New Delhi, India: Perceptions & apprehensions: A qualitative studyOral HIV self-testing among men who have sex with men in.

Background & objectives: The overall adult prevalence of HIV in India was estimated to be 0.22 per cent in 2019. The HIV prevalence among men who have sex with men (MSM), a high-risk group for HIV, was estimated to be 4.3 per cent, which is 16 times higher than the national average. In Delhi, the estimated prevalence among MSM was 1.8 per cent. Despite free HIV testing services being made available by the National AIDS Control Programme for more than two decades, many MSM were not aware about their HIV status. Therefore, newer testing strategies are needed. Oral HIV self-testing (HIVST) has proved to be one such promising innovation. At present, there are no programme guidelines on HIVST and oral HIVST kit is not available in India. The aim of this study was to understand the perceived advantages and disadvantages of introduction of oral HIVST strategy among MSM. Methods: MSM who were registered with the selected non-governmental organizations working as targeted intervention sites in Delhi, India, were recruited for focus group discussions (FGDs) between January and May 2021. For the purpose of this study, MSM were defined as males who had anal/oral sex with male/hijra partner in the past one month. A total of six FGDs were conducted using a prepared FGD guide. The FGD guide included questions on problems faced during conventional HIV testing, participants' awareness, acceptability and perceptions of oral HIVST. The data were manually coded and entered in NVivo release 1.5 and themes were identified. Results: A total of 67 respondents participated in the FGDs. A total of 28.4 per cent MSM were beggars at traffic lights, 12 per cent were sex workers and 11.9 per cent were bar/event dancers. Nearly half (50.7%) of the participants had undergone HIV testing less than twice in the preceding one year. None of the MSM were aware about oral HIVST. Perceived advantages of oral HIVST were ease of use, confidentiality and the non-invasive pain-free procedure. Perceived concerns included lack of post-test counselling, linkage to care, poor mental health outcomes and forced testing. Interpretation & conclusions: Most MSM had positive perceptions about oral HIVST. Therefore, it is likely that the introduction of oral HIVST may result in higher uptake of HIV testing among MSM.

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.

Is Inclusion of informed consent associated with HIV seropositivity rate? findings from 2017 HIV sentinel surveillance among men having sex with men in select states of India.

BACKGROUND: During round 2017 of HIV Sentinel Surveillance (HSS) for men who have sex with men (MSM) in India, sampling strategy was changed from consecutive sampling to random sampling, and recruitment was conditioned on informed written consent. OBJECTIVE: The study aimed to explore whether inclusion of informed consent is associated with HIV seropositivity rates among MSM population in select four states of Central India. METHODS: The cross-sectional study was conducted in four states of Delhi, Jharkhand, Uttar Pradesh, and Uttarakhand that were supervised by All India Institute of Medical Sciences, New Delhi. We did analysis of data collected during 2017 HSS, supplemented with additional program data from targeted intervention (TI) sites. All nine MSM sites in four states were included. Participants were defined as all those MSM who participated in HSS 2017 irrespective of whether they were mentioned in the random list or were selected by the TI partner. The MSM in the random list who either refused to participate or could not be contacted even after three attempts were classified as "nonparticipants." Seropositivity of both groups was compared. Descriptive statistics were derived. RESULTS: Overall nonparticipation rate was 14.7%, the highest being in Jharkhand (26%) and lowest in Uttarakhand (6.8%). Overall HIV positivity rate was significantly higher (P < 0.001) in nonparticipants (4.2%) when compared to participants (1.42%). CONCLUSION: The change in sampling strategy and introduction of written informed consent for recruitment of high-risk groups in HSS 2017 round could have led to an underestimation of HIV seropositivity rate among MSM in the states in Central Zone.

MD/MS thesis as a training tool.

As part of the MD/MS thesis, a postgraduate resident plans, conducts, analyses, and reports a research study under the guidance of the faculty members of the department. At the end of this process, the resident is expected to know the principles of conducting scientific research. Such an integral component of the resident's training program bears close examination. The thesis does help a resident plan a research study, collect and analyze data, and compile the results. However, lack of dedicated time for thesis-work (especially in patient-care disciplines), the absence of intermediate timelines, and variation in the research ability and interest of faculty guides limit its usefulness. Addressing these issues, ensuring availability and the optimal use of resources, as well as regular monitoring and evaluation at the departmental level, shall go a long way in meeting the goals of a thesis.

Site preparedness and quality of HIV sentinel surveillance at antenatal care clinic sites in India, 2019.

BACKGROUND: Quality of HIV sentinel surveillance (HSS) depends on preparedness of the site and adherence to the standard operating procedures (SOPs) for HSS. A designated sentinel site is considered prepared for the round of sentinel surveillance based on the availability of infrastructure, human resource, and consumables. OBJECTIVES: The study objectives were to describe the site level preparedness and adherence to SOP of antenatal care clinic (ANC) sites during the 16th round of HSS in India. METHODS: This was a cross-sectional study based on the findings of the supervisory visits conducted by public health specialists in ANC sites during the 16th round of HSS from January to March 2019. Semi-structured checklists were used to assess site-preparedness and adherence to the SOP for HSS. All supervisors were expected to upload the filled pro forma to the HSS management information system (MIS). We present here a descriptive analysis of the uploaded visit reports. RESULTS: Of 870 HSS sites, 783 (90%) were visited, and 479 (61.2%) reports were uploaded to MIS. Preround HSS training was not attended by one-fifth (22.6%) of the site in-charges; 35.8% of them had never received any HSS training. SOP was followed at most (94%) of the sites. The most frequently reported problem at the sites was inadequate or delayed availability of consumables. CONCLUSION: The overall quality of site-level preparedness at antenatal clinic sites in India was good. Attention needs to be given to timely and adequate availability of consumables at sentinel sites along with proper administrative support and preround training of site in-charges.

Prevalence and determinants of sexually transmitted infections (STIs) among male migrant factory workers in Haryana, North India.

BACKGROUND: Male migrant workers display high risk sexual behavior and have been shown to have higher prevalence of sexually transmitted infections (STIs), which make them more vulnerable to HIV infection. We aimed to estimate the prevalence of self-reported STIs and delineate their determinants among male migrant factory workers in Faridabad, Haryana. MATERIALS AND METHODS: Male workers in two selected factories, who were aged ≥18 years, were born outside Haryana (destination), and who had migrated to Haryana after the age of 15 years were eligible. Socio-demographic information, HIV/AIDS knowledge and behavior, and self-reported STI symptoms in the last 1 year were ascertained by face-to-face interview. Determinants of STIs were identified by regression analysis. RESULTS: Totally 755 eligible workers participated. Mean ± SD age was 31.4 ± 8.2 years and migration duration was 9.5 ± 6.7 years. At least one STI symptom was reported by 41.7% of the participants (burning micturition- 35%, inguinal bubos-5.2%, genital ulcers- 2.6%, urethral pus discharge- 1.3%). Factors associated with STIs were higher age at migration, lower HIV/AIDS knowledge, paid sex in the last year, non-use of condoms during the last non-spousal sex, and unfavorable intention to use condom. CONCLUSION: Prevalence of self-reported STIs among these migrant men was high. Targeted Interventions among migrant workers need to be strengthened for control and prevention of STIs.

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.

Prevalence and Associated Factors of Hypertension Among Adolescents in a Rural Community of North India.

BACKGROUND AND AIM: Hypertension exerts a substantial burden on the healthcare system in India. Recent literature suggests hypertension to be a rising health problem not only in adults but also in adolescents. The early diagnosis of hypertension in adolescents and timely interventions are key in reducing the burden of hypertension-related morbidity and mortality in later life. This study aimed to estimate the prevalence and factors associated with hypertension among adolescents residing in a rural community in north India. MATERIALS AND METHODS: This was a community-based cross-sectional study done in Ballabgarh, Haryana. A computer-generated random sample of 600 adolescents was drawn through a sampling frame of adolescents (10-19 years) listed in the Health Management Information System. House visits were made and a semi-structured interview schedule was used. Blood pressure was measured using a digital blood pressure (BP) apparatus (OMRON digital BP monitor, three readings) with age-appropriate cuffs, and hypertension was defined using the American Academy of Pediatrics 2017/Indian Academy of Pediatrics 2022 criteria. Age-adjusted BMI was calculated using AnthroPlus software (Geneva, Switzerland: WHO). The prevalence of hypertension was reported with a 95% confidence interval. Bivariate and multivariate logistic regression was done to determine the association of hypertension with the associated factors. RESULTS: In this study, 550 adolescents participated, of which 284 (51.6%) were males. The overall prevalence of hypertension was 18.9% (95% CI: 15.8-22.4%), stage 1 hypertension 17.3% (95% CI: 14.3-20.7%), and stage 2 hypertension 1.6% (95% CI: 0.8-3.1%). The participants aged 15-19 years (adjusted OR: 2.40, 95% CI: 1.51-3.80) compared to adolescents aged 10-14 years, and those who were overweight/obese (adjusted OR: 3.93, 95% CI: 2.14-7.20) compared to those with normal weight had significantly greater odds; whereas the female sex had lesser odds (adjusted OR: 0.49, 95% CI: 0.32-0.81) of having hypertension compared to male adolescents. CONCLUSION: Approximately one-fifth of the participants in this study had hypertension, highlighting the need for interventions including lifestyle modification and active case finding targeting adolescents.

Comparison of Different Anthropometric Indicators for Assessment of Nutritional Status Among Adolescent Girls in an Urban Resettlement Colony in New Delhi: A Cross-Sectional Study.

Background In India, 44.8% of adolescent girls are under-nourished, while about 8%-13% of girls are overweight. Though several studies have been done regarding the nutritional status of adolescent girls over the years, there have been no significant changes. Also, there are several different anthropometric indicators for nutritional status assessment, due to which there are huge variations in the prevalence of malnutrition across different studies. So the objectives of this study were to determine the prevalence of malnutrition using different anthropometric indicators and compare them. Methods A random sample of 426 girls was taken from Health Management Information Systems (HMIS) of the Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), and a semi-structured questionnaire was administered among 386 of them to determine associated factors. Height, weight, and mid-upper arm circumference (MUAC) were measured for 386 girls, and BMI for age and height for age z scores were calculated using WHO AnthroPlus. Mid-upper arm circumference for age z scores (MUAC for age) were calculated using Lambda-Mu-Sigma (LMS) charts by the CDC for girls aged one year to 20 years. Results It was found in this study that using BMI for age z scores (BAZ), 33.4% of the adolescent girls were malnourished; 18.9% (95% CI 15.1-23.2) being underweight, 10.6% (95% CI: 7.7-14.1) being overweight, and 3.9% (95% CI: 2.2-6.3) were obese. While using BMI solely as an indicator, the prevalence of thinness was 51.8% (95% CI: 46.9-56.9), while that of overweight and obesity was 10.6% (95% CI: 5.7-11.5) and 1.0% (95% CI: 0.2-2.6), respectively. The prevalence of under-nutrition by MUAC for age z scores was 53.4% (95% CI: 48.2-58.4), and that of over-nutrition was 1.8% (95% CI: 1.0-3.7). BMI for age z scores positively and strongly correlated with both MUAC and MUAC for age z scores and had a significant association with both on univariable linear regression. Though there was a negative correlation between BMI for age z scores and height-for-age z scores, it was not significant. Height-for-age z scores, even though positively correlated with MUAC for age z scores, the correlation was not that strong.

Prevalence and determinants of heterosexual anal-intercourse among female sex workers in India: Findings from nationwide cross-sectional biological and behavioural survey.

BACKGROUND: The vulnerability of female sex workers (FSWs) to HIV infection increases if unprotected heterosexual anal intercourse (HAI) is practiced. OBJECTIVES: To estimate the prevalence of HAI among FSWs, and associated factors, and prevalence of consistent condom use (CCU) during HAI and associated factors. METHODS: Analysis of cross-sectional data from nationwide biological and behavioural survey, conducted at 73 randomly selected domains with sample size of 27,000 in India. RESULTS: A total of 25,932 FSWs were included in the analysis, after excluding 1075 (3.9%) FSWs for which the data were incomplete. The prevalence of HAI was 29.9% (95% CI, 29.3, 30.4); The CCU during HAI in the last one month was 58.9%. Younger age at the start of sex work, use of mobile phone/internet for soliciting client, home as a place of sex work, consumption of alcohol/drug, and physical violence against FSWs were associated with higher odds of HAI. Frequent contact with outreach workers, awareness of sexually transmitted infection, and older age at the start of sex work was associated with CCU. CONCLUSION: Prevalence of HAI was high among FSW in India. The national program could target those factors that reduce the odds of HAI and/or promote CCU.

Prevalence of HIV among inmates in four states of north India: findings from the 16th round of HIV sentinel surveillance.

PURPOSE: Prisoners are at a higher risk of HIV infection compared to the general population. The purpose of this study is to estimate the prevalence of HIV and related risk behaviours among inmates of the Central Prisons in four states of North India. DESIGN/METHODOLOGY/APPROACH: The HIV sentinel surveillance was conducted in seven Central Prisons in four states of North India from February to April 2019. Four hundred inmates were included from each prison. The interviews were conducted at the Integrated Counselling and Testing Centre located within the prison premises. The Ethics Committee of the National AIDS Control Organization, New Delhi, granted ethical approval before the start of the surveillance. FINDINGS: Overall, 2,721 inmates were enrolled in this study. The mean (SD) age was 38.9 (13.9) years. One-third of prison inmates had comprehensive knowledge about HIV/AIDS. The proportion of convict (54%) and undertrial (46%) inmates was almost equal. The overall prevalence of HIV infection among inmates was 0.96% (95% CI 0.65-1.40). The odds of being HIV positive were significantly higher in never married inmates, undertrials, inmates who were in the prison for more than three months to one year, inmates incarcerated for multiple times, inmates with history of injecting drug use and inmates with history of intercourse with a commercial sex worker. ORIGINALITY/VALUE: The findings from the very first HIV sentinel surveillance in central prisons in North India have been presented in this paper. This has huge implications for future policy decisions.

Prevalence of Anemia Among Adolescent Girls Residing in Rural Haryana: A Community-Based Cross-Sectional Study.

Background Anemia continues to be a major public health problem in India despite multiple initiatives to address it among various vulnerable groups including adolescents. Aim This study was conducted to assess the prevalence of anemia among rural adolescent girls who had attained menarche. Methods The community-based cross-sectional study was conducted in 28 villages of Ballabgarh Block of district Faridabad, Haryana. From the computerized Health Management Information System data (HMIS), a random list of 363 adolescent girls was generated. Adolescent girls who had attained menarche were included in the study. Hemoglobin level was measured for all the consented or assented participants using a digital hemoglobinometer (HemoCue201+ photometer, HemoCue AB, Angelholm, Sweden). Results A total of 272 participants were enrolled in the study. Mean (SD) age at menarche was 13.2 (1.2) years. Prevalence of anemia among adolescent girls who had attained menarche was observed to be 71.7% (95% CI: 66.3 - 77.1) as per the WHO classification. Among the 195 anemic adolescent girls, severe, moderate, and mild anemia was observed in 4.8%, 41.2%, and 25.7%, respectively. In multivariable analysis, after adjusting for the age, the mother's education was significantly associated with anemia (Adjusted Odds Ratio = 0.46, 95% CI: 0.22 - 0.96, p-value = 0.04). Conclusion The prevalence of anemia among rural adolescent girls who had attained menarche was high. Mother's education status had a protective effect on anemia among adolescent girls.

Barriers in reaching new-borns and infants through home visits: A qualitative study using nexus planning framework.

Background: Home visitation has emerged as an effective model to provide high-quality care during pregnancy, childbirth, and post-natal period and improve the health outcomes of mother- new born dyad. This 3600 assessment documented the constraints faced by the community health workers (known as the Accredited Social Health Activists, ASHAs) to accomplish home visitation and deliver quality services in a poor-performing district and co-created the strategies to overcome these using a nexus planning approach. Methods: The study was conducted in the Raisen district of Madhya Pradesh, India. The grounded theory approach was applied for data collection and analysis using in-depth interviews, and focus group discussions with stakeholders representing from health system (including the ASHAs) and the community (rural population). A key group of diverse stakeholders were convened to utilize the nexus planning five domain framework (social-cultural, educational, organizational, economic, and physical) to prioritize the challenges and co-create solutions for improving the home visitation program performance and quality. The nexus framework provides a systemic lens for evaluating the success of the ASHAs home visitation program. Results: The societal (caste and economic discrimination), and personal (domestic responsibilities and cultural constraints of working in the village milieu) issues emerged as the key constraints for completing home visits. The programmatic gaps in imparting technical knowledge and skills, mentoring system, communication abilities, and unsatisfactory remuneration system were the other barriers to the credibility of the services. The nexus planning framework emphasized that each of the above factors/domains is intertwined and affects or depends on each other for home-based maternal and newborn care services delivered with quality through the ASHAs. Conclusion: The home visitation program services, quality and impact can be enhanced by addressing the social-cultural, organizational, educational, economic, and physical nexus domains with concurrent efforts for skill and confidence enhancement of the ASHAs and their credibility.

Prevalence of knee osteoarthritis, its determinants, and impact on the quality of life in elderly persons in rural Ballabgarh, Haryana.

BACKGROUND: Osteoarthritis (OA) is the most common type of arthritis and a very common disease of elderly. It is one of the leading causes of disability. The present study was conducted to estimate the burden of the knee OA among rural elderly. METHODS: A community-based cross-sectional study was conducted among 500 randomly selected elderly resident of rural Ballabgarh, Haryana. A semi-structured interview schedule was used by a trained investigator for face-to-face interview, clinical examination of knee using American College of Rheumatology criteria, and quality of life assessment using WHOQOL-BREF. RESULTS: Almost two-third of the participants among 454 elderly recruited, suffered from knee OA (292, 64.3%) had knee OA. History of a knee injury, a family history of knee pain, current physical activity and smoking status were found to be significantly associated with knee OA, in multivariate logistic regression model. Elderly suffering from knee OA had significantly lower quality-of-life scores contrasted to those not (p-value < 0.001). The scores were significantly lower for all the domains (P-value <0.001) among elderly suffering with the knee OA, with the maximum effect seen in psychological, and physical domain. CONCLUSION: Rural elderly of Ballabgarh, Haryana, had a high burden of knee OA. Elderly suffering from knee OA had significantly lower perception of their quality of life most affected is the psychological and physical domains of quality of life.

Prevalence of Common Mental Disorders among pregnant women-Evidence from population-based study in rural Haryana, India.

BACKGROUND: Mental disorders during pregnancy is one of the major public health problem because of its effect on both mother and child. OBJECTIVES: The objective of the study was to assess the burden of common mental disorders (CMDs) among pregnant women in rural Haryana, North India. METHODS: A community-based cross-sectional study was conducted in 28 villages of rural Haryana in 2016. Pregnant women in the study area with period of gestation 25-34 weeks were enrolled and assessed for presence of CMDs in two phases. Primary Care Evaluation of Mental Disorders-Patient Health Questionnaire was used for screening and Mini International Neuropsychiatric Interview (MINI) for diagnosis of CMDs. RESULTS: A total of 457 pregnant women were included in the study. Mean age of pregnant women was 23.9 years (SD- 3.9). Prevalence of CMDs was 15.3% (95% CI, 12.0-18.6). Of these, major depression was 2.8% (95% CI, 1.4- 4.4), and Generalized Anxiety Disorder was 15.1% (95% CI, 11.8-18.4) as per MINI. On multivariate analysis, no statistically significant association was found between CMDs during pregnancy with any obstetric, sociodemographic determinants, and child health outcomes. CONCLUSION: High prevalence of CMDs, especially anxiety, observed among pregnant women in rural area necessitates the need for integration of screening of CMDs during routine antenatal care in India.

Effect of Structured Yoga Program on Stress and Professional Quality of Life Among Nursing Staff in a Tertiary Care Hospital of Delhi-A Small Scale Phase-II Trial.

BACKGROUND: Nursing staff suffer from various level of stress and burnout. We aimed to assess the effect of 12 weeks of structured yoga on stress and the professional quality of life among nursing staff. DESIGN AND METHOD: An open-label, phase-II randomized clinical trial was undertaken considering a sample size of convenience was done. In service nursing staff were randomized (1:1) to intervention group and wait-list control group. Primary outcome was perceived stress which was measured by Perceived Stress Scale (PSS). Secondary measures were professional quality measured by Professional Quality of Life (ProQOL) scale, blood pressure, serum cortisol, and high-sensitive C-reactive protein. Both the per-protocol and intention to treat analysis was done. RESULTS: Total 113 participants were allocated to intervention group (n = 58, mean = 35 years, SD = 7.9 years) and wait-list control group (n = 55, mean = 32.5 years, SD = 6.8 years). After 12 weeks, 19 participants of intervention group and 32 participants of wait-list control group were included in the per-protocol analysis. Follow-up mean PSS score was 15.4 (95% CI 12.6-18.2, SD 5.8) in intervention group, 20.7 (95% CI 19.7-21.7, SD 2.8) in wait-list control group (p-value < 0.0001). The other parameters didn't differ between the groups and from baseline to end line too. CONCLUSIONS AND RELEVANCE: The finding showed supervised structured yoga may be efficacious to reduce stress. Studies with larger sample size are needed to confirm the findings. TRIAL REGISTRATION: It was approved by the Institute Ethics Committee (Reference no: IECPG-543/20.12.2017, RT-57/31.01.2018) and was registered prospectively in the Clinical Trial Registry of India prospectively (No. CTRI/2018/02/012206).

Letter to the editor regarding the article 'individual and household risk factors of severe acute malnutrition among underfive children in Mao, Chad: a matched casecontrol study'.

We would like to thank the authors Jovana Dodos et al., for the article "Individual and household risk factors of severe acute malnutrition among underfive children in Mao, Chad: a matched casecontrol study".

Burden of common mental disorders among pregnant women: A systematic review.

INTRODUCTION: Common mental disorders (CMDs) including depressive and anxiety disorders during antenatal period is reported to affect both mother and child health outcomes. There is scarce evidence about burden of CMDs during pregnancy from Lower and Middle Income Countries. OBJECTIVE: To review the evidence about the burden of common mental disorders among pregnant women METHODS: Major databases were searched systematically for English language studies on prevalence of CMDs. Quality assessment of studies was done with the modified version of Newcastle-Ottawa Scale for non-analytical studies. RESULTS: Twenty three studies were included in the review. The prevalence of CMDs among pregnant women ranged from 1%-37%. Depression was more commonly studied (ranged from 1%-30%). Prevalence of GAD ranged from 1%-26%. Factors commonly associated with CMDs were lower SES, intimate partner violence, history of previous episode of CMDs, history of mental illness in family and unmarried status. Effect of CMDs on child health outcome was also detected. CONCLUSION: CMDs are common during pregnancy with varying prevalence depending on various settings and scales used.

Critical Review of "Family Health Advisory Services" Assessment in MBBS Training Program in Community Medicine.

CONTEXT: Family Health Advisory Services (FHAS) posting as well as its assessment is resource demanding but fails to enjoy priority. Study focuses on a holistic overview of the assessment process to understand need for change. AIMS: The aim of this study is to identify perceived gaps in current assessment practices related to FHAS posting. SETTINGS AND DESIGN: A cross-sectional mixed method study among all the V semester students currently undergoing assessment for the posting, past students (selected VII semester students and interns), preceptors (supervising residents - postgraduate students in department and senior resident, health assistants, medical social service officer), and involved faculty. SUBJECT AND METHODS: Self-administered questionnaire, in-depth interview, focus group discussions (two) as well as observations using checklist were used for data collection and triangulation. STATISTICAL ANALYSIS USED: Quantitative data used in this study were statistical measures of central tendency and dispersion. Qualitative data transcript repeatedly read to identify underlying common themes, compared to draw inference. RESULTS: There was a lack of guidelines and communication regarding assessment. Formative assessment was not performed and replaced by one time end assessment. All components of learning were not assessed. End-posting assessment was not standardized and unrelated to learning objectives. Award of scores was skewed toward right for intervention and toward left for analysis and community diagnosis. CONCLUSIONS: There is a need to focus on proper implementation of programme to strengthen formative assessment. Assessment should be relevant to learning objectives of posting. Faculty has to lead by example.