and poorer metabolic profiles among adolescents and young adults. These findings suggest that eating patterns misaligned with circadian rhythms may predispose metabolically healthy youth to future metabolic risk. Promoting earlier meal timing and appropriate redistribution of energy intake during waking hours may serve as a feasible strategy for metabolic health prevention.
Background& Objectives: Hypochlorous acid (HOCl) is a safe antimicrobi aleffective for wound care in areas burdened by chronic infections such as mycetoma. Its broad antimicrobial activity, biofilm disruption, and exceptional tissue compatibility make it well-suited for the long-term management of complex wounds. In mycetoma-endemic regions, HOCl offers a practical assistant for infection control and improved wound healing, providing a low-cost option for strengthening community-level care. Methods: This preliminary field-based humanitarian effectiveness, observational study evaluated the topical application of HOCl on seven patients with mycetoma lesions in Wad Shigidi Village, Sudan. The HOCl intervention was adjunctive and topical, not systemic. Weekly field visits were conducted, and lesion responses were documented using photographic and clinical criteria. Results: Patients demonstrated marked reductions in lesion size, discharge, and pain. No adverse effects were reported. Interpretation & Conclusions: HOCl shows promise as a safe, low-cost topical agent for mycetoma and other wound care at the community level in humanitarian settings. Further studies are warranted.
Background Transgender individuals face widespread stigma, discrimination, and social exclusion, contributing to elevated levels of psychological stress, loneliness, and reduced quality of life (QOL). These challenges are particularly pronounced in South India, where culturally tailored data on the psychosocial well-being of transgender populations remain limited. Understanding the interplay between stress, loneliness, and QOL is essential to inform inclusive health interventions. Methods A cross-sectional study was conducted among 50 self-identified transgender individuals aged 18–45 years residing in urban South India. Participants were recruited through purposive sampling with the support of community leaders and NGOs. Data were collected using validated instruments: the Perceived Stress Scale (PSS-14), UCLA Loneliness Scale (Version 3), and WHOQOL-BREF. Descriptive statistics and Pearson correlation analyses were performed using SPSS version 20.0 to examine the relationships between perceived stress, loneliness, and QOL across physical, psychological, social, and environmental domains. Conclusion A high prevalence of perceived stress was observed, with 76% of participants reporting moderate stress and 24% high stress. Perceived stress and loneliness were significantly and negatively correlated with overall QOL (r = -0.643 and r = -0.421, respectively; p < 0.001). Domain-specific correlations showed that stress had the strongest negative association with social relationships (r = -0.748), while loneliness was most strongly linked to poorer mental health (r = -0.684). These findings highlight the urgent need for gender-affirmative mental health services, community-based support systems, and inclusive public health policies to improve the psychosocial well-being of transgender populations in South India.
Background: Two of the most common mental health conditions in the postpartum phase are postpartum depression and postpartum anxiety, which frequently impact domestic life, infant attachment, and maternal well-being. According to recent research, non-pharmacologic interventions specifically, structured exercise—are crucial for maintaining maternal mental health. Objective: the main goal of this review is to evaluate how structured postpartum exercise regimens affect women's postpartum anxiety and depression symptoms. Methods: Postnatal exercise, postpartum anxiety, postpartum depression, and maternal mental health were searched in literature using Pub Med, Scopus, and Google Scholar exhaustively. Meta-analyses, systematic reviews, and randomized controlled trials of studies from 2015 to 2025 were included. Discussion: Walking, yoga, stretching, and aerobic training are examples of gentle to moderate physical exercise, which are linked with improvement in mood regulation, balance of cortisol and serotonin levels, self-esteem, and social support. Exercise improves the physical and mental recovery of postpartum women when added to routine care. Conclusions: Exercise after childbirth is an innocuous, valuable, and efficient adjunct therapy for decreasing depression and anxiety among mothers. Systematic exercise is able to improve mother screening outcomes, increase the health of families, and provide long-term recuperation when incorporated into daily postpartum care.
Background:Ayushman Bharat, launched in 2018, is India’s flagship initiative toward Universal Health Coverage through the Pradhan Mantri Jan Arogya Yojana (PM-JAY) and strengthened primary healthcare services. The Ayushman Bharat Digital Mission (ABDM), introduced in 2021, further aims to improve healthcare access, efficiency, and transparency through digital health innovations. However, emerging evidence suggests that digital inequities may limit equitable access to these initiatives, particularly among rural, low-income, and digitally marginalised populations. Objective:This review examines the role of digital barriers in shaping access to and utilisation of Ayushman Bharat and ABDM, with a focus on digital literacy, infrastructure, awareness, trust, and ethical concerns within the Indian healthcare context. Methods:A narrative literature review was conducted using PubMed, Google Scholar, government reports, and policy documents published between 2018 and 2025. Relevant studies were identified using key search terms related to Ayushman Bharat, ABDM, digital health, and healthcare access in India, and were thematically synthesised. Results:The review identified persistent gaps in awareness and utilisation of PM-JAY and ABDM, especially in rural and underserved areas. Major barriers included low digital literacy, inadequate internet connectivity, limited access to digital devices, and concerns regarding data privacy and system trust. While digital tools such as ABHA IDs, electronic health records, and telemedicine platforms offer significant potential, their benefits remain unevenly distributed. Community-based intermediaries, including ASHAs and Ayushman Mitras, play a crucial role in bridging digital gaps, though systemic challenges persist. Conclusion:Despite notable progress, digital inequities continue to constrain the equity goals of Ayushman Bharat and ABDM. Strengthening digital literacy, ensuring data protection, expanding infrastructure, and maintaining offline access mechanisms are essential for achieving inclusive and equitable Universal Health Coverage in India.
Background:Clinical trials have traditionally been framed as experimental tools rather than therapeutic options, and the doctor–patient relationship has largely been paternalistic. The emergence of precision medicine and the shift toward patient-centred care challenge this dichotomy, suggesting that clinical trials could be considered part of routine treatment pathways. Methods:A narrative synthesis of published literature was conducted to examine patient and physician perspectives on clinical trials when offered as treatment choices. Evidence was analysed to identify key motivators, barriers, and areas of alignment and divergence between patients and physicians. Results:Patients value access to advanced therapies, close monitoring, and a sense of hope, while physicians emphasise therapeutic innovation and ethical responsibility. Barriers include therapeutic misconception, limited clinician awareness, workload constraints, and logistical challenges. Despite these obstacles, both groups support transparent discussion of clinical trials within clinical care. Conclusion:Integrating clinical trials into treatment frameworks, with informed patients and physicians, ethical safeguards, and institutional support, can make them a legitimate and patient-centred treatment option.
Background:Minimally invasive surgery (MIS) has transformed surgical care by reducing postoperative pain, complications, and recovery time. Laparoscopic surgery and robotic-assisted surgery (RAS) are the two principal MIS approaches; however, public understanding of their differences remains limited. This study assessed the knowledge, attitudes, and perceptions (KAP) of the Indian public toward laparoscopic and robotic surgery. Methods:A cross-sectional, questionnaire-based survey was conducted among Indian adults (≥18 years) who were patients or caregivers involved in surgical decision-making. A previously published questionnaire adapted from Brar et al. (2024) was used. The 20-item online survey assessed demographics, knowledge, perceptions of safety and cost, and surgical preferences. Healthcare professionals were excluded. Descriptive statistics were calculated using SPSS. Results:Forty-six respondents completed the survey (51.1% male; 48.9% female). Doctors were the primary source of information for laparoscopic (61.0%) and robotic surgery (43.5%). Most participants (60.9%) perceived both approaches as equally safe, while 28.3% believed robotic surgery offered better outcomes. Robotic surgery was perceived as more expensive by 80.4% of respondents. Mean trust scores were high for both techniques on a five-point Likert scale (laparoscopic: 4.26 ± 0.85; robotic: 4.08 ± 0.94). Surgical decisions were mainly influenced by physicians (60.9%), followed by self-education (32.6%). Conclusion:Respondents demonstrated high awareness and trust in minimally invasive surgery. Both laparoscopic and robotic approaches were perceived as safe and effective; however, robotic surgery was consistently viewed as more expensive. Surgical decision-making remained predominantly doctor-led, with an emerging trend toward patient self-education and shared decision-making.
Background: Ageing is a crucial life stage that is characterized by numerous changes, which make older adults more susceptible to mental health issues, particularly depression. Depression is a major problem affecting the senior population, especially those living in homes for the aged. Both India and Nepal are experiencing a rapid demographic transition with aging populations. This trend highlights an alarming prevalence of depression in institutionalized elderly. Objective: This review aims to assess the prevalence of depression in elderly residents in old age homes. Methods: Electronic databases including PubMed, ResearchGate, Google Scholar, Semantic Scholar, and ScienceDirect were used to identify relevant research articles by using keywords like prevalence, depression, older adults, elderly, and old age homes. Results: The findings show that the prevalence of depression in older individuals in homes for the aged is varied, ranging from 36.2 % to 82.6%. Conclusion: The findings highlight the critical need for regular mental health screening, psychosocial interventions, and strong supportive systems to optimize the overall well-being of elderly individuals living in institutionalized settings.
Urban green spaces (UGS) are widely recognized for their significant health and well-being benefits. However,recent research highlights increasing disparities in access to these spaces, particularly among disadvantagedgroups. This study investigates the accessibility of UGS for disadvantaged community groups in Bhubaneswar,Odisha, India.Methods: Disadvantaged communities, particularly slum settlements, were identified using high-resolutionsatellite imagery. Data on urban green spaces were sourced from previous studies. A network analysis wasconducted in QGIS to delineate Park Service Areas (PSAs) using a 500-meter walking distance threshold frompark entry points, assessing the accessibility of urban green spaces.Results: Among Bhubaneswar’s 67 wards, approximately 42 wards demonstrated that only 0–25% of slum areasfall within a 500-meter PSA. In 8 wards, 25–50% of slum areas were covered. Notably, only 9 wards showed75–100% coverage of slum areas by PSA. These findings reveal a significant deficit in UGS access for slum dwellersand residents of informal settlements.Conclusion: This study underscores the urgent need for spatially equitable planning of urban green spaces. Thefindings can inform urban planners and landscape designers in optimizing the distribution of green spaces andstrategically placing park entry points to enhance accessibility for marginalized communities.
Background: Radiation exposure, particularly in healthcare settings, poses significant risks if not managed properly. Understanding the hazards associated with radiation and adhering to protection protocols are essential, especially for allied health students who are likely to encounter radiological procedures in their professional careers. This study assessed the awareness and knowledge levels regarding radiation protection and hazards among students from various allied health departments at a private university in Guwahati. Methods: A cross-sectional study was conducted with 435 participants of allied health students at The Assam Royal Global University selected through non-probability convenience sampling. The study was conducted between June and August 2024. It was made up of 17 close-ended questions assessing their awareness about radiation and related radiation hazards. Data were collected via a self-administered online questionnaire distributed through Google Forms. Participants were also questioned about their willingness to learn more about radiation safety measures and need of awareness programs on radiation safety. Descriptive statistics, t-tests, and ANOVA were used for data analysis. Results: The majority of respondents (96.5%) were aware of radiation hazards, and 93.5% expressed willingness to attend a radiation awareness program. There was no significant difference in knowledge or awareness between male and female students (p = 0.758 and p = 0.991, respectively). However, a significant difference was observed across departments in both knowledge (p = 0.0001) and awareness (p = 0.0003), with Radiography students scoring the highest. The mean age of participants was 21.02 years, with a balanced gender distribution (52% male, 48% female), and most were undergraduate students (91.26%). Conclusion: While overall awareness of radiation hazards among allied health students was high, knowledge levels varied significantly by department. These findings highlight the need for targeted educational interventions to ensure all healthcare students receive adequate training in radiation safety, especially those in non-radiology fields.
Background: Mucormycosis, also known as black fungus, is a rare yet aggressive opportunistic fungal infection primarily caused by molds of the order Mucorales. It predominantly affects immunocompromised individuals, including those with uncontrolled diabetes mellitus, malignancies, organ transplants, or prolonged corticosteroid use. The COVID-19 pandemic further escalated mucormycosis incidence, particularly in countries like India, due to widespread steroid use and immune suppression. The pathogenesis involves spore inhalation or inoculation, followed by rapid hyphal growth, angioinvasion, tissue necrosis, and dissemination to organs such as the brain and lungs. Diagnosis relies on clinical suspicion supported by imaging, histopathology, culture, and molecular techniques. Radiological modalities like CT and MRI play crucial roles in early detection and surgical planning. Prompt and aggressive treatment combining antifungal therapy mainly liposomal amphotericin B or posaconazole and surgical debridement is vital for improving outcomes. Conclusion: Despite advancements, mucormycosis remains associated with high morbidity and mortality, necessitating heightened awareness, early intervention, and risk factor control. This review consolidates current insights into the epidemiology, risk factors, pathogenesis, diagnostic strategies, and treatment modalities of mucormycosis, emphasizing the need for multidisciplinary management to mitigate its severe consequences.
Background: Early identification of developmental delay in infancy is crucial for timely intervention, especially in low-resource settings. Pragati Pustak, a culturally adapted parent-reported screening tool, addresses gaps in community-based surveillance for children up to 2 years. Objectives: To develop and validate face/content validity and reliability of Pragati Pustak for detecting developmental delays. Methodology: Iterative development via stakeholder focus groups and expert reviews yielded a bilingual, pictorial Yes/No booklet (milestones 3-24 months; warning signs 3-15 months). Face validity used 4-point Likert scales (15 experts, 15 parents). Content validity applied CVI metrics. Reliability assessed KR-20 internal consistency and Cohen's kappa test-retest (n=6998, 14-day interval). Results: Face validity showed ≥80% endorsement. I-CVI ≥0.90; S-CVI/Ave=0.98. KR-20 ranged 0.60-0.95; kappa >0.85 (almost perfect). Conclusion: Pragati Pustak offers robust psychometrics, enabling reliable parent-led screening in primary care.
Objective: To assess breastfeeding knowledge, attitudes, and practices (KAP) among Indian suburban mothers and evaluate their correlation with infant anthropometric outcomes, identifying socioeconomic and behavioral factors associated with growth faltering. Methods: Cross-sectional study of 60 mother-infant dyads in Zahreeabad, Telangana. Data included structured questionnaires on demographics and KAP metrics, plus objective anthropometric measurements compared against age-/sex-matched standards. Descriptive and correlational analyses examined associations between maternal factors and infant growth. Results: Mean maternal age was 27.47±4.24 years; 75% were homemakers(N=45), 60% held Bachelor's degrees or higher (N=36). Early breastfeeding initiation (≤1 hour) occurred in 65%(N=39), with universally positive attitudes. Maternal education is significantly correlated with breastfeeding knowledge (p=0.824), though knowledge scores didn't differ between mothers maintaining versus discontinuing exclusive breastfeeding (EBF). Descriptively, c-section infants showed 2.42 cm greater length deficits than vaginal births. Despite 85% of infants exhibiting stunting and 55% showing weight deficits, 85% of mothers rated growth as "Average" or "Above Average," revealing a critical perception-reality gap. Conclusions: High breastfeeding knowledge and positive attitudes don't prevent growth faltering, with 85% of infants stunted despite strong maternal awareness. Structural barriers—particularly C-sections (85% of delayed initiations) and early complementary feeding (p = .042)—critically impair outcomes. A profound perception gap exists: 85% of mothers rated stunted growth as "Average" or above. Interventions must address clinical barriers and maternal perceptual frameworks, not just knowledge dissemination.
