Background:Menstrual cups (MCs) are cost-effective, sustainable, and safe alternatives, yet less popular than sanitary pads. This study estimated unmet need, prevalence, and factors associated with MC use in diverse settings. Methods:The study was conducted in a medical college in eastern India. All female medical and paramedical students and staff aged between 18 and 45 years were included in the study. Unmet need was defined as females who are willing to use MCs but do not currently use them. Bivariate and multivariable binary logistic regression models were used to find the factors associated with MC use. In the adjusted logistic regression models, individual characteristics, family-level factors, and social/environmental factors were included as independent variables. Results:Of 538 participants, 339 intend to use a MC; however, only 15 currently use one. The prevalence of MC use was 2.79% [95% confidence interval (CI): 1.57%-4.56%], while the unmet need was 95.58% [95% CI: 92.81%-97.50%]. Having good knowledge of MCs was significantly associated with their use compared to those with poor or average knowledge [adjusted odds ratio 10.81, 95% CI: 3.04-38.49]. Mother's education was significant in bivariate analysis [odds ratio 4.17 (95% CI 1.09-15.95)]; however, it was not significant in the adjusted logistic regression model. Conclusion:MC use among participants was very low despite a high level of expressed intent, indicating a substantial unmet need. Improved knowledge was strongly associated with use, suggesting that targeted awareness and educational interventions may help bridge the gap between intention and adoption of MCs.

Background: Menstrual cups are a safe and sustainable option for menstrual hygiene management, yet their uptake remains limited in India. Aims & Objectives: To assess knowledge, attitudes, and practices (KAP) regarding menstrual cup use among medical and paramedical students and staff at a tertiary medical college in Odisha, Eastern India. Methodology: A crosssectional study was conducted among females aged 18-45 years using simple random sampling. Data were collected through a semi-structured questionnaire administered via Epicollect-5. Knowledge was measured using a nine-item score and categorized as poor, average, or good. Attitudes and practices were assessed using structured questions. Data were analyzed using SPSS version 27.0. Results: Of 582 approached, 538 were analyzed. Awareness was reported by 79%, but only 15.6% demonstrated good knowledge. MBBS students had significantly higher knowledge scores than Allied Health Sciences participants (5.15 +/- 1.93 vs. 2.93 +/- 2.68; p < 0.001), while the latter expressed more favorable attitudes. Sanitary pads were the predominant product (96.9%), and only 2.2% reported current MC use. Conclusion: Despite high awareness, menstrual cup use remains low. Targeted educational and behavior change interventions are warranted to improve knowledge and MC use.

Background: We aimed to compare performance of three cardiovascular disease (CVD) risk estimation tools; the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction tool, the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ACC/AHA ASCVD) Risk Estimator, and Framingham risk score (FRS) in estimating the risk of fatal and nonfatal cardiovascular events. Methods: We conducted a prospective, observational, hospital-based study involving 200 high-risk study participants, who visited a non-communicable disease clinic in a tertiary care hospital in eastern India. The 10-year CVD risk was estimated using the ACC/AHA ASCVD Risk Estimator, FRS, and the WHO/ISH risk prediction tool. We used kappa statistics to determine agreement among these CVD risk estimators. Results: The mean (SD) age of study participants was 54.07 (9.15) years, and the majority (63.5%) were males. About 96% of the participants were diabetic, 33.5% were hypertensive, and 16% were current smokers. About 18%, 20.5%, and 0.5% were classified as high-risk using the ACC/AHA ASCVD Risk Estimator, FRS, and WHO/ISH risk tools, respectively. The agreement was moderate between the ASCVD risk estimator and FRS (Kappa 0.541, P < 0.001) and fair between the ASCVD risk Estimator and WHO/ISH (Kappa 0.305, P < 0.001) and between FRS and WHO/ISH (Kappa 0.314, P < 0.001). Conclusions: A higher level of agreement was found between FRS and ASCVD risk scores compared to the WHO-ISH risk score. The WHO-ISH risk score identified most study participants in the lower-risk category, contrary to the FRS and ASCVD risk scores.

Introduction:Occupational disorders are the causes of lost workdays, inefficient performance by workers, and medical costs. This study was done to explore the understanding and perspectives of paddy farmers on foot care and their preventive strategies. Methods:In-depth interviews (IDI) using a semi-structured IDI guide were conducted among the experienced (40 years and above) paddy farmers over two months. A total of 15 farmers were interviewed, and then a qualitative content analysis was done using ATLAS.ti. An inductive approach was taken. Results:In-depth interviews showed three themes: first, "Farmers' knowledge, beliefs, and views on foot care" included recognizing the importance of foot health, seeing foot care as part of overall well-being (general health), engaging in positive health-seeking behaviors, and having limited awareness of foot-related risks. Second, the "Experience of foot injuries" was common and included thorn pricks, lacerations, sprains, pain, swelling, and tingling. Third, farmers reported "strategies and challenges in foot care," including basic hygiene practices such as washing and oil application. Footwear was often viewed as impractical during fieldwork due to slipperiness or discomfort. However, most farmers expressed a strong need for support in accessing suitable protective footwear. Conclusion:This study uncovered a lack of formal education and public health support related to foot care among paddy farmers. These findings emphasize the need for community-level education on foot health. Improving foot care awareness and providing access to suitable, field-appropriate protective footwear could be crucial in preventing injuries and enhancing overall foot health among agricultural workers.

[This corrects the article DOI: 10.1371/journal.pgph.0003172.].

Effective menstrual hygiene management (MHM) is essential for women’s health, especially in low-resource settings. Menstrual cups are an eco-friendly and cost-effective alternative to disposable menstrual products. This study aims to systematically review the prevalence of menstrual cup use across Asian countries, providing insights into its acceptance, and potential for wider adoption. The study protocol was registered in PROSPERO (CRD42024546114). A systematic search was conducted in PubMed, Scopus, EMBASE, CINAHL, and Ovid up to June 2023. Study quality was assessed using the Joanna Briggs Institute (JBI) tool. A meta-analysis was performed using Generalized Linear Mixed Models (GLMMs) with logit transformation. Heterogeneity was evaluated using the I2 statistic and Cochran’s Q test, and a random-effects model was applied. Publication bias was examined through visual inspection of funnel plots and tested using Begg and Mazumdar’s rank correlation method. Statistical analyses were conducted using the Meta and Metafor packages in R software. The study identified 3,919 records from various databases, including PubMed (624), Scopus (1,824), EMBASE (998), CINHAL (181), and Ovid (178). After removing 1,641 duplicate records, 2,278 records were screened, out of which 13 studies that reported the prevalence of menstrual cup usage were included in the final analysis. The pooled prevalence of menstrual cup usage was estimated at 2.68

OBJECTIVES:The study aimed to estimate the willingness to pay (WTP) for a quality-adjusted life-year (QALY) to help determine the threshold for cost-effectiveness in India. We also assessed the factors affecting WTP/QALY. METHODS:We used a multistage stratified random sampling strategy to select 5460 respondents across 6 Indian states. Participants were interviewed to gather household socioeconomic and demographic data, followed by assessments of health gains using time trade-off and WTP. Respondents were presented with 12 hypothetical health states to gauge health gains and their WTP to restore health. These values were combined to determine WTP per QALY using an aggregated approach. The health gains were discounted at 3%. Weighted estimates based on state, residence, gender, age, and education were computed. A mixed-effect regression model explored the relationship between socio-demographic variables and WTP/QALY. RESULTS:Based on 21 640 observations, we found that mean weighted WTP/QALY was estimated to be INR 2 12 307 (US$ 2535). Based on the different health states, the WTP/QALY ranged from INR 1 70 414 (US$ 2034) to INR 2 58 985 (US$ 3092). Age, gender, family size, education, marital status, occupation, presence of health insurance, consumption expenditure, and number of earning members in the household significantly impacted WTP per QALY. CONCLUSIONS:To our knowledge, our study reports the first-ever estimate of WTP/QALY for the Indian population. The WTP/QALY ranges from 1 to 1.52 times the gross domestic product per capita. This could be considered as the cost-effectiveness threshold for health technology assessment in India.

Introduction: Mental, neurological, and substance use disorders are showing an increasing trend and currently constitute a 16% global burden of disease. Patient and systems-related factors contribute to the treatment gap in mental disorders of public health importance. Low- and middle-income countries (LAMIC) have unique factors contributing to the treatment gap. Methods: We report this review to summarize the prevailing treatment gap of mental disorders in LAMIC. We identified studies using PubMed and Google Scholar as search engines and by hand-searching journals. The initial search produced 3193 articles; after filtering for language, title, abstract, and full-text, we could identify 23 articles that are included in the review. There was heterogeneity in study methodology, study populations, sample size, and duration of treatment gap reported, making synthesis of data difficult. Results: Community-based mental health surveys have highlighted the immense treatment gap of mental disorders in LAMIC (86% low-middle-income countries; 78% high-middle-income countries). The treatment gap in alcohol use disorders in India and Ethiopia remains at 86% and 87%. We discuss patient- and mental health systems-related factors reported in the included studies contributing to the treatment gap. Conclusion: The current treatment gap for mental disorders is huge in LAMIC. Studies have identified symptom attribution, poor awareness, prevailing stigma, and other barriers contributing to this treatment gap. There is a need to address patient and mental health system-related issues contributing to the treatment gap, which can equitably improve service accessibility and availability in LAMIC.

Background & objectives India has the second highest number of adults with diabetes in the world, and more than one-fourth of adults have hypertension. This article describes the preparedness of public and private health facilities for type 2 diabetes mellitus and hypertension management. Methods A cross-sectional survey of the health facilities was conducted in 19 districts of seven States in India, which included an assessment of both public and private health facilities. We used the Indian Public Health Standards and other relevant guidelines for assessment. The service domain score for four domains: equipment, medicine, diagnostics capacity, staff, including the availability of guidelines, and overall readiness score, was calculated following the Service Availability and Readiness Assessment manual of the World Health Organisation. The study considered a readiness score of ≥70 per cent to classify a facility as prepared for providing hypertension and diabetes services. Results Out of 415 health facilities covered in the survey, 75.7 per cent were public facilities. Most were primary care facilities (57.6%) and were located in rural areas (53.3%). The overall readiness score for providing hypertension and diabetes services was lowest for Sub-Centres (SCs; 61%) and Community Health Centres (CHCs; 59%), compared to other facilities. The readiness score for public Primary Health Centres (PHCs) and private primary care facilities (level 2) was 73 and 57 per cent, respectively. The readiness score of district hospitals, government private medical colleges, and other private tertiary care facilities was above 70 per cent, and they were considered prepared for services. Interpretations & conclusions PHCs were better prepared for diabetes and hypertension care than SCs, CHCs, and SDHs. By ensuring adequate human resources availability and uninterrupted supply of essential medicines, programme managers can further improve the preparedness of all public health facilities.

India’s population is ageing rapidly, with an estimate that one in every five Indians will be 60 years or older by 2050. Ageing with the ongoing epidemiological transition increases the burden on already strained healthcare systems of the country. Older adults face health related, financial and social vulnerabilities including access to healthcare facilities, especially in rural areas. The study aims to find the patterns and determinants of healthcare utilisation of older adults especially in rural areas. This community-based cross-sectional study was conducted from two blocks in the Khordha district, Odisha, India from March 2023 to April 2024. Households containing older adults were included in the study. The study used a 30 × 15 cluster sampling design with villages as primary sampling units(clusters) selected by probability proportional to size. 15 households from each cluster were selected by simple random sampling. We also compared the healthcare utilisation of older adults with younger family members with health expenditure. The study collected information from 440 households and 604 older adults. More than half of the older adults (52.5

BackgroundAdequate water, sanitation, and hygiene (WASH) are essential to sustain healthy living. Providing WASH in any working facility, like hospitals and educational and non-educational institutions, helps prevent infections and the spread of disease and protects the stakeholders and the community from various infectious diseases. According to the 2030 vision for WASH in Schools agenda for Sustainable Development Goal, governments must work on universal and equitable access to safe and affordable drinking water.MethodsThis cross-sectional study assessed the WASH status of all the Anganwadi centers (AWCs)/Indian preschools and interviewed all the Anganwadi workers working in those centers using a semi-structured pre-tested questionnaire developed by modifying the Swachh Vidyalaya Puraskar assessment questionnaire. It collected data on the availability and gaps in the WASH infrastructure at the Anganwadi centers and the training needs of the Anganwadi workers using the epi-collect-5 digital platform.ResultsIn the present survey, 58.3% of the AWCs run in government buildings. A daily cleaning schedule was not followed in 68.2% of the AWCs. An improved source of drinking water was available in 83.7% of the AWCs. In more than 86% of the AWCs, there were either no toilets available or available toilets that were not child-friendly. Over 90% of the AWCs had no handwashing facility for the kids to use after toilet use or before eating the hot cooked food served. More than 70% of the Anganwadi workers need to be sensitized or trained related to WASH.ConclusionInfrastructure improvement needs to be done, such as constructing child-friendly toilets or modifying existing toilets into child-friendly ones. Once the department's human resources are sensitized about the importance of WASH through on-job training, they can be asked to supervise the kids' hand hygiene practices. In the long run, all these will lead to a decrease in health-related issues due to lack of sanitation and improve the health and learning ability of the kids.

Jharkhand has shown significant progress in reducing Maternal Mortality Ratio (MMR) from 371 in 2011 to 56 per 100,000 live births by 2020 which places it alongside the Southern states of India. MMR and TFR data from Sample Registration Surveys (SRS) and maternal and key fertility indicators from National Family Health Surveys (NFHS) were retrieved. We plotted graphically all the states of India based on their MMR and TFR achievements as reported in SRS (2018-20) and explored the reasons of the unique position of Jharkhand’s maternal health achievements. Jharkhand is the only state of India which has achieved the national MMR targets but falls short of national TFR targets. The progress of key maternal health indicators was significant whereas the improvement of key fertility indicators can be considered as work in progress. We examined the possible explanations of the unique position of Jharkhand in terms of health care provision and socio-cultural preferences. To sustain the progress achieved, Jharkhand must focus on behavioural interventions to limit the family size and achieving the national targets of TFR and ensuring respectful maternity care. While the reduction in MMR is promising, focused efforts are needed to reduce TFR by complex socio-behavioural interventions to reduce fertility while continuing the medical interventions for maternal morbidity and mortality.

Anemia prevalence among Indian adolescent girls increased from 53.2% to 57.2% from the National Family Health Survey 4–5. Uptake of four iron and folic acid (IFA) tablets per month was 10% and 54.3% among school-going adolescent girls in India and Odisha, respectively. The present study evaluated the uptake and determinants of weekly IFA supplementation (WIFS) uptake among adolescent girls and assessed the impact of culturally acceptable health education on its consumption. The present cross-sectional study was conducted between December 2022 and February 2023 in rural Odisha. A multistage sampling with simple random sampling for the selection of villages and schools followed by a universal sampling of participants was used. A semi-structured questionnaire was used to assess the WIFS uptake and determinants, followed by the utility of a culturally relevant health education session on the uptake of IFA, whose impact on WIFS uptake was evaluated after 1 month. The initial WIFS uptake was 68.7% (95% confidence interval: 63%–73%) among school-going students and absent among dropouts, increasing to 72.8% and 76.9%, respectively, 1 month after culturally appropriate health education. The key factors influencing the uptake of WIFS included the child’s level of education, consistent availability of IFA tablets, and awareness among adolescents about the importance of WIFS. The uptake of WIFS was low among adolescent girls belonging to the rural areas of Odisha. Providing health education, coupled with a reliable supply of IFA tablets, was shown to significantly improve WIFS participation.

Background: Early identification of high-risk pregnancies is essential in reducing maternal and infant mortality. The Mamata scheme, a conditional cash transfer program, aims to support pregnant women and lactating mothers by improving access to essential care and nutrition. This study aimed to assess the prevalence of high-risk pregnancies and utilization of Mamata scheme in rural Odisha. Materials and Methods: A cross-sectional study was conducted in the rural field practice area of AIIMS, Bhubaneswar, from June 1, 2021, to August 30, 2021. Women of reproductive age with amenorrhea for over 1 month were included through universal sampling. After confirming pregnancy, a structured questionnaire was used to assess registration status, eligibility for Mamata scheme, and high-risk pregnancy conditions. Results: Out of 143 participants in the study, the prevalence of high-risk pregnancies was 25.17% (95% confidence interval [CI]: 18.06–32.26). Among them, 70% were identified due to past pregnancy history, 22% based on current pregnancy history, and 8% had high-risk factors from both past and current pregnancy histories. Among identified high-risk pregnancies, the most common risk factor was those who had a previous cesarean section or any uterine surgery (38.88%). For Mamata scheme, among participants, 64.34% (95% CI: 55.90–72.16) met the eligibility criteria. The enrolled were 96.50% (95% CI: 92.03–98.85) in the scheme, which reflects the widespread access to conditional cash transfers. Conclusions: The study highlights a significant prevalence of high-risk pregnancies in rural areas, alongside high enrolment in Mamata scheme. Public health measures are required to empower community health workers regarding early identification of high-risk pregnancies and linkage with appropriate care.

To estimate the prevalence, patterns, and risk factors for injury among under-five children. A community-based cross-sectional study was conducted in the rural areas of Khordha district among 600 under-five children. A multistage sampling technique was used to assess the prevalence, patterns, and factors associated with injuries using a semi-structured questionnaire, followed by an environmental hazard assessment of the built environment of the selected participants. Childhood injury prevalence was 44.6

Background: Severe acute malnutrition (SAM) prevalence in India has increased over the last decade. SAM children are admitted to nutritional rehabilitation centres (NRCs) for medical complications. NRCs have successfully achieved weight gain among SAM children; however, long-term weight gain is difficult to maintain. This study aimed to explore caregivers’ and stakeholders’ perceptions of the treatment interventions offered at NRCs in Bhubaneswar. Methods: The research used qualitative methods, where nine in-depth interviews (IDIs) were conducted using a semi-structured interview guide among mothers of SAM children and their stakeholders. Transcripts from the recorded IDIs were prepared in English. ATLAS.ti version 7 software was used for in-depth thematic analysis using an inductive approach to generate top codes, sub-themes, and major themes. The study was approved ethically with written informed consent from the participants. Results: The study found three major themes: perceived improvement in their child's health, a sense of being welcomed and cared for, and challenges, along with a reluctance to accept intervention. Caregivers reported improvements in children’s health, including better adherence to daily routines, increased food intake, and notable weight gain. However, challenges included unfamiliarity with NRC environments, concerns about family care during their stay, and societal reluctance towards government health interventions. Stakeholders’ perspectives focused on the quality and effectiveness of services and interventions, and systemic hindrances to service provision. Conclusions: Our findings suggest that community-level challenges persist in delivering NRC services. Public health measures are needed to increase awareness in the community about the prevention and management of SAM children.

Background: Lymphatic filariasis (LF), a neglected tropical disease, is one of the main cause of lifelong disability worldwide. The objective was to estimate the prevalence of clinical manifestations of LF, the rural population’s practise of vector control methods, and their compliance with mass drug administration (MDA) and its obstacles. Methodology: A cross-sectional study was conducted among 1226 individuals from three villages under Andharua subcenter, Odisha. The data were collected by a systematic random sampling method using a structured questionnaire, check list, physical examination, and filariasis test strip. Results: Of the 1226 participants, 54.2% were female and 67.6% belonged to the 15–59 age range. Fifty-seven individuals (4.7%) exhibit clinical signs of LF. Among them, leg lymphoedema (3.3%), hand lymphedema (0.7%), elephantiasis (0.7%), and hydrocele (0.6%) were noted, and two exhibited circulating filarial antigen positive. 40.4% have Grade I, and 10.5% have Grade IV lymphoedema. 46.1% of study participants had taken the medications during MDA. The disease was associated with factors such as belonging to the below poverty line group (OR = 1.94, 95% CI = 1.12-3.445), working in agriculture (OR = 2.32, 95% CI = 1.2-4.27), and having a low vector control practise score (OR = 7.03, 95% CI = 1.09-187.7). The majority of individuals with the disease’s clinical manifestations reported experiencing social stigma at work (Relative Important Index, RII: 0.53), which was followed by issues when attending social activities (RII: 0.43). Conclusion: The research indicates that the disease is more common in the study locations, which calls for stricter control measures and to promote MDA programme compliance.