Development, validation & pilot testing of a questionnaire to assess healthcare seeking behaviour, healthcare service utilization & out-of-pocket expenditure of Particularly Vulnerable Tribal Groups of Odisha, India.

Background & objectives: Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated. Methods: Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q. Results: On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald's omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively. Interpretation & conclusions: The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.

Impact of smokeless cooking fuel use on health status of women in a rural setting of eastern India.

The sustainable development goals (SDG 7.1) reinforce to ensure that everyone has access to affordable, safe and renewable energy. In India, women are typically responsible for cooking and are most vulnerable to household air contaminants. We conducted a descriptive cross-sectional comparative study in Odisha, India between exclusive LPG (liquefied petroleum gas) users and non-LPG users. A total of 900 women, 450 from each group, were randomly selected. The LPG-users had a better predictor of physical, psychological, social, and environmental wellbeing than non-LPG users. We found the ophthalmic disorders (adjusted odds ratio (AOR) 2.87, 95% CI 1.16-7.10, p = .023), asthma (AOR 2.05, 95% CI 1.15-3.65, p = .015), and ALRI (acute lower respiratory infections) (AOR 9.19, 95% CI 2.06-40.96, p < .004) were significantly higher in non-LPG users in comparison to LPG users. Access to smokeless cooking fuel will improve women's quality of life by eliminating the consumption of biofuel and thereby providing a healthier cooking environment.

Assessment of socio-behavioural correlates and risk perceptions regarding anthrax disease in tribal communities of Odisha, Eastern India.

BACKGROUND: This study is a baseline survey to assess the knowledge, attitude and practices with regards to the anthrax disease among the communities before demonstrating a One Health approach for elimination of human anthrax in an endemic district of Odisha. A total of 2670 respondents from 112 villages of 14 blocks were interviewed for the study using a structured questionnaire by multi-stage sampling method. Descriptive statistics were reported and logistic regression was performed to estimate the relationship between the variables and knowledge of anthrax. RESULT: Out of 2670 participants in the study, 76.25% were male and about half were illiterate. Most of the respondents (54.19%) were involved in agriculture as an occupation. 71% of the respondents had livestock in their houses and farming was the main purpose for keeping the livestock. Only one-fifth of the respondents (20.26%) knew about anthrax and a majority of them have come across the disease during community outbreaks. Almost 25.9% of livestock owners had knowledge about vaccination against anthrax disease although 83.4% of the livestock owners disposed the animal carcass by burial method. CONCLUSION: The study findings indicated that the community members had poor knowledge of cause, symptoms, transmission and prevention of anthrax disease which may be improved by a One Health approach.

Infection, cases due to SARS-CoV-2 in rural areas during early COVID-19 vaccination: findings from serosurvey study in a rural cohort of eastern India.

COVID-19 serosurvey provides a better estimation of people who have developed antibody against the infection. But limited information on such serosurveys in rural areas poses many hurdles to understand the epidemiology of the virus and to implement proper control strategies. This study was carried out in the rural catchment area of Model Rural Health Research Unit in Odisha, India during March-April 2021, the initial phase of COVID vaccination. A total of 60 village clusters from four study blocks were identified using probability proportionate to size sampling. From each cluster, 60 households and one eligible participant from each household (60 per cluster) were selected for the collection of blood sample and socio-demographic data. The presence of SARS-CoV-2 antibody was tested using the Elecsys Anti-SARS-CoV-2 immunoassay. The overall seroprevalence after adjusting for test performance was 54.21% with an infection to case ratio of 96.89 along with 4.25% partial and 6.79% full immunisation coverage. Highest seroprevalence was observed in the age group of 19-44 years and females had both higher seroprevalence as well as vaccine coverage. People of other backward caste also had higher seropositivity than other caste categories. The study emphasises on continuing surveillance for COVID-19 cases and prioritizing COVID-19 vaccination for susceptible groups for better disease management.

Trend in seroprevalence of SARS-CoV-2 (IgG antibody) among tribal-dominated population: Findings from Jharkhand, India.

Background & objectives: Serosurvey of COVID-19 provides a better estimation of people who have developed antibodies against the infection. Undertaking such a serosurvey in certain districts of India which are densely populated with prominent tribes can provide valuable information regarding seropravelance of SARS-CoV-2 antibodies among such indigenous populations. In this context, two rounds of population-based, cross-sectional serosurveys for SARS-CoV-2 IgG antibody were carried out in Jharkhand, a tribal-dominated State of India, to compare the seroprevalence of SARS-CoV-2 infection and to determine the associated demographic risk factors. Methods: The surveys were carried out in June 2020 and February 2021 in ten districts of the State of Jharkhand. Blood samples were collected from the residents of the selected districts by random sampling and tested for anti-SARS-CoV-2 antibodies using an automated chemiluminescence immunoassay platform. A total of 4761 and 3855 eligible participants were included in round 1 and round 2, respectively. Results: The age- and gender-standardized seroprevalence for COVID-19 during round 1 was 0.54 per cent (0.36-0.80) that increased to 41.69 per cent (40.16-43.22) during round 2 with a gap of eight months in between. The seropositivity among male and female participants was 0.73 and 0.45 per cent, respectively, during the first round and 51.35 and 33.70 per cent, respectively, during the second round. During the first round, 17.37 per cent of the participants were tribal with seropositivity of 0.24 per cent (0.02-0.87), and during the second round, 21.14 per cent were tribal with seropositivity of 39.14 per cent (35.77-42.59). Compared to tribal group, non-tribal participants had an adjusted odds of 1.24 (95% confidence interval=1.04-1.48) for SARS-CoV-2 seropositivity. Interpretation & conclusions: COVID-19 seroprevalence was found to be low during the first round (0.54%) of the survey, possibly due to the travel restrictions during lockdown better adherence to social distancing and wearing of face masks among the people. Understanding the dynamics of SARS-CoV-2 transmission and the susceptibility to infection at the individual as well as community level will inform decision and help policy makers to design and implement effective public health strategies to mitigate the pandemic in this State.

Serological survey for SARS-CoV-2 antibodies among tribal communities of Odisha post-second wave.

Background & objectives: Serial national level serosurveys in India have provided valuable information regarding the spread of COVID-19 pandemic in the general population, but the impact of the ongoing pandemic on the tribal population in India is not well understood. In this study, we evaluated the seroprevalence of COVID-19 antibodies in the tribal population of Odisha post-second wave (September 2021). Methods: A population-based, age-stratified, cross-sectional study design was adopted for the survey, carried out in seven tribal districts of Odisha from 30th August to 16th September 2021. A multistage random sampling method was used where serum samples were tested for antibodies against the SARS-CoV-2 nucleocapsid (N) protein in each district, and a weighted seroprevalence with 95 per cent confidence interval (CI) was estimated for each district. Results: A total of 2855 study participants were included from the seven tribal districts of Odisha in the final analysis. The overall weighted seroprevalence was 72.8 per cent (95% CI: 70.1-75.3). Serological prevalence was the highest among 18-44 yr (74.4%, 95% CI: 71.3-77.3) and from Sambalpur district [75.90% (66.90-83.10)]. Among participants, 41.93 per cent had received at least one dose of any COVID-19 vaccine. Kandhamal district had the highest number of fully immunized participants (24.78%), and in Sundergarh district, most of the study participants (58.1%) were unimmunized. Interpretation & conclusions: This study found high seroprevalence against SARS-CoV-2 in the tribal population of Odisha. The vaccination coverage is at par with the general population, and efforts to address some knowledge gaps may be needed to improve the coverage in the future.

Seroprevalence of SARS-CoV-2 in Bhubaneswar, India: findings from three rounds of community surveys.

The study aims to estimate and compare the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence, the fraction of asymptomatic or subclinical infections in the population, determine the demographic risk factors and analyse the antibody development at different time points among adults in Bhubaneswar city, India. This was a serial three-round cross-sectional, community-based study where participants were selected from the residents of Bhubaneswar city using multi-stage random sampling. Blood samples were collected during household visits along with demographic and clinical data from every participant. Total anti-SARS-CoV-2 antibody present in serum was assessed using the electro-chemiluminescence immunoassay platform. Temporal comparisons of the community seroprevalence were performed against the detected number of cumulative cases, active cases, recoveries and deaths. A total of 3693 participants were enrolled in this study with a cumulative non-response rate of 18.33% in all the three rounds. The gender-weighted seroprevalence for the city in the first round was 1.55% (95% confidence interval (CI) 0.84-2.58), second round was 5.27% (95% CI 4.13-6.59) and in the third round was 49.04% (95% CI 46.39-51.68). In the first round, the seroprevalence was found to be highest in the elderly population, whereas the seroprevalence for the second and third phases was highest in the age group of 30-39 years. Seroprevalence showed an increasing trend over the three time periods, with the highest seropositivity rates among individuals sampled between 16 and 18 September 2020. By the third round, 93.93% of those who had previously been tested positive by real-time reverse transcription polymerase chain reaction had seroconversion and 46.57% of those who had been tested negative also showed seroconversion. Infection to case ratio during first round was 27.05, for second round and third round it was 5.62 and 17.91, respectively.

Health system preparedness & community participation in Japanese encephalitis/acute encephalitis syndrome (JE/AES) prevention in a tribal district of Odisha, India.

BACKGROUND & OBJECTIVES: Japanese encephalitis/acute encephalitis syndrome (JE/AES) is one of the major zoonotic arbodiseases that has a significant effect on human and animal health. Though many studies have been published on the epidemiology and transmission mechanisms of JE/AES, but there is little evidence on health system preparedness, including community-based engagement. This study was undertaken to explore a multi-stakeholder perspective on health system preparedness for the prevention of JE/AES in a tribal district of Odisha, India. METHODS: This study was conducted at Malkangiri district of Odisha. A total of nine focus group discussions (FGDs) among women having under-five children, community volunteers, and community health workers (CHWs), and 20 in-depth-interviews (IDIs) among community leaders, healthcare providers, and programme managers were conducted. The FGDs and IDIs were digitally recorded, transcribed, translated and analysed using content analysis approach. RESULTS: Health system preparedness for the prevention of JE/AES was improved, including effective vector management, implementation of the surveillance system, and vaccination programme. The JE vaccine was introduced under Universal Immunization Programme in Odisha in 2016. Behavioural Change Communication activities were provided with the support of community volunteers on Village Health Nutrition and Sanitation Day (VHNSD) under Gaon Kalyan Samiti (GKS) platforms. The CHWs were actively involved in vector management and raising sanitation and hygiene awareness. INTERPRETATION & CONCLUSIONS: Community participation and coordination between different stakeholders have a significant impact on the successful implementation of the programme. It was suggested that there was a need for a sustainability approach to active participation, orientation and capacity building training among CHWs and community volunteers to successfully implement the programme.

A qualitative exploratory study using One Health approach for developing an intervention package for elimination of human anthrax in an endemic district of Odisha, India.

BACKGROUND & OBJECTIVES: Anthrax is a zoonotic disease of public health concern in India. One of the key predisposing factors is linked to the behaviour of the community. This study was nested within a baseline survey to understand the risk perception, attitude, socio-cultural and behavioural practices among different communities in an anthrax endemic tribal district of Odisha, India. It was aimed to explore the systemic gaps from the officials of different departments while addressing the animal and human anthrax cases and the knowledge, attitude, and behavioural practices among the tribal communities with regards to both animal and human anthrax signs, symptoms, and transmission from animal to human. METHODS: A qualitative exploratory study was carried out in the district of Koraput, Odisha. Insights from eight focus group discussions (FGDs) and 42 in-depth-interviews (IDIs) with the stakeholders from health, veterinary, forest, general administrative departments and community were collected and analyzed thematically. RESULTS: Major themes that emerged were inter-departmental coordination, livestock vaccination, surveillance network, laboratory facilities, prevention and control strategies with regards to the animal and human anthrax cases. The study also emphasized setting up the surveillance system as per the standard guidelines, and strengthening the diagnostic facilities for timely detection of confirmed cases. It also highlighted the current needs and the gaps among inter-sectoral coordination, collaboration, and sensitization among Health, Veterinary, Forest, Education, Nutrition, and Tribal Welfare Departments at various levels to reduce the prevalence and control the outbreaks of anthrax in the district and State. INTERPRETATION & CONCLUSIONS: The coordination gaps, financial burden, insufficient relevant knowledge and information among the concerned stakeholders were the issues found in this study in addition to non-availability of proper diagnostic facility. The coordination among different departments adapting One Health approach may be one of the best possible ways for the elimination of anthrax cases in an endemic region.

Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study.

BACKGROUND: With an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. At the same time, a higher prevalence of elder abuse is observed in these populations. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India. METHODS: The data for this study was collected as a part of our AHSETS study comprising of 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by the MAQ PC tool while Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Functional dependence was measured by the Lawton IADL questionnaire. We used ordinal logistic regression models to identify the correlates of elder abuse and test for mediation by functional dependence. RESULTS: Around 48.8 % (95 % CI:45.13-52.53 %) older adults had multimorbidity while 33.8 % (95 % CI:30.35-37.35 %) had some form of dependence. Out of 725, 56.6 % (CI 52.85-60.19 %) were found to be at low-risk elder abuse and 15.9 % (CI 13.27-18.72 %) being at high-risk. The prevalence of higher risk of elder abuse was greater among females, non-literates, widowed persons, those not currently working and those belonging to lower socio-economic strata. The risk of elder abuse was significantly associated with multimorbidity (AOR = 1.68; 95 %CI: 1.11-2.57) and functional dependence (AOR = 2.08; 95 %CI: 1.41-3.06). Additionally, we found a partial mediation mechanism of functional dependency between the pathway of multimorbidity and elder abuse. CONCLUSIONS: Elder abuse and multimorbidity are emerging as issues of significant concern among rural elderly in Odisha, India. Multimorbidity and functional dependence are associated with significantly higher odds of elder abuse among rural older adults. Further, we report the role of functional dependence as a partial mediator between multimorbidity and elder abuse. Therefore, potential interventions on reducing the economic, physical and care dependence among multimorbid patients may reduce the risk of elder abuse.

Pooled testing for SARS-CoV-2 infection in an automated high-throughput platform.

BACKGROUND: Active detection of SARS-CoV-2 infection through testing is elementary for the control of COVID-19 pandemic. The implementation of large-scale RT-PCR testing has led to a rise in the demand for testing kits whose availability is always a concern. OBJECTIVE: To find out the feasibility of pooled testing in a high-throughput platform. METHODOLOGY: Pooled testing was conducted in Roche cobas 6800 in 2 methods. Firstly, the simple two-stage testing algorithm was conducted for 1410 samples individually and then as pooled samples. Secondly, we evaluated the sensitivity of cobas 6800 for the detection of a single positive sample within a pool of negative samples. RESULTS: Implementing the five-sample Dorfman pooling to test 1410 samples, we identified 42 (2.9%) individual SARS-CoV-2-positive samples and 27 (9.5%) positive pool samples. The pooling strategy precisely identified all the positive samples. All individually negative samples were also accurately determined by pooling. There was 100% sensitivity of detecting positive samples in a pool of negative samples even up to 1:64 dilution. There was a threefold increase in total throughput in one-third of the cost per day. CONCLUSION: A high-throughput platform such as Cobas 6800 can effectively increase the testing capacity by twofold to threefold by adopting the pooled testing strategy for successful management of SARS-CoV-2 and helping in the containment of community transmission.

Prevalence and correlates of soil-transmitted helminths in schoolchildren aged 5 to 18 years in low- and middle-income countries: a systematic review and meta-analysis.

Background: According to the Global Burden of Disease (GBD) 2019 report, up to 1.5 million disability-adjusted life years (DALYs) are lost due to soil-transmitted helminths (STHs), and 5.9 million people are at risk of acquiring STHs. Regions with the highest prevalence of STH infections include Sub-Saharan Africa, China, South America, and Asia. While there are numerous fragmented studies on STH, comprehensive information on the prevalence and geographic distribution of different species, as well as their regional variations in the context of STHs is limited. The present systematic review and meta-analysis study attempts to provide a summary of the prevalence, geographical variation, and determinants of STHs among schoolchildren aged 5 to 18 years. Methods: An extensive literature search was carried out using PubMed, Embase, Cinhal, and Psychinfo for studies published between 1999 and 2022 that reported the rate of STH infection in school-going children aged 5-18 years. A random effects model was employed in this meta-analysis due to expected heterogeneity. Subgroup analysis was carried out based on sex and STH species because of expected geographical variation. Results: A total of 19,725 of the 49,630 children examined were infected with STH, yielding an overall pooled prevalence of 37.16% (95% CI: 29.74-44.89). The prevalence was highest in the Western Pacific region at 50.41% (95% CI: 33.74-67.04) followed by Europe at 39.74% (95% CI: 20.40-61.0) and Africa at 37.10% (95% CI: 26.84-47.95). Ascaris lumbricoides was found to be the most prevalent helminth with a prevalence of 24.07% (95% CI: 17.07-31.83). Conclusion: The Western Pacific region is classified as a High-risk Zone (HRZ), while Southeast Asia, Africa, Europe, and the Eastern Mediterranean are classified as moderate-risk zones (MRZs). We found a 12% reduction in the pooled prevalence of STH infection from 1999 to 2012. Ascaris lumbricoides was the predominant species among schoolchildren. Mass Drug Administration (MDA) of Albendazole tablets and improved water, sanitation, and hygiene (WASH) practices are effective in controlling and preventing STH. Ensuring their implementation and access is crucial to addressing the problem. Systematic review registration: https://www.crd.york.ac.uk/prospero/#loginpage, CRD42022333341.

Seasonal variations in respiratory morbidity in primary care and its correlation with the quality of air in urban Odisha, India.

Poor air quality, especially in urban regions among low-and middle-income countries such as India poses a significant healthcare challenge. Amongst urban areas, metropolitan cities garner the utmost importance for air quality related policies and studies with limited studies from tier II cities which are thought to be relatively immune to air pollution. Hence, we aimed to identify the most frequent respiratory morbidities and explore its correlation with exposure to ambient PM2.5 particles in Bhubaneswar (a tier II city in coastal India), Odisha. A chart review was carried out through data extracted from the records of urban health centres. Data on PM2.5 concentrations were obtained from Odisha State Pollution Control Board. The morbidities were coded by using the International Classification of Primary Care­2 system (ICPC-2). Descriptive statistics such as incidence of respiratory illnesses was computed across seasons. The ecological correlation between respiratory morbidity patterns and corresponding concentration of PM2.5 in air was analysed for each season. A positive correlation (r = o.94) between PM2.5 and respiratory morbidities was observed. The incidence of respiratory morbidities was 183.31 per 1000 person year. We identified 21 out of 43 respiratory diseases classified under ICPC-2. Upper Respiratory Tract Infection was the most commonly (116.8 per 1000 person year) incident condition. We observed one-fourth increase in the incidence of respiratory illnesses during winters. Respiratory morbidities are common in urban Bhubaneswar which follows a seasonal pattern and are possibly linked with the seasonal variations in levels of PM2.5 particles. Our study highlights that tier II cities are equally prone to health effects of air pollution. Future programmes and policies should take these cities into consideration too.

Social and biological evaluation of antimicrobial resistance (SOBEAR) in rural India: a study protocol.

Background: Antimicrobial resistance (AMR) has been one of the biggest global health threats in recent years, mostly in low- and middle-income countries, which requires urgent research using a multidisciplinary research approach. The use of large quantities of antimicrobial drugs inappropriately for humans, poultry and agriculture has been recognized as a leading cause of antibiotic resistance and the predominance of drug-resistance pathogens in the environment. This protocol aims to describe the use/misuse of antibiotics (ABs) in the community and evaluate clinical samples from healthcare settings to detect genes associated with antimicrobial resistance. Methods: We will conduct a community-level survey in different villages of the Tigiria block to assess knowledge and awareness on ABs and AMR. We will conduct in-depth interviews (IDIs) with doctors, pharmacists, nurses and drug sellers, as well as focus group discussions (FGDs) with ASHA and ANM workers who are involved in antibiotic supplies to the community. Quantitative data from the community survey and qualitative data of IDIs and FGDs will be linked and analyzed using statistical modeling and iterative thematic content analysis. Specimens (stool, urine, blood and wound/pus) will be collected from clinically diagnosed patients of different healthcare centers of Tigiria block. The samples will be cultured for bacterial isolation and antibiotic sensitivity testing. Genomic DNA will be isolated from positive bacterial cultures and sequenced using PCR to evaluate high-threat multi-drug resistance organisms (MDROs), screening of plasmid-mediated quinolone resistance (PMQR) genes, antimicrobial genes responsible for MDR and quinolone resistance-determining regions (QRDRs). Conclusion: This is the community-based protocol to evaluate the knowledge, attitudes, awareness and practices regarding ABs and AMR. The study protocol establishes a foundation for evaluating population-based prevalence and risk factors for AMR and MDROs in rural areas of the Odisha state, India.

Effectiveness of mHealth Interventions for Monitoring Antenatal Care among Pregnant Women in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Antenatal care (ANC) is essential in maternal and child health since it provides care to pregnant women from conception through to labour in order to ensure a safe pregnancy and childbirth. In recent years, mobile health (mHealth) interventions have emerged as a promising solution to improve maternal and child health outcomes in low- and middle-income countries (LMICs). The present study aimed to conduct a systematic review and meta-analysis of trials to evaluate the effectiveness of mHealth interventions to monitor prenatal care among pregnant women in LMICs. A systematic literature review was conducted using the databases CINHAL, Embase, MEDLINE, and PsycINFO on the effectiveness of mHealth interventions in monitoring the antenatal care of pregnant women. The study selection, data extraction of the included articles, and quality appraisal were assessed. Our study included six studies considering 7886 participants. All articles were from low- and middle-income countries (LMICs). Antenatal mothers who used a mobile health intervention were more likely (RR = 1.66, 95%CI = 1.07-2.58, I2 = 98%) to attend ANC check-ups when compared with the women who did not use any mobile health applications or did not receive any short message services. mHealth technologies are being utilised more and more to increase care accessibility and improve maternal and fetal health. Policymakers should prioritise the integration of mHealth interventions into maternal healthcare services in LMICs, ensuring that they are cost-effective, accessible, and sustainable and that healthcare workers are trained to deliver these interventions effectively.

Odisha tribal family health survey: methods, tools, and protocols for a comprehensive health assessment survey.

Tribal or indigenous communities have unique health behaviors, challenges, and inequities that nationally representative surveys cannot document. Odisha has one of India's largest and most diverse tribal populations, constituting more than a fifth of the state. State and tribe-specific health data generation is recommended in India's national roadmap of tribal health. The Odisha tribal family health survey (OTFHS) aims to describe and compare the health status of tribal communities in the state of Odisha and to estimate the prevalence of key maternal-child health indicators and chronic diseases. This paper summarizes the methodology, protocols, and tools used in this survey. This is a population-based cross-sectional survey with a multistage random sampling design in 13 (tribal sub-plan areas) districts of Odisha, India. We will include participants of all age groups and gender who belong to tribal communities. The sample size was calculated for each tribe and aggregated to 40,921, which will be collected from 10,230 households spread over 341 clusters. The survey data will be collected electronically in modules consisting of Village, Household, and Individual level questionnaires. The age-group-specific questionnaires were adapted from other national family health surveys with added constructs related to specific health issues of tribal communities, including-critical indicators related to infectious and non-communicable diseases, multimorbidity, nutrition, healthcare-seeking behavior, self-rated health, psycho-social status, maternal and child health and geriatric health. A battery of laboratory investigations will be conducted at the household level and the central laboratory. The tests include liver function tests, kidney function tests, lipid profile, iron profile, and seroprevalence of scrub typhus and hepatitis infections. The datasets from household questionnaires, field measurements and tests and laboratory reports will be connected using a common unique ID in the database management system (DBMS) built for this survey. Robust quality control measures have been built into each step of the survey. The study examines the data focused on different aspects of family health, including reproductive health, adolescent and child health, gender issues in the family, ageing, mental health, and other social problems in a family. Multistage random sampling has been used in the study to enable comparison between tribes. The anthropometric measurements and biochemical tests would help to identify the indicators of chronic diseases among various age groups of the population.

Scrub typhus seroprevalence from an eastern state of India: findings from the state-wide serosurvey.

BACKGROUND: Scrub typhus is a mite-borne infectious disease caused primarily by the obligate intracellular bacteria Orientia tsutsugamushi, which is transmitted by chigger mites. The objective of this study was to determine the prevalence of scrub typhus among adults in Odisha, an eastern state of India. METHODS: A descriptive cross-sectional study was conducted to analyse 1840 serum samples from five districts (Khordha, Cuttack, Ganjam, Malkangiri and Sundargarh) of Odisha collected during 2020-2021. Both immunoglobulin G (IgG) and IgM antibodies against scrub typhus were tested using commercial enzyme-linked immunosorbent assay kits. Point estimates of the 95% confidence interval and adjusted odds ratio were calculated. RESULTS: Of 1840 participants, the prevalence of IgG positivity was 1034 (56.19%) and that of IgM was 523 (28.42%). The majority of participants were in the 18-45 y age group (53.7%). Cuttack had the highest IgG positivity (64.54%) and Malkangiri had the lowest (29.32%). The highest and lowest positivity for IgM were found in Malkangiri (40.84%) and Cuttack (25.30%), respectively. CONCLUSIONS: With an increasing number of infections detected in the state, scrub typhus is emerging as a public health threat. Increasing awareness among the general public and healthcare professionals through health education campaigns regarding scrub typhus is essential. Early detection of the disease through the establishment of a laboratory surveillance system is required to control the transmission of scrub typhus.

Hepatitis B virus infection among the tribal and particularly vulnerable tribal population from an eastern state of India: Findings from the serosurvey in seven tribal dominated districts, 2021-2022.

The Global Health Sector Strategy on viral hepatitis (2016-2021) endorsed by the World Health Assembly in 2016, called for the elimination of viral hepatitis as a public health threat by 2030. Odisha, an eastern state of India, has the third-highest percentage of tribal population in the country and limited information is available regarding the prevalence of HBsAg among them. The present study was undertaken to estimate the seroprevalence of hepatitis B surface antigen as well as HBV DNA almost after 12 years of the first prevalence study of HBsAg among the tribal community of Odisha. The present study attempted to estimate the prevalence of HBsAg among the 35 Scheduled tribal (ST) communities and 5 Particularly Vulnerable Tribal Group (PVTG) using the 2,737 number of sera collected as part of a statewide COVID-19 serosurvey, among the tribal populations of Odisha (residing in 7 districts) aged 6-75 years. HBsAg positivity ranged between 1.79 and 2.94% across various age groups. 42.9% of HBsAg positive individuals showed the presence of HBV DNA and the high viral load was 0.10 × 102-6.84 × 108 IU/mL, indicating a high potential to transmit the virus. The HBsAg positivity was 14.18 and 6.06% among the PVTGs, Kutia Khond and Paudi Bhuyan, who were first time surveyed for HBsAg prevalence. The present study documents the prevalence of HBsAg among the major tribal population residing in the eastern state of the country and highlights the need for a statewide survey of Hepatitis B infection and risk factors, coverage and impact of the Hepatitis B vaccination program introduced in 2010-2011 in Odisha among the ST and PVTG population of the state.

Serosurveys to detect SARS-CoV-2 antibodies among high-risk groups in six urban cities of Odisha, India.

INTRODUCTION: Personnel involved in essential services or residing in high-risk areas during the COVID-19 pandemic are at increased risk of getting infected. We evaluated the proportion of personnel infected in several high-risk groups in Odisha using seroprevalence studies. METHODOLOGY: During July to November, 2020, individuals from multiple high-risk groups in 6 urban cities (Bhubaneswar, Berhampur, Cuttack, Malkangiri, Paralakhemundi, and Rourkela) in Odisha, India, were recruited to the study after obtaining written informed consent. Blood samples collected from the study participants were tested for IgG antibodies against COVID-19 in Roche Cobas e441 (Roche Diagnostics, Rotkreuz, Switzerland). Information on socio-demographic variables, association with a confirmed or suspected case, and other details were collected using an electronic data capture tool and analysed with a statistical software. RESULTS: The overall COVID-19 seroprevalence was 34.9% (95%CI 33.6-36.2) among the 5434 individuals. The seroprevalence varied from 21.8% (95% CI, 19.6-24.1) in Rourkela to 54.9% (95% CI, 51.5-58.2) in Bhubaneswar. Seropositivity was maximum among prisoners (47.7%), followed by municipality/ sanitation staff (43.5%), and other office going staff (40.8%). Multivariate logistic regression indicated that participants aged 18-29 years, 30-44 years, residents of slums and vending zone, municipality staff, prisoners, residents of urban cities Malkangiri, Cuttack, Paralakhemundi, Bhubaneswar and those with previous history of COVID-19 were independent co-relates of seropositivity. CONCLUSIONS: The risk of COVID-19 varied among the high-risk groups of Odisha. Periodic seroprevalence studies in future are essential to protect the high-risk personnel involved in frontline activities during the pandemic.

Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India.

BACKGROUND/OBJECTIVES: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. METHODS: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. RESULTS: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. CONCLUSIONS/RECOMMENDATIONS: A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic.