All India Institute of Hygiene and Public Health

On the basis of an analysis of the skin temperature data on three resting human subjects from 112 experiments, a simple weighting system for computing the mean skin temperature from observations on four areas of the body, namely, chest, arms, thighs, and legs, has been proposed. The proposed system of weighting yields mean skin temperature values identical with the elaborate Hardy-Dubois weighting formula. The value of the medial thigh temperature as an index of the mean skin temperature has also been investigated and discussed. skin temperature measurement Submitted on May 20, 1963

BACKGROUND: Menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining ignorant of the scientific facts and hygienic health practices, which sometimes result into adverse health outcomes. OBJECTIVES: (i) To elicit the beliefs, conception and source of information regarding menstruation among the study population and (ii) to find out the status of menstrual hygiene among adolescent girls. MATERIALS AND METHODS: A descriptive, cross-sectional study was conducted among 160 adolescent girls of a secondary school situated in the field practice area of Rural Health Unit and Training Center, Singur, West Bengal, with the help of a pre-designed and pre-tested questionnaire. Data were analyzed statistically by simple proportions. RESULTS: Out of 160 respondents, 108 (67.5%) girls were aware about menstruation prior to attainment of menarche. Mother was the first informant regarding menstruation in case of 60 (37.5%) girls. One hundred and thirty-eight (86.25%) girls believed it as a physiological process. Seventy-eight (48.75%) girls knew the use of sanitary pad during menstruation. Regarding practices, only 18 (11.25%) girls used sanitary pads during menstruation. For cleaning purpose, 156 (97.5%) girls used both soap and water. Regarding restrictions practiced, 136 (85%) girls practised different restrictions during menstruation. CONCLUSIONS: Menstrual hygiene, a very important risk factor for reproductive tract infections, is a vital aspect of health education for adolescent girls. Educational television programmes, trained school nurses/health personnel, motivated school teachers and knowledgeable parents can play a very important role in transmitting the vital message of correct menstrual hygiene to the adolescent girl of today.

BACKGROUND AND PURPOSE: Information on essential stroke parameters are lacking in India. This population-based study on stroke disorder was undertaken in the city of Kolkata, India, to determine the subtypes, prevalence, incidence, and case fatality rates of stroke. METHODS: This was a longitudinal descriptive study comprising 2-stage door-to-door survey of a stratified randomly selected sample of the city population, conducted twice per year for 2 successive years from March 2003 to February 2005. RESULTS: Out of the screened population of 52,377 (27 626 men, 24 751 women), the age standardized prevalence rate of stroke to world standard population is 545.10 (95% CI, 479.86 to 617.05) per 100,000 persons. The age standardized average annual incidence rate to world standard population of first-ever-in-a-lifetime stroke is 145.30 (95% CI, 120.39 to 174.74) per 100,000 persons per year. Thirty-day case fatality rate is 41.08% (95% CI, 30.66 to 53.80). Women have higher incidence and case fatality rates. Despite divergence on socioeconomic status between the slum and nonslum dwellers, stroke parameters were not significantly different. CONCLUSIONS: The age standardized prevalence and incidence rates of stroke in this study are similar to or higher than many Western nations. The overall case fatality rate is among the highest category of stroke fatality in the world. The women have higher incidence and case fatality rates compared with men.

Telemedicine is the use of electronic information to communicate technologies to provide and support healthcare when distance separates the participants.(1) “Tele” is a Greek word meaning “distance “and “mederi” is a Latin word meaning “to heal”. Time magazine called telemedicine “healing by wire”. Although initially considered “futuristic” and “experimental,” telemedicine is today a reality and has come to stay. Telemedicine has a variety of applications in patient care, education, research, administration and public health.(2) Worldwide, people living in rural and remote areas struggle to access timely, good-quality specialty medical care. Residents of these areas often have substandard access to specialty healthcare, primarily because specialist physicians are more likely to be located in areas of concentrated urban population. Telemedicine has the potential to bridge this distance and facilitate healthcare in these remote areas.(3,4)

Abstract A comparative study of seven modes of carrying an identical load on the level ground was conducted on seven normal, healthy volunteers. The modes of carrying were: Head, Rucksack, Double Pack, Rico Bag, Sherpa, Yoke and Hands. The volunteers marched with 30 kg at the rate of 5 km/hr and the minute ventilation, oxygen consumption and pulse rate were recorded during the steady state of work and a 5 min recovery period after the work. Analysis of variance on the data established a significant (p<0·01) difference in the values of the physiological parameters of energy cost, cardiac rate and pulmonary ventilation due to a change in the mode of carrying. The Double Pack mode was ergonomically the best mode, followed closely by the Head mode. Carrying by Hands was the worst method and the others were intermediate as far as physiological economy is concerned. The merits and demerits of these modes of carrying loads are discussed briefly.

In the absence of any nationwide cervical screening program, cancer of cervix remains a major public health problem for India. We here assessed knowledge levels of female college students about cervical cancer, its risk factors, the human papillomavirus (HPV) etiologic agent and Pap (Papanicolaou) smear testing for screening. We conducted a questionnaire survey of the students (N=630), aged 17 to 24 years, in Kolkata, India. Only 20% correctly identified cervix cancer as the most prevalent female cancer in India, while 43% were aware of the ages of occurrence. Though 41% thought sexual activity to be associated with cervical cancer, its risk factors, like, smoking, having multiple sex partners, cervical infections, early onset of sexual intercourse, multiple parity were recognized by 29%, 3%, 4%, 13% and 15%, respectively. The terms Pap test and HPV had been heard by 11% and 15 % of the students, respectively, and 75% of the students desired to have protective vaccination. Bivariate analysis revealed that educational stream, standard of the college and family size were significantly associated with knowledge levels. Additionally, multivariate regression analysis indicated city students were more knowledgeable than those from outside the city. It is imperative that women gather adequate knowledge on cervical cancer for the success of any program to control the disease. Wide and effective spreading of awareness about the disease among women must form an integral part of public health policy of government.

BACKGROUND: Is knowledge regarding the consequences of substance use among adolescents enough to prevent them from initiating and continuing its use, is a question that needs to be clarified further? OBJECTIVE: To assess the knowledge regarding harm of use and to obtain information about attitudes among high school students. Also, to discover the opinion of substance use held by users. MATERIALS AND METHODS: This was a population based cross-sectional study conducted in two high schools of West Bengal, India, among 416 students, in classes VIII, IX, and X, with no interventions. Primary outcome measurements were substance use: knowledge regarding harm, attitude, and opinion. Following this proportions and the chi-square test were used for statistical analysis. RESULTS: Out of 416 students, 52 (12.5%) used or abused any one of the substances irrespective of time and frequency in lifetime; 26 (15.1 %) were among the urban students and 26 (10.7 %) were among their rural counterparts. More than two-thirds (73.07%) of the respondents expressed a desire to quit substance use and 57.69% had tried to stop. 'Easy availability' and 'relief from tension' were the most frequent reasons for continuation of substance use. Level of knowledge on harmfulness of substance use among students was very high (urban - -84.6% and rural - 61.5%) and they stated media as the most frequent source of information. Users were successful in influencing their peers into taking up this habit (urban - 15.4% and rural - 26.9%). CONCLUSIONS: Inspite of being aware of the harmful effects of substance use, adolescents take up this habit. This requires comprehensive prevention and control programs in schools and the community, targeted toward adolescents and their parents and other family members. Effective measures are required to encourage shaping the attitude of school children toward self-confidence and adequacy, as also to prevent risk behavior among adolescents.

BACKGROUND: Early marriage and confinement are contributing factors to high maternal and perinatal mortality and morbidity. OBJECTIVE: To assess the magnitude of the problem of teenage pregnancy and its complications. MATERIALS AND METHODS: A hospital-based cohort study was undertaken over 4 months among women admitted to a rural hospital in West Bengal. The study cohort comprised of teenage mothers between 15-19 years old and a control cohort of mothers between 20-24 years old. Data included demographic variables, available medical records, and complications viz. anemia, preterm delivery, and low birth weight. Anemia was defined as a hemoglobin level below 10 gm% during the last trimester of pregnancy, preterm delivery was defined as occurring within 37 weeks of gestation, and low birth weight was defined as babies weighing less than 2500 grams at birth. RESULT: Teenage pregnancy comprised 24.17% of total pregnancies occurring in the hospital during the study period. The study group had 58 subjects and the control group had 91 subjects. The prevalence of anemia was significantly higher (P<0.05) in the women in the teenage group (62.96%) than in the women in the control group (43.59%). However, severe anemia with a hemoglobin level below 8 gm% was only found in the control group. Preterm delivery occurred significantly more (P<0.001) in the study group (51.72%) than in the control group (25.88%). The incidence of low birth weight was significantly higher (P<0.0001) among the group of teenagers (65.52%) than among the women in the control group (26.37%). Not a single newborn was above 3 kg in the study group, while none were below 1.5 kg in the control group. The mean birth weight was 2.36 kg in the study group and 2.74 kg in the control group; the difference was strongly significant (P<0.001). CONCLUSION: The study shows that anemia, preterm delivery, and low birth weight were more prevalent among teenagers than among women who were 20-24 years old. This indicates the need for enhancing family welfare measures to delay the age at first pregnancy, thereby reducing the multiple complications that may occur in the young mother and her newborn baby.

BACKGROUND: Domestic violence has serious impact on women's health and well-being. A nationwide survey conducted in India observed that 37.2% of women experienced violence after marriage. OBJECTIVES: To assess the prevalence of domestic violence among the ever married women in reproductive age group and to find out the types of domestic violence and factors associated with it. MATERIALS AND METHODS: The study was a community based cross-sectional study, conducted in a slum area of Kolkata. RESULTS AND CONCLUSION: Overall prevalence of domestic violence was 54%, of which 41.9% suffered from both current and lifetime physical and psychological violence. Presence of property, higher per capita income and social support were protective factors against domestic violence, whereas alcohol addiction and multiple sex partners were the important contributory factors for it. The study recommended more social support, awareness and income generation for women in the slum areas.

INTRODUCTION: During menopausal transition, there is a lot of fluctuation in the hormone levels making the peri and postmenopausal women susceptible to various mental and physical disorders. There is considerably lack of awareness about the effects of the menopausal symptoms in women in India. Studies on issues relating to menopause, especially among rural women, are also lacking. With this background, the current study was carried out in a rural area of West Bengal with the objective to assess the quality of life (QOL) of peri-menopausal women. METHODOLOGY: The study was carried out among 100 peri and postmenopausal women (40-60 years) in Dearah village of West Bengal which is the rural field practice area of All India Institute of Hygiene and Public Health during February-March 2014. The questionnaire used as study tool had two parts - Part 1: Sociodemographic characteristics. Part 2: About QOL due to menopausal symptoms based on four domains (vasomotor, psychosocial, physical, and sexual) using the 29-item Menopause-Specific Quality of Life Questionnaire. RESULTS: Occurrence of vasomotor symptoms was average with 60% of them reporting hot flushes and 47% sweating. Most prevalent psychosocial symptoms reported were feeling of anxiety and nervousness (94%) and overall depression (88%). Physical symptoms were quite varying in occurrence with some symptoms such as feeling tired or worn out, decrease in physical strength and lack of energy occurring in 93% of the women to only 5% suffering from growth of facial hair. Overall sexual changes were reported among 49% who reported of avoiding intimacy with a partner and 26% complained of vaginal dryness. CONCLUSIONS: The results support that menopause causes both physical and psychiatric problems. Education, creating awareness and providing suitable intervention to improve their QOL are important which should be imparted to menopausal women at both individual and community level.

Abstract Polynomial regression of degree p in one independent variable χ is considered. Numerically large sample correlations between χα and χβ, α < β, a, β = 1, ···, p, may cause ill-conditioning in the matrix to be inverted in application of the method of least squares. These sample correlations are investigated. It is confirmed that centering of the independent variable to have zero sample mean removes nonessential ill-conditioning. If the sample values of χ are placed symmetrically about their mean, the sample correlation between χα and χβ is reduced to zero by centering when α + β is odd, but may remain large when α + β is even. Some examples and recommendations are given.

PURPOSE: Hand rim-propelled manual wheelchairs (WC) are conventionally distributed to persons with dysfunctioning lower limbs for independent ambulation in community-based rehabilitation. The purpose of the present study was to survey the fate of the donated WCs and the difficulties encountered by the users by identifying the cause of rejection, and to evaluate the performance by assessing physiological strain on the recipients during their routine ambulation using cardiorespiratory parameters. METHODS: Personal interview was arranged for the recipients and they were to answer regarding the fate of the donated WC and the cause of rejection for the recipients who rejected their WC. A simple field test was also administered to the users to evaluate the ambulatory performance using the WC. The energetics of WC propulsion at freely chosen speed was studied. RESULTS: Of the WC, 10.49% were for attendant-dependent ambulation, 57.4% were not used, 14.19% were sold and 7.4% were in regular use and 10.5% in occasional use. Most of the recipients rejected their WC due to pain, fatigue and discomfort and lack of habitat adaptability. The cardiorespiratory response was higher in occasional users than regular users. Locomotive tasks using WC are highly energy demanding and contribute to physiological strain. CONCLUSIONS: Hand rim-propelled manual WC are unsuitable for outdoor ambulation due to low speed and high physiological demand; they are also of little use indoors as they are difficult to maneuver under the environmental conditions and architectural restraints. So, they should not be recommended without proper assessment of the user's activity level and requirements.

Good nutrition forms the basis for good health of a child. Nutrition is required for a child to grow, develop, stay active, and to reach adulthood as well.(1) Exclusive breastfeeding (EBF) is recommended as the optimum method of feeding for the first 6 months of life and semi-solid foods are to be introduced after 6 months while continuing breastfeeding to meet the physiological requirements of the infants.(2) Studies(3) have reported that the practices of early introduction of top feeds and late introduction of semi-solids are widely prevalent, more so in urban slums. Studies by the Nutrition Foundation of India (NFI) in urban slums of three major cities (Mumbai, Kolkata, and Chennai) revealed serious erosion of breastfeeding practices. Other studies from urban slums repeatedly documented that exclusive breastfeeding was practiced in only 30-40% of infants, colostrum was discarded in upto 90%, use of prelacteal feeds was almost universal, use of feeding bottles, animal milk, and commercial milk formulae was very common. Also it was found that the introduction of complementary foods is markedly delayed and the foods lack the consistency, energy density and are fed in inadequate amounts and in unhygienic ways.(3) With this background, the study had been conducted to assess the feeding practices of the children in an urban slum and to determine the factors influencing it, if any.

PURPOSE: This study aimed to determine the prevalence, incidence, and mortality rates of epilepsy in the city of Kolkata, India. This is the first such longitudinal study in a heterogeneous urban Indian population. METHODS: A two-stage door-to-door survey of a stratified random sample was undertaken within the municipal limits of Kolkata. Trained field workers detected and interviewed the cases using a simple screening questionnaire, and the detailed follow-up was done by neurologists. The survey was conducted annually for five consecutive years from March 2003 through February 2008. RESULTS: A total of 52,377 (52.74% men) individuals were screened. There were 309 prevalent and 66 incident cases of active epilepsy. The prevalence and average annual incidence rate (AAIR) with 95% confidence interval (CI), age-standardized to World Standard Population, were 572.8 (509.79-641.54) per 100,000 and 27.27 (21.03-34.80) per 100,000 per year, respectively. The age-specific incidence rates of epilepsy showed bimodal distribution. During the 5-year period, 20 cases of active epilepsy died. The average annual mortality rate (AAMR) was 7.63 (95% CI 4.45-11.26) per 100,000 population per year. Compared to the general population of Kolkata, the all-cause standardized mortality ratio (SMR) for persons with epilepsy was 2.58 overall (men 3.67; women 1.77). There was no significant difference between slum and nonslum dwellers in epidemiologic parameters. CONCLUSIONS: The AAIR of epilepsy is comparable to that observed in developed countries, but AAMR is higher. The all-cause SMR for epilepsy relative to the general population is, however, similar to that of developed nations.

Serological properties of 468 strains of the cholera group of vibrios, in which cholera and NAG vibrios are included, were studied. The results are summarized as follows:1. By cross agglutination tests, 39 O groups of which O group 1 was assigned to cholera vibrio were established within the group.2. It was demonstrated that H antigen of the cultures of all O groups was identical with that of cholera vibrio but was different from that of other species of the genus Vibrio.3. The mucoid antigen which inhibits O agglutination was found in some strains.The results support the findings of Gardner and Venkatraman. In addition, it was emphasized that the O groups established in this study should be referred to as serotypes within Vibrio cholerae including NAG vibrios, since all the strains of this species possessed a common H antigen.

Vitamin A deficiency is still considered a major nutritional problem in the developing world. Increasing evidence of the role of vitamin A in the control of both morbidity and mortality is a point of great concern. Vitamin A supplementation began several years ago, and it still continues in many countries. However, there is a gradual realization that one of the most effective and sustainable ways to overcome vitamin A deficiency is through food-based strategies, which become a way of life. the most effective way to achieve this is by the following methods, in order of priority: dietary diversification (food supplementation, horticultural interventions, management of proper distribution, and availability of vitamin A–rich foods), nutrition education on all issues related to vitamin A (e.g., sources of vitamin A, importance of and need for vitamin A, methods of obtaining vitamin A–rich foods, and community involvement and participation in the process), and food fortification (identification of foods that can be fortified, development of proper cost-effective methods taking into account local food tastes and availability, and development of a mechanism to reach the most needy). This paper summarizes various case studies to ascertain the effectiveness of the different approaches.

The difficulties of organizing mental health services in developing countries are made all the greater by inadequacy of information about the extent of illness and disability. Some beginnings have been made in India, particularly under the sponsorship of the All India Institute of Mental Health, Bangalore. The Mental Health Advisory Committee of the Government of India (1966) suggested a probable prevalence of mental illness of 20 per 1,000 population in general, 18 per mille for semi-rural and 14 per mille for rural areas. These figures are much lower than the 72 per 1,000 suggested by Sethi et al . (1967). Ganguli (1968) estimated a prevalence rate of 140 per 1,000 in industrial workers near Delhi. Incidence rates have been much less studied than prevalences (Lin and Standley, 1962). A WHO Expert Committee on mental health convened in 1960 suggested as a working definition of a case of mental illness:

INTRODUCTION Menstruation is a normal physiological phenomenon that women and adolescent girls experience every month. Ability to manage menstruation hygienically is fundamental to the dignity and well-being of women and constitutes an integral component of basic hygiene, sanitation, and reproductive health services. Poor awareness of the physiology, unscientific attitude, myths, and misconceptions including the notion that menstruating women are “contaminated,” “dirty,” and “impure” adversely affect their health and social lives. Unfortunately, it continues to be treated as a taboo in many societies, shrouded in a culture of silence and shame. Issues and challenges related to menstrual hygiene management (MHM) in low and middle-income countries are gaining increased recognition in the water, sanitation, and hygiene (WASH) sector globally. WHO and UNICEF(2014) have defined MHM as “Women and girls are using clean menstrual hygiene management material to absorb or collect blood, that can be changed in privacy as and when necessary for the duration of the menstrual period, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management materials.”[1] Since 2014, May 28 is observed as the Menstrual Hygiene Day worldwide to raise awareness regarding the challenges women and girls face to deal with menstrual cycles and highlight solutions implementable at global, national, and local levels to address these issues.[2] Although there is no direct mention of any goal or indicator of menstrual health and hygiene in the UN Sustainable Development Goals (SDGs), it is well recognized that poor MHM practices will adversely affect the initiatives and performances of the countries toward achieving a number of important developmental goals (SDGs 3, 4, 5, 6, 8, and 12).[3] Menstrual hygiene management initiatives in India In India, number of women in the reproductive age group (15–49 years) is more than 31 crores (Census 2011).[4] Taking cognizance of the quantum of morbidity and poor quality of life that a woman would have to bear in the absence of proper MHM perception and practices in the country, Government of India has incorporated MHM into national policies and programs as part of initiatives for improving health, well-being, and nutritional status of adolescent girls and women, as well as for reducing school absenteeism of adolescent girls. UNICEF has also been instrumental in providing technical guidance and support toward raising awareness, addressing behavior change, capacity building of frontline community cadre, sensitization of key stakeholders, and creation of WASH facilities including safe disposal options. “Swachh Bharat: Swachh Vidyalaya” campaign has been launched to ensure that every school in India has a set of functioning and well-maintained WASH facilities including soap, private space for changing, adequate water for washing, and disposal facilities for used menstrual absorbents.[5] MHM has been made an integral part of the Swachh Bharat Mission Guidelines. Ministry of Drinking Water and Sanitation has published operational guidelines to be implemented by state governments, district-level officials, engineers, and school teachers for improved MHM in the country.[6] Ministry of Health and Family Welfare has also focused MHM as a priority area in National Health Mission[7] and in the RMNCH+A strategy.[8] High quality and highly subsidized sanitary napkins are being made available to the adolescent girls in rural areas by Accredited Social Health Activists (ASHAs)[9] and “Training Module for ASHA on Menstrual Hygiene” are also used for their capacity building.[10] The SABLA program of Ministry of Women and Child Development has incorporated awareness generation on MHM as an important initiative to improve health, nutrition, and empowerment for adolescent girls.[11] Efforts are being made to provide sanitary napkins to school-going girls by installing napkin-vending machines at schools and to increase accessibility of environmentally safe disposal mechanisms such as low-cost incinerators attached to the girls' toilets in schools for disposal of used MHM products. Very recently, on International Women's Day on March 8, 2018, Government has launched 100% oxy-biodegradable sanitary napkins “Suvidha” in packs of four priced at Rs. 10 which will be available shortly at Pradhan Mantri Bhartiya Janaushadhi Pariyojana Stores.[12] Despite the array of initiatives put up so far, a myriad of challenges still remain to be addressed. Ensuring healthy MHM for women would require a clear understanding of the intricacies related to the problem, the needs, and the influencing factors that could potentially affect the perception and practices of Indian women. The challenges Menstrual hygiene management awareness: Minimizing barriers Access to accurate and pragmatic information is an essential prerequisite to hygienic menstrual practices. Studies from different parts of the country have revealed that awareness and understanding of menstruation as a normal biological phenomenon is abysmally poor in different sections of the society.[13] Prevailing sociocultural norms, beliefs, and practices make it difficult for women and girls to talk freely about menstruation without fear or shame. It is such a taboo subject in the society that not only girls and women feel shy about menstruation, school teachers, and even health workers also feel uncomfortable to discuss MHM related issues. All-out efforts are needed to change the age-old social attitude toward menstruation and to break the culture of silence and inertness. Puberty education needs to include MHM at curricular level for healthy development of adolescents. Innovative IEC approaches like utilization of community contact opportunities (e.g. VHNDs) and proactive involvement of mass media and social media would further minimize barriers to MHM awareness. Capacity building of school teachers and health service providers including AWWs to disseminate timely and accurate information to both boys and girls on the biological and psychosocial aspects of puberty, menstruation, and MHM customized to local contexts, rather than focusing only on the practical aspects of managing menstruation, i.e. product use, would holistically improve the effectiveness of the awareness programs. Male sensitization at community level to increase their understanding and thereby foster supportive attitude will have stronger effect in removing discriminatory practices faced by women. Involvement of key cultural influencers, that is, social and religious leaders in countering the negative myths and misconceptions, would also help to build up support system at societal level. However, the challenge is to build on appropriate and effective communication methods to open dialog and make the stakeholders realize the importance of MHM. Furthermore, evaluation of the existing ongoing awareness interventions at programmatic level in shifting the community norms about menstruation would help in better understanding of the critical gaps that need to be filled in future for sustainable scaling up of MHM awareness. Improving access to hygienic menstrual hygiene management products Accessibility of hygienic menstrual absorbents at affordable cost is an important determinant of healthy menstrual management practice. Over the years, various initiatives have been taken in this direction, and the recent National Family Health Survey 4 (NFHS 4) data show that overall 57.6% of women are using hygienic methods for menstrual protection.[14] However, availability and accessibility of clean and safe menstrual absorbents for all women seem to be a distant dream in the current Indian context. NFHS 4 also reveals that about 62% women are using cloth which can be reused after washing, cleaning, and drying. However, these reusable materials are often not sanitized properly with soap and clean water in compelling circumstances or due to lack of awareness and social taboos also restrict women to dry them indoors, away from sunlight. Compostable disposables (e.g., sanitary pads made out of locally grown materials such as bamboo, banana stem fiber, and sugarcane waste, and reusable cloth pads) have limited availability and higher cost while noncompostable disposables (e.g., cellulose-based sanitary pads with plastic barriers) with the largest market share are a double-edged sword. Although they provide safe and hygienic MHM, they remain unaffordable for women from low-income household. In spite of government initiatives to provide low-cost disposable sanitary pads, for example, “Free Days” and “Suvidha,” requirement for safe MHM products far outweigh their availability and accessibility. Decentralized models for production of low-cost sanitary napkins by community-based organizations/self-help groups might be promoted as a viable solution to match the requirement. Corporate sectors can effectively contribute by supporting behavior change initiatives and manufacturing and/or disposal of low-cost sanitary pads. Importantly, mechanism for monitoring the quality of the products should be put into operation. Exemption from the goods and services tax: The need Sanitary napkins in no way can be considered as luxury items for women. However, the unfair bracketing of sanitary napkins for tax purposes limits access to this essential commodity to a large section of the needy women.[15] The government has declared Hindu marital signifiers such as sindoor, bangles, and bindis as tax exempt; condoms and contraceptives are already tax exempt, but sanitary napkins continue to be taxed. Removing the tax on sanitary napkins will not only increase their accessibility but also will facilitate a positive change in the personal hygiene of millions of women. Disposal infrastructure: Limited capacity Used napkins need to be disposed safely in environment-friendly manner. However, disposal of used napkins has become an increasing problem in India. It is not yet decided whether soiled absorbents will be classified as hazardous solid waste (due to the presence of plastic in disposable napkins) or as biomedical waste as it is contaminated with blood and body fluid. The decision will have implications in planning and implementing appropriate menstrual waste management in the country. Currently, about 42% of Indian women of 15–24 years are using sanitary napkins (NFHS 4) and it is obvious that the use of commercial sanitary products will continue to grow with time. If an estimated 121 million girls and women in India are currently using an average of eight disposable sanitary pads in a month, generation of waste load is estimated to be 1.021 billion pads per month, the safe disposal of which in an environment-friendly manner is a real challenge to the nation.[16] Due to lack of efficient disposal mechanism at the community and institutions (schools, colleges, work places, and hospitals), used sanitary pads are dumped into the urban sewerage system, landfills, rural fields, and water bodies.[16] Since the usual disposal practice at community level is along with the household garbage, appropriate innovations need to be designed to make the menstrual waste materials easily identifiable for segregation during routine waste collection, keeping exposure of the waste collectors in mind. While incinerators are favored options in schools and institutions, challenges still exist in terms of designing cost-effective incinerators without emission of toxic fumes from burning of plastics (e.g., furans and dioxins). Menstrual hygiene management in special situations Menstrual hygiene management often remains as a low-priority component in any emergency/humanitarian crisis situation, as it is not considered life-threatening and women and girls face formidable challenges to manage their menstruation safely and comfortably and with dignity. There is a strong need for international consensus and improved guidance across all relevant sectors for improving MHM response in emergency context. Database to influence program or policy: The gap Formulation and implementation of any national program is heavily dependent on availability of strong evidence base for effective advocacy, program planning, implementation, and evaluation at all levels of health care. MHM practices are known to be influenced by factors such as knowledge about the process, socioeconomic characteristics, cultural acceptability, personal preferences, perception of risks, and access to funds and WASH facilities, etc. Available data from isolated studies portray a curtailed picture of the pattern of usage and methods of disposal of used absorbents, emphasizing the urgent need of incorporating MHM related data generation through national-level surveys. Very recently, NFHS 4 has generated some data on the type of menstrual protection used by women of 15–24 years age;[14] but no nationally representative or state-specific data on methods of disposal of used absorbents are available till date. CONCLUSION Good menstrual hygiene triggers health, confidence, and self-esteem of women and is linked to gender equality and basic human rights. Concerns are manifold and calls for concerted multisectoral inputs and interventions to break the social taboos, myths, and misconception; support innovative sustainable solutions to manufacture and distribute low-cost, yet high-quality sanitary pads; and address the burgeoning problem of disposing menstrual waste in an environmentally safe manner. Ensuring menstrual hygiene for girls and women should be at the top of developmental agenda which calls for urgent and intensive action from all relevant stakeholders to change the scenario of menstrual hygiene in India. There is also emerging need for development of indicators under Swachh Bharat Mission Guidelines to measure the extent of achievement in MHM in India. Furthermore, setting up realistic time bound targets to indicate successful implementation of existing policy and programs would be a welcome endeavor for providing basic hygiene and reproductive services to girls and women.

BACKGROUND: Empathy is a desirable quality in every clinician. It is a crucial determinant of patient-physician communication and relation. There are very few existent Indian studies on empathy of medical students and its correlates. AIM: The aim of the study was to assess empathy level of medical students and its correlates. METHODOLOGY: It was a cross-sectional, hospital-based, analytical observational study conducted from July to November 2017. In total, 249 undergraduate medical students of a medical college of Kolkata were interviewed with a structured schedule. The schedule comprised of the sociodemographic questionnaire, career satisfaction, future career choice, and Jefferson Scale of Empathy. RESULTS: The mean empathy score was 98.5 ± 12.5. Third-semester students had higher empathy scores (102.4 ± 12.4) compared to fifth (97.2 ± 12.9) and seventh semester (95.0 ± 10.9) students. The difference between the mean scores of different semesters was statistically significant. Female students were more empathic than male students. In the multivariable linear regression model, sex, semester, residence, career satisfaction, future career choice, and current place of living were significant predictors of empathy scores. CONCLUSION: Empathy level of medical students of our study was quite low compared to other studies conducted outside India. Empathy eroded with semester, which supports earlier pieces of evidence in this regard.

BACKGROUND: In the absence of any approved treatment or vaccine against novel Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) infection, Non-Pharmaceutical Interventions (NPIs) are the cornerstone to prevent the disease, especially in a populous country like India. OBJECTIVES: To understand the effectiveness of NPIs reported in the contemporary literatures describing prediction models for prevention of the ongoing pandemic of SARS-CoV-2 specifically in Indian population. METHODS: Original research articles in English obtained through keyword search in PubMed, WHO Global Database for COVID19, and pre-print servers were included in the review. Thematic synthesis of extracted data from articles were done. RESULTS: Twenty-four articles were found eligible for the review - four published articles and twenty pre-print articles. Compartmental model was found to be the most commonly used mathematical model; along with exponential, time varying, neural network and cluster kinetic models. Social distancing, specifically lockdown, was the most commonly modelled intervention strategy. Additionally, contact tracing using smartphone application, international travel restriction, increasing hospital/ICU beds, changes in testing strategy were also dealt with. Social distancing along with increasing testing seemed to be effective in delaying the peak of the epidemic and reducing the peak prevalence. CONCLUSION: Although there is mathematical rationality behind implementation of social distancing measures including lockdown, this study also emphasised the importance of other associated measures like increasing tests and increasing the number of hospital and ICU beds. The later components are particularly important during the social mixing period to be observed after lifting of lockdown.