Analyzing the Impact of Image Denoising and Segmentation on Melanoma Classification Using Convolutional Neural Networks.

Early skin cancer detection and its treatment are crucial for reducing death rates worldwide. Deep learning techniques have been used successfully to develop an automatic lesion detection system. This study explores the impact of pre-processing steps such as data augmentation, contrast enhancement, and segmentation on improving the convolutional neural network (CNN) performance for lesion classification. The classification network was designed from scratch by uniquely organizing its layers and using a different number of kernels, depth of the network, size, and hyperparameters. In addition, the network's performance was improved by pre-processing and segmentation steps. The proposed network was compared with the current state-of-the-art to demonstrate its best performance on the benchmark HAM10000 lesion dataset. The experimental study revealed that the classification network using denoised+segmented data achieved an accuracy (ACC), precision (PRE), recall (REC), specificity (SPE), and F-score of 93.40%, 93.45%, 94.51%, 92.08%, and 93.98%, respectively. To conclude, classification performance can be improved by incorporating pre-processing and segmentation steps.

High prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among unvaccinated children of Chandigarh, Northwest India, in a household-based paediatric serosurvey post-second wave of pandemic (June to July 2021).

OBJECTIVE: Current national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination policy covers children aged >12 years. Unvaccinated, uninfected children remain susceptible to SARS-CoV-2 and play a role in community transmission, as paediatric infection is mostly mild or asymptomatic. To estimate the proportion of susceptible children in a community for public health measures, there is a need to assess the extent of natural infection. STUDY DESIGN: We performed a cross-sectional household serosurvey of SARS-CoV-2 antibodies in unvaccinated children aged between 6 and 18 years after the second COVID-19 wave. METHODS: Anti-SARS-CoV-2 immunoglobin G (IgG) testing in serum was done using chemiluminescence immunoassay. We used a logistic regression model to investigate predicted factors of seropositivity. RESULTS: We observed a high prevalence (weighted average: 68.3%) of anti-SARS-CoV-2 IgG in 2700 enrolled children. Logistic regression for predictors of IgG seropositivity showed lower odds in households with completely vaccinated adults (adjusted odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.26-0.71, P = 0.0011) compared with households with unvaccinated adults. Other factors for low seropositivity included frontline workers as family members (adjusted OR: 0.69, 95% CI: 0.52-0.91, P = 0.0091) and non-crowded households (adjusted OR: 0.74, 95% CI: 0.61-0.89, P = 0.0019). CONCLUSION: A high SARS-CoV-2 IgG prevalence in unvaccinated children was indicative of previous exposure to potentially infected contacts. This implies in-person academic activities for children can be continued during future community transmission. Comparatively lower seropositivity in children of completely vaccinated households or frontline workers suggests decreased transmission due to vaccination-induced immunity of family members. Vaccination will still be required in these children to maintain protective IgG levels, particularly in low seroprevalence groups.

Perceived stigma among diabetic patients and their caregivers: a review.

AIMS: Considerable number of studies in the existing literature indicate the existence of stigma related to many diseases, disabilities, and disorders, but less attention has been given to diabetes-related stigma. This narrative review of literature aims to explore the existence of stigma surrounding type 1 diabetes mellitus (T1DM). METHODS: Literature were searched using search engines, Google Scholar, PubMed, and Scopus electronic databases published from year 2000 to 2020. Both qualitative and quantitative studies focusing on the stigma associated with T1DM were included. A total of 21 articles met the inclusion criteria. Thematic analysis of collected research material was done. RESULTS: Results provided substantial evidence that stigma associated with T1DM was experienced by T1DM patients and their caregivers at some point in their lives and it had affected their lives in different domains such as difficulty finding a spouse, discrimination at employment opportunities, educational institutions, management of disease, being misjudged as a druggie, poor quality of life of the patient and caregiver, depressive symptoms among parents of patients, constant worrying of their child's disease management, and so on. CONCLUSION: Stigma related to T1DM is experienced by individuals suffering from it, and it is widespread. It not only affects the sufferers but their loved ones also. To reduce and cope-up with stigma, there is a need to increase public education and awareness at a mass level. Further research and awareness will serve to build our understanding of the experience of diabetes-related stigma.

Effect of Twin Block Therapy Versus Fixed Functional Appliances on Pharyngeal Airway Space in Skeletal Class II Patients: A Prospective Cephalometric Study.

Background: Class II malocclusion is one of the most common malocclusion with varied prevalence. Functional therapy with appliances like Twin Block or Fixed functional appliances forms the mainstay of treatment in growing Class II patients. These patients might demonstrate narrow airway due to the retrognathic position of the mandible. This study investigated the effects of twin block and fixed functional appliance therapy (Forsus™ FRD) on the pharyngeal airway space in skeletal Class II patients. Methods: Forty patients with Class II malocclusion were selected and divided into two equal groups of 20 patients each for both Twin block and Forsus group. Lateral cephalograms were obtained before and after the functional appliance therapy. Evaluation was done for changes in hyoid bone position, pharyngeal airway dimensions and tongue position. Results: The variables of the study showed better hyoid position in both the groups. In Twin Block group, an increase in hy-apw2 and hy-PoFH suggested anterior positioning of hyoid and a decrease in H-MP and hy-ML indicated superior positioning. In Forsus group an increase in H-H', hy-FH, hy-ML, hy-NL, hy-NSL and hy-OL suggested inferior positioning of hyoid, while an increase in hy-apw2, hy-CVT, hy-PoFH, hy-RL and hy'-tgo indicated anterior positioning of hyoid bone after functional therapy. Conclusion: Both the twin block and Forsus™ FRD improved the position of the hyoid bone after the functional appliance therapy however the changes were not statistically significant. Twin block and Forsus™ had similar effect on the hyoid bone position, pharyngeal dimensions and the tongue position.

Impact of blood donor characteristics on quality of packed red blood cell concentrates.

INTRODUCTION: Impact of blood donor characteristics on quality of packed red blood cell concentrates. OBJECTIVE: To determine the impact of donor factors on the quality of packed red blood cell concentrates. MATERIAL AND METHODS: The analytical cross sectional study was conducted on 505 whole blood donors after approval by the Institutional Ethics Committee and written informed consent from blood donors. Two mL EDTA sample was collected for pre-donation haemoglobin estimation and all relevant donor details were recorded. Whole blood was collected in 350mL double blood bags. PRBCs were prepared as per the departmental SOP. Volume of each PRBC was recorded and sample from each bag was taken for estimation of total haemoglobin content and haematocrit. RESULTS: Of 505 blood donors, 459 (90.9%) were males and 324 donors (64.2%) were less than 30 years of age. The majority of the donors were repeat donors (61%, n=308 repeat donors), vegetarians (52.9%, n=267 vegetarians) and non-smokers (92.7%, n=468). Mean haemoglobin was found to be significantly higher in males (14.9 vs. 13.3; P≤0.001), donors more than 30 years of age (15 vs. 14.7; P=0.042), repeat donors (14.9 vs. 14.7), non-vegetarians (15.1 vs. 14.6; P≤0.001) and smokers (15.3 vs. 14.8g/dL; P=0.020). PRBC units prepared from male blood donors, repeat donors and non vegetarians had significantly higher mean volume and mean total haemoglobin content. Strong positive correlation was observed between haemoglobin of the blood donor and total haemoglobin content of the PRBC and volume of blood collected. CONCLUSIONS: Donor characteristics do have effect on total haemoglobin content of packed red blood cells.

Reporting of delayed adverse donor reactions in whole blood donors: Just the tip of an iceberg!

BACKGROUND AND OBJECTIVES: The study was planned to determine the incidence and analyze how various epidemiological factors tend to be associated with delayed adverse donor reactions (ADR). MATERIAL AND METHODS: The prospective observational study was conducted in Department of Transfusion Medicine of tertiary care hospital from January to December 2019. Eligible blood donors were observed for any adverse reactions after 15 minutes of removal of phlebotomy needle. Further, telephonic calls were made to each enrolled blood donor on day-2 and day-7 of the whole blood donation. For each day, two calls were made at an interval of 4 hours before declaring the participant to be non-responder. RESULTS: A total of 1540 (84.1%) blood donors responded on day-2 and 1610 (87.9%) responded on day-7 of follow-up. Total 180 (11.2%) blood donors experienced delayed ADRs. Two donors (1.1%) experienced on-site while 178 (98.89%) reported off-site delayed ADRs when followed-up telephonically. The commonest delayed ADRs reported were bruise (n=72; 30.9%), arm-pain (n=61; 26.2%) and generalised weakness (n=44; 18.9%). Female donors (27.3% vs. 11.2%; P=0.004), first time donors (15.2 vs. 9.9%; P=0.002), donors with low body-weight (range of 45-60kg; 15.9% vs. 11.5% vs. 6.1%; P=0.011) and body mass index<18.5 (24% vs. 12.5% vs. 9.7% vs. 11.3%; P=0.028) experienced more delayed ADRs. CONCLUSION: Blood donors do experience delayed ADRs but these are not reported to the blood centers as these are usually mild. However, it is important to capture these delayed adverse donor reactions and report it to National Hemovigilance Program so that strategies can be formulated to prevent their occurrence and recurrence.

Lesion Border Detection of Skin Cancer Images Using Deep Fully Convolutional Neural Network with Customized Weights.

Deep learning techniques have been widely employed in semantic segmentation problems, especially in medical image analysis, for understanding image patterns. Skin cancer is a life-threatening problem, whereas timely detection can prevent and reduce the mortality rate. The aim is to segment the lesion area from the skin cancer image to help experts in the process of deeply understanding tissues and cancer cells' formation. Thus, we proposed an improved fully convolutional neural network (FCNN) architecture for lesion segmentation in dermoscopic skin cancer images. The FCNN network consists of multiple feature extraction layers forming a deep framework to obtain a larger vision for generating pixel labels. The novelty of the network lies in the way layers are stacked and the generation of customized weights in each convolutional layer to produce a full resolution feature map. The proposed model was compared with the top four winners of the International Skin Imaging Collaboration (ISIC) challenge using evaluation metrics such as accuracy, Jaccard index, and dice co-efficient. It outperformed the given state-of-the-art methods with higher values of the accuracy and Jaccard index.

Phenotypic presentation of PCOS with respect to BMI in a north Indian population.

ABSTRACT: PCOS is one of the emerging health issues of women in their reproductive age with a range of associated signs and symptoms. In the present study, 250 PCOS subjects age ranged from 18 to 45 years and residing in the Chandigarh Capital Region (CCR) were selected from the OPD, PGIMER, Chandigarh, (North India). In the present study H+O phenotypic group (NIH criteria) was the most commonly occurring with the prevalence of 50.4% followed by complete PCO or classic PCOS phenotype (P+H+O) with 39.2% prevalence. The ovula-tory PCOS (P+H) and non-hyperandrogenic PCOS (P+O) demonstrated little prevalence of 6% and 4.4% respectively. Maximum overweight/obese PCOS women were recorded in the (H+O) phenotypic group (27.2%) followed by classic PCOS phenotype (20.4%), (P+H) phe-notype (4%) and lowest prevalence in P+O phenotype (1.2%), thereby indicating that hyperandrogenism and oligo-anovulation was common symptoms among overweight/obese PCOS women.

Drug Information Association (DIA) 2021 Global Annual Meeting (June 26-July 1, 2021 - Virtual Meeting).

At the 57th Global Annual Meeting of the Drug Information Association (DIA), attendees met virtually for the second time to support the theme of 'Collaboration without Boundaries.' Sessions included presenters and speakers from regulatory agencies, patient advocacy and academia, with patients at the forefront of discussions. This report covers a number of presentations and panel discussions from the 4-day meeting that primarily focused on the COVID-19 global pandemic.

Biodegradation of endocrine disrupting chemicals benzyl butyl phthalate and dimethyl phthalate by Bacillus marisflavi RR014.

AIM: The objectives of the present study were to explore the benzyl butyl phthalate (BBP) and dimethyl phthalate (DMP) degradation potential of Bacillus marisflavi RR014 isolated from the tap water of public toilet and also to optimize the phthalates degradation process using response surface methodology. METHODS AND RESULTS: The minimal salt medium was used for the biodegradation analysis of phthalates. The quantification of phthalates and their intermediate metabolites identification were done by using UHPLC and LC-MS/MS respectively. The results revealed that B. marisflavi RR014 is capable of degrading both the phthalates under varying pH, temperature and salinity conditions. The formation of phthalic acid from the breakdown of BBP and DMP (500 mg l-1 ) in the medium was observed after 24 h. After 72 h, 61% of BBP and 98·9% of DMP in the medium was degraded as monitored by UHPLC. The identification of intermediate metabolites by LC-MS/MS revealed that hydrolysis of BBP and DMP produces phthalic acid. CONCLUSIONS: The degradation rate of both the phthalates was increased as the parameters increased up to an optimum level. The three environmental factors (pH, temperature and salt concentration) strongly affect the rate of degradation of both the phthalates. The maximum degradation rate for both the phthalates was achieved at pH 7, temperature 35°C and salt concentration of 1% as observed from the central composite experimental design. SIGNIFICANCE AND IMPACT OF THE STUDY: It is the first report on the phthalates biodegradation potential of B. marisflavi RR014 isolated from the tap water of public toilet. The bacterium is capable of degrading BBP and DMP under varying pH, temperature and salinity, therefore, ideal to treat the phthalate contaminated environments.

Anti-atherogenic properties of Kgengwe (Citrullus lanatus) seed powder in low-density lipoprotein receptor knockout mice are mediated through beneficial alterations in inflammatory pathways.

Kgengwe fruits are commonly consumed in sub-Saharan countries. Recent reports indicated low coronary artery disease rates in those regions. To investigate anti-atherogenic properties and potential mechanisms of action of Kgengwe seed powder (KSP), male low-density lipoprotein receptor knockout (LDL-r-KO) mice were fed with an atherogenic diet supplemented with (treated, n = 10) or without (controls, n = 10) 10% (w/w) KSP for 20 weeks. Proximate analysis revealed that KSP contained 38% fibre and 15% lipids. KSP supplementation was not associated with significant changes in body weight gain rate, food intake, and plasma lipid levels. However, the average atherosclerotic lesion size in the aortic roots in the KSP-treated group was 58% smaller than that in the control group (0.26 vs 0.11 mm2, p < 0.05). This strong anti-atherogenic effect was associated with significant increases in the average plasma levels of certain cytokines such as IL-10 (6 vs 13 pg/mL, p < 0.05), GM-CSF (0.1 vs 0.2 pg/mL, p < 0.05), and EPO (7 vs 16 pg/mL, p < 0.05) along with reductions in the average levels of plasma MCP-1 (19 vs 14 pg/mL, p < 0.05) and MIP-2 (28 vs 13 pg/mL, p < 0.05). Except for relatively high levels of saturated fatty acids, KSP possesses balanced nutrient compositions with strong anti-atherogenic properties, which may be mediated through alterations in inflammatory pathways. Additional studies warrant confirmation and mechanism(s) of action of such effects. Novelty: Kgengwe seeds prevent atherogenesis in LDL-r-KO mice. Kgengwe seeds increase circulating levels of IL-10 and EPO. No reduction in plasma total cholesterol levels.

Identification and characterization of a halocin-producing haloarchaeon isolated from Pachpadra salt lake.

Haloarchaea are known to produce antimicrobial proteins, halocins which are generally stable at extreme conditions suggesting their potential biotechnological applications. Here, we report a halocin-producing haloarchaeon isolated from salt lake and identified as Haloferax larsenii HA4 using partial 16S rDNA sequence and biochemical properties. Whole-cell methanolysate showed ether-linked lipids, which is a characteristic feature of haloarchaea. Strain HA4 was able to grow at pH 6·0-10·0 and 15-30% NaCl. The growth response was normal but antimicrobial activity was detected only during the log-phase. Crude halocin HA4 was active in the pH range of pH 2·0-10·0 with stability up to 100°C. Cell-free supernatant (CFS) was also stable in different organic solvents and detergents tested. However, halocin activity was reduced after treatment with proteinase K suggesting the proteinaceous nature of the active compound. Concentrated CFS showed the presence of several proteins from 6·5-66 kDa but bioassay suggested ~14 kDa protein as halocin. Crude halocin preparation showed cytocidal activity against indicator strain, H. larsenii HA10 and inhibited the growth of other related strains such as H. larsenii HA3, HA8, HA9 and HA10.

Nanotechnology and its challenges in the food sector: a review.

Antibacterial activity of nanoparticles has received significant attention worldwide because of their great physical and chemical stability, excellent magnetic properties, and large lattice constant values. These properties are predominate in the food science for enhancing the overall quality, shelf life, taste, flavor, process-ability, etc., of the food. Nanoparticles exhibit attractive antibacterial activity due to their increased specific surface area leading to enhanced surface reactivity. When nanoparticles are suspended in the biological culture, they encounter various biological interfaces, resulting from the presence of cellular moieties like DNA, proteins, lipids, polysaccharides, etc., which helps antibacterial properties in many ways. This paper reviews different methods used for the synthesis of nanoparticles but is specially focusing on the green synthesis methods owing to its non-toxic nature towards the environment. This review highlights their antibacterial application mainly in the food sector in the form of food-nanosensors, food-packaging, and food-additives. The possible mechanism of nanoparticles for their antibacterial behavior underlying the interaction of nano-particles with bacteria, (i) excessive ROS generation including hydrogen peroxide (H2O2), OH- (hydroxyl radicals), and O- 2 2 (peroxide); and (ii) precipitation of nano-particles on the bacterial exterior; which, disrupts the cellular activities, resulting in membranes disturbance. All these phenomena results in the inhibition of bacterial growth. Along with this, their current application and future perspectives in the food sector are also discussed. Nanoparticles help in destroying not only pathogens but also deadly fungi and viruses. Most importantly it is required to focus more on the crop processing and its containment to stop the post-harvesting loss. So, nanoparticles can act as a smart weapon towards the sustainable move.

Women's responses and understanding of polygenic breast cancer risk information.

It is estimated that polygenic factors can explain up to 18% of familial breast cancer. Clinical implementation of polygenic testing has begun, with several commercial laboratories now testing. Despite commercial implementation, there is little research investigating how women respond and understand polygenic risk information. This study aimed to explore women's experience receiving their personalised polygenic risk score (PRS) and compare responses of women at different levels of polygenic risk. Eligible participants were affected and unaffected women from families clinically assessed to be at high risk for breast cancer who had received their personalised PRS as part of the Variants in Practice Psychosocial Study (ViPPs). In-depth semi-structured interviews were conducted with 21 women (mean age 53.4 years) up to four weeks after receiving their PRS. Interviews were transcribed verbatim and analysed using thematic analysis. Eleven women received a PRS that was in the top quartile of PRS distribution and 10 in the lowest quartile. Women's lived experience with breast cancer informed how they responded to their PRS, constructed and made sense of breast cancer risk following receipt of their PRS, and integrated this new information into their breast cancer risk management. Regardless of polygenic risk level, all participants demonstrated broad knowledge of concepts related to polygenic information and were able to accurately describe the implications of their PRS. Receiving PRS did not appear to negatively impact women's reported distress levels. Our findings suggest polygenic breast cancer information is well received and understood by women at high-risk for breast cancer.

Evaluation of implementation of risk management guidelines for carriers of pathogenic variants in mismatch repair genes: a nationwide audit of familial cancer clinics.

INTRODUCTION: This nationwide study assessed the impact of Lynch syndrome-related risk management guidelines on clinicians' recommendations of risk management strategies to carriers of pathogenic variants in mismatch repair genes and the extent to which carriers took up strategies in concordance with guidelines. MATERIALS AND METHODS: Clinic files of 464 carriers (with and without colorectal cancer) were audited for carriers who received their genetic testing results in July 2008-July 2009 (i.e. before guideline release), July 2010-July 2011 and July 2012-July 2013 (both after guideline release) at 12 familial cancer clinics (FCCs) to ascertain the extent to which carriers were informed about risk management in accordance with guidelines. All carriers captured by the audit were invited to participate in interviews; 215 were interviewed to assess adherence to recommended risk management guidelines. RESULTS: The rates of documentation in clinic files increased significantly from pre- to post-guideline for only two out of eight risk management strategies. The strategies with the highest compliance of carriers post-guidelines were: uptake of one or two-yearly colonoscopy (87%), followed by hysterectomy to prevent endometrial cancer (68%), aspirin as risk-reducing medication (67%) and risk-reducing salpingo-oophorectomy (63%). Interrater reliability check for all guidelines showed excellent agreement (k statistics = 0.89). CONCLUSION: These results indicate that there is scope to further increase provision of advice at FCCs to ensure that all carriers receive recommendations about evidence-based risk management. A multi-pronged behaviour change and implementation science approach tailored to specific barriers is likely to be needed to achieve optimal clinician behaviours and outcomes for carriers.

Interpregnancy interval and risk of perinatal death: a systematic review and meta-analysis.

BACKGROUND: Interpregnancy interval (IPI) <6 months is a potentially modifiable risk factor for adverse perinatal health outcomes. OBJECTIVE: This systematic review evaluated the international literature on the risk of perinatal death associated with IPI. SEARCH STRATEGY: Two independent reviewers screened titles and abstracts identified in MEDLINE, EMBASE and Scopus from inception to 4 April 2019 (Prospero Registration #CRD42018092792). SELECTION CRITERIA: Studies were included if they provided a description of IPI measurement and perinatal death, including stillbirth and neonatal death. DATA COLLECTION AND ANALYSIS: A narrative review was performed for all included studies. Random effects meta-analysis was used to compare unadjusted odds of perinatal death associated with IPI <6 months and IPI ≥6 months. Analyses were performed by outcome of the preceding pregnancy and study location. MAIN RESULTS: Of the 624 unique articles identified, 26 met the inclusion criteria. The pooled unadjusted odds ratio of perinatal death for IPI <6 months was 1.34 (95% CI 1.17-1.53) following a previous live birth, 0.85 (95% CI 0.73-0.99) following a previous miscarriage and 1.07 (95% CI 0.84-1.36) following a previous stillbirth compared with IPI ≥6 months. However, few high-income country studies reported an association after adjustment. Fewer studies evaluated the impact of long IPI on perinatal death and what evidence was available showed mixed results. CONCLUSIONS: Results suggest a possible association between short IPI and risk of perinatal death following a live birth, particularly in low- to middle-income countries. TWEETABLE ABSTRACT: Short IPI <6 months after a live birth was associated with greater risk of perinatal death than IPI ≥6 months.

Effectiveness of Interventional Strategies in Modulating Knowledge and Attitude of Health Care Professionals for Promoting Organ Donation: A Study in Tertiary Care Public Hospital of North India.

OBJECTIVE: To evaluate the impact of interventional "educational module" on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance. STUDY DESIGN: Interventional and prospective. METHODS: We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention. RESULTS: A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the "concept of organ donation," while nurses were more familiar with "procedures and protocols." Both had low knowledge about "clinical criteria for brain death" and "legal issues" preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause. CONCLUSION: Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

Hand hygiene compliance of patients' family members in India: importance of educating the unofficial 'fourth category' of healthcare personnel.

INTRODUCTION: In India, due to manpower constraints, patients' family members are often actively involved in healthcare activities of their near and dear ones. They have significant contact with the patient at all World Health Organization (WHO) 'five moments for hand hygiene'. This study analysed the impact of decade-long awareness campaigns on the hand hygiene compliance (HHC) by our patients' carers. METHODS: Trained infection control nurses observed the HHC at each of the five moments for patients' attendants in different hospital settings from January 2014 to December 2018. Compliance was calculated as percentage of events divided by total opportunities. FINDINGS: A total of 7302 opportunities were observed with an overall compliance of 46.1% (35.5% in 2014 to 48.2% in 2018, P < 0.0001). Compliance at WHO moments 1, 2, 3, 4, and 5 was 51.0%, 47.4%, 67.6%, 48.8%, and 24.3% respectively. Among family members, mothers of newborns had a much higher HHC (77%) than others (44.5%) (P < 0.0001). Also, the compliance was higher in medical versus surgical wards and in paediatric wards versus adult wards (P < 0.0001 in both). CONCLUSION: This is the first study on family members' HHC in a hospital setting in a low- and middle-income country. The study shows that family members, once trained, exhibit fairly good HHC while caring for their patients, especially mothers of newborns. It is worthwhile empowering and educating patient attendants about the importance and process of hand hygiene as it is likely to result in immense benefit for patients.