Influence of Sociodemographic Factors on Stunting, Wasting, and Underweight Among Children Under Two Years of Age Born During the COVID-19 Pandemic in Central India: A Cross-Sectional Study.

Introduction The adverse effects of the coronavirus disease 2019 (COVID-19) pandemic on maternal and reproductive health extend beyond the immediate morbidity and mortality attributed directly to the disease. Pandemic-induced disruptions in the healthcare, social and economic infrastructures can exacerbate the already high burden of childhood undernutrition in India. Method A cross-sectional study was conducted in a selected district of the central Indian province of Madhya Pradesh. Data was collected from eligible children born during the COVID-19 pandemic (February 2020 to December 2021) who visited a selected tertiary care hospital for routine immunization during the study period. Weight-for-length, weight-for-age, and length-for-age were compared with reference values to obtain corresponding z-scores. Children with z-scores two standard deviations below the reference values were considered wasting, underweight and stunting, respectively. Descriptive statistics were employed to summarise the sociodemographic characteristics of participants. The association of sociodemographic, nutritional, and pregnancy-related factors with the z-scores were assessed via unpaired t-test and ANOVA. Result The studied 147 children were in the age group of nine to 29 months, of which 61 (58.1%) were males. Forty-two (28.6%) were found to be underweight, 22 (14.9%) had wasting and 51 (34.7%) were stunted. These prevalences were comparable to the estimates of the National Family Health Survey 2019-2021 (NFHS-5) for Madhya Pradesh and lower than the NFHS-4 (2015-2016), showing no discernible effect of being born during the pandemic on growth indicators. However, mothers' employment and family income were independent predictors of stunting whereas gestational age at birth, maternal education, and prolonged breastfeeding were all substantially linked with wasting in this study. Conclusion This study adds to the evidence base by reporting the prevalence of stunting, wasting and underweight along with their determinants in central India among children born during the COVID-19 pandemic. Our data did not reflect the expected increase in child malnutrition due to the COVID-19 pandemic-related disruptions in healthcare, social and economic infrastructure. Future research should incorporate the lessons learnt from our study to design a population-based study of under-five children and compare the prevalence of undernutrition in pandemic-born versus non-pandemic-born children.

Effect of the Built Environment on the Cumulative Incidence of Acute Diarrheal Diseases: A Community-Based Cohort Study From Underprivileged Areas of Bhopal, India.

Background Diarrhea is a major public health problem in under-five children worldwide. Various sociodemographic, environmental, and behavioral factors play a role in the occurrence of diarrheal disease in children under the age of five. This study aims to estimate the cumulative incidence of acute diarrheal diseases during a one-year study period and examine its association with the built environment factors among children under the age of five in selected underprivileged areas of Bhopal. Methodology We conducted this study in Bhopal, a city in central India. We surveyed the underprivileged dwellers of Vajpayee Nagar, Sanjay Nagar, and Mother India Colony of Bhopal city. This is a prospective cohort study with a one-year follow-up period to examine the cumulative incidence of acute diarrheal diseases among under-five-year-old children in the study area. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Data were collected from February 2021 to February 2022. A total of 658 families of eligible children were contacted to participate in the study. After excluding 38 participants for various reasons (denied consent: 3; lost to follow-up: 32; moved out of the study area: 3), data were finally analyzed for 620 participants. In the study among the under-five-year-old children, the cumulative incidence of acute diarrheal diseases was 23.8% (148 out of 620). In our study, lower age (adjusted odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.99, p = 0.041) and non-availability of flush latrine in the house (adjusted OR = 4.95, 95% CI = 1.80-13.59, p = 0.002) were statistically associated with a higher incidence of acute diarrheal disease among the study population. Conclusions In our investigation, we observed a cumulative incidence of diarrhea at 23.8% (148 out of 620) among the underprivileged under-five population residing in Bhopal, India. This incidence exhibited significant associations with younger age and the absence of in-house flush latrines.

Interventions to promote household waste segregation: A systematic review.

Waste segregation at source, particularly at the household level, is an integral component of sustainable solid waste management, which is a critical public health issue. Although multiple interventions have been published, often with contradictory findings, few authors have conducted a comprehensive systematic synthesis of the published literature. Therefore, we undertook a systematic review to synthesize all published interventions conducted in any country in the world which targeted household-level waste segregation with or without additional focus on recycling or composting. Following PRISMA guidelines, Web of Science, Medline, Global Health, and Google Scholar were searched using a search strategy created by combining the keywords 'Waste', 'Segregation', and 'Household'. Two-stage blinded screening and consensus-based conflict resolution were done, followed by quality assessment, data extraction, and narrative synthesis. 8555 articles were identified through the database searches and an additional 196 through grey literature and citation searching. After excluding 2229 duplicates and screening title abstracts of 6522 articles, 283 full texts were reviewed, and 78 publications reporting 82 intervention studies were included in the data synthesis. High methodological heterogeneity was seen, excluding the possibility of a meta-analysis. Most (n = 60) of the interventions were conducted in high-income countries. Interventions mainly focused on information provision. However, differences in the content of information communicated and mode of delivery have not been extensively studied. Finally, our review showed that the comparison of informational interventions with provision of incentives and infrastructural modifications needs to be explored in-depth. Future studies should address these gaps and, after conducting sufficient formative research, should aim to design their interventions following the principles of behaviour change.

Is ambient air pollution a risk factor for Parkinson's disease? A meta-analysis of epidemiological evidence.

Current evidence shows inconsistencies about ambient air pollution (AAP) exposure as a risk factor for Parkinson's disease (PD). We performed meta-analyses to estimate the pooled risk of PD due to AAP exposure. We performed a systematic search in PubMed, Google Scholar, The Cochrane Library, and J-GATEPLUS databases for peer-reviewed epidemiological studies reporting the risk of PD due to exposure to PM2.5, PM10, O3, CO, NO2, NOX and SO2; from the beginning until October 2021. The pooled odds ratio (OR) for the effect of NO2 (per 1 µg/m3) and O3 (per 1 ppb) on PD was 1.01[95% CI: 1.00,1.02; I2 = 69% (p = .01)] and 1.01 [95% CI: 1.00,1.02; I2 = 66% (p = .03)], respectively. The ORs for the effects of PM2.5 (per 1 µg/m3) and CO (per 1 ppm) on PD were 1.01 [95% CI: .99,1.03; I2 = 40%] and 1.64 [95% CI: .96,2.78; I2 = 75% (p = .01)], respectively. The study showed the adverse roles of NO2, O3, PM2.5, and CO in increasing the risk for PD.

Facilitators and barriers to the uptake of COVID-19 vaccine precaution dose among adult population: qualitative analysis across six different states of India.

Introduction: India launched the COVID-19 vaccination drive on 16th January 2021 by vaccinating the adult population above 18 years of age. This was followed by the introduction of an additional precaution dose. As on 18th October 2022, 1,02,66,96,808 (1.02 Billion) first dose and 94, 95, 39,516 (949 Million) second doses of COVID-19 vaccine were administered. However, when compared to the uptake of the primary doses, the precaution dose uptake lagged behind with only 21,75, 12,721 (217 million) doses administered. Even though, the uptake of the primary doses remained optimal, irrespective of different interventions by the Government of India, the uptake of the precaution dose remained poor. In this context, the Ministry of Health & Family Welfare wanted to understand the facilitators and Barriers for precaution dose uptake among adults so that future immunization campaigns could address these issues. Methods: An exploratory qualitative study was conducted to assess the facilitators and barriers for COVID-19 precaution dose uptake at community level across 6 different states in India. From each of the states, two districts with the highest and lowest rates of COVID-19 vaccine precaution dose uptake were selected. In each of these districts, 2 block Primary Healthcare Centres (PHCs), one with high and one with low uptake were identified. Within these block PHCs, a PHC field area with high and low precaution dose uptakes was identified. From the identified sites a minimum of four IDIs, four FGDs were conducted among the community members. KIIs of the State Immunization Officers, District Immunisation Officers, PHC Medical Officers, healthcare workers like Accredited Social Health Activist/Auxiliary Nurse Midwife were also conducted. The data was audio recorded and it was transcribed, translated and analysed using framework approach. Results: It was observed that rise in COVID-19 cases prompted the community to take the precaution dose, this along with the cost of hospitalization and the number of productive days being lost as a result of being infected resulted in vaccine uptake. The fear of non-availability of COVID-19 vaccines latter on also prompted people for vaccine uptake. While the barriers were, poor accessibility to vaccination centers, long hours of travel, poor road connectivity and lack of transportation facilities. However, the most prominent barriers observed across all study sites was that a sense of pandemic fatigue and complacency had developed both among the providers as well as the beneficiaries. Other barriers include differences in vaccination schedules and longer duration between the primary doses of some vaccines. Media was identified to be both a barrier and facilitator for Covid-19 Precaution dose uptake. Even though media played an important role in disseminating information in the beginning of the campaign, it was soon followed by the circulation of both misinformation and disinformation. Discussion: The study identified that dissemination of accurate information and community involvement at each stage of planning and implementation are crucial for the success of any campaign. Efforts should be constantly made to address and re-invent strategies that will be most suitable for the needs of the community. Therefore, in order to ensure successful vaccination campaigns, it is crucial that along with political will it is also important to have a decentralized approach with inter-sectoral coordination with different stakeholders such as healthcare workers, community members and the different departments such as the local self-governments, education department, law & order department etc. These lessons learnt from COVID-19 vaccination campaigns must not be forgotten and must be applied in future vaccination campaigns and while framing public health policies.

Evaluation of health impacts of the improved housing conditions on under-five children in the socioeconomically underprivileged families in central India: A 1-year follow-up study protocol.

Unacceptable housing conditions prevalent in Indian urban slums adversely affect the health of residents. The Government of India initiated the Basic Services to the Urban Poor (BSUP) as a sub-mission under the Jawaharlal Nehru National Urban Renewal Mission (JNNURM), to provide basic services to the urban poor. As per the available scientific literature, the health effects of such improved housing schemes for the poor have not been studied so far in India, especially in under-five children (0-5 years old) who spend most of their time indoors. The present paper describes the protocol for a follow-up research study proposed to fill this gap. This study, funded by the Indian Council of Medical Research (Sanction No. 5/8-4/9/Env/2020-NCD-II dated 21.09.2021), will be conducted in Bhopal in the central Indian province of Madhya Pradesh for over 2 years. We will recruit 320 under-five children each from Group 1 (Beneficiary families residing in the houses constructed under BSUP) and Group 2 (Slum dwelling families eligible for improved housing but who did not avail of benefit). Eligible children will be recruited in the first household visit. During the same visit, we will record clinical history, examination findings and take anthropometric measurements of participants. We will also collect data regarding socio-economic-environmental parameters of the house. During subsequent monthly follow-up visits, we will collect primary data on morbidity profile, anthropometric details and medical history over 1 year. Approval for the study was obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2020-21/198, dated 22/06/2020). This study will evaluate the impact of different housing conditions on the health of under-five children. Finding of this research will be beneficial in guiding future housing-related policy decisions in low- and middle-income countries.

Is Air Pollution Associated with Increased Risk of Dementia? A Meta-Analysis of Epidemiological Research.

Background: There are prevailing inconsistencies in epidemiological research about air pollution being a risk factor for dementia. Objective: We performed meta-analyses to calculate the pooled estimates of the risk of developing dementia due to air pollution exposure. Methods and Materials: We performed a systematic search in PubMed, Google Scholar, The Cochrane Library, and J-GATEPLUS databases for peer-reviewed epidemiological studies reporting the risk of developing all-cause dementia, cognitive decline, Alzheimer's disease (AD), and vascular dementia (VaD) due to exposure to particulate matter with an aerodynamic diameter less than 2.5 µm (PM2.5) and less than 10 µm (PM10), ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxides (NOX) and sulfur dioxide (SO2) from the beginning until December 2020. Meta-analysis was performed by adopting the random-effects model using Meta-XL. Results: In all-cause dementia, the pooled hazard ratio (HR) for PM2.5 and NO2 exposure was 1.03 [(95%CI: 1.01-1.06; I2 = 99% (P < 0.001)] and 1.00 [(95%CI: 1.00-1.01; I2 = 96% (P < 0.001)], respectively. The pooled HR for NOX was 1.00 [(95%CI: 1.00-1.01; I2 = 61% (P = 0.05)]. In AD, the pooled HRs for PM2.5 and O3 was 1.08 (95%CI: 1.01-1.15; I2 = 99% (P < 0.001)]) and 1.02 (95%CI: 0.96-1.08; I2 = 100% (P < 0.001)], respectively. In VaD, the pooled HR for PM2.5 exposure was 1.03 (95%CI: 1.01-1.06; I2 = 91% (P < 0.001)]. In NO2/NOX, the results were found to be equivocal. Meta-analysis could not be performed in cognitive decline because of wide variations in assessments methods. Conclusions: The present study showed exposure to PM2.5 as a risk factor for all-cause dementia, AD, and VaD and exposure to O3 as a possible risk factor for AD. These findings can be used for policy measures and further research.

Environmental monitoring and health assessment in an industrial town in central India: A cross-sectional study protocol.

BACKGROUND: Textile industry has been widely implicated in environmental pollution. The health effects of residing near manufacturing industries are not well documented in India, especially in central India. Hence, a cross-sectional environmental monitoring and health assessment study was initiated as per directions of the local authorities. METHODS: Comprehensive exposure data about the concentrations of relevant pollutants in the ambient air and ground water samples in the study area will be collected over one year. Using stratified random sampling, 3003 apparently healthy adults will be selected from the study area. Sociodemographic and anthropometric information, relevant medical and family history, and investigations including spirometry, electrocardiogram, neurobehavioral tests, and laboratory investigations (complete blood count, lipid profile and random blood glucose) will be conducted. Finally Iodine azide test and heavy metal level detection in urine and blood samples respectively will be conducted in a subset of selected participants to assess individual pollution exposure. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/IEC-7-II/1027, dated 07/01/2021). DISCUSSION: This manuscript describes the protocol for a multi-disciplinary study that aims to conduct environmental monitoring and health assessment in residential areas near viscose rayon and associated chemical manufacturing industries. Although India is the second largest manufacturer of rayon, next only to China, and viscose rayon manufacturing has been documented to be a source of multiple toxic pollutants, there is a lack of comprehensive information about the health effects of residing near such manufacturing units in India. Therefore implementing this study protocol will aid in filling in this knowledge gap.

Perceptions and Experiences of Caregivers on Child Injuries: A Qualitative Study from Central India.

To explore caregivers' perceptions of childhood injuries in the rural and urban areas of India, with a focus on causes, consequences, prevention, and treatment. We conducted eight focus group discussions with fifty female caregivers in rural and urban areas of Ujjain in Central India and used thematic content analysis. The caregivers identified how children injured themselves through falls, road traffic injuries, metallic nails and tool injuries, ingestions of foreign objects and poisons, burns, drowning, and suffocation. The reported consequences of injuries ranged from pain, infections, scar formation, phobia, stigma, and emotional stress to complications like physical disability, loss of eyesight, head injury, paralysis, and even death. Many caregivers blamed children and their mischievousness for the injuries and failed to realise/acknowledge the role of better supervision and environmental modifications in injury prevention. Caregivers used several first aid methods to respond to injuries. These included applying pressure to stop bleeding during fall and road traffic injuries, inducing vomiting by giving the poison victims saltwater to drink, and tobacco leaves to chew. In addition, some caregivers resorted to using coconut oil and toothpaste on burnt skin and giving back blows for choking. Caregivers in communities had experiences of different types of child injuries. Further education on need for better supervision, relevant environmental modification and appropriate first aid treatment of various injuries is required.

Establishing the National Institute for Research in Environmental Health, India.

Problem: Multiple environmental health issues resulting from pollution and climate change threaten public health in India. Approach: The Government of India recognized the need for a permanent environmental health research institute; the Indian Council of Medical Research therefore established the National Institute for Research in Environmental Health in Bhopal in 2010. Scientists at the institute assessed the multiple long-term health effects of exposure to methyl isocyanate, and are now conducting research on a wide array of locally relevant environmental health issues. Local setting: The Union Carbide India Limited pesticide factory in Bhopal was the site of a methyl isocyanate gas leak in 1984, which affected half a million people. The Indian Council of Medical Research set up a coordinating unit in the immediate aftermath, which was upgraded to the Bhopal Gas Disaster Research Centre in 1986 and then the Centre for Rehabilitation Studies in 1995. Relevant changes: Scientists at the institute undertake environmental monitoring and health risk assessment studies among communities located near polluted areas, such as industrial areas. They are also assessing the training needs of practising physicians, with the aim of developing a curated curriculum to meet the deficiencies in environmental health education in the country. Lessons learnt: Environmental legislation was introduced in the wake of the disaster and a research institute in environmental health was established. Researchers at the institute have recognized the importance of engaging communities in environmental health research, as well as knowledge dissemination to relevant stakeholders.

Nutraceuticals with Anti-inflammatory and Anti-oxidant Properties as an Intervention for Reducing the Health Effects of Fine Particulate Matter: Potential and Prospects.

Air pollution, especially particulate matter pollution, adversely affects human health. A growing pool of evidence has emerged which underscores the potential of individual-level nutritional interventions in attenuating the adverse health impact of exposure to PM2.5. Although controlling emission and reducing the overall levels of air pollution remains the ultimate objective globally, the sustainable achievement of such a target and thus consequent protection of human health will require a substantial amount of time and concerted efforts worldwide. In the meantime, smaller-scale individual-level interventions that can counter the inflammatory or oxidative stress effects triggered by exposure to particulate matter may be utilized to ameliorate the health effects of PM2.5 pollution. One such intervention is the incorporation of nutraceuticals in the diet. Here, we present a review of the evidence generated from various in vitro, in vivo and human studies regarding the effects of different anti-inflammatory and antioxidant nutraceuticals in ameliorating the health effects of particulate matter air pollution. The studies discussed in this review suggest that these nutraceuticals, when consumed as a part of the diet or as additional supplementation, can potentially negate the cellular level adverse effects of exposure to particulate pollution. The potential benefits of adopting a non-pharmacological diet-based approach to air pollution-induced disease management have also been discussed. We argue that before a nutraceuticals-based approach can be used for widespread public adoption, further research, especially human clinical trials, is essential to confirm the beneficial action of relevant nutraceuticals and to explore the safe limits of human supplementation and the risk of side effects. Future research should focus on systematically translating bench-based knowledge regarding nutraceuticals gained from in vitro and in vivo studies into clinically usable nutritional guidelines.

Effects of ambient air pollution on psychological stress and anxiety disorder: a systematic review and meta-analysis of epidemiological evidence.

OBJECTIVES: Ambient air pollution (AAP) is an important risk factor for increased mental health morbidity. Studies have highlighted the effect of AAP on psychological stress and anxiety disorder. However, existing evidence regarding this is largely equivocal. This systematic review with meta-analysis aims to synthesize published evidence to calculate the pooled estimate of the effect of AAP on psychological stress and anxiety disorder. CONTENT: A systematic bibliographic search was undertaken using PubMed, JGateplus, Google Scholar, and Cochrane Library for observational human studies published in English till 31st March 2020 reporting the effect of AAP on psychological stress and anxiety disorder. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analysis was performed adopting a random-effects model using Meta-XL. Of 412 articles retrieved, a total of 30 articles [AAP and anxiety disorders, (n=17, 57%); AAP and psychological stress, (n=9, 30%) and AAP and both psychological stress and anxiety disorders, (n=4, 13%)] fulfilled the inclusion criteria covering a total population of 973,725 individuals. The pooled estimate (OR) of the effects of PM10 on psychological stress was 1.03 [(95% CI: 1.00, 1.05) (p=0.17, I 2=41%)]. The pooled estimate of the effects of NO2 and PM10 on anxiety disorder was 0.93 [(95% CI: 0.89, 0.97) (p=0.91, I 2=0%)] and 0.88 [(95% CI: 0.78, 0.98) (p=0.01, I 2=59%)] respectively. The pooled estimate of the effects of PM2.5 on anxiety Disorder was 0.88 [(95% CI: 0.72, 1.06) (p=0.00, I 2=80%)]. SUMMARY AND OUTLOOK: The present study provides the most updated pooled estimate of the effect of AAP on psychological stress and anxiety disorder. Future studies should focus on longitudinal studies conducted in LIC and LMIC countries using uniform and standardized criteria for exposure and outcome assessment as well as robust adjustment for confounders to minimize methodological heterogeneity resulting in reliable and comparable estimation of environmental mental health burden.

A mixed-methods community-based participatory research to explore stakeholder's perspectives and to quantify the effect of crop residue burning on air and human health in Central India: study protocol.

BACKGROUND: Crop residue burning adversely affects air quality and consequently human health. India, being one of the largest agro-economies of the world, produces around 500 Million tonnes of crop residue annually most of which is burnt on-farm. However, integrated studies that simultaneously quantify the effects of crop residue burning while exploring the subjective determinants of the practice are lacking in India. This paper describes the protocol for a longitudinal mixed methods research study employing a community-based participatory approach to fill this gap. METHODS: Both quantitative and qualitative data will be collected in a rural setting of the central Indian province of Madhya Pradesh, over 1 year. A steering committee comprising of the research team and community representatives will be formed. The proportion of cultivable land burnt in one crop burning season will be estimated. The association between crop residue burning, level of ambient air pollutants, and pulmonary function of village residents will be determined. Focus groups, interviews, and participatory rural appraisal methods will be used to explore stakeholder perspectives about crop residue burning. Potential barriers and opportunities for substituting burning with an alternative crop residue management technique will be ascertained as the basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2019-20/1494, dt 06/01/2020). DISCUSSION: This manuscript describes the protocol for a novel community-based participatory study to investigate thoroughly the phenomenon of crop residue burning from the perspective of the agricultural community through their active collaboration. The lack of comprehensive evidence regarding the factors responsible for crop residue burning in India underlines the importance of implementing this study protocol to fill in this critical gap in knowledge. While acknowledging that findings of this study will be not generalizable to agricultural communities other than the one studied, it is expected that the study will generate baseline evidence that might be beneficial in developing and implementing an appropriate intervention strategy.

Medical schools in India: pattern of establishment and impact on public health - a Geographic Information System (GIS) based exploratory study.

BACKGROUND: Indian medical education system is on the brink of a massive reform. The government of India has recently passed the National Medical Commission Bill (NMC Bill). It seeks to eliminate the existing shortage and maldistribution of health professionals in India. It also encourages establishment of medical schools in underserved areas. Hence this study explores the geographic distribution of medical schools in India to identify such under and over served areas. Special emphasis has been given to the mapping of new medical schools opened in the last decade to identify the ongoing pattern of expansion of medical education sector in India. METHODS: All medical schools retrieved from the online database of Medical Council of India were plotted on the map of India using geographic information system. Their pattern of establishment was identified. Medical school density was calculated to analyse the effect of medical school distribution on health care indicators. RESULTS: Presence of medical schools had a positive influence on the public health profile. But medical schools were not evenly distributed in the country. The national average medical school density in India amounted to 4.08 per 10 million population. Medical school density of provinces revealed a wide range from 0 (Nagaland, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep) to 72.12 (Puducherry). Medical schools were seen to be clustered in the vicinity of major cities as well as provincial capitals. Distance matrix revealed that the median distance of a new medical school from its nearest old medical school was just 22.81 Km with an IQR of 6.29 to 56.86 Km. CONCLUSIONS: This study revealed the mal-distribution of medical schools in India. The problem is further compounded by selective opening of new medical schools within the catchment area of already established medical schools. Considering that medical schools showed a positive influence on public health, further research is needed to guide formulation of rules for medical school establishment in India.