Vulnerability to Sexually Transmitted Infections (STI) / Human Immunodeficiency Virus (HIV) among adolescent girls and young women in India: A rapid review.

Limited evidence is available on the vulnerability of Adolescent Girls and Young Women (AGYW) to sexual risk behaviour and STI/HIV. Though there are almost no statistics available on vulnerability, related literature suggests that AGYW have low awareness about sexual risk behaviour/ transmission and the prevalence of STI/HIV, making them vulnerable. We conducted a rapid review of peer-reviewed studies addressing transmission network, prevalence, incidence awareness, common determinants of sexual risk behaviour/STI/HIV, health-seeking behaviour and existing interventions addressing the situation among AGYW (age 15-24) to inform the evidence gap in this crucial area of research. We registered the study in PROSPERO (CRD42023403713). We developed detailed inclusion/exclusion criteria, searched JSTOR, PubMed, Google Scholar, Science Direct and Population Council Knowledge Commons databases and followed the guidance from Cochrane Rapid Review to develop the rapid review. We also searched the bibliography of the included studies. We included the English language peer-reviewed quantitative, qualitative, mixed method studies published from Jan 1 2000 to Mar 31 2023. Six reviewers extracted data, and the seventh reviewer independently assessed the quality. Ninety-six studies met the inclusion criteria. We used descriptive statistics and narrative synthesis methods for data analysis. We also conducted a Risk of Bias Assessment (RoB) to check the quality of the included studies. Inadequate literature was found on the transmission network. Prevalence and awareness of STI/HIV are low among AGYW. However, Female Sex Workers, sex-trafficked women or drug users in this age group suffer more. Age, education, income, relationship dynamics with spouses/partners, multiple partners, and substance use are crucial in determining STI/HIV. Traditional sources of health seeking are more popular than formal sources because of social stigma. Mass media campaigns, community mobilization programs, and life skills training programs increase awareness about HIV, condom use and self-efficacy. The inclusion of only English language studies and not conducting meta-analysis because of high heterogeneity are some of the limitations of the study.

Transition in dietary quality: evidence from India.

Despite significant economic growth over the past decades, poor nutritional status in India is a serious concern. The social transformation led by growth in income influences both the composition of food and the quality of diet consumed. Against this backdrop of changing lifestyles and the rise in obesity and non-communicable diseases, in this study, we examined changes in diet quality and the critical socio-economic correlates of this quality from 1983 to 2012 using three rounds of nationally representative surveys providing information on food consumption for more than 100 000 households in each round. We constructed diet quality indices at the household level using deficient and excess intake of macro and micronutrients compared with the recommended daily allowances (RDA) for different age-sex groups of the Indian population. We found that in relation to the RDA, fat consumption increased over time while protein and energy consumption decreased. The average diet quality index improved in the rural sector while it deteriorated in the urban sector. Caste and religion are significant correlates of the diet quality index. The deficiency index of nutrients decreased for poor households as they get richer; however, it increased with affluence level for the non-poor. It is suggested that the Indian Government may play a more proactive role in implementing coherent national policies in trade, food and agriculture to protect public health by promoting the demand for a healthy diet.

Economies of scale of large-scale international development interventions: Evidence from self-help groups in India.

Livelihoods and microfinance programs for women often show reduced impacts after scale-up. Yet, program scale-up may reduce average per capita costs and maintain cost-effectiveness despite lower impact. This paper presents evidence on the association between program scale, costs, and cost-effectiveness by analyzing how the costs of a large-scale Self-Help Group (SHG) program in India changed from its inception in 2007 to its scale-up in 2019. We use expenditure data from program's audit statements of Jeevika - the Bihar Rural Livelihoods Promotion Society - and find that a 1% increase in program membership was associated with a 0.6% increase in annual program expenditures, indicating large economies of scale. Predicted costs from regressions suggest that the annual per capita program expenditures declined from $29 when the program covered 100,000 members to $5 when it reached 10 million members. Previous impact evaluations of Jeevika showed sizeable but smaller substitutions away from high-cost debt after scale-up than during the pilot, but we found that economies of scale led to similar cost-effectiveness ratios for this outcome. We also found that formation of higher-level federations is associated with lower marginal costs than setting up SHGs. However, previous evidence suggests that Jeevika did not generate average impacts on women's agency and asset ownership after scale-up. Building on a rich history of research on Jeevika, we argue that program implementers must identify key success factors in pilot programs to minimize tradeoffs between cost savings and potentially reduced impacts after scale-up. Further, we suggest investments in linking SHGs to federations to improve the cost-effectiveness of SHGs.

Maternal education, health care system and child health: Evidence from India.

Global evidence suggests that maternal education is a crucial determinant of a child's health. The health system moderates the maternal education and child health relationship. However, there is sparse evidence on which direction health system moderates this relationship, especially in developing nations because of limited data availability. In order to address this gap in the evidence, we study this question in the Indian context, where the health system is still in a transitioning phase. We use two nationally representative surveys, the fourth round of the National Family Health Survey (2015-16) and the fourth round of the District Level Health Survey data (2012-13), to estimate the effects of maternal education and the health care system on child death and child anaemia. We map district-level data on health infrastructure and human resources information with individual-level information on health outcome, insurance, and antenatal care coverage along with other socio-economic characteristics. In accordance with global evidence, we find that maternal education remains an important determinant of child health outcomes in India too. However, the association between maternal education and child health outcomes weakens in the presence of a poor health care system. Health system improvement first benefits the already privileged in the Indian context. Yet, it should not hinder the policy focus either on the improvement of women's education or the medical care system.

Universalisation versus targeting in maternal and child health care provisioning: Evidence from India.

To eradicate the persistent inequality in utilisation of Maternal Health Care Services (MHCS), India's Government has adopted various programmes under the National Rural Health Mission (NRHM) in 2005. The Janani Suraksha Yojana (JSY), a demand-side intervention, is one of the flagship programmes under the NRHM. Using two rounds of the nationally representative National Family Health Survey (NFHS) data collected in 2005-06 and 2015-16, respectively, we attempt to map the extent to which inequality in MHCS utilisation has changed over time across states after the implementation of NRHM; analyse whether there are differences in the patterns of inequality prevalent in the universal and targeted states; and find evidence to decide whether universalisation is more effective than targeting in reducing inequality in MHCS utilisation. We measure relative inequality and use the difference in difference technique to answer the research questions. For analysis, we have considered five outcome variables spanning across three stages of the continuum of care in maternal health. We find that relative inequality in MHCS utilisation declined across states during the period 2006-16, though in varying degrees. Universal states experienced a higher level of inequality as compared to the targeted states. However, universal states observed a higher decline in inequality over time relative to the targeted states controlling for other state-level characteristics. The study establishes that the programme implementation strategy and conditional cash transfer programmes influence the reduction of inequality in MHCS utilisation. This study makes an important contribution to the literature on public health policy and inequality in health care utilisation by highlighting the differential impact of universalisation and targeting on reducing inequality in the use of MHCS.

Effect of uphill walking with varying grade and speed during load carriage on muscle activity.

Indian soldiers, while guarding the mountainous border areas, often carry loads in steep uphill gradients. This activity may predispose the risk of muscle injury. The present study aimed to examine the effects of an increasing load, speed and gradient during incremental uphill treadmill walking on different muscles. Twelve infantry soldiers walked on a treadmill at two speeds (2.5 and 4 km/h) with no load, and carrying 10.7, 17 and 21.4 kg loads at 0, 5, 10, 15, 20, 25% gradients. Electromyographic responses of erector spinae (>240%) and vastus medialis (>240%) were mostly affected, followed by soleus (>125%) and gastrocnemius medialis (>100%) at maximum speed, load and gradient combination compared to 0% gradient. Carrying 10.7 kg at 15% gradient and above was found to be highly strenuous and fatiguing with the risk of muscle injury. Uphill load carriage in slower speed is recommended for the maintenance of combat fitness of the individual at higher gradients. Practitioner Summary: The present article has evaluated the stress encountered by soldiers during load carriage at incremental uphill gradients while walking at different speeds by recording the muscular activities. Load carriage in steep uphill gradients is highly strenuous and may lead to muscle injury thus compromising the combat fitness.

Technique for delivering large tumors in video-assisted thoracoscopic lobectomy.

BACKGROUND: The optimal technique for delivering large tumors during video-assisted thoracoscopic lobectomy remains uncertain. METHODS: In 258 patients receiving video-assisted thoracoscopic lobectomy for lung cancer, techniques for delivering the resected lobe included complete video-assisted thoracoscopic lobectomy without rib spreading (n = 206, 80%), resection of a short rib segment (n = 9, 3%), brief rib spreading (n = 12, 5%), and conversion to a minithoracotomy (n = 21, 8%). In 10 (4%) patients, a novel anterior rib cutting technique was used: one rib at the utility port was cut near its anterior end to widen the intercostal space without forcible rib spreading for lobe delivery. RESULTS: There was no mortality or major morbidity using the anterior rib cutting technique, and it delivered tumors of a larger mean diameter than complete video-assisted thoracoscopic lobectomy (5.4 ± 3.4 vs. 2.3 ± 1.4 cm, p = 0.017) whilst yielding a similar mean operation time and blood loss to the other non-complete video-assisted thoracoscopic lobectomy techniques. The anterior rib cutting technique gave similar postoperative patient pain scores and analgesic use to complete video-assisted thoracoscopic lobectomy, and shorter mean hospital stay than the other non-complete video-assisted thoracoscopic lobectomy techniques (5.6 ± 2.8 vs. 10.0 ± 7.1 days, p = 0.003). CONCLUSIONS: In video-assisted thoracoscopic lobectomy, the anterior rib cutting technique is a safe and feasible procedure for delivering large tumors, causing no more pain than complete video-assisted thoracoscopic lobectomy, and allowing faster recovery than other non-complete video-assisted thoracoscopic lobectomy techniques.