Background:Scrub typhus, a vector-borne febrile illness caused by Orientia tsutsugamushi, has shown significant global resurgence, affecting an estimated one billion people at risk and causing up to one million cases annually. In India, it is a major cause of acute undifferentiated fever but remains under-recognized and a clear research gap regarding long-term national trends, and the heterogeneity of case fatality across states exists. This study aimed to quantify the national burden, geographical distribution, temporal trends, and mortality associated with scrub typhus using Integrated Disease Surveillance Programme (IDSP) data, identifying surveillance and reporting gaps. Materials and Methods:A retrospective, trend-based analysis was conducted using data from the IDSP portal covering 2009-2018. Data were extracted into Microsoft Excel and analyzed using SPSS version 20 and Epitools (version 2023.2). The Chi-square test for linear trend assessed temporal changes in the case fatality rate (CFR). Results:A total of 1,141 cases and 39 deaths were reported across 16 states/UTs, yielding an overall CFR of 3.4%. A significant decline in CFR was observed over the decade (P < 0.001). Northeast India, particularly Mizoram (503 cases) and Meghalaya (136 cases), contributed the highest caseloads. High fatality rates in low-case states (e.g. Gujarat CFR 100%; Rajasthan CFR 74.1%) likely reflect reporting bias or data quality issues. Conclusions:Scrub typhus shows a nationwide spread with seasonal peaks from October to January. Strengthened surveillance, early diagnosis, and public awareness are essential to reduce mortality and ensure standardized data reporting.

World Health Organization (WHO) in 2010, recommended 0.75 mg/kg single dose primaquine for killing gametocytes after ruling out glucose-6-phosphate dehydrogenase (G6PD) deficiency. However, considering the practical feasibility of G6PD testing, WHO revised the recommendation in 2012 to 0.25 mg/kg single dose primaquine on day-1. This study aims to investigate the efficacy and safety of single-low dose primaquine (0.25 mg/kg) administered on day-1 to intervention arm compared to standard regimen, high-dose primaquine (0.75 mg/kg) administered on day-2 to control arm. This is a hospital based, open-label, multi-centric, randomized-controlled trial being conducted at four different sites in India, with a target sample size of 496 i.e., 124 participants per site. Participants above 18 years of age with uncomplicated P. falciparum malaria and normal glucose-6-phosphate dehydrogenase (G6PD) activity, defined as > 4.0 IU/g Hb using the point-of-care test, weight > 40 kg, haemoglobin > 8 g/dL are treated with ACT and randomized to either control or intervention arm. Efficacy assessment is based on gametocytemia as inferred from examination of stained peripheral blood smears during enrolment and follow-up. In addition, quantitative nucleic acid sequence-based amplification (QT-NASBA) for Pfs25 mRNA, will be used to quantify the gametocytes on day 1, 2/3, 7, and 14. Safety assessment during 14-day follow-up will be based on percentage of participants with more than 25

Human papillomavirus (HPV) is a major cause of genital diseases and cancers in both sexes, including cervical, penile, anal, and oropharyngeal cancers, as well as genital warts. Although HPV vaccination programs initially targeted females due to their link with cervical cancer, increasing recognition of HPV-related disease burden in males has led to advocacy for gender-neutral vaccination. This meta-analysis assessed the effectiveness of HPV vaccination in preventing genital diseases among males by synthesising data from randomised controlled trials (RCTs). A systematic PubMed search was conducted in July 2025 following PRISMA guidelines. Studies involving HPV-vaccinated males compared with placebo recipients were included, and data were extracted independently by two different reviewers. The Joanna Briggs Institute checklist was used to assess the study quality. The random-effects model in Review Manager 5.4 (The Cochrane Collaboration, Copenhagen, Denmark) was used to calculate pooled risk ratios with their 95% confidence intervals (CIs). Out of 120 screened studies, four RCTs met the inclusion criteria, comprising 4,200 male participants (2,091 vaccinated and 2,109 controls). The pooled analysis yielded a relative difference (RD) of -0.03 (95% CI: -0.04 to -0.01), indicating a statistically significant difference in the risk of genital disease between vaccinated and unvaccinated males. Two trials showed statistically non-significant protective effects, while two did not, suggesting that differences in study design and baseline HPV exposure influenced the outcomes. Despite the lack of statistical significance, the direction of effect aligns with previous evidence of strong vaccine-induced protection in HPV-naïve males, with reported efficacy exceeding 90% against genital warts and anal intraepithelial neoplasia (AIN). These findings emphasise the benefit of early vaccination before sexual initiation, though partial protection may also occur in previously exposed or high-risk populations, such as men who have sex with men (MSM) and people living with HIV/AIDS (PLWHA). Although global HPV vaccine coverage in males remains low, cost-effectiveness analyses justify expanding vaccination programs when accounting for male disease burden and community-level benefits. In conclusion, this meta-analysis suggests that HPV vaccination may lower the risk of genital diseases in males by approximately 3%, supporting its role in comprehensive HPV prevention. Broader implementation of early and gender-neutral vaccination, along with targeted strategies for high-risk groups, is essential for equitable control of HPV-related morbidity and mortality worldwide.

Introduction: Quality medical education may also depend on the satisfaction of faculties and doctors in their medical institution while performing their duty. The present study was conducted to assess the job satisfaction of medical college faculties in Jharkhand. Materials and Methods: In the present mixed-method study, 30 faculties from state medical colleges and 15 faculties from autonomous medical institute were included. To assess job satisfaction, rating from 0 to 10 was used on given questions. ‘t’ test was used to compare the mean scores of job satisfaction domain between both group of faculties. Thematic analysis was done for qualitative data. Results: Overall job satisfaction was higher for autonomous institute faculties than state medical college faculties (P = 0.03). Faculties from state government medical colleges were not satisfied with their salary structure, infrastructure, workforce shortage and poor career development prospects as compared to autonomous medical institute faculties. Because of the changing directives of the National Medical Commission, faculties feel difficulty in curriculum implementation. Conclusions: Better salary structure and other perks similar to the central autonomous medical institute can improve faculty retention and ultimately medical education in Jharkhand.

BACKGROUND:Diabetes mellitus, affects millions of people globally. Over the years, diabetes has emerged as a significant global health concern, with steadily increasing prevalence. OBJECTIVES:This review explores the various aspects of diabetes mellitus, and delves into the evolving field of new emerging treatments and diabetes vaccines, highlighting the potential they hold in revolutionizing diabetes management in the future. MATERIALS AND METHODS:Literature search was done in PubMed database and relevant articles were selected for the narrative review. RESULTS:The review reveals that currently most vaccines that have been developed are in animal studies and early phases of trials. Only few human trials have been conducted, but, with positive outcome. There are also some novel therapeutics emerging as potential management options for diabetes. Therefore, it is imperative to know about the potential vaccines and novel emerging treatment options for diabetes mellitus, to understand the challenges faced in constructing novel vaccines and the intricate relationship between diabetes and Alzheimer's disease, an emerging entity as Type 3 Diabetes. CONCLUSION:There is a growing interest in the development of vaccines as a revolutionary approach to diabetes management. As our understanding of diabetes deepens and vaccine technology advances, the prospect of a diabetes vaccine becoming a reality offers hope for millions living with this condition and in reducing the burden of diabetes-related complications.

Background  Appropriate complementary feeding during the period of 6-24 months is essential for meeting the growing nutritional requirements of infants that cannot be met by breast milk alone after six months of age. Maternal knowledge, attitudes, and practices (KAP) are critical determinants of infant feeding behavior. Urban-rural disparities in education, socioeconomic status, and healthcare access may contribute to differences in these practices. This study aimed to assess and compare maternal KAP regarding complementary feeding in urban and rural areas of Ranchi district, Jharkhand, using a validated scoring framework. Methods  A community-based cross-sectional study was conducted among 305 mothers of children aged 6-24 months in urban Doranda (n=107) and rural Ormanjhi (n=198), the field practice areas of the Department of Community Medicine, RIMS, Ranchi. Data were collected using a pre-tested semi-structured questionnaire. KAP was assessed using a Bloom's cut-off-based scoring system: knowledge scores were classified as good (≥80%), moderate (60-79%), or poor (<60%); attitude as positive, neutral, or negative; and practice as good, moderate, or poor. Associations were tested using the chi-square test, and ORs were calculated to describe KAP pathways. Statistical significance was set at p<0.05. Results  Overall, 63.3% of mothers had good knowledge, 58.0% held positive attitudes, and 54.1% demonstrated good complementary feeding practices. Urban mothers performed significantly better across all three domains (p=0.032, p=0.041, and p=0.006, respectively). Good knowledge was strongly associated with positive attitude (OR=5.35; 95% CI: 3.23-8.86; p<0.001) and good practice (OR=4.47; 95% CI: 2.60-7.68; p<0.001). Positive attitude showed the strongest association with good complementary feeding practices (OR=5.27; 95% CI: 3.05-9.11; p<0.001). Maternal education and household income were the most significant sociodemographic determinants of KAP (p<0.001 for both). Conclusion  While general awareness was relatively high, significant gaps existed in practices, particularly in rural areas. The study demonstrates a sequential pathway from knowledge to attitude to practice, with socioeconomic factors as the primary underlying determinants. Targeted nutrition education and behavior change communication through frontline health workers are essential to translate knowledge into improved complementary feeding practices.

INTRODUCTION:With growing urbanization, cities are becoming increasingly polluted, and air pollution is becoming a major health concern. The objective of our study was to compare children travelling either by air-conditioned (AC) vehicles or non-AC school buses in terms of respiratory illnesses, spirometry parameters, and school attendance. MATERIALS AND METHODS:Children aged 6-11 years from classes 1 to 5 were included. Data were collected on demography, transportation details, history, and spirometry findings. Multinomial logistic regression and bivariate correlation tests were applied for the analysis of data. RESULTS:In total, 216 children were randomly selected, of which 210 students were included for the data analysis. In our study, we found 76. Seven percent of children had some or other respiratory symptoms in the last 30 days in either mode of transportation. Pulmonary function test results, including forced expiratory volume in 1 s (FEV1) and FEV1: Peak expiratory flow rate ratio, were similar in both groups, with P = 0.99 and 0.400, respectively. Students who travel by bus or non-AC vehicles are 20% more likely to miss their attendance as compared to those who travel by AC vehicles, with an odds ratio of 1.20 (confidence interval 0.55-2.64; P = 0.641). CONCLUSION:Our research study concluded that children who ride on non-AC buses are more vulnerable to the negative impacts of air pollution and greater distances result in longer exposure to pollution, which aggravates respiratory conditions more frequently and raises school absenteeism.

Lymphatic filariasis (LF) remains a significant public health concern, with India contributing nearly 55

Purpose Adolescence is a critical period of rapid growth where nutritional needs are heightened by biological and social factors. Tribal adolescent girls in rural India experience a disproportionate burden of undernutrition despite the presence of multiple government nutrition programmes. Existing research is largely quantitative and inadequately explains the social and institutional processes sustaining malnutrition. So this grounded theory explaining the determinants of nutritional status among adolescent tribal girls. Methods This qualitative study used a constructivist grounded theory design conducted among ten government school teachers. Data was collected by in-depth face-to-face interviews in the month of April 2025. Collected data were analysed by using Open Code version 4.03, using constant comparison, memo writing, and theoretical integration following Charmaz's grounded theory approach. Results The core process identified was normalising gendered undernutrition through household survival practices and institutional non-responsiveness. Four interrelated processes shaped this outcome: reproducing nutritional deprivation through gendered household practices; prioritising household survival over nutritional continuity; failing to translate institutional nutrition intentions into household practice; and adapting to nutritional deprivation through constrained agency and health avoidance. Together, these processes rendered undernutrition an ordinary and socially legitimate condition rather than a health crisis. Conclusion Undernutrition among tribal adolescent girls is sustained through everyday adaptations shaped by poverty, gender norms, and weak institutional mediation. Addressing adolescent malnutrition requires interventions that break the social normalisation of deprivation, strengthen culturally relatable programme delivery, and engage household survival rationalities beyond expanding nutritional coverage alone.

BACKGROUND AND AIM:Immunization is one of the most effective public health interventions, significantly reducing morbidity and mortality from infectious diseases worldwide. While childhood vaccination programs are well-established, adult immunization remains underutilized, particularly in developing countries like India. This study aimed to assess the knowledge, attitudes, and practices (KAP), along with beliefs, misconceptions, and barriers related to adult vaccination among medical students in Western Rajasthan, specifically at Government Medical College, Pali, and to examine their association with selected socio-demographic factors. METHODS:A cross-sectional study was conducted among 575 undergraduate medical students at a tertiary care center using a pre-tested, semi-structured questionnaire. Participants were recruited through convenience sampling, and data were analyzed using descriptive and inferential statistics. RESULTS:Overall, 69.6% of participants were aware of the adult vaccination schedule. Knowledge was higher for commonly administered vaccines, such as COVID-19 (96.5%) and hepatitis B (92.3%), but lower for newer vaccines, such as monkeypox (56.5%) and respiratory syncytial virus (55.1%). Attitudes were largely favorable, with 98.6% recognizing the importance of adult vaccination and 94.4% supporting its inclusion in national programs. However, misconceptions were widespread, with 72.7% believing vaccines may cause serious complications. Although all participants reported receiving at least one vaccine after 18 years (primarily COVID-19), only 61.6% were willing to receive adult vaccines, indicating a gap between knowledge and practice. Lack of awareness and fear of side effects were the most commonly reported barriers. CONCLUSION:Despite moderate knowledge and positive attitudes, significant misconceptions and gaps in uptake persist among medical students. Targeted educational interventions and strengthened curriculum integration are needed to improve vaccine literacy and acceptance. Findings are limited by a single-center design, convenience sampling, and self-reported data.

Introduction:This study investigates the barriers faced by key populations, men who have sex with men (MSM), transgender individuals (TGs), and female sex workers (FSWs), in two districts of Jharkhand in accessing healthcare services through targeted interventions (TIs). The objectives were to identify service delivery gaps, gain insights into participant experiences, and inform recommendations for improving healthcare access. Methods:A mixed-methods approach combining quantitative data collection was used. A total of 104 participants were surveyed by phone or in person, 30 of whom participated in FGDs. For qualitative data. The quantitative responses were scored on a five-point Likert scale for acceptability across the intervention's four dimensions: accessibility, approachability, availability, and appropriateness. SPSS was used for quantitative data analysis, whereas ATLAS.ti was used for qualitative data analysis. Statistical significance was set at P < 0.05. Results:Stigma, discrimination, lack of awareness and infrastructural challenges were the key thematic areas revealed. Discrimination, particularly for TGs, was greater. Scoring on a Likert scale revealed a high level of acceptability; however, only gender was found to be statistically significant (P < 0.05). MSMs reported fear of disclosure, whereas partner testing reluctance was commonly noted. Alcohol and drug abuse was noted to be significantly high. Conclusion:This study highlighted the need for culturally sensitive outreach, peer-based inclusion, and structural changes in health care settings. The findings provide actionable insights for policy makers to enhance inclusivity within national healthcare programs and address the unique challenges faced by key populations.

BackgroundDespite widespread vaccination programs, mumps has resurged globally. This systematic review and meta-analysis assessed the epidemiological characteristics, attack rates (ARs), and complications of mumps outbreaks worldwide from 2004 to 2024.MethodsWe systematically searched MEDLINE, Embase, CINAHL and Google Scholar for studies reporting on mumps outbreaks. Confirmed mumps cases, defined by WHO criteria, were included across all age groups. Epidemiological characteristics were summarized using the Time-Place-Person format. Pooled ARs and complication rates were calculated using random-effects models. Subgroup analyses examined variations by age, region, vaccination status, and outbreak period. A random-effects meta-regression and leave one out sensitivity analysis was used to explore the influence of study-level characteristics heterogeneity in the attack rate among mumps outbreak studies. Heterogeneity was assessed using Cochran’s Q and I2, and publication bias was evaluated with funnel plots and Egger’s test.ResultsA total of 47 studies from 21 countries reporting 71,174 mumps cases, were included in the systematic review, with 30 studies in the meta-analysis. The pooled AR of mumps outbreaks was 14.5% (95% CI: 12.91–16.11), with adults having the highest AR (31.8%). The pooled complication rate was 10.3% (95% CI: 5.7–14.9), with orchitis being the most common complication (63.1%). Temporal trends showed peaks during 2004–2009 and 2016–2020, while regional analysis revealed higher ARs in the Americas (29.2%) and Eastern Mediterranean (28.8%) regions compared to Europe (7.6%) and South-East Asia (9.6%). Among vaccinated individuals, ARs were highest with a single dose (35.7%) and lowest with three doses (10.1%).ConclusionMumps outbreaks remain a global concern due to waning vaccine-induced immunity. Incorporating a third MMR booster dose into vaccination schedules is recommended, particularly for high-risk groups, to reduce ARs and complications effectively.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/.

Tuberculosis (TB) remains a significant public health challenge in India, particularly among vulnerable populations. The Saharia tribe, a Particularly Vulnerable Tribal Group (PVTG), faces a disproportionately high TB burden. This study aimed to systematically review and quantify the TB burden among the Saharia tribe through meta-analysis. A comprehensive search was conducted in PubMed, Embase, Scopus, and Web of Science databases. Studies reporting TB prevalence in the Saharia tribe were included. The quality of included studies was assessed using the JBI Critical Appraisal Checklist. A random-effects model was used to estimate the pooled TB prevalence. Heterogeneity was assessed using I2 statistics, and publication bias was evaluated using funnel plots. Eight studies encompassing 163,562 Saharia individuals were included. The pooled TB prevalence was 2,416 per 100,000 population (95

BACKGROUND:There has been a recent rise of viral exanthem outbreaks in Jharkhand and other parts of India over the last 2-3 years. This may be due to low immunization coverage of measles vaccination or due to spread of other causes of fever and rash. This study aims to identify the key predictors of fever and rashes among children under five years old by analysing demographic, clinical, and environmental factors. METHODS:This study employed age-matched case-control design to investigate the association between fever with rash (cases) and the absence of such symptoms (controls), along with identifying potential predictors. The study was conducted retrospectively among children aged 0-60 months who presented with fever and rash at various healthcare centres across affected districts in Jharkhand during a measles outbreak from January to May 2023. We included 611 cases and control thus making total sample size to be 1222. Multivariable logistic regression was performed to identify independent risk factors associated with fever and rash during the outbreak. RESULTS:The mean age for cases was found to be 37.37 ± 22.8 months and while for control it was found to be 25.89 ± 18.6 months. Majority of cases with fever with rash were found among the female child, 50.6% (279) but was not statistically significant. Significant factor as fever and rashes were found to be more amongst the children 200 (68.5%) who had not taken first dose and 325 (53%) of cases who had not taken second dose of measles vaccine with P-value of less than 0.001 and 0.022 respectively. On applying Multivariate analysis religion was 2.5 times more associated and even ethnicity was 3 times more associated with the fever and rash cases. CONCLUSION:The study concludes that ethnicity, religion, and caste are important predictors of fever and rash cases. The most important factor is non-receipt of all age-appropriate vaccine as one of key factors for fever and rashes. The sociodemographic factors have a crucial role in transmission of viral exanthem and stakeholders must keep a vigil over these factors while dealing outbreaks of fever with rash disease.

Background: The delayed acceptance or abject refusal to take vaccines despite the availability of vaccination services has been termed as vaccine hesitancy (VH). The 5C Model of VH includes Confidence, Convenience, Complacency, and Communication as major determinants of VH in the population. Materials and Methods: This study was conducted among vaccinees enrolled at the Vaccination Center of the largest tertiary hospital in the tribal state of Jharkhand. The study was a cross-sectional study aimed to determine the extent of VH for COVID-19 vaccines prevalent in the study population and the associated factors. The study subjects included vaccinees at RIMS, Ranchi Vaccination Center. It included all subjects aged 18 years and above, consenting to be a part of the study. Study participants were recruited from the line list prepared for COVID-19 vaccination from the Co-win portal. A total of 625 participants were recruited. A predesigned, pretested, semistructured questionnaire was administered to all the study participants. Results: Out of the 625 recruited participants, VH was found in 165 subjects. The factor that is the biggest contributor to VH was the fear of the potential long-/short-term side effects of the vaccine (31.7%), which was followed by the fear of the pain from the shot (14.9%) and distrust in the vaccines due to shorter clinical trials (14.9%). Conclusion: V is a significant, living phenomenon that is translating into geographical clustering of epidemics and requires attention on both the micro- and macrolevels to be addressed successfully.

This review article examines the role of access to safe water, sanitation and hygiene (WASH) services on child health and survival. Observational studies consistently indicate a strong association of inadequate WASH with diarrhoea prevalence, stunting and child mortality. Interventional research on WASH demonstrates varying effects on health outcomes. These interventions are more effective in reducing diarrhoea and other infections than in improving child nutrition. Despite progress in WASH worldwide, there is still substantial scope for its improvement in low- and middle-income countries. As per the World Health Organization, 2.2 billion people lack access to safe drinking water and 800 million people do not have the luxury of having basic access to water. To strengthen WASH interventions in these areas, efforts should focus on expanding household and healthcare facility access to safe water, promoting community-based sanitation programmes and integrating hygiene education into maternal and child health initiatives. The stronger linkage and integration of various sectors and primary healthcare is required for faster progress on WASH interventions.

BACKGROUND:Vaccine hesitancy poses a significant challenge to immunization programs, particularly in tribal communities where unique sociocultural and systemic barriers exist. This study aimed to assess the prevalence, determinants, and underlying reasons for vaccine hesitancy among parents of children under seven years of age in Ormanjhi, a tribal block in Jharkhand, India. METHODS:A community-based cross-sectional study was conducted from April to September 2017 using the World Health Organization (WHO) cluster sampling method to select 30 clusters and 210 households. Data were collected using a pretested, semi-structured questionnaire covering sociodemographic characteristics, Vaccine Appropriate for Age (VAFA), and reasons for vaccine hesitancy. Descriptive statistics, agreement analysis, and chi-square tests were applied for data analysis. RESULTS:Vaccine hesitancy was reported by 15.24% (n = 32) of parents, while only 22.9% (n = 48) of children were vaccinated appropriately for their age. The most common reasons for hesitancy included fear of adverse effects (8.57%), lack of knowledge (6.19%), and mistrust (6.19%). Hesitancy was significantly associated with mothers as the primary responders (p = 0.036) and beliefs in alternative preventive methods (p = 0.019). Other sociodemographic factors, such as education and caste, showed no significant association. CONCLUSION:In Ormanji, vaccine hesitancy is largely driven by misinformation, fear, and mistrust, compounded by low vaccination coverage. Targeted interventions, particularly community-based education and trust-building through local health workers, are essential to improving immunization rates in tribal communities.

ObjectivesJharkhand was the first state in India to introduce ROTASIIL to reduce rotavirus diarrhea-related morbidity and mortality in children. This analysis focused on the burden of rotavirus diarrhea, associated risk factors, and the most prevalent rotavirus genotypes in children hospitalized with acute gastroenteritis (AGE).MethodsSurveillance of AGE in children aged under 5 y was carried out in 12 health facilities in four districts of Jharkhand from 2019 to 2023. Stool samples were screened for rotavirus, and the positive samples were subsequently genotyped. Factors associated with rotavirus positivity were identified using multivariable logistic regression.ResultsOf 3,319 children screened, 1,937 eligible children were included in the analysis. Of 1,801 stool samples tested, 39.8% were rotavirus-positive, with a peak prevalence in the winter months. The total family size [aOR 95% CI, 0.69 (0.55-0.86)], paternal education [aOR 95% CI, 0.68 (0.55-0.85)], age of the child [aOR 95% CI, 0.37 (0.25-0.55)], rotavirus vaccination status [aOR 95% CI, 0.66 (0.50-0.86)], and length of hospital stay [aOR 95% CI, 0.82 (0.66-1.01)] were significantly associated with rotavirus positivity. The most prevalent rotavirus genotypes were G2P[4], and G3P[8].ConclusionsRotavirus remains an important cause of gastroenteritis in children aged under 5 y, particularly in infants, despite the availability of rotavirus vaccination. Declining rotavirus positivity in children with AGE and changes in the distribution of rotavirus genotypes during the study period may be attributable to the effects of vaccination.