Double Jab: Survey Evidence on Vaccine Hesitancy, Beliefs, and Attitudes in India.

India witnessed a large surge in COVID-19 cases in April 2021, a second wave of nearly 350,000 daily new infections across the country. As of December 2021, cases have reduced drastically, in part due to greater vaccine coverage across the country. This study reports results on vaccine hesitancy, attitudes, and behaviors from an online survey conducted between February and March 2021 in nine Indian cities (N = 518). We find that vaccine hesitancy negatively predicts willingness to take the vaccine, and beliefs about vaccine effectiveness supersede hesitancy in explaining vaccine uptake. Furthermore, we find that mask-wearing and handwashing beliefs, information sources related to COVID-19, and past COVID-19 infection and testing status are all strongly associated with the hypothetical choice of vaccine. We discuss these findings in the context of behavioral theories as well as outline implications for vaccine-related health communication in India.

Biocompatible dressing for pediatric hypospadias repair.

PURPOSE: The search for an ideal Hypospadias repair dressing continues. We aimed to develop a hypoallergenic optimized biocompatible dressing (BD). METHOD: BD with a multi-layered structure of hydrophilic treated Polypropylene with three-layered technologies; Absorbent-spunlaced hydroentangled polyester/viscose blend, outer Polypropylene, Polyester, Acrylic, and Spandex, with super Absorbent Polymer and Acrylic adhesive. Wistar rat abdominal wound model was divided into two groups: control (normal gauze dressing with adhesive) and Study (BD). The physical properties and wound characteristics were compared. RESULTS: Average mass: thickness of BD was 626.7 ± 5.6 g m-2: 2.6 ± 0.015 mm. Absorption was 1425.2 ± 127.6%. Percentage desorption of solution A from dressings at 24:40 h was 1249 ± 150%:1417 ± 230%. BD was hydrophilic with no particles/residue after immersion and pH neutral. The average air permeability was 11.6 ± 1.6 cm3/cm2/sec. The tensile force was 200N-220N with an extension on the breaking point at 24 mm. BD was superior for ease of removability on Day 6 (p = 0.012) and sticking quality (p = 0.036), absorption (p = 0.036), ease of removability(p = 0.036), and sustenance (p = 0.030) on Day 10. BD dressing demonstrated better wound healing (p = 0.015) and decreased redness (p = 0.002) on Day 10. Histopathological healing was better with BD on Day 14(p = 0.025) and Day 20 (p = 0.034). CONCLUSION: BD demonstrated better desirable physical and wound healing qualities with less inflammation compared with control normal dressing.

No going back: COVID-19 disease threat perception and male migrants' willingness to return to work in India.

This paper explores the causal link between the likelihood of re-migration to cities and the perceived threat of contracting COVID-19 using novel data on male reverse migrant workers in India. We find that reverse-migrants who believe there is a significant chance of contracting COVID-19 display a significantly lower likelihood of returning to their urban workplaces, regardless of their duration of migration. On the other hand, longer-duration migrants display a lower perceived chance of contracting COVID-19 than shorter-duration migrants. We also contribute to the migration literature by linking behavioural attributes to the decision to migrate. We find that more impatient individuals display a heightened belief regarding contracting COVID-19 and a higher projected likelihood of returning to work. Finally, we find that while both loss and risk-averse individuals have a lower projected likelihood of returning to urban workplaces, only loss-averse individuals perceive that their chance of contracting COVID-19 is lower.

Diabetic Foot Care Knowledge and Practices in Rural North India: Insights for Preventive Podiatry.

BACKGROUND: Diabetic foot ulcer (DFU) is one of the most dreaded complications of Type 2 Diabetes Mellitus (T2DM). Preventive podiatry is most efficient way of minimising DFU. The main aim of the study was to assess the knowledge and foot care practices among patients living with T2DM concerning the DFU. MATERIALS AND METHODS: We conducted a cross-sectional study in a rural-area of Haryana, India between January to March 2019 amongst 416 people living with T2DM after using multistage random sampling. A pre-tested, structured survey instrument prepared from the recommendation of the American College of Foot and Ankle Surgeons and the Diabetes UK was used after Hindi translation as per standard protocol. The knowledge and practices were classified as good, satisfactory and poor if the total score was between 8-11, 6-7 and <6. RESULTS: 14.2% had a previous history of DFU. The prevalence of good, satisfactory and poor knowledge was 63.5%, 12.5% and 24.0%. Further, 46.7%, 32.7% and 20.6% respondents depicted good, satisfactory and poor practices regarding foot care. On multivariate binary logistic regression analysis, younger age group, higher education, Per capita family income in INR, Blood glucose levels, HbA1c Levels, physical activity and previous history of DFU emerged as significant predictors of good foot-care knowledge and practices. CONCLUSION: There is an evident gap between foot-care knowledge and practices that should be addressed through comprehensive behaviour change strategies. Comprehensive risk-assessments for diabetes associated complications needs to be piloted at community level to assess the feasibility.

Glycaemic hygiene.

Hygiene is the foundation of health. This communication proposes the concept of glycaemic hygiene, defined as "conditions and practices that help to maintain health, and prevent the development of diabetes mellitus and its complications". Glycaemic hygiene is relevant at the level of the person, the physician and the community. Aspects such as personal hygiene, food hygiene, physical activity hygiene, mental/ emotional hygiene and dental hygiene must be optimized to ensure good health individuals. Skin hygiene, vaccine hygiene and environmental hygiene are equally important in diabetes care. Physicians should ensure pharmacological hygiene, language hygiene and information hygiene to foster good diabetes self-care and management.

Endemic Syndromes associated with Diabetes - A call for Awareness, recognition and management in India and beyond.

Diabetes mellitus has reached pandemic proportions throughout the globe. Though hyperglycaemia is the hall mark feature of diabetes, there are several variations in its etiology, clinical presentation, and associated complications. Some of these variations have been distinctly described in specific regions and ethnicities across India and other regions in the world. In this commentary we describe these endemic syndromes associated with diabetes to improve their awareness, recognition and management. A focused attention on these relatively neglected clinical challenges would encourage future discussion and research to address these conditions.

Social insulin resistance: The forgotten frontier.

This opinion piece discusses the concept of social insulin resistance, and helps create a comprehensive biopsychosocial model of insulin resistance. Social insulin resistance is defined as a negative attitude, present in some social groups, directed towards avoidance or rejection of insulin therapy. The various aspects of social insulin resistance are described in detail. This important construct has both clinical and public health relevance, and will help plan strategies to improve the acceptance and usage of insulin in diabetes care.

Incidence of Obstructive Sleep Apnea in Elderly Edentulous Patients and the Possible Correlation of Serum Serotonin and Apnea-Hypopnea Index.

PURPOSE: To estimate the incidence of obstructive sleep apnea (OSA) in elderly edentulous patients (aged 60-65 years) and investigate a correlation of serum serotonin levels with the apnea-hypopnea index (AHI), respiratory effort-related arousal (RERA), and respiratory disturbance index (RDI). MATERIALS AND METHODS: 381 elderly completely edentulous patients (307 male, 74 female) aged 60 to 65 years with a history of edentulism of 12 to 15 months, seeking oral rehabilitation at the prosthodontic clinic at Saraswati Dental College & Hospital, Lucknow, India, between January 2014 and January 2016 were enrolled for the present study. After application of the inclusion and exclusion criteria of this study, 183 patients (162 male, 21 female) who were found susceptible, were subjected to the BERLIN questionnaire and Epworth Sleepiness Scale (ESS) to assess sleep disordered breathing (SDB) and then put through all-night polysomnography (PSG). On the basis of AHI, RERA, and RDI scores, 156 patients (143 male, 13 female) who tested positive for OSA were classified according to its intensity. All 156 patients underwent body-mass index (BMI) estimation, cephalometry, and intraoral examination for skeletal and soft tissue profile record. Serum serotonin was estimated from whole blood samples for the 156 OSA and the 27 normal patients. The 156 (147 nonobese, 9 obese) OSA-positive patients were provided with complete dentures and were trained to use the same as a modified mandibular advancement device (MAD) during sleep at night. These patients were kept on a quarterly follow-up for 9 months. Data collected was subjected to statistical analysis, and inferences drawn. RESULTS: The incidence of OSA in elderly edentulous subjects was found to be 32.03% in males and 8.91% in females. A mere 9 out of 156 (5.76%) elderly edentulous OSA patients were found to be obese (Class I) on the basis of BMI estimation. Cephalometry of the patients showed that they had a skeletal class I maxillomandibular relationship. AHI scores of nonobese patients revealed that most of the patients had moderate OSA, followed by mild OSA and severe OSA. Serum serotonin levels ranged from 53 to 83 ng/dL. AHI score of the 9 obese patients were in the moderate to severe range, and their serum serotonin levels were 60 to 70 ng/dL. A correlation between severity of OSA and serum serotonin level was validated in this study. CONCLUSION: OSA was found to be prevalent in edentulous subjects due to pharyngeal collapse and decreased neuromuscular control. An inverse relationship of serum serotonin levels and AHI scores was established.

Clinical Profile, Intensive Care Unit Course, and Outcome of Patients Admitted in Intensive Care Unit with Chikungunya.

OBJECTIVE: Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome. METHODS: All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated. Primary outcome measured was 28-day mortality and secondary outcomes measured were length of hospital and ICU stay and the need for vasopressor support, renal replacement therapy (RRT), and mechanical ventilation (MV). Logistic regression analysis was performed to identify factors predicting mortality. RESULTS: The most common complaints were fever (96.67%) and altered sensorium (56.67%). Mean admission APACHE II and SOFA scores were 17.28 ± 7.9 and 7.15 ± 4.2, respectively. Fifty-one patients had underlying comorbidities. Vasopressors were required by 46.76%; RRT by 26.67%, and MV by 58.33%, respectively. The 28-day mortality was 36.67%. High APACHE II score (odds ratio: 1.535; 95% confidence interval: 1.053-2.237; P = 0.026) and need for dialysis (odds ratio: 833.221; 95% confidence interval: 1.853-374,664.825; P = 0.031) could independently predict mortality. CONCLUSIONS: Patients with chikungunya fever may require ICU admission for organ failure. They are generally elderly patients with underlying comorbidities. Despite aggressive resuscitation and organ support, these patients are at high risk of death. Admission APACHE II score and need for dialysis may predict patients at higher risk of death.

A cadaver study validating CT assessment of acetabular component orientation: the Perth CT hip protocol.

OBJECTIVE: The aim was to develop a CT-based protocol to accurately measure post-operative acetabular cup inclination and anteversion establishing which bony reference points facilitate the most accurate estimation of these variables. MATERIALS AND METHODS: An all-polyethylene acetabular liner was implanted into a cadaveric acetabulum. A conventional pelvic CT scan was performed and reformatted images created in both functional and anterior pelvic planes. CT images were transferred to a Freedom-Plus Graphics software package enabling an identical, virtual 3D model of the cadaveric pelvis to be created and definitive acetabular cup orientation established. Using coronal and axial slices of the CT scans, acetabular cup inclination and anteversion were measured on five occasions by ten radiographers using differing predetermined bony landmarks as reference points. The intra- and inter-observer variation in measurement of acetabular cup orientation using varying bony reference points was assessed in comparison to the elucidated definitive cup position. RESULTS AND CONCLUSION: Virtually derived definitive acetabular cup orientation was measured showing cup inclination and anteversion as 41.0 and 22.5° respectively. Mean CT-based measurement of cup inclination and anteversion by ten radiographers were 43.1 and 20.8° respectively. No statistically significant difference was found in intra- and inter-observer recorded results. No statistically significant differences were found when using different bony landmarks. CT assessment of acetabular component inclination and anteversion is accurate, reliable and reproducible when measured using differing bony landmarks as reference points. We recommend measuring acetabular inclination and anteversion from the inferior acetabular wall/teardrop and posterior ischium respectively.

Axillary Artery Injury Associated with Proximal Humeral Fractures: Review of Long-Term Vascular, Orthopedic, and Neurologic Outcomes.

BACKGROUND: Fracture and dislocation of the proximal humerus is common. It is associated with a number of vascular, neurologic, and orthopedic complications; these include brachial plexopathy and avascular necrosis (AVN) of the humeral head. These complications are rare but can potentially cause severe disability to patients; however, they remain poorly described in the literature. To describe vascular, orthopedic, and neurologic outcomes after axillary artery repair, in patients with proximal humeral fractures or dislocations. METHODS: We conducted a retrospective review of patients admitted to 2 tertiary trauma centers in Victoria, Australia, with fracture or dislocation of the proximal humerus and associated axillary artery injury. Patients were selected according to guidelines for trauma call or alert and the presence of high-risk mechanism of injury. Data on vascular, orthopedic, and neurologic complications were collected. RESULTS: Twenty-one patients were identified. Injury to the first part of the axillary artery was noted in 11 patients (52%). Brachial plexus exploration was performed in 17 patients (81%). Four patients (19%) underwent nerve repair. Long-term neurologic recovery was universally poor. Major orthopedic complications included AVN of the humeral head, delayed union, and the need for prosthesis or arthrodesis. Eleven patients (52%) received upper limb fasciotomy. Five patients (24%) underwent delayed secondary upper limb amputation. CONCLUSIONS: There was an unusually high rate of injuries to the first part of the axillary artery. Close clinical observation is recommended for such patients. AVN of the humeral head and brachial plexopathy remain significant and debilitating complications.

Effect of gingival displacement cord and cordless systems on the closure, displacement, and inflammation of the gingival crevice.

STATEMENT OF PROBLEM: The gingival sulcus should remain open long enough for the impression material to flow into it and completely fill the space provided by the gingival displacement. Impressions with less sulcal width have a higher incidence of voids, tearing of impression materials, and reduction in marginal accuracy. PURPOSE: The purpose of this clinical study was to investigate the closure, gingival displacement, and gingival inflammation of the gingival crevice after the use of medicated gingival displacement cord and cordless systems. MATERIAL AND METHODS: Gingival sulcus closure was studied in 40 participants. They were divided into 4 groups: 2 cord (Ultrapack, SilTrax AS) and 2 cordless (Expasyl, Traxodent Hemodent paste) methods. The labial surfaces of the maxillary right and left central incisors were evaluated. Gingival sulcus was photographed every 20 seconds from 0 to 180 seconds after the removal of the cord or cordless system. The bleeding index (BI) and gingival index (GI) were measured at day 0, day 1, and day 7. The width of the sulcal orifice was measured at the mid-buccal (MB) and transitional line angle (TLA) on a digital image, using computer software (Photoshop version 7.0; Adobe). Data were analyzed with ANOVA, Tukey honest significant difference (HSD), Kruskal-Wallis, and Mann-Whitney U tests (α=.05). RESULTS: All groups showed a sulcal width greater than 0.22 mm up to 60 seconds after the removal of the displacement materials at the MB and up to 40 seconds at the TLA. Among all groups, Expasyl showed the fastest closure. Gingival displacement in the MB area for the cord group was greater than for the cordless groups. GI and BI indices were larger for the cord group than for the cordless group at days 0 and 1. CONCLUSIONS: At up to 60 seconds, the cord and cordless techniques were equally effective. The cord group showed a greater amount of displacement than the cordless group. However, the cordless materials showed reduced frequency of changes to the gingival index.

Effect of Prosthodontic Rehabilitation of Maxillary Defects on Hypernasality of Speech.

PURPOSE: To establish a correlation between the effective internal diameter of the maxillary defect, the resonating frequency, and the effectiveness of the definitive obturator in reducing the percentage nasality. MATERIALS AND METHODS: Twenty-nine patients who underwent maxillectomy confined only to the hard palate (Aramany's class I and class II defect) and were wearing a definitive obturator for at least 3 months were included. The percentage nasality and resonating frequency were calculated with the help of Praat software. The patients were asked to read out a "Rainbow" passage and also to phonate and articulate vowels. Both parameters were assessed with and without the obturator prosthesis. RESULTS: Following obturator use, a mean change of 1.07 ± 0.83 kHz was observed in the resonating frequency (p < 0.001). The percentage change in resonating frequency was found to be 27.48 ± 4.99% following obturator use (p < 0.001). The effective internal diameter of the maxillary defect was calculated with the help of a Vernier calliper. The correlation between absolute and percentage values of resonating frequency and nasality before and after obturator use was found to be negative. CONCLUSION: This study found that efficacy of the obturator prosthesis in reducing nasality was greater in smaller defects than in large defects.

The efficacy of guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient. A correlative study.

PURPOSE: This report describes the efficacy of a guiding flange appliance in correcting mandibular deviation in the hemi-mandibulectomy patient and correlates the time elapsed between surgery and placement of the appliance and the extent of initial mandibular deviation to the success rate of a guiding flange appliance in correcting the deviation. MATERIALS AND METHODS: A total of 15 hemi-mandibulectomy patients participated in the study. All had various degree of mandibular shift consequent to surgery. The patients were given a guiding flange prosthesis for about 4 months, and the efficacy of the guiding flange prosthesis was calculated in terms of percentage deviation corrected after 4 months. RESULTS: Time elapsed between surgery and prosthetic rehabilitation was in inverse relation to the percentage correction in mandibular deviation at 4 months (B = -7.668; p = 0.002). The less the initial deviation postsurgery, the better the correction (B = 9.798; p = 0.008). CONCLUSION: Percentage correction of mandibular deviation is dependent on the timing of prosthetic rehabilitation. The less the initial deviation, the better the correction.

Modulating the hAM/PCL Biocomposite for Expedited Wound Healing: A Chemical-Free Approach for Boosting Regenerative Potential.

There is an arising need for effective wound dressings that retain the bioactivity of a cellular treatment, but without the high costs and complexities associated with manufacturing, storing, and applying cell-based products. As skin wound recovery is a dynamic and complicated process, a significant obstacle to the healing of skin wounds is the lack of an appropriate wound dressing that can imitate the microenvironment of healthy skin and prevent bacterial infection. It requires the well-orchestrated integration of biological and molecular events. In this study, we have fabricated full-thickness skin graft biocomposite membranes to target full-thickness skin excision wounds. We reinforced human amniotic membrane (hAM) with electrospun polycaprolactone (PCL) to develop composite membranes, namely, PCL/hAM and PCL/hAM/PCL. Composite membranes were compared for physical, biological, and mechanical properties with the native counterpart. PCL/hAM and PCL/hAM/PCL displayed improved stability and delayed degradation, which further synergically improved the rapid wound healing property of hAM, driven primarily by wound closure analysis and histological assessment. Moreover, PCL/hAM displayed a comparable cellular interaction to hAM. On application as a wound dressing, histological analysis demonstrated that hAM and PCL/hAM promoted early epidermis and dermis formation. Studies on in vivo wound healing revealed that although hAM accelerates cell development, the overall wound healing process is similar in PCL/hAM. This finding is further supported by the immunohistochemical analysis of COL-1/COL-3, CD-31, and TGF-ß. Overall, this conjugated PCL and hAM-based membrane has considerable potential to be applied in skin wound healing. The facile fabrication of the PCL/hAM composite membrane provided the self-regenerating wound dressing with the desired mechanical strength as an ideal regenerative property for skin tissue regeneration.

Outcome of obstructed total anamalous pulmonary venous connection (TAPVC) repair patients with milrinone versus milrinone and inhaled nitric oxide (INO): A prospective randomized observational study.

Background: Obstructed total anomalous pulmonary venous connection (TAPVC) typically present with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. Milrinone and inhaled nitric oxide (iNO) efficiently reduce pulmonary artery pressure (PAP) and help to improve the outcome. The aim was to determine the outcome of patients with high PAP with milrinone alone and a combination of iNO and milrinone. Material and Method: After ethical committee approval, the study was conducted over a period of 3 years in 80 patients with obstructed TAPVC repair. A total of 80 patients having severe PAH (supra systemic arterial pressure) randomly divided into two groups with 40 patients in each (M & MN). Group M (milrinone) patients received milrinone and Group MN (milrinone & iNO) patients received both milrinone (after opening aortic cross clamp) and iNO (post operative ICU). Ventilation time, hospital stay, ICU stay, complications, in hospital mortality were compared between both groups. Result: Ventilation time, Intensive Care Unit (ICU) stay, hospital stay for group M was 8.02 ± 5.74 days, 11.25 ± 7.33 day, 14.92 ± 8.55 days, respectively, and for group MN was 5.02 ± 1.78 days, 8.27 ± 3.24 days, 10.3 ± 3.18 days, respectively. In hospital mortality for group M and MN was 10% and 2.5%, respectively. P value for each variable was significant < 0.05 (except mortality). Conclusion: Most of the patients with obstructed TAPVC had severe PAH. Management of severe PAH with a combination of milrinone with iNO had a better outcome than milrinone alone.

SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India.

Introduction: The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design: This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion: The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.

A community-based intervention to improve screening, referral and follow-up of non-communicable diseases and anaemia amongst pregnant and postpartum women in rural India: study protocol for a cluster randomised trial.

BACKGROUND: Medical complications during pregnancy, including anaemia, gestational diabetes mellitus and hypertensive disorders of pregnancy place women are at higher risk of long-term complications. Scalable and low-cost strategies to integrate non-communicable disease screening into pregnancy care are needed. We aim to determine the effectiveness and implementation components of a community-based, digitally enabled approach, "SMARThealth Pregnancy," to improve health during pregnancy and the first year after birth. METHODS: A pragmatic, parallel-group, cluster randomised, type 2 hybrid effectiveness-implementation trial of a community-based, complex intervention in rural India to decrease anaemia (primary outcome, defined as haemoglobin < 12g/dL) and increase testing for haemoglobin, glucose and blood pressure (secondary outcomes) in the first year after birth. Primary Health Centres (PHCs) are the unit of randomisation. PHCs are eligible with (1) > 1 medical officer and > 2 community health workers; and (2) capability to administer intravenous iron sucrose. Thirty PHCs in Telangana and Haryana will be randomised 1:1 using a matched-pair design accounting for cluster size and distance from the regional centre. The intervention comprises (i) an education programme for community health workers and PHC doctors; (ii) the SMARThealth Pregnancy app for health workers to support community-based screening, referral and follow-up of high-risk cases; (iii) a dashboard for PHC doctors to monitor high-risk women in the community; (iv) supply chain monitoring for consumables and medications and (v) stakeholder engagement to co-develop implementation and sustainability pathways. The comparator is usual care with additional health worker education. Secondary outcomes include implementation outcomes assessed by the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), clinical endpoints (anaemia, diabetes, hypertension), clinical service delivery indicators (quality of care score), mental health and lactation practice (PHQ9, GAD7, EuroQoL-5D, WHO IYCF questionnaire). DISCUSSION: Engaging women with screening after a high-risk pregnancy is a challenge and has been highlighted as a missed opportunity for the prevention of non-communicable diseases. The SMARThealth Pregnancy trial is powered for the primary outcome and will address gaps in the evidence around how pregnancy can be used as an opportunity to improve women's lifelong health. If successful, this approach could improve the health of women living in resource-limited settings around the world. TRIAL REGISTRATION: ClinicalTrials.gov NCT05752955. Date of registration 3 March 2023.