Test concordance and diagnostic accuracy of three serological assays for detection of anti-SARS-CoV-2 antibody: result from a population-based sero-epidemiological study in Delhi.

BACKGROUND: Several methodological tests are available to detect SARS-CoV-2 antibody. Tests are mostly used in the aid of diagnosis or for serological assessment. No tests are fully confirmatory and have variable level of diagnostic ability. We aimed at assessing agreement with three serological tests: quantitative anti receptor binding domain ELISA (Q-RBD), qualitative ELISA (WANTAI SARS-CoV-2 Ab) and qualitative chemiluminescence assay (CLIA). METHODS: This study was a part of a large population based sero-epidemiological cohort study. Participants aged 1 year or older were included from 25 randomly selected clusters each in Delhi urban (urban resettlement colony of South Delhi district) and Delhi rural (villages in Faridabad district, Haryana). Three type of tests were applied to all the baseline blood samples. Result of the three tests were evaluated by estimating the total agreement and kappa value. RESULTS: Total 3491 blood samples collected from March to September, 2021, out of which 1700 (48.7%) from urban and 1791 (51.3%) from rural. Overall 44.1% of participants were male. The proportion of sero-positivity were 78.1%, 75.2% and 31.8% by Wantai, QRBD and CLIA tests respectively. The total agreement between Wantai and QRBD was 94.5%, 53.1% between Wantai and CLIA, and 56.8% between QRBD and CLIA. The kappa value between these three tests were 0.84 (95% CI 0.80-0.87), 0.22 (95% CI 0.19-0.24) and 0.26 (95% CI 0.23-0.28). CONCLUSIONS: There was strong concordance between Wantai and QRBD test. Agreement between CLIA with other two tests was low. Wantai and QRBD tests measuring the antibody to same S protein can be used with high agreement based on the relevant scenario.

A qualitative study regarding menstrual hygiene in a rural community of Haryana, India.

INTRODUCTION: Adolescent girls face challenges in menstrual hygiene in routine patterns which impacts their education and health. A qualitative study was undertaken to assess the knowledge and practices regarding menstruation in a rural community of Haryana and to identify the barriers to menstrual hygiene. METHODOLOGY: The study was conducted in the month of September 2019 among various stakeholders i.e. adolescent females, adolescent males, Accredited Social Health Activist (ASHA) workers, Anganwadi workers, school teachers and Medical Officers. The stakeholders were mapped with the help of a Multi-Purpose Health Worker and ASHA of the village. Interview guides for focus group discussion (FGD) and in-depth interview (IDI) were prepared from previous literature to understand menstrual health management among the stakeholders. RESULTS: After IDI and FGD, we found that there is a barrier to accessibility of regular sanitary pads, a lack of education on menstrual hygiene among adolescent girls. School absenteeism was a concern due to the unavailability of mechanisms for the disposal of sanitary pads in school and poor maintenance of toilets. CONCLUSION: Proper implementation of the Adolescent Reproductive Sexual Health program and Menstrual health education can improve the use and reduce stigma and ignorance. Free uninterrupted supply of sanitary pads through school and Anganwadi will help improving accessibility and separate toilets for girls would lead to a reduction in absenteeism.

Willingness of medical students to volunteer during the Covid-19 pandemic: Assessment at a tertiary care hospital in India.

Background The involvement of medical students in strategies to control Covid-19 might be considered to cope with the shortage of healthcare workers. We assessed the knowledge about Covid-19, willingness to volunteer, potential areas of involvement and reasons for hesitation among medical students towards volunteering. Methods We did this cross-sectional study among undergraduate students at a tertiary care teaching hospital in New Delhi. We used a web-based questionnaire to elicit demographic information, knowledge of Covid-19, willingness to volunteer and reasons deterring them from working during the Covid-19 pandemic, and self-declared knowledge in six domains. Results A total of 292 students participated in the study with a mean (SD) age of 19.9 (3.1) years. The mean (SD) knowledge score of Covid-19 was 6.9 (1.1) (maximum score 10). Knowledge score was significantly different among preclinical (6.5), paraclinical (7.18) and clinical groups (7.03). Almost three-fourth (75.3%) participants were willing to volunteer in the Covid-19 pandemic, though 67.8% had not received any training in emergency medicine or public health crisis management. Willingness to work was maximum in areas of social work and indirect patient care (62.3% each). Lack of personal protective equipment was cited as a highly deterring factor for volunteering (62.7%) followed by fear of transmitting the infection to family members (45.9%), fear of causing harm to the patient (34.2%) and the absence of available treatment (22.2%). Conclusions A majority of the students were willing to volunteer even though they had not received adequate training. Students may serve as an auxiliary force during the pandemic, especially in non-clinical settings.

Anaemia in Indians aged 10-19 years: Prevalence, burden and associated factors at national and regional levels.

Anaemia control programmes in India are hampered by a lack of representative evidence on anaemia prevalence, burden and associated factors for adolescents. The aim of this study was to: (1) describe the national and subnational prevalence, severity and burden of anaemia among Indian adolescents; (2) examine factors associated with anaemia at national and regional levels. Data (n = 14,673 individuals aged 10-19 years) were from India's Comprehensive National Nutrition Survey (CNNS, 2016-2018). CNNS used a multistage, stratified, probability proportion to size cluster sampling design. Prevalence was estimated using globally comparable age- and sex-specific cutoffs, using survey weights for biomarker sample collection. Burden analysis used prevalence estimates and projected population from 2011 Census data. Multivariable logistic regression models were used to analyse factors (diet, micronutrient deficiencies, haemoglobinopathies, sociodemographic factors, environment) associated with anaemia. Anaemia was present in 40% of girls and 18% of boys, equivalent to 72 million adolescents in 2018, and varied by region (girls 29%-46%; boys 11%-28%) and state (girls 7%-62%; boys 4%-32%). Iron deficiency (ferritin < 15 µg/L) was the strongest predictor of anaemia (odds ratio [OR]: 4.68, 95% confidence interval [CI]: [3.21,6.83]), followed by haemoglobinopathies (HbA2 > 3.5% or any HbS) (OR: 2.81, 95% CI: [1.66,4.74]), vitamin A deficiency (serum retinol <20 ng/ml) (OR: 1.86, 95% CI: [1.23,2.80]) and zinc deficiency (serum zinc < 70 µg/L) (OR: 1.32, 95% CI: [1.02,1.72]). Regional models show heterogeneity in the strength of association between factors and anaemia by region. Adolescent anaemia control programmes in India should continue to address iron deficiency, strengthen strategies to identify haemoglobinopathies and other micronutrient deficiencies, and further explore geographic variation in associated factors.

Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6-59 Months.

INTRODUCTION: Globally around 47.4% of children and in India, 58% of children aged 6-59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. OBJECTIVES: To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6-59 months compared with hematology analyzer. METHODS: The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli's hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. RESULTS: A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli's hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli's hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli's hemoglobinometer (70%). Invasive DH took the least time (2-3 min) for estimation of hemoglobin per participant, followed by Sahli's (4-5 min) and non-invasive DH (5-7 min). CONCLUSION: All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli's can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summaryIn India, anemia is a serious public health problem, where 58% of the children aged 6-59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices-invasive DH, non-invasive DH and Sahli's hemoglobinometer among 6-59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6-59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli's (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli's hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli's (70%).

Evaluation of promotion of iron-rich foods for the prevention of nutritional anemia in India.

BACKGROUND: Nutritional anemia due to iron deficiency is the most common cause of anemia in India. The average diet in India is low in iron and mostly of vegetable origin. This can be improved by increasing awareness of foodstuffs that are rich in iron and ensuring their availability. OBJECTIVE: The objective of the study was to assess the quality of information available on iron-rich foods and to assess their production and consumption in India. METHODS: This was a review of common textbooks for medical, nursing, and home science students; related policy and program documents; and government publications on production and consumption of various foodstuffs in India. RESULTS: Details of specific foods that are rich in iron have not been provided. Instead, food groups such as pulses, cereals, nuts, and green leafy vegetables (GLVs) have been mentioned that are good sources of non-heme iron. This is in spite of the fact that all the foodstuffs in these groups are not uniformly iron rich. Among cereals and pulses, rice and red gram dal (arhar) are the most commonly produced and consumed, though they have the lowest iron content. Spinach and mustard leaves believed to be iron rich and commonly consumed are among those GLVs having lowest iron content. CONCLUSION: Details of 5-10 foodstuffs which have the highest iron content within each food group should be available in relevant books and documents meant for education, production, and consumption data.

Meta-analysis of efficacy of iron and iodine fortified salt in improving iron nutrition status.

BACKGROUND: Salt fortification with iron is a potential strategy to increase population-level iron intake. The current evidence regarding double-fortified salt (DFS) in improving iron nutrition status is equivocal. OBJECTIVE: To study the efficacy of DFS as compared to iodine fortified salt (IS) in improving iron nutrition status. METHODS: Randomized controlled trials comparing DFS and IS until August 2016 were systematically searched across multiple databases to assess for change in mean hemoglobin (Hb), prevalence of anemia, iron deficiency (ID), ID anemia (IDA), serum ferritin, and serum transferrin receptor (TfR). Meta-analysis was performed using R software. RESULTS: Of the initial 215 articles retrieved using the predetermined search strategy, data from 10 comparisons of DFS and IS across 8 randomized controlled trials are included. There was significant heterogeneity across included studies and the studies were of low to very low quality as per GRADE criteria. DFS significantly increased mean Hb by 0.44 g/dl (95% confidence interval [CI]: 0.16, 0.71) and significantly decreased anemia (risk difference -0.16; 95% CI: -0.26, -0.06) and ID (risk difference -0.20; 95% CI: -0.32, -0.08) as compared to IS. There was no statistically significant difference in change in ferritin levels (mean difference 0.62 µg/L; 95% CI: -0.12, 1.37), serum TfR levels (mean difference -0.23 mg/dL; 95% CI: -0.85, 0.38), and IDA (risk difference -0.08; 95% CI: -0.28, 0.11). CONCLUSION: DFS is a potentially efficacious strategy of addressing anemia as a public health problem at population level. There is a need for effectiveness trials before DFS can be scaled up in program mode at population level.

High national and sub-national coverage of iodised salt in India: evidence from the first National Iodine and Salt Intake Survey (NISI) 2014-2015.

OBJECTIVE: The National Iodine and Salt Intake Survey (NISI) 2014-2015 was undertaken to estimate household iodised salt coverage at national and sub-national levels in India. DESIGN: Cross-sectional survey with multistage stratified random sampling. SETTING: India was divided into six geographic zones (South, West, Central, North, East and North-East) and each zone was further stratified into rural and urban areas to yield twelve distinct survey strata. SUBJECTS: The target respondent from each household was selected as per predefined priority; wife of the household head, followed by women of reproductive age, followed by any adult available during the visit. RESULTS: Households (n 5717) were surveyed and salt samples (n 5682) were analysed. Household coverage of iodised salt (iodine≥5 ppm) was 91·7 (95 % CI 91·0, 92·7) %. Adequately iodised salt (iodine≥15 ppm) was consumed in 77·5 (95 % CI 76·4, 78·6) % of households. Significant differences in coverage were seen across six geographic regions, with North and North-East zones on the verge of achieving the universal salt iodisation target of >90 % coverage. Coverage of households with adequately iodised salt (adjusted OR; 95 % CI) was significantly less in rural households (0·55; 0·47, 0·64), lower/backward castes (0·84; 0·72, 0·98), deprived households (0·72; 0·61, 0·85) as assessed by multidimensional poverty index, households with non-diverse diet (0·73; 0·62, 0·86) and households using non-packaged salt (0·48; 0·39, 0·59) and non-refined salt (0·17; 0·15, 0·20). CONCLUSIONS: India is within striking reach of achieving universal salt iodisation. However, significant differentials by rural/urban, zonal and socio-economic indicators exist, warranting accelerated efforts and targeted interventions for high-risk groups.

National Iodine Deficiency Disorders Control Programme: Current status & future strategy.

Iodine deficiency disorders (IDDs) constitute a significant public health problem globally. In India, the entire population is prone to IDDs due to deficiency of iodine in the soil of the sub-continent and thus both animal and plant source food grown on the iodine-deficient soil. IDDs encompass the spectrum of disability and disease and include goitre, cretinism, hypothyroidism, abortion, stillbirth, brain damage, learning disabilities, mental retardation, psychomotor defects, hearing and speech impairment. Iodine deficiency is known to be the single largest cause of preventable brain damage. IDDs with their causal association with brain development, cognition, and learning disabilities impair the human resource development and progress of the country. The children born in iodine-deficient regions on an average have 13.5 intelligence quotient (IQ) points lesser than children born in iodine-sufficient regions. IDD control programme in India is a public health success story, with 92 per cent of the population consuming iodized salt. The partnership between government agencies, academic institutions, salt industry, development agencies and civil society has been key to achieve this success story. The sustainable elimination of iodine deficiency in India is within reach, what is required is accelerated and coordinated effort by all key stakeholder at national and State level.

Effect of directly observed oral iron supplementation during pregnancy on iron status in a rural population in Haryana: A randomized controlled trial.

BACKGROUND: In India, more than half of the pregnant women suffer from anemia. Low compliance to iron supplementation is one of the important reasons. OBJECTIVES: The objective of the study is to estimate the reduction in the prevalence of anemia, improvement in iron status, and to compare the compliance to oral iron supplementation during pregnancy between directly observed iron-folic acid (IFA) supplementation group and control group. METHODS: This was a community-based open labeled parallel block-randomized controlled trial including 400 pregnant women in a rural setting of north India. In the intervention group, the first dose of IFA every week was supervised by ASHA and women were instructed to take the remaining tablets during the week as per the prescription. In control group, IFA tablets were supplemented without direct supervision. RESULTS: After 100 days of IFA supplementation, the reduction in anemia in the intervention group was 6% higher as compared to control group (P = 0.219). The increase in the mean hemoglobin level over and above control group was 0.52 g/dl in intervention group (P < 0.001). However, the mean increase in serum ferritin level in the intervention group was similar to the control group. The mean percentage compliance in the intervention group was almost 9% higher than that of control group (P = 0.001). CONCLUSION: Directly supervised oral iron (IFA) supplementation improves compliance to oral iron (IFA) supplementation and also improves hemoglobin status among pregnant women. However, the mean increase in serum ferritin and reduction in the prevalence of anemia in the intervention group were not higher than the control group.

Household Coverage with Adequately Iodized Salt Varies Greatly between Countries and by Residence Type and Socioeconomic Status within Countries: Results from 10 National Coverage Surveys.

Background: Household coverage with iodized salt was assessed in 10 countries that implemented Universal Salt Iodization (USI).Objective: The objective of this paper was to summarize household coverage data for iodized salt, including the relation between coverage and residence type and socioeconomic status (SES).Methods: A review was conducted of results from cross-sectional multistage household cluster surveys with the use of stratified probability proportional to size design in Bangladesh, Ethiopia, Ghana, India, Indonesia, Niger, the Philippines, Senegal, Tanzania, and Uganda. Salt iodine content was assessed with quantitative methods in all cases. The primary indicator of coverage was percentage of households that used adequately iodized salt, with an additional indicator for salt with some added iodine. Indicators of risk were SES and residence type. We used 95% CIs to determine significant differences in coverage.Results: National household coverage of adequately iodized salt varied from 6.2% in Niger to 97.0% in Uganda. For salt with some added iodine, coverage varied from 52.4% in the Philippines to 99.5% in Uganda. Coverage with adequately iodized salt was significantly higher in urban than in rural households in Bangladesh (68.9% compared with 44.3%, respectively), India (86.4% compared with 69.8%, respectively), Indonesia (59.3% compared with 51.4%, respectively), the Philippines (31.5% compared with 20.2%, respectively), Senegal (53.3% compared with 19.0%, respectively), and Tanzania (89.2% compared with 57.6%, respectively). In 7 of 8 countries with data, household coverage of adequately iodized salt was significantly higher in high- than in low-SES households in Bangladesh (58.8% compared with 39.7%, respectively), Ghana (36.2% compared with 21.5%, respectively), India (80.6% compared with 70.5%, respectively), Indonesia (59.9% compared with 45.6%, respectively), the Philippines (39.4% compared with 17.3%, respectively), Senegal (50.7% compared with 27.6%, respectively) and Tanzania (80.9% compared with 51.3%, respectively).Conclusions: Uganda has achieved USI. In other countries, access to iodized salt is inequitable. Quality control and regulatory enforcement of salt iodization remain challenging. Notable progress toward USI has been made in Ethiopia and India. Assessing progress toward USI only through household salt does not account for potentially iodized salt consumed through processed foods.

α-l-rhamnosidase selective for rutin to isoquercitrin transformation from Penicillium griseoroseum MTCC-9224.

An α-l-rhamnosidase secreting fungal strain has been isolated from the decaying goose berry (Emblica officinalis) fruit peel. The fungal strain has been identified as Penicillium greoroseum MTCC-9224. The α-l-rhamnosidase of this fungal strain has been purified to homogeneity using a simple procedure involving concentration by ultra filtration and an anion exchange chromatography on DEAE-cellulose. The purified enzyme gave a single protein band corresponding to molecular mass of 97kDa in SDS-PAGE analysis. The native-PAGE analysis also gave a single protein band confirming the purity of the enzyme. Using p-nitrophenyl-α-l-rhamnopyranoside as the substrate, Km and kcat values of the enzyme were 0.65mM and 43.65s-1, respectively. The pH and temperature optima of the enzyme were 6.5 and 57°C, respectively. The activation energy for the thermal denaturation of the enzyme was 27.9kJ/mol. The purified α-l-rhamnosidase hydrolyzed rutin to isoquercitrin and l-rhamnose but has no effect on naringin and hesperidin.

Directly observed iron supplementation for control of iron deficiency anemia.

Anemia is major public health problem affecting 1.6 billion people worldwide. The poor compliance of iron supplementation remains main contributor for high prevalence of anemia. The current paper reviewed the effectiveness of direct observation of oral iron supplementation on anemia. A systematic search was performed through electronic databases and local libraries. Search strategies used subject headings and key words "directly observed" and "iron supplementation." Searches were sought through April 2014. A total of 14 articles were included in the study. Findings were presented in three categories. First, all of those reported an improvement in compliance of iron supplementation. Second, reduction in the prevalence of anemia was reported by all and third, all except one reported increased blood hemoglobin level. Directly observed an iron supplementation is an effective approach for prevention and management of anemia in vulnerable groups. However, larger trials are needed before concluding that scaling up directly observed iron supplementation through community health volunteers would be beneficial.

Estimating the burden of 'weighing less': A systematic review and meta-analysis of low birth-weight in India.

BACKGROUND: The National Family Health Survey-3 (NFHS- 3; 2005-06) reports that the prevalence of low birth-weight babies is 22% in India. This old figure is probably an underestimate as this nationwide survey acquired information on birth-weight of only 34% of babies. We aimed to make a fresh estimate of the proportion of low birth-weight babies. METHODS: A systematic search was done through PubMed, Google Scholar, Cochrane Library, Medline, IndMed, Embase, WHO and Biomed Central databases. Studies published from 2004 to 2014 were included. Study quality was assessed using the adapted Mirza and Jenkins checklist. An 'adjustment' of 24% was applied to the published estimates where data were collected through records or through a combination of records and anthropometry. The adjustment was done to account for the heaping of birth-weight data at 2500 g. Metaanalysis using both random and fixed effects model was done to derive an estimate. RESULTS: Nineteen studies with 44 133 subjects were included in the review. The pooled estimate for the prevalence of low birth-weight was 27% (95% CI 24%-30%) and the 'adjusted' pooled prevalence was 31% (95% CI 28%-33%). The prevalence in urban and rural areas was 30% (95% CI 23%- 38%) and 26% (95% CI 22%-30%), respectively. Regionwise estimates revealed that the prevalence at 33% was comparatively higher in eastern regions (95% CI 29%-37%). CONCLUSION: The pooled prevalence of low birth-weight is higher than that reported by NFHS-3. Updated estimates should be used to guide future interventions and policies.

A reliable and accurate portable device for rapid quantitative estimation of iodine content in different types of edible salt.

BACKGROUND: Continuous monitoring of salt iodization to ensure the success of the Universal Salt Iodization (USI) program can be significantly strengthened by the use of a simple, safe, and rapid method of salt iodine estimation. This study assessed the validity of a new portable device, iCheck Iodine developed by the BioAnalyt GmbH to estimate the iodine content in salt. MATERIALS AND METHODS: Validation of the device was conducted in the laboratory of the South Asia regional office of the International Council for Control of Iodine Deficiency Disorders (ICCIDD). The validity of the device was assessed using device specific indicators, comparison of iCheck Iodine device with the iodometric titration, and comparison between iodine estimation using 1 g and 10 g salt by iCheck Iodine using 116 salt samples procured from various small-, medium-, and large-scale salt processors across India. RESULTS: The intra- and interassay imprecision for 10 parts per million (ppm), 30 ppm, and 50 ppm concentrations of iodized salt were 2.8%, 6.1%, and 3.1%, and 2.4%, 2.2%, and 2.1%, respectively. Interoperator imprecision was 6.2%, 6.3%, and 4.6% for the salt with iodine concentrations of 10 ppm, 30 ppm, and 50 ppm respectively. The correlation coefficient between measurements by the two methods was 0.934 and the correlation coefficient between measurements using 1 g of iodized salt and 10 g of iodized salt by the iCheck Iodine device was 0.983. CONCLUSIONS: The iCheck Iodine device is reliable and provides a valid method for the quantitative estimation of the iodine content of iodized salt fortified with potassium iodate in the field setting and in different types of salt.

Prevalence of iodine deficiency among adult population residing in Rural Ballabgarh, district Faridabad, Haryana.

Community-based surveys are essential to monitor iodine deficiency disorders (IDD) program at both the state and national levels. There is paucity of information on population iodine nutrition status in Haryana state using standard methods. A cross-sectional study was conducted in villages of Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, Haryana, India. A total of 465 randomly selected individuals were assessed for urinary iodine concentration (UIC) by microplate method and household salt iodine content using iodometric titration. Of the interviewed households, 73% were using adequately iodized salt (≥15 ppm). Iodine nutrition was deficient in 17% respondents (UIC <100 µg/L); 20.2% among males and 13.9% among females. Iodine intake of the study population as measured by UIC was adequate but nearly one-fourth of households in the study population were consuming inadequately iodized salt. The availability and access to adequately iodized salt in the study population should be improved by strengthening regulatory monitoring.

Successful implementation of a laboratory iodization quality assurance system in small-scale salt production facilities in India.

OBJECTIVE: To establish a laboratory iodization quality assurance system to support small-scale salt production facilities in India and to assess the level of agreement for the internal quality assurance (IQA) and external quality assurance (EQA) protocols. DESIGN: Operational research. The IQA and EQA programme was established in the year 2008. Agreement between field laboratories and the reference laboratory for estimation of iodine content of salt from 2008 to 2011 was assessed. Agreement was assessed using the χ 2 test, kappa statistics and the Bland-Altman plot. SETTING: Small-scale salt producers in the states of Andhra Pradesh, Gujarat, Rajasthan, Tamil Nadu, Odisha and Karnataka; 'field laboratories' supporting the small-scale salt producers; and the 'reference laboratory' of the Regional Office (South Asia) of the International Council for the Control of Iodine Deficiency Disorders. SUBJECTS: Three hundred small-scale salt producers in the states of Andhra Pradesh, Gujarat, Rajasthan, Tamil Nadu, Odisha and Karnataka and seventeen 'field laboratories'. RESULTS: A total of 6573 salt samples for IQA and 347 salt samples for EQA were exchanged between field and reference laboratories during 2008-2012. Out of the total salt sample exchanges, 527 were from Andhra Pradesh and Odisha, 2343 from Gujarat, 2016 from Rajasthan and 1677 from Tamil Nadu and Karnataka. The overall between-laboratory agreement was for 61·6 % for IQA and 64·8 % for EQA. The mean difference between iodine content estimation of field laboratories and the reference laboratory was 0·3 ppm (sd 8·2 ppm) for IQA and -0·3 ppm (sd 3·5 ppm) for EQA. CONCLUSIONS: Our study successfully documents implementation of a laboratory iodization quality assurance protocol in laboratories supporting small-scale salt production facilities in India.

Prevalence of household-level food insecurity and its determinants in an urban resettlement colony in north India.

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world's largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean family-size being 5.5 (SD +/- 2.5) and the mean monthly household income being INR 9,784 (SD +/- 631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p < or = 0.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p < or = 0.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem.

Perception and Practices Regarding Stubble Burning in Rural Community of Haryana.

Background: Agricultural emissions pose significant health risks, especially in countries like India with abundant agricultural waste. This study focuses on understanding stubble burning perceptions and practices in rural National Capital Region to inform targeted interventions for sustainable farming practices and improved public health. Methods and Material: This community-based cross-sectional study was conducted among the randomly selected households of rural Ballabgarh, Haryana. A pre-tested, semi-structured questionnaire was used to obtain information on perception and practices on stubble burning. Data were collected in Epicollect 5 and analyzed in STATA 14. Results: Of the 2000 households approached, 1813 responded with a response rate of 90.7%. Around 53% of the study participants believed that vehicular pollution is the main reason for air pollution, and 90% of them were unaware of the Government schemes related to stop stubble burning and with respect to the practices of stubble disposal. Around 70% of the participants mentioned that respiratory illness is the most severe effect of air pollution. Conclusion: The public was mostly unaware of the government's efforts to reduce stubble burning. Health promotion initiatives must be carried out to raise community knowledge about the programs available to combat stubble burning, therefore decreasing air pollution and its health implications.

Facilitating Factors and Barriers to Physical Activity among Undergraduate Medical Students in North India: A Qualitative Study.

Background: Medical undergraduate students are the doctors of the future. Evidence supports that medical students who practice physical activity (PA) regularly will continue to perform PA in the future and are more likely to counsel patients about it in their practice. This study was planned to understand the facilitating factors and barriers to PA among Bachelor of Medicine and Bachelor of Surgery (MBBS) students using a qualitative approach. Materials and Methods: This study is part of a larger study on PA among undergraduate medical students from a medical college in North India. A cross-sectional study with a qualitative approach was conducted on undergraduate medical (MBBS) students enrolled from 2012 to 2017 at the All India Institute of Medical Sciences (AIIMS), New Delhi. Results: The most common facilitating factors identified in the study were self-motivation and personal preference, followed by health consciousness to maintain fitness and the continuation of habits from early childhood. Other facilitating factors reported are being good at sports, having sports-loving friends, an increase in self-confidence, the desire to build six packs, and reducing weight. Those with a concern for self-health, prevention of disease in the future, or a family member already suffering from a disease related to PA were also likely to practice it. Barriers found in the study broadly were competing for time, gender issues, resource-related issues, and sole focus on academics. Conclusion: Rigorous efforts are needed from the individual level to the system level to reinforce the facilitators and fight the barriers. Future studies should focus on finding ways to overcome the barriers and strengthen the facilitating factors for PA among medical students in India.