Abstract Background: Fall among the elderly is a rising concern, notably in low- and middle-income countries. Uttarakhand’s rugged terrain and limited healthcare pose challenges for elderly fall injuries. This study examines prevalence, risk factors, and health-seeking behaviors after falls in Uttarakhand’s elderly. Methods: A community-based cross-sectional study was conducted among 220 elderly participants aged 60 and above in the Dehradun district of Uttarakhand. Data were collected through structured interviews and analyzed to identify the prevalence of falls, socio-demographic risk factors, and health-seeking behaviors post-fall using Chi-square tests and multivariable logistic regression. Results: Of the participants, 43.6% experienced a fall, mostly at home, in the past year, with 78% suffering injuries. Key risk factors included male gender, living in hilly areas, vision issues, irregular intake of chronic medications, poor health perception, lower cognitive scores, and walking or balance problems. Adjusted analysis showed that male gender and walking issues were linked to higher fall odds. Half sought medical help; the main barrier was a lack of perceived need. Conclusion: The study revealed a high prevalence of falls (43.6%) among the elderly, with a significant proportion (78.1%) suffering from injuries. Identified risk factors (male and walking problem) underscore the need for targeted fallprevention strategies focusing on early identification and management of mobility impairments among the elderly. Financial constraints and geographical barriers further complicate health-seeking behaviors, emphasizing the importance of accessible healthcare services for this vulnerable population.

Abstract Background: Gamified learning in medical education involves using game elements to improve learning behaviors and outcomes. Digital gamification is underexplored in community medicine. We aimed to assess students’ perceptions about gamified learning and their preference for individual or team-based participation, and compare the user experience between different digital platforms. Materials and Methods: We conducted this one-group posttest-only quasiexperimental study at a medical college in North India. We included students of Phase II and Phase III part 1 MBBS who had attended at least one gamified learning session of community medicine during the study period. We utilized six platforms per batch to deliver electronic quizzes for team-based (Classmarker and Nearpod) or individual participation (Formative, Google Forms, Quizizz, and Slido). We sought feedback using semistructured questionnaires. We used Jamovi version 2.3 for descriptive and inferential statistics. We performed manual inductive thematic analysis involving semantic-level coding of complete response units for qualitative data. Results: All 292 respondents (Phase II: 143; Phase III part 1: 149) attended at least three gamified learning sessions. Over 75% of the participants perceived gamification favorably across all parameters. Phase II students showed significantly higher favorability for perceived increase in interest (92.3% vs. 81.9%, P = 0.001) and engagement (87.4% vs. 83.2%, P = 0.003). Only 26.4% of students preferred team-based participation, with a higher preference in the junior batch (35.7% vs. 17.6%, P < 0.001). Formative and Slido received the highest median scores (9/10). Conclusion: Gamified learning is a well-received adjunct to traditional medical pedagogy.

Abstract Background: India has witnessed a fall in fertility rates, but there are regional variations. Spatial planning requires an understanding of the spatial pattern of fertility rates and the factors affecting them. This research was undertaken with the objective of understanding the spatial pattern of total fertility rates and socioeconomic factors in India. Materials and Methods: This ecological study used state-level data from the National Family Health Survey-5 (2019–2021). TFR was the outcome variable. Explanatory variables included early marriage, female literacy, women’s workforce participation, urbanization, poverty, and the multidimensional poverty index (MPI). Exploratory spatial data analysis assessed global spatial autocorrelation using Moran’s I and identified clusters using Local Indicators of Spatial Association (LISA). Spatial regression models—ordinary least squares (OLS), spatial lag (SLM), and spatial error (SEM)—examined associations while accounting for spatial dependence. Results: TFR ranged from 1.1 to 3.0 across states (mean 1.81). Global spatial autocorrelation was weak (Moran’s I = 0.020). LISA analysis identified high-fertility clusters in Bihar, Jharkhand, and Assam and low-fertility clusters in Tamil Nadu and Kerala. MPI was the only significant predictor of TFR. In OLS, a one-unit increase in MPI was associated with a 9.443 increase in TFR ( P < 0.001); similar associations were observed in SLM (β = 9.309, P < 0.001) and SEM (β = 9.174, P < 0.001). Conclusion: India has shown declining fertility rates with localized and regional variations. The need for addressing poverty reduction and reproductive health together has been emphasized by the fact that multidimensional poverty still remains the largest predictor of increasing fertility.

Abstract Introduction: This study investigates the barriers faced by key populations, men who have sex with men (MSM), transgender individuals (TGs), and female sex workers (FSWs), in two districts of Jharkhand in accessing healthcare services through targeted interventions (TIs). The objectives were to identify service delivery gaps, gain insights into participant experiences, and inform recommendations for improving healthcare access. Methods: A mixed-methods approach combining quantitative data collection was used. A total of 104 participants were surveyed by phone or in person, 30 of whom participated in FGDs. For qualitative data. The quantitative responses were scored on a five-point Likert scale for acceptability across the intervention’s four dimensions: accessibility, approachability, availability, and appropriateness. SPSS was used for quantitative data analysis, whereas ATLAS.ti was used for qualitative data analysis. Statistical significance was set at P < 0.05. Results: Stigma, discrimination, lack of awareness and infrastructural challenges were the key thematic areas revealed. Discrimination, particularly for TGs, was greater. Scoring on a Likert scale revealed a high level of acceptability; however, only gender was found to be statistically significant ( P < 0.05). MSMs reported fear of disclosure, whereas partner testing reluctance was commonly noted. Alcohol and drug abuse was noted to be significantly high. Conclusion: This study highlighted the need for culturally sensitive outreach, peer-based inclusion, and structural changes in health care settings. The findings provide actionable insights for policy makers to enhance inclusivity within national healthcare programs and address the unique challenges faced by key populations.

Abstract Introduction: Auxiliary nurse midwives (ANMs), a key cadre within India’s National Health Programs (NHPs). However, gaps in training, particularly in practical application, limit their effectiveness. This study evaluates the impact of a comprehensive training package on the knowledge and skills of ANMs in Haryana, India. Methodology: A quasi-experimental pre–post design with no control group was conducted among 250 ANMs across 149 subcenters in Ambala and Panchkula districts, Haryana. A universal sampling method was used. Data collection included a self-administered questionnaire (SAQ) and an objective structured clinical examination (OSCE) checklist to assess knowledge and skills. A training intervention consisting of a modular training package and video demonstrations was implemented. Data analysis involved paired t -tests and multivariate regression to evaluate changes in knowledge and skill scores. Results: Baseline data revealed significant knowledge gaps, particularly in mental health and tobacco control. Following the training, knowledge scores improved by 46% and skill scores by 37% ( P < 0.0001). Notable skill improvements were observed in areas, such as pregnancy detection, blood pressure measurement, newborn resuscitation, and ORS preparation at home, with most ANMs shifting from the poor/average categories to the good category (>70% score). The greatest overall gains were seen in the National Tuberculosis Elimination Program (NTEP) and Reproductive Maternal and Child Health (RMNCH + A). Factors positively influencing knowledge scores included working alongside a second ANM and receiving the training intervention ( P < 0.05). However, a decline was noted in certain skills, such as tetanus toxoid (TT) administration, highlighting the need for targeted refresher training. Conclusion: A structured, job-oriented training package significantly enhances ANMs’ competencies. Integrating practical, hands-on training with existing theoretical models is essential for improving public health outcomes. Policymakers should prioritize periodic refresher training and comprehensive capacity-building strategies to optimize the impact of trainings on ANMs.

Dear Editor, I read with interest the paper on the high antimicrobial resistance (AMR) of uropathogens to common antibiotics in Afghanistan.[1] Concurring with the authors, I firmly advocate for the necessity to adapt stringent policies aimed at curtailing AMR. The available alternatives of treatment options for managing even uncomplicated urinary tract infections (UTIs) remain notably limited. Implementing simple measures could be just as effective, given the urgency to stop the increasing trend of AMR. Spain’s experience could serve as a model for enhancing the appropriate use of antibiotics in treating UTIs through simple interventions.[2] Three years ago, we initiated an antimicrobial stewardship program in the Barcelona area, prompted by our observation that over 30% of Escherichia coli strains presented resistance to fluoroquinolones and amoxicillin-clavulanate. Despite this, many doctors continued to prescribe these antibiotics, even for uncomplicated lower UTIs. The strategy solely aimed to promote the use of narrow-spectrum first-line antibiotics for cystitis, such as nitrofurantoin and fosfomycin. Following the intervention, which comprised a 45-minute session with other doctors in primary care centers, as well as primary care out-of-hours services, infographics for doctors, nurses, and patients, and information about the resistance rates of common uropathogens and their prescribing rates, there was an increase in the use of first-line antibiotics. Most importantly, there was a significant decrease in the percentage of these antibiotics to which uropathogens showed high resistance. In this context, the low resistance of E. coli to nitrofurantoin observed in Afghanistan highlights the importance of implementing a similar policy. This would involve promoting the usage of this narrow-spectrum antibiotic while concurrently restricting the use of the Watch antibiotics, such as quinolones, amoxicillin, and cotrimoxazole. Similar to numerous other regions worldwide, the sale of over-the-counter antibiotics is widespread in Spain, despite legal restrictions. However, studies conducted in the last decade using simulated patients revealed that most cases simulating a UTI were given fosfomycin, a first-choice antibiotic in our country, given the low resistance rates of E. coli toward it (less than 10%).[3] Considering the challenge of changing such a common practice as dispensing antibiotics without a medical prescription, a similar policy should be considered for implementation in other areas. Fosfomycin should not be promoted for sale in Afghan pharmacies due to the high resistance rates. Instead, nitrofurantoin could be offered as an alternative, limiting the use of other antibiotics. Changing ingrained habits like dispensing antibiotics without medical prescriptions poses a significant challenge.[4] However, implementing some simple measures, such as promoting the distribution of antibiotics designated by the World Health Organization as Access antibiotics, and for short durations, could effectively mitigate the escalating rates of AMR observed globally.[5] A notable concern lies in the dispensing of antibiotics for respiratory tract infections, where many uropathogens are highly resistant. Nevertheless, restricting antibiotic packaging to contain a few doses, thereby limiting therapy to a maximum of 3 days, could serve as a simple yet impactful strategy to curb the proliferation of AMR. This approach would likely have acceptance from both pharmacists and patients as pharmacists could assist patients presenting with infection symptoms,[6] and patients would receive the desired medication for a short duration without compromising safety.[7] Given the pressing need to address the rising threat of AMR, it is imperative to adopt straightforward interventions. These could include promoting the use of first-line narrow-spectrum antibiotics for common infections in the community and restricting the dispensing of antibiotics in community pharmacies to those classified as Access antibiotics, and only for short durations. Financial support and sponsorship None. Conflicts of interest No conflicts of interest.

Abstract Background: Individuals with chronic disease must comprehend their diagnosis (sense) and gain control over the ailment (grip on disease). However, HIV-AIDS is different due to stigma and discrimination. Yet, persons living with HIV, with a robust sense of grip on disease (SoGoD), can lead satisfying lives. This study aimed to assess the SoGoD status and its associates, and then elicit the perspective of the stakeholders. Materials and Methods: This mixed-method study was conducted among People Living with HIVs (PLHIVs) visiting a tertiary care hospital in Kolkata, India, from November 2023 to January 2024. The quantitative strand of the study was conducted among 120 PLHIVs on antiretroviral therapy (ART), and then the qualitative strand was conducted by in-depth interviews (IDIs) with study participants and key informant interviews (KIIs) with healthcare personnel. SPSS software was utilized for quantitative data analysis, and factors associated with the SoGoD were analyzed using logistic regression models. Qualitative data were analyzed thematically. Results: Among the study participants, 34% have a dynamic grip. Illiteracy (adjusted odds ratio [aOR] = 7.22, 95% confidence interval [CI] = 1.94–10.97), current marriage (aOR = 4.44, 95% CI = 1.61–12.27), no history of substance use (aOR = 2.79, 95% CI = 1.99–7.85), and lesser stigma and discrimination (aOR = 5.41, 95% CI = 1.96–7.86) were significantly associated with dynamic grip. Self-care, family and community support, and integrated institutional care were identified as major ways to enhance disease grip. Conclusion: Since HIV is a heavily stigmatized disease, measures such as early family engagement and counseling, and comprehensive and adaptable institutional care should be undertaken to improve their disease grip.

Background: Every infant and child possess fundamental right to adequate nutrition. Nearly 1/5 th of deaths in children under five could be prevented by proper Infant and Young Child Feeding (IYCF) practices. The current study was conducted to determine the prevalence of IYCF practices in Dibrugarh district and to identify its influencers and barriers among different communities (Missing (tribal), Bengali (linguistic minority), Muslim (religious minority), and Riverine community (hard to reach)) residing in Dibrugarh district, Assam. Materials and Methods: This mixed-method study was conducted from March 2023 to February 2024; it included children aged 0-23 months and their primary caregivers. Considering the prevalence of children (6-8 months) receiving solid/semisolid food and breastmilk in Assam as 51.7%, with 20% relative precision, 95% confidence interval (CI), design effect of 2, and 10% nonresponse rate, the sample size became 198, rounded up to 210. Four communities were purposefully selected for FGDs, with two FGDs per community. Data were collected via house-to-house visits using the UNICEF/WHO schedule. FGDs were audio-recorded, transcribed, coded, and thematically analyzed. Chi-square and Fisher’s exact tests were applied, and the unadjusted odds ratio (U-OR) was calculated with 95% CI. Results: Only 66.7% were exclusively breastfed; while 55.9% children received solid, semisolid or soft foods 6–8 months. Only 36.7% achieved minimum acceptable diet, while bottle feeding 0–23 months occurred in 59.5% of children. Rural, ST children were significantly less likely to have early initiation of breastfeeding. Early introduction of complementary foods is driven by both tradition (tribal community use “Apong” rice beer; Muslim community use sugar water prelacteally) and necessity (Riverine community starts early due to work/financial demands). Reliance on traditional healers and practices—such as Jhar phook (Muslim), Domai (Riverine), and rituals against the “evil eye” (Missing community)—remains a dominant feature. Conclusion: Our study shows that higher SES, education, paternal involvement, and avoiding teenage pregnancies improve IYCF practices. Cultural beliefs and financial constraints also impact dietary choices.

The National Medical Commission (NMC) of India introduced Family Adoption Programme (FAP) as a part of curriculum based medical education (CBME) for undergraduate medical students in March 2022. This program was started to provide experiential learning opportunities to undergraduate students towards community-based healthcare. A descriptive cross-sectional study was conducted including undergraduate medical students from all over the country through an online survey. A structured and validated questionnaire was circulated that consisted of both closed and open-ended questions related to perceptions regarding FAP, challenges faced and suggestions for better implementation. Data were collected, responses were analysed and SWOT (Strength, Weakness, Opportunity and Threats) analysis was conducted. Responses were received from 1054 undergraduate medical students from government & private medical colleges across the country. 51.2%, 41.2% and 5.1% participants were from the 1 st Professional Year, 2 nd Professional Year and 3 rd Professional Year respectively. 85% and 87% students agreed/strongly agreed that FAP is helpful to gain an understanding of rural life and to develop a sense of social responsibility respectively. 90% agreed/strongly agreed that FAP is helpful to develop AETCOM skills. Language barrier and resistance offered by families were major challenges. Frequent community visits, training in the local language, provision of benefits to the families and development of a digital database are suggestions for better implementation. Undergraduate medical students are enthusiastic towards the family adoption program and consider it important in the development of social responsibility and AETCOM skills. Future studies are required to include perception of all stakeholders.

Abstract Eradication and elimination programs are considered the natural corollary of disease control programs. It is often the case that global or regional goals are missed several times. Deconstruction of the global programs has unraveled that the initial program theories can be inadequate and partial, and programs are often required to make definitional and tactical shifts. Social and political determinants are well established but are rarely foregrounded in terms of program formulation and often receive adequate resources and inputs. The World Health Organization (WHO) is now seeking to move towards a multidisease elimination (MDE) approach and advocating a “people-centered approach” to achieving these with greater efficiency, effectiveness, and equity. We call for a greater measure of social compact beyond the mere task of shifting to the community health workers (CHWs) and the community.